Fast-track referral for health interventions during pregnancy: study protocol of a randomised pragmatic experimental study to reduce low birth weight in Portugal (STOP LBW)

Introduction Low birth weight (LBW) is associated with a wide range of short-term and long-term consequences and is related to maternal psychosocial and behavioural determinants. The objective of this study is to estimate the effect of implementing fast-track referral for early intervention on psychosocial and behavioural risk factors—smoking, alcohol consumption, depression and physical violence—in reducing the incidence of LBW. Methods and analysis Parallel superiority pragmatic clinical trial randomised by clusters. Primary healthcare units (PHCU) located in Portugal will be randomised (1:1) to intervention or control groups. Pregnant women over 18 years of age attending these PHCU will be eligible to the study. Risk factors will be assessed through face-to-face interviews. In the intervention group, women who report at least one risk factor will have immediate access to referral services. The comparison group will be the local standard of care for these risk factors. We will use intention-to-treat analyses to compare intervention and control groups. We estimated a sample size of 2832 pregnant women to detect a 30% reduction in the incidence rate of LBW between the control and intervention groups. Secondary outcomes are the reduction of preterm births, reduction of the four risk factors and acceptance of the intervention. Ethics and dissemination The study was approved by the Ethics Committee of the Public Health Institute of the University of Porto (no CE20140). The findings will be disseminated to the public, the funders, health professionals, health managers and other researchers.This project was funded by the Calouste Gulbenkian Foundation under the Knowledge Challenge 'The Importance of the Right Weight at Birth'. Sponsor contact information: HB. ISPUP. [email protected]

Sixty years of irrigated wheat yield increase in the Yaqui Valley of Mexico: Past drivers, prospects and sustainability

Continued global wheat yield increase (about 1.3% p.a. for 2000–2019) remains an essential condition for greater world food security. Relevant to this challenge is the rise in average farm yield (FY) of irrigated spring wheat in the Yaqui Valley of northwest Mexico from 2 to 7 t/ha between 1960 and 2019. Since the early 1950s the region has been the prime target of wheat research by the International Maize and Wheat Improvement Centre (CIMMYT) and its predecessors, research still having significant impact on wheat in the developing world, a grouping that today delivers more than half the world's wheat. FY increase was investigated in detail by dividing the interval into three 20-year periods, correcting FY for the strong influence of inter-annual variation in January to March minimum temperature (Tmin J-M, warming lowering yield around 7%/°C) and measuring the remaining linear increase in FY (Fischer et al., 2022). Total yield increase, corrected for Tmin J-M and CO2 rise, relative to average yield in each period, was 4.17%, 0.47%, and 1.59% p.a. for 1960–79, 1980–99, and 2000–19, respectively. The breeding component, estimated by the increase in the Varietal Yield Index in farmers’ fields, rose at 0.97%, 0.49%, and 0.71% p.a., respectively. The remaining yield change (3.16, −0.02% and 0.87% p.a., respectively) comprised the net effect of improved crop management (agronomic progress) plus that of off-farm changes, together here called agronomy+. Major changes in agronomy included: a large increase in fertiliser N use, benefitting early on from a large positive variety × N interaction; in the second period a switch to planting on raised beds and a decline in rotational diversity; and in the final period, consolidation of operational crop units and probably more skilful and timely management. Off-farm developments saw strong government financial support in the first period, but in the second period breakdown of the traditional small holder land system and withdrawal of government support. The last period saw better prices and improved access to technical advice. Breeding progress is expected to continue in the Yaqui Valley but at a slowly diminishing rate (currently 0.66% p.a.), while progress from new agronomy appears limited. Although FY gaps are small, some gap closing remains possible, and 1.2% p.a. FY progress is estimated for the next 20 years in the absence of new technologies. World wheat food security without area increase will increasingly depend on developing countries where yield gaps are generally wider and gap closing prospects better. Biophysical sustainability of the Yaqui Valley wheat system is moderately good but N management and diversity can be improved

Quantitative modelling of hip fracture trends in 14 European countries: testing variations of a shared reversal over time

Qualitative similarities between hip fracture trends in different countries suggests variations of the same epidemic. We tested a single statistical shape to describe time trends in Europe, while allowing for country-level variability. Using data from 14 countries, we modelled incidence rates over time using linear mixed-effects models, including the fixed effects of calendar year and age. Random effects were tested to quantify country-level variability in background rates, timing of trend reversal and tempo of reversal. Mixture models were applied to identify clusters of countries defined by common behavioural features. A quadratic function of time, with random effects for background rates and timing of trend reversal, adjusted well to the observed data. Predicted trend reversal occurred on average in 1999 in women (peak incidence about 600 per 100 000) and 2000 in men (about 300 per 100 000). Mixture modelling of country-level effects suggested three clusters for women and two for men. In both sexes, Scandinavia showed higher rates but earlier trend reversals, whereas later trend reversals but lower peak incidences were found in Southern Europe and most of Central Europe. Our finding of a similar overall reversal pattern suggests that different countries show variations of a shared hip fracture epidemic

