Vitamins C and E and the risks of preeclampsia and perinatal complications

Copyright © 2006 Massachusetts Medical Society.Background: Supplementation with antioxidant vitamins has been proposed to reduce the risk of preeclampsia and perinatal complications, but the effects of this intervention are uncertain. Methods: We conducted a multicenter, randomized trial of nulliparous women between 14 and 22 weeks of gestation. Women were assigned to daily supplementation with 1000 mg of vitamin C and 400 IU of vitamin E or placebo (microcrystalline cellulose) until delivery. Primary outcomes were the risks of maternal preeclampsia, death or serious outcomes in the infants (on the basis of definitions used by the Australian and New Zealand Neonatal Network), and delivering an infant whose birth weight was below the 10th percentile for gestational age. Results: Of the 1877 women enrolled in the study, 935 were randomly assigned to the vitamin group and 942 to the placebo group. Baseline characteristics of the two groups were similar. There were no significant differences between the vitamin and placebo groups in the risk of preeclampsia (6.0 percent and 5.0 percent, respectively; relative risk, 1.20; 95 percent confidence interval, 0.82 to 1.75), death or serious outcomes in the infant (9.5 percent and 12.1 percent; relative risk, 0.79; 95 percent confidence interval, 0.61 to 1.02), or having an infant with a birth weight below the 10th percentile for gestational age (8.7 percent and 9.9 percent; relative risk, 0.87; 95 percent confidence interval, 0.66 to 1.16). Conclusions: Supplementation with vitamins C and E during pregnancy does not reduce the risk of preeclampsia in nulliparous women, the risk of intrauterine growth restriction, or the risk of death or other serious outcomes in their infants. (Controlledtrials.com number, ISRCTN00416244 [controlled-trials.com] .)Alice R. Rumbold, Caroline A. Crowther, Ross R. Haslam, Gustaaf A. Dekker and Jeffrey S. Robinso

An assets-based approach to bereavement care

A survey of bereaved clients of four funeral providers in Australia confirms a public health model predicting that over half the group would demonstrate low risk of complicated grief, another third moderate risk, while a small minority would meet the criteria for prolonged grief disorder. The survey also shows differing patterns of need and sources of support for each of the three groups. While our findings support targeting the bereavement care provided by health services, our primary interest is in the care received by most bereaved people. Some is provided in the community through the everyday activities of healthcare professionals. Most comes from a range of people already involved in the everyday lives of those recently bereaved. We contend that the most effective way to provide bereavement care is to support these ‘everyday assets’, ensuring that their care is recognised, appreciated, and not disrupted by over-reach from professional services

Megacities and climate change: a brief overview

Cities have developed into the hotspots of human economic activity. From the appearance of the first cities in the Neolithic to 21st century metropolis their impact on the environment has always been apparent. With more people living in cities than in rural environments now it becomes crucial to understand these environmental impacts. With the immergence of megacities in the 20th century and their continued growth in both, population and economic power, the environmental impact has reached the global scale. In this paper we examine megacity impacts on atmospheric composition and climate. We present basic concepts, discuss various definitions of footprints, summarize research on megacity impacts and assess the impact of megacity emissions on air quality and on the climate at the regional to global scale. The intention and ambition of this paper is to give a comprehensive but brief overview of the science with regard to megacities and the environment

Matching response to need: What makes social networks fit for providing bereavement support?

© 2019 Aoun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The objectives of this study were to explore the goodness of fit between the bereaved peoples’ needs and the support offered by their social networks; to ascertain whether this support was experienced as helpful or unhelpful by bereaved people; and to explore both the types of social networks that offer effective support and the characteristics of the communities that encourage and nurture such networks. This study was based on qualitative interviews from twenty bereaved people, in Western Australia, interviewed in 2013. A framework analysis of these interviews was undertaken using a deductive approach based on the goodness of fit framework. Much of this support is provided informally in community settings by a range of people already involved in the everyday lives of those recently bereaved; and that support can be helpful or unhelpful depending on its amount, timing, function and structure. Improving the fit between the bereaved person’s needs and the support offered may thus involve identifying and enhancing the caring capacity of existing networks. An important strategy for achieving this is to train community members in mapping and developing these naturally occurring networks. Some such networks will include relationships of long standing, others may be circles of care formed during a period of caring. Peer support bereavement networks develop from these existing networks and may also recruit new members who were not part of the caring circle. The findings endorse social models of bereavement care that fit within a public health approach rather than relying solely on professional care. As exemplified by Compassionate Communities policies and practices, establishing collaboration between community networks and professional services is vital for effective and sustainable bereavement care

