Wednesday, March 06, 2024

 

Has Medicaid expansion affected pregnancy outcomes among women with gestational diabetes?



Peer-Reviewed Publication

WILEY



The Affordable Care Act (ACA) aims to broaden healthcare access, but its effect on maternal and newborn health among women with gestational diabetes—or diabetes that develops during pregnancy—across diverse demographics is unclear. In a study published in the International Journal of Gynecology & Obstetrics, researchers compared the impact of the implementation of the ACA on maternal and newborn health in Maryland (with ACA implementation) and Georgia (without ACA implementation) among 52,479 women.

The investigators found that after ACA implementation, Maryland showed improved newborn outcomes compared with Georgia. This included measures related to Agar scores, the need for assisted ventilation, and the need for neonatal intensive care. There were no significant differences in Cesarean section deliveries.

“It is plausible that Maryland's decision to adopt Medicaid expansion, coupled with the state's proclivity for inclusiveness and adaptability, could inherently drive better outcomes,” said corresponding author Oluwasegun Akinyemi, MD, MPH, a senior research fellow at the Howard University College of Medicine and a PhD student at the University of Maryland School of Public Health. “This perspective aligns with the supposition that state‐specific sociocultural dynamics, beyond mere policy adoption, profoundly influence health outcomes.”

URL upon publication: https://onlinelibrary.wiley.com/doi/10.1002/ijgo.15439

 

Additional Information
NOTE: 
The information contained in this release is protected by copyright. Please include journal attribution in all coverage. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com.

About the Journal
The International Journal of Gynecology & Obstetrics publishes articles on all aspects of basic and clinical research in the fields of obstetrics and gynecology and related subjects, with emphasis on matters of worldwide interest.

About Wiley
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Improving women’s fertility choices: avoiding environmental catastrophe caused by population growth


Peer-Reviewed Publication

FLINDERS UNIVERSITY

Ecological footprint using seven example nations 

IMAGE: 

ECOLOGICAL FOOTPRINT USING SEVEN EXAMPLE NATIONS: USA, AUSTRALIA, FINLAND, UK, CHINA AND NIGERIA. THE NUMBERS ON THE RIGHT INDICATE HOW MANY EARTHS WOULD BE REQUIRED IF EVERYONE ON EARTH CONSUMED RENEWABLE RESOURCES AT THE SAME RATE AS THE NATION INDICATED. CREDIT: FLINDERS UNIVERSITY.

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CREDIT: PROFESSOR COREY BRADSHAW, FLINDERS UNIVERSITY.




Declining fertility rates and ageing populations in Western nations have recently set off alarm bells, but continued global population growth will actually raise the pressure billions more people place on a destroyed environment, according to new research.

Scientists have assessed the risks that an expanding global population will have on global ecosystems and human societies in a new study published in the journal Frontiers in Public Health, which helps understand the direct relationship between population size and environmental decline.

These risks are global in scale and include increasing greenhouse-gas emissions, climate disruption, pollution, loss of biodiversity, and the spread of disease—all potentially catastrophic for our standard of living and wellbeing.

The study funded by Population Matters and led by Chitra Saraswati, a researcher with the Telethon Kids Institute, and Matthew Flinders Professor of Global Ecology, Corey Bradshaw from Flinders University, shows that empowering women to make choices about their fertility and family planning is a core issue, but addressing it won’t prevent overpopulation on its own.

Professor Bradshaw said working to increase child health and introducing government policies that addressed food security and climate change would also help reduce unprecedented population growth.

“While a smaller human population will benefit the most people on Earth, we emphasise that we are not advocating an end to childbirth. Instead, we join the globally progressive voice of promoting the empowerment of girls and women worldwide through ethical and practical solutions to determine their own fertility, he said.

“Unfortunately, some national attitudes still obscure the links between population and environmental degradation, so traction for quality family planning in such regions has stalled.

“We also emphasise that determining family size should not be left to women alone; men also need to be educated adequately and provided with contraceptive options to allow them to promote prosperous and just outcomes for their family.”

