Women's Health in Maternal and Child Health: Time for a New Tradition?

Objectives. The status quo in maternal and child health (MCH) focuses on obstetric health. An emerging alternative is to broaden the notion to reproductive health. An inclusive perspective encompasses women's health issues in MCH. The purpose of this paper is to further the debate on the relationship of women's health to MCH. Specific aims are (1) to describe activities promoting women's health in MCH and (2) to examine consequences of alternative perspectives for MCH research, services, and training. Method. To achieve the first objective, I discuss developments in a state health agency and pertinent documents from the MCH Section of the American Public Health Association. To address the second aim, I follow the Bush Policy Analysis Model of weighing the three paradigms against the following evaluative criteria: equity, efficiency, satisfaction, stigma, indirect effects, feasibility, sensitivity to class and race, and social responsibility. Results. The obstetric approach meets most criteria in a positive fashion; reproductive health satisfies criteria more positively and less equivocally. A women's health perspective bears the most potential for improving reproductive outcomes at this time, since no area of women's general health has been definitively shown to be irrelevant to reproduction (or vice versa). Conclusions: This analysis suggests that women's health should be incorporated more fully into the MCH field, as well as other areas of public health and medicine. Once research deficits have been addressed and the scope of reproductive health delineated more clearly, the alignment of women's health with MCH may be reevaluated.     

A Typology of Work‐Family Arrangements Among Dual‐Earner Couples in Norway

A symmetrical family model of two workers or caregivers is a political goal in many western European countries. We explore how common this family type is in Norway, a country with high gender‐equality ambitions, by using a multinomial latent class model to develop a typology of dual‐earner couples with children based on the partners' allocations of paid and unpaid work. Using data on 2,617 respondents from the Norwegian Generations and Gender Survey, we estimate 4 classes, of which 2 are characterized by a fairly equal sharing between the partners and 2 have more traditional arrangements. Equal sharing is practiced by 4 out of 10 couples and is most likely when the partners are well educated and work regular hours and the father is in public‐sector employment. A traditional practice is likely when the partners have less education, the mother has health problems, the father has private‐sector employment, and the partners work irregular hours.     

Coronary bypass graft patency cannot be determined by multidetector spiral computed tomography

Objectives. Angiography by selective catheterization is the reference standard for coronary bypass graft patency assessment but carries a risk of serious complications. We have investigated whether 16-slice multidetector spiral computed tomography (MDCT) can substitute for selective angiography. Design. Two to three years after coronary artery bypass grafting, 45 patients with a total of 156 bypasses (100 single and 28 sequential grafts) were examined with both MDCT and conventional selective angiography on the same day. The bypasses were classified as patent, stenotic or occluded. Results. The likelihood ratio for MDCT-detected occlusion was 40, reflecting a fairly high combined sensitivity and specificity. However, 24% of the distal anastomoses could not be evaluated by MDCT, mainly because of respiratory movements, artifacts due to metal clips, and small vessel dimensions. Moreover, seven out of 117 bypasses (6%) deemed evaluable by MDCT were wrongly classified by this method. Conclusions. At present, 16-slice MDCT cannot replace selective angiography for assessment of coronary bypass graft patency since 24% of bypasses could not be evaluated by this method, and an error rate of 6% is unacceptable.     

Factors Associated with Home Meal Preparation and Fast-Food Sources Use among Low-Income Urban African American Adults

This study aimed to assess the factors associated with home meal preparation (HMP) and fast-food sources use (FFS) frequencies of low-income African-American adults and their healthy food beliefs and attitudes, food-related psychosocial factors, food acquisition patterns, food sources use, and BMI. We used cross-sectional data from 295 adults living in Baltimore, USA. HMP was inversely associated with FFS, which had lower odds of HMP ≥1 time/day and higher BMI scores. HMP was positively associated with positive beliefs and self-efficacy toward healthy foods, getting food from healthier food sources, and lower FFS. Higher odds of HMP ≥1 time/day were associated with getting food from farmers’ market and supermarkets or grocery stores. FFS had an inverse association with positive beliefs and self-efficacy toward healthy foods, and a positive association with less healthy food acquisition scores. Higher odds of FFS ≥1 time/week were associated with getting food from corner stores, sit-down restaurants, and convenience stores.     

