Conceptualizing pathways linking women's empowerment and prematurity in developing countries.

BackgroundGlobally, prematurity is the leading cause of death in children under the age of 5. Many efforts have focused on clinical approaches to improve the survival of premature babies. There is a need, however, to explore psychosocial, sociocultural, economic, and other factors as potential mechanisms to reduce the burden of prematurity. Women's empowerment may be a catalyst for moving the needle in this direction. The goal of this paper is to examine links between women's empowerment and prematurity in developing settings. We propose a conceptual model that shows pathways by which women's empowerment can affect prematurity and review and summarize the literature supporting the relationships we posit. We also suggest future directions for research on women's empowerment and prematurity.MethodsThe key words we used for empowerment in the search were "empowerment," "women's status," "autonomy," and "decision-making," and for prematurity we used "preterm," "premature," and "prematurity." We did not use date, language, and regional restrictions. The search was done in PubMed, Population Information Online (POPLINE), and Web of Science. We selected intervening factors-factors that could potentially mediate the relationship between empowerment and prematurity-based on reviews of the risk factors and interventions to address prematurity and the determinants of those factors.ResultsThere is limited evidence supporting a direct link between women's empowerment and prematurity. However, there is evidence linking several dimensions of empowerment to factors known to be associated with prematurity and outcomes for premature babies. Our review of the literature shows that women's empowerment may reduce prematurity by (1) preventing early marriage and promoting family planning, which will delay age at first pregnancy and increase interpregnancy intervals; (2) improving women's nutritional status; (3) reducing domestic violence and other stressors to improve psychological health; and (4) improving access to and receipt of recommended health services during pregnancy and delivery to help prevent prematurity and improve survival of premature babies.ConclusionsWomen's empowerment is an important distal factor that affects prematurity through several intervening factors. Improving women's empowerment will help prevent prematurity and improve survival of preterm babies. Research to empirically show the links between women's empowerment and prematurity is however needed

Defining myocardial fibrosis in haemodialysis patients with non-contrast cardiac magnetic resonance

Background: Extent of myocardial fibrosis (MF) determined using late gadolinium enhanced (LGE) predicts outcomes, but gadolinium is contraindicated in advanced renal disease. We assessed the ability of native T1-mapping to identify and quantify MF in aortic stenosis patients (AS) as a model for use in haemodialysis patients. Methods: We compared the ability to identify areas of replacement-MF using native T1-mapping to LGE in 25 AS patients at 3 T. We assessed agreement between extent of MF defined by LGE full-width-half-maximum (FWHM) and the LGE 3-standard-deviations (3SD) in AS patients and nine T1 thresholding-techniques, with thresholds set 2-to-9 standard-deviations above normal-range (1083 ± 33 ms). A further technique was tested that set an individual T1-threshold for each patient (T11SD). The technique that agreed most strongly with FWHM or 3SD in AS patients was used to compare extent of MF between AS (n = 25) and haemodialysis patients (n = 25). Results: Twenty-six areas of enhancement were identified on LGE images, with 25 corresponding areas of discretely increased native T1 signal identified on T1 maps. Global T1 was higher in haemodialysis than AS patients (1279 ms ± 5.8 vs 1143 ms ± 12.49, P < 0.01). No signal-threshold technique derived from standard-deviations above normal-range associated with FWHM or 3SD. T11SD correlated with FWHM in AS patients (r = 0.55) with moderate agreement (ICC = 0.64), (but not with 3SD). Extent of MF defined by T11SD was higher in haemodialysis vs AS patients (21.92% ± 1 vs 18.24% ± 1.4, P = 0.038), as was T1 in regions-of-interest defined as scar (1390 ± 8.7 vs 1276 ms ± 20.5, P < 0.01). There was no difference in the relative difference between remote myocardium and regions defined as scar, between groups (111.4 ms ± 7.6 vs 133.2 ms ± 17.5, P = 0.26). Conclusions: Areas of MF are identifiable on native T1 maps, but absolute thresholds to define extent of MF could not be determined. Histological studies are needed to assess the ability of native-T1 signal-thresholding techniques to define extent of MF in haemodialysis patients. Data is taken from the PRIMID-AS (NCT01658345) and CYCLE-HD studies (ISRCTN11299707)

EFSA Panel on Food Contact Materials, Enzymes, Flavourings and Processing Aids (CEF); Scientific Opinion on Flavouring Group Evaluation 20, Revision 3 (FGE.20Rev3): Benzyl alcohols, benzaldehydes, a related acetal, benzoic acids, and related esters from chemical groups 23 and 30