To quantify the scale of the problem, the experts scoured online databases to identify all relevant peer-reviewed and grey-literature sources examining the consequences of human population size and growth on the Earth’s environment.

Their assessment shows that a global population of between nine and more than 10 billion by the end of this century is likely. The experts argue growing concerns about population decline ignore evidence of the economic and wellbeing advantages of smaller populations, as well as the fact that there is zero possibility of a “population collapse” over the coming century.

Co-author, Professor of Paediatrics, Peter Le Souëf from The University of Western Australia, emphasises that children will suffer most from an increasing population.

“Most of the population increase will be in low-and middle-income nations where resources for children are already too limited to maintain their health. Rapidly expanding populations in impoverished nations will condemn children born there to increasing mortality rates and declining health that will soon reverse the hard-won advances made over recent decades, Professor Le Souëf said.

“To protect these children, stopping poverty is essential but doing so will accelerate demand for natural resources and worsen climate change. Global strategies needed to prevent this from happening include reducing natural resource use, providing equity of access to these reduced resources and improved fertility options for women.”

Chitra Saraswati said a combination of factors linked to population growth would deplete natural resources and accelerate environmental degradation, so policies were needed to support countries going through demographic transition.

“We have to look at the big picture on unabated population growth to ensure progress occurs within planetary boundaries and promotes equity and human rights. Ensuring the wellbeing for all under this aim itself will lower population growth and promote environmental sustainability.

“Enabling a “safe and just space for all” requires empowering women, improving health and wellbeing for women and their children, and increasing economic prosperity — actions that conveniently all lower fertility rates, knowing that falling fertility is indicative of economic development.”

Co-author, Dr Melinda Judge from The University of Western Australia and the Telethon Kids Institute, highlighted the need for increased global equity.

“Providing women and men the opportunity to determine their family size free of any form of coercion cannot be deemed “population control” — rather, it is an important human right that has been neglected. In particular, empowering women — especially disadvantaged women — to make decisions about when and how many children they have, will have positive impacts on their lives and the lives of their children, and is a proven path to overall development.”

Alistair Currie, Head of Campaigns and Communications at Population Matters, said the dominance of the 'baby bust' narrative obscured the reality that global population was set to grow by billions, and that the consequences of that would be devastating for the most vulnerable communities.

“As this paper authoritatively shows, population growth holds people back from the lives they deserve and is one of the most important drivers of our environmental crisis. It's also the product of our shameful failure to achieve gender equality, tackle poverty, ensure that pregnancy, childbirth and childhood are safe and healthy for everyone, and ensure people are able and free to use modern family planning so they can choose the family size they want.”

Population Matters is a UK-based charity working internationally to promote the benefits of a sustainable population to protect nature and improve people's lives

 

Study: SCOTUS created two-tier health care system with Dobbs decision


Interviews with providers in abortion restrictive, protective states show ruling has negatively affected health delivery; argues court ignored question of gender


Peer-Reviewed Publication

UNIVERSITY OF KANSAS





LAWRENCE — When the Supreme Court overturned the constitutional right to abortion, it did so by insulating itself from considering the effect the decision would have on women and marginalized communities, according to authors of a new study.

By refusing to connect the decision in Dobbs v. Jackson Women’s Health Organization to the gendered impact of its decision, the authors said the decision has resulted in a two-tiered system of health care that exacerbates existing disparities.

Alesha Doan, professor of public affairs & administration and women, gender & sexuality studies, is co-author of a study that examines the Dobbs decision, published in the Journal of Women, Politics & Policy.

In a critical legal analysis of the Dobbs decision, the authors wrote that the court did not connect abortion with “invidiously discriminatory animus against women” by claiming the topic was not about gender, nor did preventing abortion constitute sex discrimination. That ignores previous abortion cases like Roe v. Wade and Planned Parenthood v. Casey, both of which noted clearly that gender was paramount in the issue.

