Family learning environments in Scandinavia: dimensions, types and socioeconomic profiles

Parental values and family activities have a strong influence on children's learning. Based on data from 44 Danish families, researchers have identified four types of family learning environments

UNIVERSITY OF COPENHAGEN

 

IMAGE: 

THE FIGURE ILLUSTRATES THE FOUR LEARNING ENVIRONMENTS, CATEGORISED ACCORDING TO THE DEGREE OF STRUCTURE AND ACTIVITY IN FAMILY LIFE. THE FIGURE SHOWS THE TYPICAL EDUCATIONAL BACKGROUND OF THE PARENTS AND EXAMPLES OF THE CHARACTERISTICS, ACTIVITIES AND STATEMENTS OF THE LEARNING ENVIRONMENTS: BLUE = CHARACTERISTICS. RED = ACTIVITIES. GREEN = STATEMENTS AND EXAMPLES FROM THE APPLICATION DATA.

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CREDIT: UNIVERSITY OF COPENHAGEN

Do children have regular bedtimes and do parents enforce strict screen time policies? And do parents take their children to museums so that they can learn from an early age? Or is everyday life more about having fun together, without clear rules and any ambition to ‘develop’ children in any particular way?

Family life can be lived in many different ways, and what children bring with them from the home environment has a substantial impact on their opportunities and development later in life.

A new study from the Department of Sociology, University of Copenhagen, and VIVE - The Danish Center for Social Science Research now offers a research-based typology of how the everyday lives of Danish families with young children can be grouped into four types of family learning environments. Four types that might influence children in very different ways.

"Learning environments are not just about playing spelling games with children," says Professor Mads Meier Jæger from the Department of Sociology, co-author of the study.

"Our study shows that there are big differences in the learning environments in which Danish children grow up, but also that it is possible to categorise them into different general types. Consequently, the study provides a comprehensive picture of children's learning environments and how individual dimensions of these environments interact," he says.

Level of activity, daily structure and learning environments

The study derives four types of family learning environments from rich data collected from 44 Danish families with children aged 3-6. Using a custom digital diary app, parents documented their family life with text, photos, audio and video over a period of 12 weeks. Parents were also interviewed.

From the data collected, the authors of the study outlined six dimensions particularly salient in characterising learning environments: Family activities, emotional climate, organisation of everyday life, social networks, expectations and values, and out-of-home care.

The six dimensions were then condensed into four typical learning environments on the basis of the level (and type) of family activities and the degree of structure in everyday life (see figure as well as brief description below). The diagram illustrates each learning environment by means of specific activities and statements.

According to Mads Meier Jæger, one of the strengths of the typology is that it is based on the activity level and everyday organisation of families. Previous research has confirmed that these are key dimensions in children's learning. In addition, the model shows a relationship between learning environments and parental education. This is consistent with research suggesting that education is the single strongest dimension of socioeconomic status.

The four categories should not be interpreted too rigidly. Many families may resemble more than one learning environment. Nor does the study say how many families belong to each of the four types. It is only the association between different activities, attitudes and underlying social factors that the researchers have mapped.

New Scandinavian perspective

Nevertheless, the categories provide a new, Scandinavian perspective on children's learning environments, as the study also includes children's school, institutional and leisure lives. The 'casual pragmatists' and 'recreational home dwellers' are very much products of the Scandinavian welfare regime and reflect other forms of inequality than those in economic and social typically of Anglo-Saxon countries.

"For example, children whose parents have vocational education and jobs are not socially disadvantaged. Parents have jobs and resources, but their focus is not on academic stimulation and children acquiring higher education. These families simply have other priorities," Mads Meier Jæger explains.

This way, the new typology provides a richer picture of how many individual parts of family life together create a family learning environment. This is important, Mads Meier Jæger says.

"In Denmark, we also have social inequality and lack of mobility in some dimensions. If we want to tackle these challenges, we need to understand where inequality originates. Our study tries to provide some answers by taking a more holistic approach.

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The four learning environments in brief

(See also the attached simplified figure (Figure 1) and the study's original figure (Figure 2) with more examples)

Expansive curators tend to have a college/university degree and ensure that children have many educational and stimulating activities inside and outside the home (e.g. word games, music lessons and museum visits). The emotional climate is safe and everyday life is organised, for example with regular bedtimes and strict rules regarding children's use of screens. Parents are very active in their children's lives outside the home, which they see as an extension of their in-house learning environment.