&lt;p&gt;The Panel on Food Contact Materials, Enzymes, Flavourings and Processing Aids of the European Food Safety Authority was requested to evaluate five flavouring substances in the Flavouring Group Evaluation 304, using the Procedure in Commission Regulation (EC) No 1565/2000. None of the substances were considered to have genotoxic potential. The substances were evaluated through a stepwise approach (the Procedure) that integrates information on structure-activity relationships, intake from current uses, toxicological threshold of concern, and available data on metabolism and toxicity. The Panel concluded that the three substances [FL-no: 16.117, 16.123 and 16.125] do not give rise to safety concerns at their levels of dietary intake, estimated on the basis of the MSDI approach. For the remaining two candidate substances [FL-no: 16.118 and 16.124], no appropriate NOAEL was available and additional data are required. Besides the safety assessment of these flavouring substances, the specifications for the materials of commerce have also been considered. Specifications including complete purity criteria and identity for the materials of commerce have been provided for all five candidate substances.&lt;/p&gt

Determining the optimal paddle force for external defibrillation.

In summary, 8-kg paddle force achieves 95% of the overall attainable decrease in TTI when using adult defibrillation paddles placed in an anterior-apical position. We recommend that this is the minimum force that should be applied, with a maximum force of 12 kg if physically possible

Differential contribution of skin impedance and thoracic volume to transthoracic impedance during external defibrillation

Background: Two mechanisms by which firm external paddle force decreases transthoracic impedance (TTI) have been proposed. Decreased impedance at the paddle-skin interface has been assumed to be the primary mechanism, but expulsion of air from the lungs, reducing lung volume is also likely to contribute. The relative contribution of each mechanism is unknown. Methods and results: Thirty five intubated patients undergoing general anaesthesia for cardiac surgery were studied. TTI across external defibrillation paddles was measured as paddle force was increased to 12 kgf. Measurements were performed twice; once allowing the volume of the lungs to change and once with lung volume held at functional residual capacity. TTI with constant lung volume was significantly higher at all paddle forces (P&lt;0.001), confirming that a reduction in lung volume contributes to the decrease in TTI. At an optimal paddle force of 8 kg, the reduction in lung volume contributed to 16.2% of the overall decrease in TTI. Conclusion: The decrease in TTI seen with increasing external paddle force is due primarily to improved electrical contact at the paddle-skin interface, with a decrease in thoracic volume accounting for no more than 16% of the overall decrease at forces used clinically

Is the orientation of the apical defibrillation paddle of importance during manual external defibrillation?

Objective: Transthoracic impedance (TTI) is a factor determining the magnitude of the transmyocardial current during external defibrillation. Minimising TTI increases the chances of successful defibrillation. Most external defibrillation paddles are rectangular in shape and can, therefore, be placed in a transverse or longitudinal orientation. The apical paddle is often placed in a transverse orientation. This may theoretically result in a higher TTI than a longitudinal orientation because of poorer contact at the lateral paddle edges. We compared TTI with the apical paddle in both a transverse and longitudinal orientation. Materials and methods: Twenty sequential anaesthetised patients were studied. A pair of defibrillator paddles were instrumented to measure paddle force. TTI was recorded pre-operatively at end-expiration with the apical paddle in both longitudinal and transverse orientations. The sternal paddle was placed in a longitudinal orientation for all measurements. Results: TTI decreased in both transverse and longitudinal orientations as paddle force increased. Transverse paddle orientation resulted in a significantly (P&lt;0.01) higher TTI than longitudinal orientation at all paddle forces below 12 kg force. Conclusion: The longitudinal orientation of a rectangular defibrillation paddle provides a lower TTI than orientation horizontally

Comparison of the effects of removal of chest hair with not doing so before external defibrillation on transthoracic impedance

Chest hair contributes significantly to transthoracic impedance (TTI) during defibrillation. The magnitude of this effect has not been established using external paddles. We compared TTI in 40 men before elective cardiac surgery, and before and after shaving their chests. Chest hair causes a significant increase in TTI during external defibrillation, the magnitude of the effect being related to both the quantity of hair and force applied to the defibrillation paddles. When the chests of nonhirsute patients were shaved, a decrease in TTI occurred, which was probably related to the creation of low-impedance pathways through skin abrasions