How do women prepare for pregnancy? Preconception experiences of women attending antenatal services and views of health professionals

Copyright: © 2014 Stephenson 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.Main objective - To determine the extent to which women plan and prepare for pregnancy. Methods - Cross-sectional questionnaire survey of pregnant women attending three maternity services in London about knowledge and uptake of preconception care; including a robust measure of pregnancy planning, and phone interviews with a range of health care professionals. Main results - We recruited 1173/1288 (90%) women, median age of 32 years. 73% had clearly planned their pregnancy, 24% were ambivalent and only 3% of pregnancies were unplanned. 51% of all women and 63% of those with a planned pregnancy took folic acid before pregnancy. 21% of all women reported smoking and 61% reported drinking alcohol in the 3 months before pregnancy; 48% of smokers and 41% of drinkers reduced or stopped before pregnancy. The 51% of all women who reported advice from a health professional before becoming pregnant were more likely to adopt healthier behaviours before pregnancy [adjusted odds ratios for greatest health professional input compared with none were 2.34 (95% confidence interval 1.54–3.54) for taking folic acid and 2.18 (95% CI 1.42–3.36) for adopting a healthier diet before pregnancy]. Interviews with 20 health professionals indicated low awareness of preconception health issues, missed opportunities and confusion about responsibility for delivery of preconception care. Significance of the findings - Despite a high level of pregnancy planning, awareness of preconception health among women and health professionals is low, and responsibility for providing preconception care is unclear. However, many women are motivated to adopt healthier behaviours in the preconception period, as indicated by halving of reported smoking rates in this study. The link between health professional input and healthy behaviour change before pregnancy is a new finding that should invigorate strategies to improve awareness and uptake of pre-pregnancy health care, and bring wider benefits for public health.Department of Healt

Mapping interactions between the sustainable development goals: lessons learned and ways forward

Pursuing integrated research and decision-making to advance action on the sustainable development goals (SDGs) fundamentally depends on understanding interactions between the SDGs, both negative ones (“trade-offs”) and positive ones (“co-benefits”). This quest, triggered by the 2030 Agenda, has however pointed to a gap in current research and policy analysis regarding how to think systematically about interactions across the SDGs. This paper synthesizes experiences and insights from the application of a new conceptual framework for mapping and assessing SDG interactions using a defined typology and characterization approach. Drawing on results from a major international research study applied to the SDGs on health, energy and the ocean, it analyses how interactions depend on key factors such as geographical context, resource endowments, time horizon and governance. The paper discusses the future potential, barriers and opportunities for applying the approach in scientific research, in policy making and in bridging the two through a global SDG Interactions Knowledge Platform as a key mechanism for assembling, systematizing and aggregating knowledge on interactions

Loss of MITF expression during human embryonic stem cell differentiation disrupts retinal pigment epithelium development and optic vesicle cell proliferation

Microphthalmia-associated transcription factor (MITF) is a master regulator of pigmented cell survival and differentiation with direct transcriptional links to cell cycle, apoptosis and pigmentation. In mouse, Mitf is expressed early and uniformly in optic vesicle (OV) cells as they evaginate from the developing neural tube, and null Mitf mutations result in microphthalmia and pigmentation defects. However, homozygous mutations in MITF have not been identified in humans; therefore, little is known about its role in human retinogenesis. We used a human embryonic stem cell (hESC) model that recapitulates numerous aspects of retinal development, including OV specification and formation of retinal pigment epithelium (RPE) and neural retina progenitor cells (NRPCs), to investigate the earliest roles of MITF. During hESC differentiation toward a retinal lineage, a subset of MITF isoforms was expressed in a sequence and tissue distribution similar to that observed in mice. In addition, we found that promoters for the MITF-A, -D and -H isoforms were directly targeted by Visual Systems Homeobox 2 (VSX2), a transcription factor involved in patterning the OV toward a NRPC fate. We then manipulated MITF RNA and protein levels at early developmental stages and observed decreased expression of eye field transcription factors, reduced early OV cell proliferation and disrupted RPE maturation. This work provides a foundation for investigating MITF and other highly complex, multi-purposed transcription factors in a dynamic human developmental model syste

Fourier transform for quantum DD-modules via the punctured torus mapping class group

