Factor V Leiden as risk factor for pregnancy complications : Epidemiological study of Finnish women

Factor V Leiden (FV Leiden) is the most common inherited thrombophilia in Caucasians increasing the risk for venous thrombosis. Its prevalence in Finland is 2-3%. FV Leiden has also been associated with several pregnancy complications. However, the importance of FV Leiden as their risk factor is unclear. The aim of the study was to assess FV Leiden as a risk factor for pregnancy complications in which prothrombotic mechanisms may play a part. Specifically, the study aimed to assess the magnitude of the risk, if any, associated with FV Leiden for pregnancy-associated venous thrombosis, pre-eclampsia, unexplained stillbirth, and preterm birth. The study was conducted as a nested case-control study within a fixed cohort of 100,000 consecutive pregnant women in Finland. The study was approved by the ethics committee of the Finnish Red Cross Blood Service and by the Ministry of Social Affairs and Health. All participants gave written informed consent. Cases and controls were identified by using national registers. The diagnoses of the 100,000 women identified from the National Register of Blood Group and Blood Group Antibodies of Pregnant Women were obtained from the National Hospital Discharge Register. Participants gave blood samples for DNA tests and filled in questionnaires. The medical records of the participants were reviewed in 49 maternity hospitals in Finland. Genotyping was performed in the Finnish Genome Center. When evaluating pregnancy-associated venous thrombosis (34 cases, 641 controls), FV Leiden was associated with 11-fold risk (OR 11.6, 95% CI 3.6-33.6). When only analyzing women with first venous thrombosis, the risk was 6-fold (OR 5.8, 95% CI 1.6-21.8). The risk was increased by common risk factors, the risk being highest in women with FV Leiden and pre-pregnancy BMI over 30 kg/m2 (75-fold), and in women with FV Leiden and age over 35 years (60-fold). When evaluating pre-eclampsia (248 cases, 679 controls), FV Leiden was associated with a trend of increased risk (OR 1.7, 95% CI 0.8-3.9), but the association was not statistically significant. When evaluating unexplained stillbirth (44 cases, 776 controls), FV Leiden was associated with over 3-fold risk (OR 3.8, 95% CI 1.2-11.6). When evaluating preterm birth (324 cases, 752 controls), FV Leiden was associated with over 2-fold risk (OR 2.4, 95% CI 1.3-4.6). FV Leiden was especially associated with late preterm birth (32-36 weeks of gestation), but not with early preterm birth (< 32 weeks of gestation). The results of this large population-based study can be generalized to Finnish women with pregnancies continuing beyond first trimester, and may be applied to Caucasian women in populations with similar prevalence of FV Leiden and high standard prenatal care.

Precarious Pregnancies : Alcohol, drugs and the regulation of risks

Since the 1970s alcohol and drug use by pregnant women has become a target of political, professional and personal concern. The present study focuses on prenatal substance use and the regulation of risks by examining different kinds of societal responses to prenatal alcohol and drug use. The study analyses face-to-face encounters between professionals and service users at a specialised maternity clinic for pregnant women with substance abuse problems, medical and political discourses on the compulsory treatment of pregnant women as a means of FAS prevention and official recommendations on alcohol intake during pregnancy. Moreover, the study addresses the women s perspective by asking how women who have used illicit drugs during pregnancy perceive and rank the dangers linked to drug use. The study consists of five empirical sub-studies and a summary article. Sub-study I was written in collaboration with Dorte Hecksher and Sub-study IV with Riikka Perälä. Theoretically the study builds on the one hand, on the socio-cultural approach to the selection and perception of risks and on the other on governmentality studies which focus on the use of power in contemporary Western societies. The study is based on an ethnographic approach and makes use of the principles of multi-sited ethnography. The empirical sub-studies are based on three different types of qualitative data: ethnographic field notes from a maternity clinic from a period of 7 months, documentary material (medical journals, political documents, health education materials, government reports) and 3) interviews from maternity clinics with clients and members of staff. The study demonstrates that the logic of the regulation of prenatal alcohol use in Finland is characterised by the rise of the foetus , a process in which the urgency of protecting the foetus has gradually gained a more prominent role in the discourses on alcohol-related foetal damage. An increasing unwillingness to accept any kinds of risks when foetal health is at stake is manifested in the public debate on the compulsory treatment of pregnant women with alcohol problems and in the health authorities decision to advise pregnant women to refrain from alcohol use during pregnancy (Sub-studies I and II). Secondly, the study suggests that maternity care professionals have an ambivalent role in their mundane encounters with their pregnant clients: on the one hand professionals focus on the well-being of the foetus, but on the other, they need to take into account the women s needs and agency. The professionals daily encounters with their clients are thus characterised by hybridisation: the simultaneous use of technologies of domination and technologies of agency (Sub-studies III and IV). Finally, the study draws attention to the women s understanding of the risks of illicit drug during pregnancy, and shows that the women s understanding of risk differs from the bio-medical view. The study suggests that when drug-using pregnant women seek professional help they can feel that their moral worth is threatened by professionals negative attitudes which can make service-use challenging.