“The majority opinion in Dobbs completely dismissed and ignored the fundamentally gendered reality of abortion,” Doan said. “There is a line in the majority opinion that says, ‘This has nothing to do with gender.’ However, if you read the briefs submitted by hundreds of experts, providers, physicians, advocates and others, it is expressly present. And it is present in decades of research that provides empirical evidence that women suffer medical, legal, economic and other dire consequences when the government criminalizes abortion.”

The Supreme Court's dissenting opinion also pointed out that gender was a central component of previous rulings on the matter, in addition to amicus briefs submitted to the court, Doan said. The result in curtailing women’s rights is unique in that legal arguments are generally on the side of expanding rights, she added, but the court insulated itself from discussion of removing rights by claiming the case was not about gender.

The study, co-written with Lori Brown of Syracuse University and Shoshanna Ehrlich of the University of Boston, connects a critical legal analysis with an examination of how the Dobbs decision has affected practitioners and those seeking abortion care. The authors conducted interviews with 22 providers in states with both abortion restrictions and protections.

Providers were interviewed after the Dobbs case was argued but before the decision was announced. That uncertain period, including the leaking of the decision to the media, created a snapshot of a fraught period of time. Results showed that providers were highly concerned about how the decision would affect their ability to deliver care equitably. 

About a year after the Dobbs decision, approximately half of the providers were interviewed again. Many worked in states where abortion was criminalized or in the process of being criminalized.

“If you take one thing away from this paper, it should be the compounding inequality that resulted after Dobbs," Doan said. "Although these were issues that existed before the decision, they have dramatically increased the difficulty for society’s more vulnerable people to receive abortion care, reproductive health care, reduce the quality of care they do receive and so much more.

“We know that women of color and people living in poverty have poorer health outcomes, and the physicians we interviewed unanimously expressed their concern about how this disparity will only get worse,” she said.

Providers expanded on how the decision has reduced the quality of care they could provide. Specifically, for women who travel to abortion-protective states, they often do not have the time for follow-up visits or to spend more than the minimum time at a care facility because of child care or work responsibilities waiting at home, or they cannot afford the travel-related costs of a longer stay. 

Further, routine OBGYN care dictates that doctors serving a pregnant woman ask questions such as how many times they have been pregnant and how many miscarriages or abortions they have had previously.

“Because abortion is criminalized in many states, miscarriages may be called into question, so people are less willing to disclose them to their physician if they are criminal,” Doan said. “That’s just one of many ways the quality of reproductive health care has been compromised and reduced.”

Providers also expressed concern about the training of future doctors and health care providers. Several noted that medical schools in their states can no longer provide training on how to manage miscarriages, a common occurrence and necessity for OBGYN practitioners, or how to perform abortions. Medically, they are the same, but because the latter is now illegal in some states, some schools are shying away from its teaching. 

Additionally, OBGYN residents are accepting more residencies in abortion-protective states, interviewees said. And data shows that residents tend to continue their medical careers in the states in which they complete residences, Doan added.

As a result, some states will have fewer fully trained health care providers, not only in OBGYN, but family medicine and other areas, the interviewees said.

As the dissenting justices wrote, the Supreme Court’s majority decision and claim the Dobbs decision was not about gender shows it “knows or cares little about women’s lives or about the suffering its decision will cause,” which the authors underscore in the study. 

“You’re getting a two-tiered system of medical training, which translates to a two-tiered system of health care delivery. This was a very significant concern voiced in the interviews, this fracturing of reproductive medical care and what it will mean for deepening the existing inequitable health outcomes for women of color and other communities living in precarity,” Doan said.

 

Research exposes security, privacy and safety issues in female technology apps used to track fertility, menopause and monthly cycle


Peer-Reviewed Publication

NEWCASTLE UNIVERSITY





Academics are calling for regulatory action after their research highlighted security and privacy risks  in female-oriented technologies (FemTech), such as  period-tracker mobile apps, and fertility and menopause smart and connected devices.

Experts at Royal Holloway, University of London, Newcastle University, University of London and ETH Zurich, have identified significant security, privacy, and safety issues surrounding FemTech, which can pose a potential threat to users.