We construct a certain cross product of two copies of the braided dual $\tilde H$ of a quasitriangular Hopf algebra $H$, which we call the elliptic double $E_H$, and which we use to construct representations of the punctured elliptic braid group extending the well-known representations of the planar braid group attached to $H$. We show that the elliptic double is the universal source of such representations. We recover the representations of the punctured torus braid group obtained in arXiv:0805.2766, and hence construct a homomorphism to the Heisenberg double $D_H$, which is an isomorphism if $H$ is factorizable. The universal property of $E_H$ endows it with an action by algebra automorphisms of the mapping class group $\widetilde{SL_2(\mathbb{Z})}$ of the punctured torus. One such automorphism we call the quantum Fourier transform; we show that when $H=U_q(\mathfrak{g})$, the quantum Fourier transform degenerates to the classical Fourier transform on $D(\mathfrak{g})$ as $q\to 1$.Comment: 12 pages, 1 figure. Final version, to appear in Quantum Topolog

Objective Indicators for Monitoring Drought in Grasslands

Australia’s National Drought Policy was ratified by the Commonwealth (Federal), State and Territory governments in 1992. However, a sequence of El Niño-based events that started in Queensland in 1991 culminated in much of Australia experiencing abnormally low rainfall throughout 1994 and into 1995. Many farmers experienced substantial loss of income. The Commonwealth government therefore devised measures to determine which areas had been exposed to exceptional drought so that financial assistance could be directed as effectively as possible. In this paper we discuss progress in developing regionally-sensitive indicators and methodologies to aid in future assessments of drought exceptional circumstances

Tauiwi general practitioners explanations of Maori health: Colonial relations in primary healthcare in Aotearoa/New Zealand?

This paper reports initial findings from qualitative research investigating how general practitioners talk about Maori health. Transcripts of semi-structured interviews with 25 general practitioners from urban Auckland were subjected to critical discursive analyses. Through this process of intensive, analytic reading, interpretative repertoires – patterns of words and images about a particular topic – were identified. This paper presents the main features of one such repertoire, termed Maori Morbidity, that the general practitioners used in accounting for poor Maori health status. Our participants were drawing upon a circumscribed pool of ideas and explaining the inequalities in health between Maori and Tauiwi in ways that gave primacy to characteristics of Maori and their culture. We discuss the implications of this conclusion for relations between Maori patients and Tauiwi doctors in primary healthcare settings

Transformational capacity and the influence of place and identity

Climate change is altering the productivity of natural resources with far-reaching implications for those who depend on them. Resource-dependent industries and communities need the capacity to adapt to a range of climate risks if they are to remain viable. In some instances, the scale and nature of the likely impacts means that transformations of function or structure will be required. Transformations represent a switch to a distinct new system where a different suite of factors become important in the design and implementation of response strategies. There is a critical gap in knowledge on understanding transformational capacity and its influences. On the basis of current knowledge on adaptive capacity we propose four foundations for measuring transformational capacity: (1)how risks and uncertainty are managed, (2)the extent of skills in planning, learning and reorganizing, (3)the level of financial and psychological flexibility to undertake change and (4)the willingness to undertake change. We test the influence of place attachment and occupational identity on transformational capacity using the Australian peanut industry, which is presently assessing significant structural change in response to predicted climatic changes. Survey data from 88% of peanut farmers in Queensland show a strong negative correlation between transformational capacity and both place attachment and occupational attachment, suggesting that whilst these factors may be important positive influences on the capacity to adapt to incremental change, they act as barriers to transformational change