Casual pragmatists tend to have a medium level of higher education, such as a bachelor's degree or perhaps a vocational education. As with the ‘expansive curators’, they also engage in many and varied activities, but typically with less focus on cognitive stimulation and under less supervision. Overall, daily life, while still emotionally stable, is more loosely structured in terms of meals, bedtimes, etc.

Recreational home dwellers tend to have a vocational education or similar. Like ‘expansive curators’, daily life is structured. However, family activities tend to take place in or near the home, and parents emphasise recreation rather than deliberately stimulating children. Spending time in the garden is preferred to visiting a museum, and watching Eurovision for kids is more common than playing the piano. The type of education children receive is less important if they receive one.

Disempowered strugglers have weakest social networks, few financial resources and sometimes no formal education. Families participate in few activities and family life is often characterised by uncertainty and lack of structure and, unlike the other three groups, the emotional climate can be unstable. Parents are rarely involved in their children's lives outside the home.

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Facts about the study

The article 'Family learning environments in Scandinavia: dimensions, types and socioeconomic profiles' has been published in the British Journal of Sociology of Education.

The authors of the article are Mads Meier Jæger, Department of Sociology/UCPH, Katrine Syppli Kohl, Saxo Institute/UCPH, and Jens-Peter Thomsen, Sofie Henze-Pedersen, Kirstine Karmsteen and Rasmus Henriksen Klokker, all from VIVE - The Danish Center for Social Science Research.

The study is based on extensive analyses of qualitative data from 44 Danish families with children aged 3-6 years, including the families' electronic diaries, supplemented by a systematic literature review. The families were selected to cover a range of educational levels but are not representative of all Danish families.

The study is part of the project 'Learning environments in Danish families and their importance for children's development', which is supported by the A.P. Møller Foundation and primarily anchored at VIVE.

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JOURNAL

British Journal of Sociology of Education

DOI

10.1080/01425692.2024.2322723 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Family learning environments in Scandinavia: dimensions, types and socioeconomic profiles

 

Same species, different sizes: Rare evolution in action spotted in island bats

UNIVERSITY OF MELBOURNE

 

IMAGE: 

A COMPARISON OF THE BODY SIZES OF THE SMALLER HIPPOSIDEROS DIADEMA BAT AND THE LARGER H. DINOPS.

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CREDIT: TYRONE LAVERY

A University of Melbourne researcher has spotted a rare evolutionary phenomenon happening rapidly in real time in bats living in the Solomon Islands.

Dr Tyrone Lavery reports in a paper published in Evolution that two groups of leaf-nosed bats with vastly different body sizes that were thought to be separate species are an example of a rare type of parallel evolution. Parallel evolution is when different populations living in similar environments evolve similar features independently.

The smaller bat, Hipposideros diadema, is found across its six main islands and many smaller islands. It is also common in South East Asia, Papua New Guinea and parts of northern Australia. The much larger bats were named in 1905 as H. dinops, or Fierce Leaf-Nosed Bat, and are found only in the Solomon Islands. The two sizes live together on most islands, which all have similar forested habitat.

“Although they are very different sizes, the bats’ DNA is very similar. They use very different sonar frequencies, they probably eat different food, and even when they live in the same cave together they don’t interbreed. That is why no one has ever really questioned whether they were different species,” Dr Lavery said.

Dr Lavery said despite their independent origins, each group of larger bats has evolved to look the same, averaging more than double the weight of the small bat. “Our research suggests the rapid and repeated evolution of larger bodied bats from smaller bats, each happening independently on separate islands,” he said.

“When we created family trees using the bats’ DNA, we found that what we thought was just one species of large bat in the Solomon Islands was actually a case where bigger bats had evolved from the smaller species multiple times across different islands,” he said.

This type of parallel evolution arising from separated populations of the same species has only been observed in action a few times before and is believed to be the first time it has been documented in real time in mammals.