These threats include the apps accessing users’ personal contacts, camera, microphone, location and other personal data (e.g., medical scans), as well as system settings and other accounts that expose security and privacy risks.

These apps and IoT (Internet of Things) devices collect a wide range of data about users, their relatives (children, partner, family), their bodies and environments via embedded sensors.

The research showed that such practices can reveal very sensitive and intimate information about users (such as gender, fertility, and medical data) to third parties.

FemTech is a term applied to the collection of digital technologies focused on women’s health and wellbeing. FemTech includes applications, software and wearable devices, and can range from mobile period apps and fertility-tracking wearables to IVF services.

Publishing the findings in the journal Frontiers in the Internet of Things and Symposium on Usable Privacy and Security Workshop, the authors are calling on policymakers to explicitly acknowledge and accommodate the risks of these technologies in the relevant regulations.

The market is estimated to reach more than $75b by 2025. The devices and apps reviewed in this study include a breast smart pump, cycle and fertility trackers (such as bracelets and rings), a smart bottle, Kegel trainers, sex toys, menopause management solutions, a digital pill organiser, and general health trackers.

The research team reviewed the existing regulations related to FemTech in the UK, EU, and Switzerland to identify gaps in regulations, compliance practices of the industry and enforcements by running experiments on a range of FemTech smart devices, apps, and websites.

Their analysis of FemTech-related regulations shows they are inadequate in addressing the risks associated with these technologies. The EU and UK medical devices regulations don’t currently have any references to FemTech data and user protection. The GDPR and Swiss FADP have references to sensitive and special category data, which overlap with FemTech data. However, the industry practices include many non-complaint practices in data collection and sharing.

The study also focused on industry non-compliance. The team identified a range of inappropriate security and privacy practices in a subset of FemTech systems. The research shows that these systems do not brand as medical devices, do not present valid consent and do not give extra protection to sensitive data, and track users without consent.

The authors show that, not only is such intimate data collected by FemTech systems, but also this data is processed and sold to third parties.

The findings have exposed a lack of research and guidelines for developing cyber-secure, privacy-preserving and safe products.

Dr Maryam Mehrnezhad, lead author of the research and Senior Lecturer at Royal Holloway said: “We have identified multiple threat-actors interested in FemTech data such as fertility and sex information.

“We have been conducting security and privacy research on this topic since 2019. Apart from our system studies, our user studies also highlight that end-users are indeed concerned about their intimate and sensitive data being handled by FemTech products. We constantly share our research results with the industry and related regulatory bodies, such as the Information Commissioner's Office. We hope to see better collaborative efforts across the stakeholders to enable the citizens to use FemTech solutions to improve the quality of their lives without any risk and fear.”

Professor Mike Catt of Newcastle University, one of the study authors, added: “We urge regulatory bodies to update and strengthen guidelines to ensure the development and use of secure, private, and safe FemTech products.


“Many of the apps surveyed access mobile and device resources too. Some of these permissions are marked as dangerous, according to Google’s protection levels. Such access potentially exposes contacts, camera, microphone, location and other personal data. Some specific permissions, such as access to system Settings and other Accounts on the device, also impose security and privacy risks. Access to sensors on the mobile phone can also be used to break user privacy. Users deserve better protection, especially where this relates to sensitive personal health and gender data.”

This research was supported by the UKRI EPSRC PETRAS CyFer and AGENCY projects. These multi-disciplinary research teams are working with other stakeholders on the complex risks and harms of modern technologies such as FemTech to mitigate these risks and to design privacy-preserving, cyber-secure, and safe products which are inclusive.

Ends

Note to editors:

According to data from the German online platform, Statista, which specialises in data gathering, the FemTech market is worth almost $65 billion and is projected to grow to more than$100 billion in 2030. 

