Neighborhood Environment and Poor Maternal Glycemic Control-Associated Complications of Gestational Diabetes Mellitus

INTRODUCTION: Risk of complications due to gestational diabetes mellitus is increasing in the U.S., particularly among individuals from racial minorities. Research has focused largely on clinical interventions to prevent complications, rarely on individuals\u27 residential environments. This retrospective cohort study aims to examine the association between individuals\u27 neighborhoods and complications of gestational diabetes mellitus. METHODS: Demographic and clinical data were extracted from electronic health records and linked to American Community Survey data from the U.S. Census Bureau for 2,047 individuals who had 2,164 deliveries in 2014-2018. Data were analyzed in 2021-2022 using Wilcoxon rank sum test and chi-square test for bivariate analyses and logistic regression for analysis of independent effects. All census tract-based variables used in the model were dichotomized at the median. RESULTS: Bivariate analysis showed that the average percentage of adults earning CONCLUSIONS: Clinical interventions in concert with environmental changes could contribute to preventing maternal and neonatal complications of gestational diabetes mellitus

Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial.

AIMS: To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. METHODS AND RESULTS: This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI -0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or €4356 (95% CI €284, €8323). CONCLUSION: An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective. CLINICAL TRIAL REGISTRATION: ISRCTN 48334791

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Not AvailableThis publication is based on an assessment of fish and fishing gear loss from selected gillnet and trammel net fisheries of India. It presents information on the types, causes and levels of losses, as well as technological, social, environmental and policy options to reduce losses from fishing and post-harvest operations. A secondary data review provided a preliminary understanding of fish and gear losses in India. Data from state governments, fishers cooperative societies, and community centres was used to address some knowledge gaps. Research teams undertook primary data collection in 12 locations, and 583 fishing vessels were surveyed. Respondents in group and key informant interviews included vessel captains, crew, fish vendors and auction agents. Women respondents were interviewed where available. The study found that gillnet fisheries were characterized by sizeable losses of both fish and gear, with a number of causes being highlighted. The combined loss of fish and nets amounted to almost one third of a motorized vessel owner’s income, and was significantly higher than the household’s expenditure on fishing, household maintenance, quality-of-life costs (healthcare, etc.), loan servicing, or leisure activities. Conclusions seek to locate the fish and gear losses in the wider fisheries and macroeconomic context, and emphasize the need to address them as part of broader and holistic development and management agendas. This publication will be of interest to technical specialists and extension agents concerned with loss and waste prevention and reduction, and to those wishing to learn more about the topic and conduct similar research.Not Availabl

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