Sustainability of Open Access Services - Phases 1 & 2

Although some services that support Open Access have developed a sustainable business model, many started as projects and continue to run on recurrent project funding or goodwill. If these are critical components of the evolving scholarly communication system the foundation of Open Access is vulnerable. Knowledge Exchange has commissioned this study as part of a larger programme of work to look at the issue of sustaining key services into the long term. This report focuses on phases one and two of the programme. Phase one was a scoping exercise, carried out mainly through a literature review and an extensive stakeholder interview exercise, to describe the services that are currently available or would be valuable in the future. It also investigated what roles stakeholders could play in this future scenario. Phase two was a stakeholder consultation and engagement exercise. The aim was to engage stakeholders with the work programme so that they could contribute their views, get involved with the work and have a voice in the thinking about future scenarios. The key services are presented for three future scenarios: ‘Gold’ Open Access, fully ‘Green’ Open Access and Green’ Open Access supplementing subscription access as ‘Gold’ OA grows. Three strategic areas are identified as having particular potential for future work. These are embedding business development expertise into service development; consideration of how to move money around the system to enable Open Access to be achieved optimally; and governance and coordination of the infrastructural foundation of Open Access. The report concludes with seven recommendations, both high-level and practical, for further work around these strategic areas.

Limited access alternatives for the Pacific groundfish fishery

Despite its wide acceptance in other fisheries, limited access remains a controversial topic among Pacific coast groundfish fishermen and fishery managers. It is controversial because it immediately opens a wide array of public policy issues. How should the public conserve fish stocks, and who should benefit from harvesting those fish? What are the costs and benefits to the public, the taxpayer, the fishing industry, and the coastal communities supporting the groundfish industry? Should the government push the industry to be economically efficient in harvesting; or should it discourage technical efficiency to conserve fish stocks? Should management preserve the economic status quo by protecting existing harvest shares? These are the broad issues occupying the discussions of policy makers and academic writers concerned with resource management. The goal of this introductory section is to define limited access, to dispel some basic misunderstandings about limited access, to clarify the optional forms oflimited access, and to review the various resource management objectives addressed. This should set the stage for the following more lengthy discussions. By reducing the scope of needless misunderstandings, it should also help to make future discussions of limited access more productive. (PDF file contains 52 pages.)

Determinants of self-reported smoking and misclassification during pregnancy, and analysis of optimal cut-off points for urinary cotinine: a cross-sectional study

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A review of diseases associated with cage culture systems: diagnosis and control in smale scale fish farming

Fish cage culture is a rapid aquacultural practice of producing fish with more yield compared to traditional pond culture. Several species cultured by this method include Cyprinus carpio, Orechromis niloticus, Sarotherodon galilaeus, Tilapia zilli, Clarias lazera, C. gariepinus, Heterobranchus bidorsalis, Citharinus citharus, Distochodus rostratus and Alestes dentes. However, the culture of fish in cages has some problems that are due to mechanical defects of the cage or diseases due to infection. The mechanical problems which may lead to clogged net, toxicity and easy access by predators depend on defects associated with various types of nets which include fold sieve cloth net, wire net, polypropylene net, nylon, galvanized and welded net. The diseases problems are of two types namely introduced diseases due to parasites. The introduced parasites include Crustaseans, Ergasilus sp. Argulus africana, and Lamprolegna sp, Helminth, Diplostomulum tregnna: Protozoan, Trichodina sp, Myxosoma sp, Myxobolus sp. the second disease problems are inherent diseases aggravated by the very rich nutrient environment in cages for rapid bacterial, saprophytic fungi, and phytoplanktonic bloom resulting in clogging of net, stagnation of water and low biological oxygen demand (BOD). The consequence is fish kill, prevalence of gill rot and dropsy conditions. Recommendations on routine cage hygiene, diagnosis and control procedures to reduce fish mortality are highlighted

Changes in social inequalities in disability-free life expectancy in Southern Europe: the case of the Basque Country