Parallel evolution has been found in parts of the world when populations are geographically separated but live in similar environments – such as different islands or lakes. One common type of parallel evolution is convergent evolution. For example thylacines and wolves are two separate species with different origins that evolved separately to look similar. But Dr Lavery said it was rare to see two isolated populations of the same species go through the same evolutionary process.

“Something very strong is pushing or selecting for these big bats, and it is strong enough for it to happen multiple times on different islands. We think these larger bats might be evolving to take advantage of prey that the smaller bats aren’t eating. Although they could probably interbreed, they don’t for some reason,” he said.

Across the islands, the sonar frequencies of larger bats are lower and suited to hunting bigger prey, while the smaller bats use a higher frequency. This probably means the larger bats are eating larger insects, or even frogs, Dr Lavery said.

Measuring 103 bat specimens from the Australian Museum, Queensland Museum, University of Kansas Natural History Museum, and the Bernice Pauahi Bishop Museum in Hawaii, Dr Lavery also found no overlap in body size between the two groups – the smaller “species” was always easily identified from the larger bats.

“Over time larger body size may have been part of behavioural and physical adaptations needed to hunt larger prey. This might mean the bigger and smaller bats no longer recognise each other as mates, and so they live separate lives.”

Dr Lavery said this parallel evolution pattern in leaf-nosed bats had been observed in Solomon Islands on Guadalcanal and in the Western Province, and more research was needed to see if the same pattern was repeated on other islands.

“We may think of evolution as very slow process, but it can happen rapidly when the conditions are right and two groups are separated and stop interbreeding. They can begin to evolve on different pathways,” he said.

“Islands are famous for helping us to observe and understand the processes for how species evolve in real time. They’re also places that are very vulnerable to the types of disturbance created by humans create. It’s important that we look after these incredible landscapes in Solomon Islands before we lose these stories even before we find them.”

A University of Melbourne researcher has spotted a rare evolutionary phenomenon happening rapidly in real time in bats living in the Solomon Islands.

Dr Tyrone Lavery reports in a paper published in Evolution that two groups of leaf-nosed bats with vastly different body sizes that were thought to be separate species are an example of a rare type of parallel evolution. Parallel evolution is when different populations living in similar environments evolve similar features independently.

The smaller bat, Hipposideros diadema, is found across its six main islands and many smaller islands. It is also common in South East Asia, Papua New Guinea and parts of northern Australia. The much larger bats were named in 1905 as H. dinops, or Fierce Leaf-Nosed Bat, and are found only in the Solomon Islands. The two sizes live together on most islands, which all have similar forested habitat.

“Although they are very different sizes, the bats’ DNA is very similar. They use very different sonar frequencies, they probably eat different food, and even when they live in the same cave together they don’t interbreed. That is why no one has ever really questioned whether they were different species,” Dr Lavery said.

Dr Lavery said despite their independent origins, each group of larger bats has evolved to look the same, averaging more than double the weight of the small bat. “Our research suggests the rapid and repeated evolution of larger bodied bats from smaller bats, each happening independently on separate islands,” he said.

“When we created family trees using the bats’ DNA, we found that what we thought was just one species of large bat in the Solomon Islands was actually a case where bigger bats had evolved from the smaller species multiple times across different islands,” he said.

This type of parallel evolution arising from separated populations of the same species has only been observed in action a few times before and is believed to be the first time it has been documented in real time in mammals.

Parallel evolution has been found in parts of the world when populations are geographically separated but live in similar environments – such as different islands or lakes. One common type of parallel evolution is convergent evolution. For example thylacines and wolves are two separate species with different origins that evolved separately to look similar. But Dr Lavery said it was rare to see two isolated populations of the same species go through the same evolutionary process.

“Something very strong is pushing or selecting for these big bats, and it is strong enough for it to happen multiple times on different islands. We think these larger bats might be evolving to take advantage of prey that the smaller bats aren’t eating. Although they could probably interbreed, they don’t for some reason,” he said.

Across the islands, the sonar frequencies of larger bats are lower and suited to hunting bigger prey, while the smaller bats use a higher frequency. This probably means the larger bats are eating larger insects, or even frogs, Dr Lavery said.

Measuring 103 bat specimens from the Australian Museum, Queensland Museum, University of Kansas Natural History Museum, and the Bernice Pauahi Bishop Museum in Hawaii, Dr Lavery also found no overlap in body size between the two groups – the smaller “species” was always easily identified from the larger bats.