Near-linear response of mean monsoon strength to a broad range of radiative forcings

Theoretical models have been used to argue that seasonal mean monsoons will shift abruptly and discontinuously from wet to dry stable states as their radiative forcings pass a critical threshold, sometimes referred to as a “tipping point.” Further support for a strongly nonlinear response of monsoons to radiative forcings is found in the seasonal onset of the South Asian summer monsoon, which is abrupt compared with the annual cycle of insolation. Here it is shown that the seasonal mean strength of monsoons instead exhibits a nearly linear dependence on a wide range of radiative forcings. First, a previous theory that predicted a discontinuous, threshold response is shown to omit a dominant stabilizing term in the equations of motion; a corrected theory predicts a continuous and nearly linear response of seasonal mean monsoon strength to forcings. A comprehensive global climate model is then used to show that the seasonal mean South Asian monsoon exhibits a near-linear dependence on a wide range of isolated greenhouse gas, aerosol, and surface albedo forcings. This model reproduces the observed abrupt seasonal onset of the South Asian monsoon but produces a near-linear response of the mean monsoon by changing the duration of the summer circulation and the latitude of that circulation’s ascent branch. Thus, neither a physically correct theoretical model nor a comprehensive climate model support the idea that seasonal mean monsoons will undergo abrupt, nonlinear shifts in response to changes in greenhouse gas concentrations, aerosol emissions, or land surface albedo.Monsoons deliver water to billions of people, so catastrophe would likely result if a gradual and small change in a forcing produced a comparatively abrupt and large change in monsoon strength. Previous studies (1, 2) used theoretical models to argue that monsoons will undergo exactly this sort of abrupt transition if anthropogenic or natural forcings exceed a critical threshold, which they referred to as a “tipping point” (3). Changes in land use or atmospheric aerosols sufficient to increase local top-of-atmosphere albedo to 0.5 have been predicted to cause a shift in the Indian summer monsoon from its current wet state to a dry state (1). The idea that anthropogenic climate forcings might produce an abrupt shutdown of some monsoons has become prominent (3, 4), even though some argue that this is unlikely to occur in the next century (5).Paleoclimate records contain abundant evidence for abrupt changes in various measures of monsoon strength (6, 7). However, such records typically measure variations at a particular location and so may not distinguish between a nonlinear response of the entire monsoon and a more gradual, linear shift of a spatial pattern with sharp horizontal gradients. It is also unclear whether mechanisms that govern monsoon changes on orbital to geological time scales are relevant for the response to anthropogenic forcings. However, even if proxy records of past monsoons are ambiguous, the modern seasonal cycle contains evidence for the abrupt response of monsoons to a radiative forcing: South Asian summer monsoon onset occurs more rapidly than can be explained by a linear response to the annual cycle of insolation (8, 9). Although the cause of this nonlinear seasonal evolution is the subject of active research (10, 11), it seems plausible that the same mechanism might produce an abrupt response of the seasonal mean monsoon to an imposed seasonal mean forcing.These results motivate our examination of how monsoon strength scales with a range of forcings. In particular, we use a simple energetic theory and an ensemble of global climate model (GCM) integrations to determine whether the summer mean strength of tropical monsoons will change discontinuously in response to a large range of radiative forcings.     

Dietary Intake in Early Pregnancy and Glycemia in Late Pregnancy among Women with Obesity

Women with obesity have increased risk for hyperglycemia during pregnancy, with negative health consequences for mother and child. We aimed to investigate adherence to nutritional recommendations in early pregnancy and to examine associations between early pregnancy dietary intake and late pregnancy glycemia among women with obesity. We included 120 women with pre-pregnancy body mass index (BMI) ≥30 kg/m² who participated in one of two randomized controlled trials. The participants completed a food frequency questionnaire in early pregnancy (gestational weeks 12–22). Fasting and 120 min glucose tolerance after ingestion of 75 g glucose were assessed in late pregnancy (gestational weeks 32–37). About 90% of the participants reported early pregnancy diary intake within the recommendations. Average intakes of vitamin D, iron, and folate were below recommended levels. High intakes of dairy products and protein in early pregnancy were associated with lower fasting glucose in late pregnancy, whereas high intake of bread was associated with lower 120 min glucose. There were no clear associations between single dietary variables and gestational diabetes mellitus (GDM) diagnosis in late pregnancy. In conclusion, some early pregnancy dietary variables were associated with late pregnancy glycemia. Potential causality of these findings should be investigated in future studies.