[1] Mehrnezhad, van der Merwe, Catt, Mind the FemTech Gap: Regulation Failings and Exploitative Systems, Journal of Frontiers in IoT, 2024, earlier version at: Privacy Engineering in Practice (PEP), Symposium on Usable Privacy and Security Workshop, USA, 2023

Open access link: https://pep23.com/assets/pdf/pep23-paper6.pdf

[2] Mehrnezhad, and Almeida. "" My sex-related data is more sensitive than my financial data and I want the same level of security and privacy": User Risk Perceptions and Protective Actions in Female-oriented Technologies." The European Symposium on Usable Security, ACM, Denmark, 2023

Open access link: https://dl.acm.org/doi/fullHtml/10.1145/3617072.3617100

 

Poverty shown to reduce women's ovarian reserves


New study suggests that aggregate exposure to neighborhood poverty increases a woman's level of antimullerian hormone to potentially cause greater ovarian follicle loss over time


Peer-Reviewed Publication

THE MENOPAUSE SOCIETY





CLEVELAND, Ohio (March 6, 2024)—Earlier menopause onset is associated with a variety of health consequences, including osteoporosis, neurologic disorders, cardiovascular disease, and mortality. Evidence suggests that the exhaustion of the ovarian follicle pool leads to menopause. A new study proposes that neighborhood disadvantage may affect the ovarian reserve and the timing of menopause. Results of the survey are published online today in Menopause, the journal of The Menopause Society.  

This is not the first study to link socioeconomic status with ovarian reserve and an earlier age at menopause. For example, in the Study of Women’s Health Across the Nation, lower education attainment and unemployment status were associated with earlier menopause onset independent of race/ethnicity, smoking, use of contraceptives, parity, marital status, and history of heart disease.  

What makes this new study involving more than 1,000 healthy premenopausal women unique is its focus on the effect of socioeconomic disadvantage at the neighborhood level. Specifically, it looked at aggregate exposure to neighborhood poverty over the period of adulthood in relation to ovarian reserve as indexed by antimüllerian hormone levels and antral follicle count.  

The findings of this study, as well as related future research, have important implications for women’s health and well-being overall because they may point to areas for potential intervention.  

Survey results are published in the article “Association between neighborhood poverty and ovarian reserve: the ovarian aging study.”  

“This study highlights the potential effect of early life adversity, and specifically neighborhood poverty, on ovarian reserve, which in turn has implications for the timing of menopause onset and risk for diseases of aging. These findings add to the understanding of the adverse effect of psychological stress on reproductive health,” says Dr. Stephanie Faubion, medical director for The Menopause Society.  

For more information about menopause and healthy aging, visit www.menopause.org.  

The Menopause Society (formerly The North American Menopause Society) is dedicated to empowering healthcare professionals and providing them with the tools and resources to improve the health of women during the menopause transition and beyond. As the leading authority on menopause since 1989, the nonprofit, multidisciplinary organization serves as the independent, evidence-based resource for healthcare professionals, researchers, the media, and the public and leads the conversation about improving women’s health and healthcare experiences. To learn more, visit menopause.org. 

 

Study: Black boys are less likely to be identified for special education when matched with Black teachers



Relationship is strongest for students from economically disadvantaged backgrounds


Peer-Reviewed Publication

AMERICAN EDUCATIONAL RESEARCH ASSOCIATION





WASHINGTON, March 6, 2024—Black male elementary school students matched to Black teachers are less likely to be identified for special education services, according to new research published today. The relationship is strongest for economically disadvantaged students. The study, by Cassandra Hart at the University of California, Davis, and Constance Lindsay at the University of North Carolina at Chapel Hill appeared in the American Educational Research Journal, a peer-reviewed journal of the American Educational Research Association.

The researchers also found that the connection is especially strong in special education categories that are more open to teacher discretion, such as learning disabilities. For their study, Hart and Lindsay drew on rich statewide administrative data from North Carolina that included more than 540,000 observations of Black children in grades 1 to 4 and their assigned teachers from 2008–08 through 2012–13.

“Our findings add to the growing body of evidence that having access to Black teachers matters to Black children’s educational journeys,” said Hart, a professor of education at the University of California, Davis. “We show that access to Black teachers most strongly affects precisely the types of special disability placements that are more subject to teacher discretion, and therefore where the need for services is more questionable.”