“Over time larger body size may have been part of behavioural and physical adaptations needed to hunt larger prey. This might mean the bigger and smaller bats no longer recognise each other as mates, and so they live separate lives.”

Dr Lavery said this parallel evolution pattern in leaf-nosed bats had been observed in Solomon Islands on Guadalcanal and in the Western Province, and more research was needed to see if the same pattern was repeated on other islands.

“We may think of evolution as very slow process, but it can happen rapidly when the conditions are right and two groups are separated and stop interbreeding. They can begin to evolve on different pathways,” he said.

“Islands are famous for helping us to observe and understand the processes for how species evolve in real time. They’re also places that are very vulnerable to the types of disturbance created by humans create. It’s important that we look after these incredible landscapes in Solomon Islands before we lose these stories even before we find them.”

A photo of H.Dinops in a cave in the Solomon Islands.

H.diadama

CREDIT

Tyrone Lavery

JOURNAL

Evolution

DOI

10.1093/evolut/qpae039 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Parallel evolution in an island archipelago revealed by genomic sequencing of Hipposideros leaf-nosed bats

 

Rise seen in use of antibiotics for conditions they can’t treat – including COVID-19

Five-year trend study shows rebound in inappropriate use after an early-pandemic dip, and a need to tackle overuse in all patients during viral illness outbreaks

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

America is going the wrong way when it comes to prescribing antibiotics, with 1 in 4 prescriptions going to patients who have conditions that the drugs won’t touch, a new study finds.

In fact, the percentage of all antibiotic prescriptions given to treat conditions they’re useless against was even higher in December 2021 than it was before the pandemic began, the study shows.

And that means more chances for disease-causing bacteria to evolve in ways that could make antibiotics useless for the patients who truly need them.

The percentage of people getting antibiotics for inappropriate reasons actually decreased a bit in the early months of the pandemic, when far fewer people sought medical care for infectious or non-infectious reasons, the new research shows. But it got back on the wrong track soon after.

The study, published in the journal Clinical Infectious Diseases by a team from the University of Michigan, Northwestern University and Boston Medical Center, is based on data from more than 37.5 million children and adults covered by private insurance or Medicare Advantage plans from 2017 to 2021. Patients received antibiotic prescriptions from both in-person and telehealth visits.

The team looked back at any new diagnosis given to each patient on the day they received a prescribed antibiotic, or in the three days prior to getting the prescription. If none of these diagnoses justified the use of antibiotics, they classified the prescription as inappropriate.

“Our study shows that the decline in exposure to inappropriate antibiotic prescriptions during the pandemic was only temporary,” says lead author Kao-Ping Chua, M.D., Ph.D., a pediatrician and health care researcher in the Department of Pediatrics at the U-M Medical School. “Our findings highlight the continued importance of quality improvement initiatives focused on preventing unnecessary antibiotic prescribing and antimicrobial resistance, which kills 48,000 Americans per year.”

Chua is a member of the Susan B. Meister Child Health Evaluation and Research center, and the U-M Institute for Healthcare Policy and Innovation, and has a joint appointment in the U-M School of Public Health.

Key findings:

• In all, 60.6 million antibiotic prescriptions were dispensed in the five years of the study period from January 2017 to December 2021. The share that were inappropriate rose from 25.5% to 27.1% during this period. 
• The proportion of people getting inappropriate antibiotics was 1.7% in December 2019, dipped to 0.9% in April 2020 – largely because fewer people get antibiotics in general – and returned to 1.7% by December 2021.
• Some groups of people were more likely to receive inappropriate antibiotics. At the end of 2021, 30% of antibiotics for older adults with Medicare Advantage coverage were inappropriate, compared with 26% of antibiotics for adults with private health insurance and 17% of antibiotics for children with private insurance.
• Among the diagnoses listed for people who received antibiotics for inappropriate reasons, “contact with and suspected exposure to COVID-19” was one of top two most common reasons from March 2020 through December 2021. There is no evidence that taking antibiotics after an exposure can reduce risk of developing COVID-19.
• Of all the inappropriately prescribed antibiotics dispensed in the last half of 2021, 15% were for a COVID-19 infection. And COVID-19 infections accounted for 2% of all antibiotic prescribing – regardless of appropriateness -- from March 2020 through December 2021.
• Telehealth appointments accounted for 9% of all inappropriate antibiotic prescriptions in the latter half of 2021, down somewhat from 2020. There were almost no telehealth-based antibiotic prescriptions before March 2020.
• For 28% to 32% of the antibiotic prescriptions filled by patients in the study period, there was no diagnosis available to judge appropriateness, potentially because the patient received the prescription at an appointment that didn’t get billed to their insurance, or it was a refill of a past prescription. The percentage was especially high in the first months of the pandemic.
• 45% of all the patients in the study received antibiotics at least once in the five years, and 13% received them four or more times.