Background: Health expectancy is a useful tool to monitor health inequalities. The evidence about the recent changes in social inequalities in healthy expectancy is relatively scarce and inconclusive, and most studies have focused on Anglo-Saxon and central or northern European countries. The objective of this study was to analyse the changes in socioeconomic inequalities in disability-free life expectancy in a Southern European population, the Basque Country, during the first decade of the 21st century. Methods: This was an ecological cross-sectional study of temporal trends on the Basque population in 1999-2003 and 2004-2008. All-cause mortality rate, life expectancy, prevalence of disability and disability free-life expectancy were calculated for each period according to the deprivation level of the area of residence. The slope index of inequality and the relative index of inequality were calculated to summarize and compare the inequalities in the two periods. Results: Disability free-life expectancy decreased as area deprivation increased both in men and in women. The difference between the most extreme groups in 2004-2008 was 6.7 years in men and 3.7 in women. Between 1999-2003 and 2004-2008, socioeconomic inequalities in life expectancy decreased, and inequalities in disability-free expectancy increased in men and decreased in women. Conclusions: This study found important socioeconomic inequalities in health expectancy in the Basque Country. These inequalities increased in men and decreased in women in the first decade of the 21st century, during which the Basque Country saw considerable economic growth.

Dobutamine in Paediatric Population: A Systematic Review in Juvenile Animal Models

Objective: Although dobutamine is widely used in neonatal clinical practice, the evidence for its use in this specific population is not clear. We conducted a systematic review of the use of dobutamine in juvenile animals to determine whether the evidence from juvenile animal experiments with dobutamine supported the design of clinical trials in neonatal/ paediatric population. Methods: Studies were identified by searching MEDLINE (1946-2012) and EMBASE (1974-2012). Articles retrieved were independently reviewed by three authors and only those concerning efficacy and safety of the drug in juvenile animals were included. Only original articles published in English and Spanish were included. Results: Following our literature search, 265 articles were retrieved and 24 studies were included in the review: 17 focused on neonatal models and 7 on young animal models. Although the aims and design of these studies, as well as the doses and ages analysed, were quite heterogeneous, the majority of authors agree that dobutamine infusion improves cardiac output in a dose dependent manner. Moreover, the cardiovascular effects of dobutamine are influenced by postnatal age, as well as by the dose used and the duration of the therapy. There is inadequate information about the effects of dobutamine on cerebral perfusion to draw conclusions. Conclusion: There is enough preclinical evidence to ensure that dobutamine improves cardiac output, however to better understand its effects in peripheral organs, such as the brain, more specific and well designed studies are required to provide additional data to support the design of clinical trials in a paediatric population.

Transboundary Movement of Atlantic Istiophorid Billfishes Among International and U.S. Domestic Management Areas Inferred from Mark-Recapture Studies

Billfish movements relative to the International Commission for the Conservation of Atlantic Tunas management areas, as well as U.S. domestic data collection areas within the western North Atlantic basin, were investigated with mark-recapture data from 769 blue marlin, Makaira nigricans, 961 white marlin, Tetrapturus albidus, and 1,801 sailfish, Istiophorus platypterus. Linear displacement between release and recapture locations ranged from zero (all species) to 15,744 km (mean 575, median 119, SE 44) for blue marlin, 6,523 km (mean 719, median 216, SE 33) for white marlin, and 3,845 km (mean 294, median 98, SE 13) for sailfish. In total, 2,824 (80.0%) billfish were recaptured in the same management area of release. Days at liberty ranged from zero (all species) to 4,591 (mean 619, median 409, SE 24) for blue marlin, 5,488 (mean 692, median 448, SE 22) for white marlin, and 6,568 (mean 404, median 320, SE 11) for sailfish. The proportions (per species) of visits were highest in the Caribbean area for blue marlin and white marlin, and the Florida East Coast area for sailfish. Blue marlin and sailfish were nearly identical when comparing the percent of individuals vs. the number of areas visited. Overall, white marlin visited more areas than either blue marlin or sailfish. Seasonality was evident for all species, with overall results generally reflecting the efforts of the catch and release recreational fishing sector, particularly in the western North Atlantic. This information may be practical in reducing the uncertainties in billfish stock assessments and may offer valuable insight into management consideration of time-area closure regulations to reduce bycatch mortality of Atlantic billfishes.