“It may be that Black teachers interpret certain behaviors as simple inattentiveness rather than a disability, or that Black students respond to Black teachers with more engagement,” said Lindsay, an assistant professor of educational leadership at the University of North Carolina at Chapel Hill.  

Hart and Lindsay noted that special education placement, when appropriate, can be beneficial for children. However, concerns arise when children are exposed to the potential stigma of special education in cases where the benefits may be less pronounced and the need for services may be more discretionary. Prior research has also suggested that Black teachers hold higher expectations for Black students.

Approximately 7 percent of teachers nationwide are Black, compared to 15 percent of students, according to the U.S. Department of Education.

“Our results add to the growing evidence for why diversifying the teacher workforce is important for improving student outcomes from all backgrounds,” said Hart. “Beyond that, school districts may want to consider providing clear guidance to teachers around when they should urge screening for disabilities, to minimize the role of teacher discretion in the identification process.”

Hart and Lindsay also found that Black teachers were less likely to identify White children for disability services than non-Black teachers, although the relationship was not as strong as it was with Black boys.

“Black teachers may be simply less likely across the board to suggest screening for disabilities,” Lindsay said. “Regardless of the reason, this finding is consistent with prior research showing that diversifying teachers does not harm, and often benefits, non-Black students as well.”

Study citation: Hart, C. & Lindsay, C. (2024). Teacher-student race match and identification for discretionary educational services. American Educational Research Journal. Prepublished March 6, 2024. https://doi.org/10.3102/00028312241229413

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About AERA

The American Educational Research Association (AERA) is the largest national interdisciplinary research association devoted to the scientific study of education and learning. Founded in 1916, AERA advances knowledge about education, encourages scholarly inquiry related to education, and promotes the use of research to improve education and serve the public good. Find AERA on FacebookTwitterLinkedInInstagramThreads, and Bluesky.

 

A new genus of fungi on grasses


Peer-Reviewed Publication

TSINGHUA UNIVERSITY PRESS

Metacampanella dendrophora 

IMAGE: 

METACAMPANELLA DENDROPHORA. BASIDIOMATA, HABIT. (A) TFB 7335 (TENN-F-054395). (B) TFB 7340 (TENN-F-054442). STANDARD BARS = 10 MM.

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CREDIT: KAREN W. HUGHES AND RONALD H. PETERSEN, UNIVERSITY OF TENNESSEE, KNOXVILLE, TN, USA



While ecologically important, small mushrooms on monocots (grasses and sedges) are rarely studied and a lack of information about their habitat and DNA sequences creates difficulties in determining their presence or absence in ecological studies and their genetic relationships to other mushroom taxa. 

 

This study led by Drs. Karen W. Hughes and Ronald H. Petersen (University of Tennessee, Knoxville, TN, USA) examined a mushroom species, Campanella subdendrophora, (also known as Tetrapyrgos subdendrophora)which fruits on grasses in the US Pacific Northwest. 

 

The researchers evaluated its phylogenetic position concerning both Campanella and Tetrapyrgos and determined that a new genus, Metacampanella was needed for this taxon (e.g., Metacampanella subdendrophora). Further, they identified other taxa that belonged to this group including taxa from Costa Rica and New Zealand, and named and described them where feasible. Metacampanella also includes an unknown taxon from the central US prairie grassland. In this latter case, the sequences were isolated from Prairie Dog dung (Rodents that eat root and shoot vegetation) and are presumably grass endophytes. (Herrera J. et al. 2011. Microb. Ecol. 61(2), 239–244). An endophyte of Elymus mollis (dune grass)was also identified as belonging to Metacampanella, (Metacampanella sinecystidia). 

 

“To date, several Metacampanella appear to be associated with grasses. Future environmental studies may identify other members of this new genus.” Dr. Karen W. Hughes said.

 


See the article: Metacampanella gen. nov.: The Campanella dendrophora complex