The effect of the General Data Protection Regulation on medical research

Background: The enactment of the General Data Protection Regulation (GDPR) will impact on European data science. Particular concerns relating to consent requirements that would severely restrict medical data research have been raised. Objective: Our objective is to explain the changes in data protection laws that apply to medical research and to discuss their potential impact. Methods: Analysis of ethicolegal requirements imposed by the GDPR. Results: The GDPR makes the classification of pseudonymised data as personal data clearer, although it has not been entirely resolved. Biomedical research on personal data where consent has not been obtained must be of substantial public interest. Conclusions: The GDPR introduces protections for data subjects that aim for consistency across the EU. The proposed changes will make little impact on biomedical data research

Self-reported prevalence of Polycystic Ovary Syndrome in a population sample

Oral Presentation: GynecologyPROBLEM STATEMENT Polycystic Ovary Syndrome (PCOS), the most common endocrine disorder in women, generates numerous health problems. PCOS affects 5-18% of women of reproductive age in Australia. Another 70% of women with PCOS remain undiagnosed. This may be related to different severities of the presentation of the phenotype of PCOS, which may mean these women do not seek medical help. PCOS has profound medical implications across the lifespan including reproductive, metabolic and psychological implications. Women with PCOS need information and guidance about this to enable them to take control of their own health, but these women need to be identified in the population so they can benefit from prevention and treatment programs. It has been almost 10 years since the last prevalence data was obtained regarding PCOS in Australia. These data were collected via mailed questionnaires, from the Australian Longitudinal Women’s Health Study (ALWHS), and approximately 1700 South Australian women were included. This study found a prevalence of 5.8%, however this is a likely an underestimate, with a self-reported population likely to have more severe symptoms, and therefore possibly more severe reproductive, metabolic and psychological health. There is a continued need for accurate population data and use of more precise estimates of other health conditions associated with PCOS. METHODS The 2015 South Australia Health Omnibus Survey (HOS)is an annual, representative population survey. It uses a clustered, self-weighting, systematic, multistage area sample of metropolitan and country areas with populations of more than 1000 and interviews are conducted face-to-face with those aged fifteen years or over. The nature of an omnibus survey means that a number of questions regarding different health topics are included from different users. Over 3000 respondents are interviewed with a response rate of 60%; this means approximately 1500 women are surveyed. Using HOS as a data collection vehicle provides a wider age group than previous Australian studies. There have been few recent whole of population studies that identify a subset of women with PCOS, enabling an epidemiological comparison of PCOS attributes with the rest of the population. The 2015 HOS contained a question on self-report PCOS prevalence. PRELIMINARY RESULTS The self-reported prevalence of women with PCOS was found in this sample to be 5%. PCOS was assessed by cardiometabolic risk factors, body mass index, nutrition and dieting, pregnancies, physical activity, mental health, alcohol consumption, smoking, quality of life and demographic factors were assessed in women with and without self-reported PCOS to find the features that are associated with PCOS. Although many problems associated with PCOS are unique to the condition, there are factors affecting QoL which women with PCOS may share with those experiencing other chronic conditions. We can also identify what is unique about PCOS compared with other chronic conditions. CONCLUSION The self-reported prevalence of PCOS in this population compares with previous prevalence rates in this population found, however, we consider this to be an underestimate. Further research using the HOS will determine PCOS prevalence in the population reflecting the Rotterdam Criteria from 2003 which includes self-report presence of 2 of the 3 of hyperandrogenism, menstrual dysfunction, or polycystic ovaries on ultrasound, enabling a more accurate prevalence to be obtained. [Provided by author]Jodie Avery, Lisa Moran, Alice Rumbol