Exposure to natural environments during pregnancy and birth outcomes in 11 european birth cohorts

Research suggests that maternal exposure to natural environments (i.e., green and blue spaces) promotes healthy fetal growth. However, the available evidence is heterogeneous across regions, with very few studies on the effects of blue spaces. This study evaluated associations between maternal exposure to natural environments and birth outcomes in 11 birth cohorts across nine European countries. This study, part of the LifeCycle project, was based on a total sample size of 69,683 newborns with harmonised data. For each participant, we calculated seven indicators of residential exposure to natural environments: surrounding greenspace in 100m, 300m, and 500m using Normalised Difference Vegetation Index (NDVI) buffers, distance to the nearest green space, accessibility to green space, distance to the nearest blue space, and accessibility to blue space. Measures of birth weight and small for gestational age (SGA) were extracted from hospital records. We used pooled linear and logistic regression models to estimate associations between exposure to the natural environment and birth outcomes, controlling for the relevant covariates. We evaluated the potential effect modification by socioeconomic status (SES) and region of Europe and the influence of ambient air pollution on the associations. In the pooled analyses, residential surrounding greenspace in 100m, 300m, and 500m buffer was associated with increased birth weight and lower odds for SGA. Higher residential distance to green space was associated with lower birth weight and higher odds for SGA. We observed close to null associations for accessibility to green space and exposure to blue space. We found stronger estimated magnitudes for those participants with lower educational levels, from more deprived areas, and living in the northern European region. Our associations did not change notably after adjustment for air pollution. These findings may support implementing policies to promote natural environments in our cities, starting in more deprived areas. © 2022Funding text 1: This project received funding from the European Union's Horizon 2020 research and innovation programme (LIFECYCLE, grant agreement No 733206; EUCAN-Connect grant agreement No 824989). ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation and State Research Agency through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program. For more information of each cohort individual funding, see Supplementary Material s, Information S2. ; Funding text 2: We would like to thanks to all the mothers, fathers, and children for their generous contribution as participants in the cohorts that are part of the LifeCycle project. For more information of each cohort individual acknowledgment, see Supplementary Materials, Information S1. This project received funding from the European Union's Horizon 2020 research and innovation programme (LIFECYCLE, grant agreement No 733206; EUCAN-Connect grant agreement No 824989). ISGlobal acknowledges support from the Spanish Ministry of Science and Innovation and State Research Agency through the “Centro de Excelencia Severo Ochoa 2019-2023” Program (CEX2018-000806-S), and support from the Generalitat de Catalunya through the CERCA Program. For more information of each cohort individual funding, see Supplementary Materials, Information S2. DAL has received support from Medtronic Ltd and Roche Diagnostics for research unrelated to this study. All the other authors declare that they have no competing interests

The Perioperative Management of Partial Knee Arthroplasty: Anesthesia, Pain Management, and Blood Loss

Pain is the body’s physiological reaction to tissue injury and involves nociceptive, inflammatory, and ischemic phenomena. Inflammation can lead to peripheral and central pain sensitization. The extent of this pain will depend on both phenotype and genotype of the patient. The following chapter discusses the advantages of unicompartmental knee arthroplasty (UKA) to reduce pain and blood loss after knee arthroplasty. Optimizing pain management starts with preemptive and preventive analgesia. Today’s modern pain control consists of multimodal pain management by combining different drugs and anesthetic techniques with different mechanisms of action. Most often, acetaminophen and NSAIDs are used with morphine only for breakthrough pain. The latter should be limited as much as possible because of its side effects. Local infiltration analgesia (LIA) or adductor canal blockade is used most commonly to reduce peripheral sensitization. Unicompartmental knee arthroplasty, which is less invasive, will help reduce the intensity of the postoperative pain. Optimizing blood management has the aim to reduce or eliminate blood transfusion. UKA reduces blood loss by its surgical technique, but a multimodal approach is indicated here also. Preoperative hemoglobin optimization, preoperative bleeding risk assessment and bridging strategy, the use of tranexamic acid, and the local hemostatic effect of LIA with the adrenergic properties of ropivacaine should all be part of this multimodal program. Multimodal pain strategies and blood management protocols have proven value after total knee arthroplasty. The same protocols can logically be applied to patients undergoing UKA. Patients undergoing UKA today can expect excellent pain relief, low morbidity, and rapid recovery when advanced pain and blood management protocols are employed