Um estudo sobre a vivência da gravidez tardia

Atualmente, no Brasil e no mundo, há um aumento do número de mulheres que postergam a gravidez para após os 35 anos em função da estabilidade profissional, espera de um relacionamento, infertilidade, incerteza sobre o desejo de ser mãe. Independente do motivo, na proporção em que acontece, o aumento do número de mulheres que vivenciam a gravidez tardia configura-se um fenômeno irreversível, que só tende a aumentar. Esta pesquisa teve como objeto a vivência da gravidez tardia e seus objetivos foram: descrever a vivência da mulher que engravida após os 35 anos e analisar a vivência sob a perspectiva de gênero e vulnerabilidade. Estudo descritivo, com abordagem qualitativa, tendo como técnica de coleta de dados a entrevista aberta, realizada com 16 mulheres no ciclo gravídico puerperal, com idade entre 36 e 48 anos, internadas em duas maternidades públicas, cenários da pesquisa, situadas no município do Rio de Janeiro. Foram observados os princípios da Resolução n 466 de 12 de dezembro de 2012 do Conselho Nacional de Saúde. Realizou-se análise temática dos dados categorizados. O estudo mostrou que fazem parte da vivência da mulher que engravida após os 35 anos, o desejo de ser mãe; aspectos positivos relativos à idade, maturidade, discernimento, profissão mais definida, aspectos que interferem favoravelmente na relação com a criança; e como aspectos negativos, cansaço, discriminação geracional e problemas de saúde. A espiritualidade, religiosidade e rede de apoio fortalecem a mulher para o enfrentamento de possíveis dificuldades. O planejamento familiar mostrou-se inexistente para as participantes e conclui-se que ao postergar a gravidez a mulher reduz a sua prole. Os resultados evidenciaram que para o planejamento da assistência o enfermeiro ou profissional de saúde deve trabalhar em equipe e conhecer o risco e a vulnerabilidade (individual, social e programática) da sua cliente. Deve considerar a situação socioeconômica e aspectos da vida familiar e afetiva, profissional, jornada de trabalho, trabalho doméstico, rede de apoio e acessibilidade aos serviços. A fim de detectar aspectos individuais, coletivos e contextuais que aumentam a suscetibilidade da cliente. A escuta qualificada é a primeira providência para identificar as necessidades e singularidades das clientes e definir a estratégia de cuidados.

A Review of Recent Developments in the World Sea Cucumber Fisheries

Sea cucumbers (Holothuridae and Stichopodidae) have been harvested commercially for at least 1,000 years. The world fisheries for sea cucumbers, however, are not well documented and in general are poorly managed. Depending upon the species exploited, there are two processing procedures for the sea cucumber product. Some species are eaten raw, while most commercial species are processed into a dry product called beche-de-mer or trepang. This dry product is exported to a central market such as Hong Kong and then re-exported to the consumers. In this review, recent statistics on the world sea cucumber fisheries, collected from different services, are detailed for each major fishing area. Case studies for each fishing area are also presented. Recent major changes in the Indo-Pacific fishery include the participation of new producer countries, the shift in the species being exploited, and an increase in the Chinese market. The expansion of the largely monospecific temperate North Pacific fisheries is also described. Statistics from Hong Kong, Singapore, Taiwan, and the Food and Agriculture Organization provide valuable information on the producer and importer countries. Particular attention is paid to the reciprocal trade of beche-de-mer between Hong Kong and Singapore. An evaluation of the world sea cucumber landings and beche-de-mer production is presented. Recent developments include an expansion of the Hong Kong market due to increased demand by China, the importance of Indonesia as a major world producer, and an increase in the fisheries of Tropical Pacific nations. This increase is best documented for New Caledonia and Fiji. Ways to improve the access and the reliability of the statistics for the sea cucumber fishery are discussed, as is the potential for management of artisanal fisheries.

Restricted Access vs. Open Access Methods of Management: Toward More Effective Regulation of Fishing Effort

This paper gives an overview of the economic rationale for limited entry as a method of fishery management and discusses general advantages and disadvantages of license limitation and catch rights as the two primary methods of restricting access to marine fisheries. Traditional open-access methods of regulation (e.g., gear restrictions, size limits, trip limits, quotas, and closures) can be temporarily effective in protecting fish populations, but they generally fail to provide lasting biological or economic benefits to fishermen because they do not restrict access to the fishery. The general result of regulation with unrestricted access to a fishery is additional and more costly and complex regulations as competition increases for dwindling fishery resources. Regulation that restricts access to a fishery in conjunction with selected traditional methods of regulation would encourage efficient resource usage and minimize the need for future regulatory adjustments, provided that enforcement and monitoring costs are not too great. In theory, catch rights are superior to license limitation as a means of restricting access to a fishery.

A U.S. Perspective on Access to Fisheries Resources

The passage of the Magnuson Fishery Conservation and Management Act of 1976 (MFCMA) and the establishment of a 200-mile exclusive economic zone (EEZ) in 1983 have resulted in a radical change in the pattern of foreign fishing operations off the U. S. coasts. Likewise, the extensions of 200-mile EEZ's by other nations have impacted U.S. distant-water fisheries. The result has been that a new international framework for fisheries is emerging and is continuing to evolve.