The greatest air quality experiment ever: Policy suggestions from the COVID-19 lockdown in twelve European cities

COVID-19 (Coronavirus disease 2019) hit Europe in January 2020. By March, Europe was the active centre of the pandemic. As a result, widespread "lockdown" measures were enforced across the various European countries, even if to a different extent. Such actions caused a dramatic reduction, especially in road traffic. This event can be considered the most significant experiment ever conducted in Europe to assess the impact of a massive switch-off of atmospheric pollutant sources. In this study, we focus on in situ concentration data of the main atmospheric pollutants measured in twelve European cities, characterized by different climatology, emission sources, and strengths. We propose a methodology for the fair comparison of the impact of lockdown measures considering the non-stationarity of meteorological conditions and emissions, which are progressively declining due to the adoption of stricter air quality measures. The analysis of these unmatched circumstances allowed us to estimate the impact of a nearly zero-emission urban transport scenario on air quality in 12 European cities. The clearest result, common to all the cities, is that a dramatic traffic reduction effectively reduces NO2 concentrations. In contrast, each city’s PM and ozone concentrations can respond differently to the same type of emission reduction measure. From the policy point of view, these findings suggest that measures targeting urban traffic alone may not be the only effective option for improving air quality in cities

Upregulation of Inflammatory genes and downregulation of sclerostin gene expression are key elements in the early phase of fragility fracture healing

Peer reviewe

Do bone mineral content and density determine fracture in children? A possible threshold for physical activity

BackgroundRelations between bone parameters, physical exertion, and childhood fractures are complex. We aimed to estimate the associations between fracture history and bone mineral content (BMC) and areal bone mineral density (aBMD) at 7 years of age, by levels of physical activity, as a proxy for trauma frequency.MethodsWe used data collected from 2,261 children of the Generation XXI birth cohort, assembled in 2005/6 in Porto, Portugal. At the age of 7 years (2012/4), fracture history, time spent per week in active play, and sports practice were reported by parents. Subtotal and lumbar spine (LS) BMC and aBMD were measured using whole-body dual-energy X-ray absorptiometry.ResultsBoys and girls in the highest categories of time spent in sports practice or active play generally had higher BMC and aBMD. Among girls, BMC and aBMD were protective of fracture only in the highest quarter of active play (>660 min/week)-odds ratios (OR; 95% confidence interval (95% CI)) for subtotal BMC=0.27 (0.11-0.67), subtotal aBMD=0.18 (0.06-0.49), and LS aBMD=0.41 (0.22-0.75). For boys in the highest quarter of sports practice (>240 min/week), subtotal and LS BMC were protective of fracture-OR=0.39 (0.16-0.98) and 0.51 (0.27-0.96), respectively.ConclusionIn prepubertal children, BMC and aBMD predicted fracture history only in the highest levels of physical activity.info:eu-repo/semantics/publishedVersio

Relationship between the Mediterranean dietary pattern and musculoskeletal health in children, adolescents, and adults: systematic review and evidence map

Context: An understanding of the modifiable effects of diet on bone and skeletal muscle mass and strength over the life course will help inform strategies to reduce age-related fracture risk. The Mediterranean diet is rich in nutrients that may be important for optimal musculoskeletal health. Objective: The aim of this systematic review was to investigate the relationship between a Mediterranean diet and musculoskeletal outcomes (fracture, bone density, osteoporosis, sarcopenia) in any age group. Data Sources: Ten electronic databases were searched. Study Selection: Randomized controlled trials and prospective cohort studies that investigated a traditional Mediterranean diet, published in any language, were eligible. Studies using other designs or other definitions of the Mediterranean diet were collated separately in an evidence map. Data Extraction: Details on study design, methods, population, dietary intervention or exposure, length of follow-up, and effect on or association with musculoskeletal outcomes were extracted. Results: The search yielded 1738 references. Data from eligible randomized controlled trials (n = 0) and prospective cohort studies (n = 3) were synthesized narratively by outcome for the systematic review. Two of these studies reported on hip fracture incidence, but results were contradictory. A third study found no association between the Mediterranean diet and sarcopenia incidence. Conclusions: Overall, the systematic review and evidence map demonstrate a lack of research to understand the relationship between the Mediterranean diet and musculoskeletal health in all ages. Systematic Review Registration: PROSPERO registration number IDCRD42016037038