In addition to Chua, the study’s authors are Michael Fischer, MD, MS of the Boston Medical Center, statistician Moshiur Rahman, PhD of CHEAR, and Jeffrey Linder, MD, MPH of Northwestern University.

The study did not involve external funding.

Citation: Changes in the Appropriateness of U.S. Outpatient Antibiotic Prescribing after the COVID-19 Outbreak: An Interrupted Time Series Analysis of 2016-2021 Data, Clinical Infectious Diseases. DOI: 10.1093/cid/ciae135 

https://academic.oup.com/cid/advance-article-abstract/doi/10.1093/cid/ciae135/7655672?redirectedFrom=fulltext 

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JOURNAL

Clinical Infectious Diseases

DOI

10.1093/cid/ciae135 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Citation: Changes in the Appropriateness of U.S. Outpatient Antibiotic Prescribing after the COVID-19 Outbreak: An Interrupted Time Series Analysis of 2016-2021 Data

ARTICLE PUBLICATION DATE

22-Apr-2024

WOMAN'S HEALTH

Active military service may heighten women’s risk of having low birthweight babies

Findings highlight need for more female-specific research in armed forces, say study authors

BMJ

Active military service may heighten a woman’s risk of having a low birthweight baby, suggests a review of the available scientific evidence published online in the journal BMJ Military Health.

 

The findings highlight the need for more research specifically focused on women in the armed forces, and their reproductive health in particular, conclude the study authors.

Worldwide, increasing numbers of women are on active service in their country’s armed forces. The UK Armed Forces, for example, has set a target of 30% female representation by 2030. And more and more countries are deploying women in combat units, and in other challenging environments, such as submarines, note the study authors.

Mounting evidence suggests that stress experienced during pregnancy is associated with birth complications, such as preterm delivery and low birthweight. And a military career and lifestyle expose service personnel to a wide range of physical, mental, and environmental stressors that could potentially influence pregnancy outcomes.

The study authors therefore wanted to explore the potential impact of active military service on the risks of preterm labour and birth, low birthweight, and stillbirth.

They scoured research databases for relevant studies, and included 21 that met all the eligibility criteria in their analysis. The studies, which involved 650,628 women serving in the US military, were all published between 1979 and 2023.

Ten of the studies included a comparison group—usually the wives of active service personnel. By way of a proxy for those that didn’t include a comparator, the study authors drew on national data from the US National Vital Statistics for any given year.

Analysis of the study results indicated no heightened risk of preterm birth among pregnant active service women. But there were significant methodological differences; most studies had a moderate to high risk of bias; and several included only small sample sizes, caution the study authors.  

There was no observed association between branch of military service and increased risk of preterm birth, although again this should be interpreted cautiously as 5 studies included mixed service samples and the study design varied considerably, say the study authors.

There was no clear evidence for an increased risk of stillbirth among women on active military service, either.

But nearly two thirds (62.5%) of the studies concluded that women on active service may be at heightened risk of having a low birthweight baby, including one study with the lowest risk of bias. And 4 of the 5 studies that included a comparison group also indicated an increased risk of low birthweight.

Seven of the 8 studies reporting on low birthweight were carried out in single-service settings. Both of those from the US Air Force suggested a higher prevalence of low birthweight babies born to active duty military personnel.

But some 53% and 38% of the studies reporting on preterm birth and low birthweight, respectively, didn’t have a matched comparison group and relied on a proxy drawn from national statistical data. 

This introduces a risk of systematic error as the baseline characteristics of the two groups are inherently different, caution the study authors.