Livestock, Climate Change and Food Security Conference, 2014

The GRAZPLAN biophysical models were used to simulate the dynamics of coupled climate-soil-grassland-livestock systems at 25 representative farms across Australia’s extensive grazing region under historical and a range of projected climates (4 GCMs at 2030, 2050 and 2070 under SRES A2 scenario). The modelling analysis suggests that primary production of grasslands and livestock are likely to decrease across most of southern Australia’s grazing lands under future climate. By including changes in on-farm management in our models we were able to evaluate the effectiveness of certain adaptation options. Options considered individually were not always effective but a combination of Incremental grassland management and animal genetic improvement options (currently available to graziers) was able to offset productivity declines at cross-regional scale. Through implementation of the optimal combination of adaptation options, profitability across southern Australia was shown to increase by +69%, +84% and +116% in 2030, 2050, and 2070, compared to no adaptation. Optimal systemic adaptation could make addition of $A 2.00 billion in 2030,$A 2.10 billion in 2050, and $A 2.12 billion in 2070 to industry with current farm management. In comparison with historical production, adaptation value to industry would be$A 1.51 billion in 2030, $A 1.51 billion in 2050, and$A 1.12 billion in 2070 (all for a full adaption). If the most-profitable combination of adaptations is used at the baseline instead of the current-practice, then the optimal combinations of grassland adaptations would provide a further increase in operating profitability at 28%, 28%, and 16% of sites in 2030, 2050, and 2070. If the livestock genetic adaptations –cannot be adopted at the present for lack of seed stock – are also included, the optimal systemic adaptations would be more profitable than the alternative baseline including grassland management options at 60%, 56%, and 48% of the locations in 2030, 2050, and 2070. We discuss 3 conceptual issues which arose during our study: (i) how to estimate impact when current management is environmentally infeasible under future climates; (ii) estimating the effectiveness of combinations of adaptations, only some of which are currently available to graziers; and (iii) dealing with the tension between modelling best-practice systems, so that present and future can be compared, versus modelling typical practice for economic valuation

Landholder Typologies Used in the Development of Natural Resource Management Programs in Australia - A Review

This article reviews the literature on the identification of landholder typologies that can be used to assist the design and delivery of natural resource management (NRM) programs. Australian researchers have developed typologies of landholders based on a variety of criteria. The rationale for developing landholder typologies is first discussed before reviewing the various approaches that have been used by Australian researchers and comparing their findings. The methods employed have differed according to the theories used to guide the research and the 'clients' or 'sponsors' of the research. The landholder types they describe, however, have a number of similarities. These similarities suggest that the studies have identified the same fundamental divisions in the rural community, and that it may be possible to integrate landholder typologies for a variety of NRM and non-NRM applications. It is concluded that further research could usefully investigate whether concepts of social class or sub-cultures may be appropriate to define and describe the variations in landholder types

Why do women invest in pre-pregnancy health and care? A qualitative investigation with women attending maternity services

Background Despite the importance attributed to good pre-pregnancy care and its potential to improve pregnancy and child health outcomes, relatively little is known about why women invest in pre-pregnancy health and care. We sought to gain insight into why women invested in pre-pregnancy health and care. Methods We carried out 20 qualitative in-depth interviews with pregnant or recently pregnant women who were drawn from a survey of antenatal clinic attendees in London, UK. Interviewees were purposively sampled to include high and low investors in pre-pregnancy health and care, with variation in age, partnership status, ethnicity and pre-existing medical conditions. Data analysis was conducted using the Framework method. Results We identified three groups in relation to pre-pregnancy health and care: 1) The “prepared” group, who had high levels of pregnancy planning and mostly positive attitudes to micronutrient supplementation outside of pregnancy, carried out pre-pregnancy activities such as taking folic acid and making changes to diet and lifestyle. 2) The “poor knowledge” group, who also had high levels of pregnancy planning, did not carry out pre-pregnancy activities and described themselves as having poor knowledge. Elsewhere in their interviews they expressed a strong dislike of micronutrient supplementation. 3) The “absent pre-pregnancy period” group, had the lowest levels of pregnancy planning and also expressed anti-supplement views. Even discussing the pre-pregnancy period with this group was difficult as responses to questions quickly shifted to focus on pregnancy itself. Knowledge of folic acid was poor in all groups. Conclusion Different pre-pregnancy care approaches are likely to be needed for each of the groups. Among the “prepared” group, who were proactive and receptive to health messages, greater availability of information and better response from health professionals could improve the range of pre-pregnancy activities carried out. Among the “poor knowledge” group, better response from health professionals might yield greater uptake of pre-pregnancy information. A different, general health strategy might be more appropriate for the “absent pre-pregnancy period” group. The fact that general attitudes to micronutrient supplementation were closely related to whether or not women invested in pre-pregnancy health and care was an unanticipated finding and warrants further investigation.This report is independent research commissioned and funded by the Department of Health Policy Research Programme Pre-Pregnancy Health and Care in England: Exploring Implementation and Public Health Impact, 006/0068