Women on active military service will also be medically screened before any tours of duty and will have fewer co existing conditions, while national data will include high risk and multiple pregnancies, they explain.

Only observational studies were included in the review, and the data collection methods and/or adjustment for influential factors varied, acknowledge the study authors. Only 8 studies reported on smoking status despite a high prevalence of smoking in the military and the fact that smoking is associated with several health issues before and during pregnancy.

The data also focused exclusively on the US military, which although unsurprising given that it is one of the largest in the world, this does limit the generalisability of the findings to armed forces personnel elsewhere, highlight the study authors.

Nevertheless, they conclude: This review highlights a need for more female-specific research in armed forces, beyond the US military setting, to inform military maternity pathways and policies in ways that safeguard mothers and their babies while enhancing military readiness.”

 

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JOURNAL

BMJ Military Health

DOI

10.1136/military-2023-002634 

METHOD OF RESEARCH

Systematic review

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Effect of active-duty military service on neonatal birth outcomes: a systematic review

ARTICLE PUBLICATION DATE

22-Apr-2024

Excessive pregnancy weight gain and substantial postpartum weight retention common in military health care beneficiaries

THE OBESITY SOCIETY

ROCKVILLE, Md.— Compared to their civilian counterparts, excessive pregnancy weight gain is more frequent among military health care beneficiaries, in particular active duty personnel, and is associated with costly maternal/neonatal complications. Women in this sample with excessive pregnancy weight gain were also three times more likely to have substantial postpartum weight retention, according to a new study published in the journal Obesity, The Obesity Society’s (TOS) flagship journal.

Substantial weight retention at 12 months postpartum was also more common among military health care beneficiaries in this sample than previously documented in civilian samples. Postpartum weight retention is a key concern for the United States military because it impacts active duty women’s ability to pass their fitness tests and is also associated with long-term maternal overweight and obesity.

“These results emphasize the importance of weight management before, during and after pregnancy for military populations, given the high health care costs of weight-related health complications affecting the mother and baby as well as the importance of maintaining fitness in the active duty population,” said Rebecca Krukowski, PhD, professor, Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Va. Krukowski is the corresponding author of the study.

Data for military health care beneficiaries were obtained from the Military Health System Data Repository. More than 48,000 women who had given birth in 2018 and 2019 were included. Researchers examined relationships among overweight and obesity, pregnancy weight gain, maternal and neonatal complications and substantial postpartum weight retention.

Pregnancy weight gain was determined by the amount of weight gained between a measured pre-pregnancy weight to a delivery weight. The amount of pregnancy weight gain was then compared to the national guidelines for pregnancy weight gain from the National Academy of Medicine. For body mass index, women were classified into four categories: underweight, healthy, overweight, and obesity based on the pre-pregnancy weight and height. Substantial postpartum weight retention was defined as retention of at least 10 pounds at 12-months postpartum compared with pre-conception weight. Clinical outcomes potentially related to pregnancy weight gain and body mass index were abstracted from the maternal and neonatal health care records. For maternal clinical outcomes, cases of preeclampsia, pregnancy-induced hypertension, gestational diabetes and caesarean delivery were identified. For neonatal outcomes, researchers identified infants who experienced intrauterine growth restriction, were small or large for gestational age, had low birth weight and had a neonatal intensive care unit admission.

Results showed that 75% of TRICARE beneficiaries had excessive pregnancy weight gain. Military spouses and other family members were less likely than active duty women to have excessive pregnancy weight gain. Those with excessive pregnancy weight gain and/or overweight or obesity were more likely to have maternal complications such as pregnancy-induced hypertension and cesarean delivery. The findings also showed that 42% of the military beneficiaries had substantial postpartum weight retention. Additionally, women with excessive pregnancy weight gain were three times more likely to have substantial postpartum weight retention. Researchers add that pregnancy-related weight gain above the national guidelines and substantial postpartum weight retention may make it challenging to regain the required fitness levels for active duty women and for these women (who want to serve their country) to maintain their career in the military. 

Other authors of the study include Wen You and Carol Copeland, Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Va. Copeland is also with the 59th Medical Wing, Clinical Health Psychology, Joint Base San Antonio, Texas. Erin Solomon, Department of Psychology, University of Memphis, Memphis, Tenn.; Juan Lang, Department of Biostatistics, College of Public Health, University of Kentucky, Lexington, Ky.; Emily Stone, Geneva Foundation, Bethesda, Md.; Rosemary Estevez Burns, 59th Medical Wing, Clinical Health Psychology, Joint Base San Antonio, Texas; Zoran Bursac, Department of Biostatistics, Florida International University, Miami, Fla.; Marion E. Hare, Department of Preventative Medicine, University of Tennessee Health Science Center, Memphis, Tenn.; and Teresa M. Waters, Augusta University, Institute for Public and Preventative Health, Augusta, Ga.

The authors declared no conflicts of interest.

The study, titled “Overweight/Obesity, Gestational Weight Gain, Postpartum Weight Retention and Maternal/Neonatal Complications in the Military” will be published in the May 2024 issue of Obesity.

#  #  #

The Obesity Society (TOS) is the leading organization of scientists and health professionals devoted to understanding and reversing the epidemic of obesity and its adverse health, economic and societal effects. Combining the perspective of researchers, clinicians, policymakers and patients, TOS promotes innovative research, education and evidence-based clinical care to improve the health and well-being of all people with obesity. For more information, visit www.obesity.org.

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JOURNAL

Obesity

Women’s heart disease is underdiagnosed, but new machine learning models can help solve this problem

Using machine learning, scientists built more accurate models to predict heart disease risk and found that women are underdiagnosed compared to men, highlighting the need for sex-specific criteria

FRONTIERS

When it comes to matters of the heart, cardiovascular disease in women is underdiagnosed compared to men. A popular scoring system used to estimate how likely a person is to develop a cardiovascular disease within the next 10 years is the Framingham Risk Score. It is based on factors including age, sex, cholesterol levels, and blood pressure.

Researchers in the US and the Netherlands have now used a large dataset to build more accurate cardiovascular risk models than the Framingham Risk Score. They also quantified the underdiagnosis of women compared to men. The results were published in Frontiers in Physiology.

“We found that that sex-neutral criteria fail to diagnose women adequately. If sex-specific criteria were used, this underdiagnosis would be less severe,” said Skyler St. Pierre, a researcher at Stanford University's Living Matter Lab. “We also found the best exam to improve detection of cardiovascular disease in both men and women is the electrocardiogram (EKG).”

Underdiagnosis due to heart differences

Anatomically, female and male hearts are different. For example, female hearts are smaller and have thinner walls. Yet, the diagnostic criteria for certain heart diseases are the same for women and men, meaning that women’s hearts must increase disproportionally more than men’s before the same risk criteria are met.

When the researchers quantified the underdiagnosis of women compared to men, they found that the use of sex-neutral criteria leads to severe underdiagnosis of female patients. “Women are underdiagnosed for first degree atrioventricular block (AV) block, a disorder affecting the heartbeat, and dilated cardiomyopathy, a heart muscle disease, twice and 1.4 times more than men, respectively,” St. Pierre said. Underdiagnosis of women was also found for other heart disorders.

Old vs new

To achieve more accurate predictions for both sexes, the scientists leveraged four additional metrics that are not considered in the Framingham Risk Score: cardiac magnetic resonance imaging, pulse wave analysis, EKGs, and carotid ultrasounds. They used data from more than 20,000 individuals in the UK Biobank – a biomedical database comprising information from approximately half a million UK individuals aged 40 and older – who had undergone these tests.

“While traditional clinical models are easy to use, we can now use machine learning to comb through thousands of other possible factors to find new, meaningful features that could significantly improve early detection of disease,” explained St. Pierre. Just 10 years ago, these methods were not available, which is why assessment scales like the Framingham Risk Score have been used for half a century.

Using machine learning, the researchers determined that of the tested metrics, EKGs were most effective at improving the detection of cardiovascular disease in both men and women. This, however, does not mean that traditional risk factors are not important tools for risk assessment, the researchers said. “We propose that clinicians first screen people using a simple survey with traditional risk factors, and then do a second stage screening using EKGs for higher risk patients.”

Paving the way for custom medicine

The present study provides a first step into rethinking risk factors for heart disease. Leveraging new technologies is a promising way to improve risk prediction. However, there are some limitations to the study which should be addressed in the future, the researchers said.

One such limitation is the fact that in the UK Biobank sex is treated as a binary variable. Sex, however, is inherently complex, relating to hormones, chromosomes, and physical characteristics, all of which may fall somewhere on a spectrum between ‘typically’ male and ‘typically’ female.

In addition, the study population was middle-aged and older people residing in the UK, so the results may not be transferable to people from other backgrounds and ages. “While sex-specific medicine is one step in the right direction, patient-specific medicine would provide the best outcomes for everyone,” St. Pierre concluded.

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JOURNAL

Frontiers in Physiology

DOI

10.3389/fphys.2024.1339866 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Sex-specific cardiovascular risk factors in the UK Biobank

ARTICLE PUBLICATION DATE

23-Apr-2024

COI STATEMENT

The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision. The authors also declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Follow-up 50 years on finds landmark steroid study remains safe

A follow-up analysis 50 years later finds no adverse heart health risk from Professor Graham 'Mont' Liggins' landmark steroid study to reduce illness and death for pre-term babies

UNIVERSITY OF AUCKLAND

A new study has found there are no adverse long-term cardiovascular health consequences for the now-adult children of mothers who were given corticosteroids because they were at risk of early birth in a landmark trial conducted in Auckland, New Zealand, 50 years ago.

The Auckland Steroid Study by obstetrician Professor Graham ‘Mont’ Liggins and paediatrician colleague Dr Ross Howie from 1969 to 1974 in Green Lane Hospital, Auckland, found that two corticosteroid injections given to pregnant women at risk of early (preterm) birth halved the incidence of respiratory distress in the babies and significantly reduced neonatal deaths.

Co-author of the new study, Dr Anthony Walters, says: “It was clear there were short-term benefits, but steroids are potent medications, and some have serious side effects."

He and colleagues carried out an analysis of the health data of 424 of the 1218 infants born about half a century ago. Their research found no evidence of adverse consequences for cardiovascular health, pre-diabetes and diabetes - health issues that were a possible risk based on animal studies but unlikely to develop in humans until they reached middle age.

“We’ve proven we don’t need to worry,” Walters says. “We are confident that although preterm babies have a whole range of health problems as they grow up, these are not caused by the steroid.”

The Liggins Institute continues to look at how steroids might be used as a treatment to reduce complications at birth, says Professor Dame Jane Harding of the Liggins Institute’s LiFePATH research group. “There are ongoing trials about the use of steroids to prevent lung disease in newborn babies. This study provides reassurance that these trials should go ahead.”

The study is part of the ANCHOR research programme, following up on the original Auckland Steroid Study and the later ACTORDS study, a multi-centre study at 23 centres across New Zealand and Australia between 1998 and 2004 to see if repeated courses of corticosteroids reduced the risk of lung disease and other serious illness.

Cardiovascular outcomes 50 years after antenatal exposure to betamethasone: Follow-up of a randomised double-blind, placebo-controlled trial, Plos Medicine
 

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JOURNAL

PLoS Medicine

DOI

10.1371/journal.pmed.1004378 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Cardiovascular outcomes 50 years after antenatal exposure to betamethasone: Follow-up of a randomised double-blind, placebo-controlled trial

ARTICLE PUBLICATION DATE

21-Apr-2024

Analyzing the impact of ovulation-inducing agents on the quality of embryo

Settling a long-standing debate, researchers analyze the effects of artificial ovarian stimulation on fertility using a mouse model and live-cell imaging

KINDAI UNIVERSITY

 

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SOME EXPERTS ADVOCATE THE USE OF OVULATION-INDUCING AGENTS TO COLLECT MULTIPLE EGGS FROM THE OVARIES IN ONE GO. HOWEVER, THERE IS AN ONGOING DEBATE ON WHETHER THIS APPROACH CAN PRODUCE HIGH-QUALITY EGGS FOR IN VITRO FERTILIZATION. IN THIS STUDY, RESEARCHERS USED A MOUSE MODEL AND A STATE-OF-THE-ART LIVE-CELL IMAGING TECHNIQUE TO OBSERVE THE DEVELOPMENT AND CHROMOSOME SEGREGATION OF FERTILIZED EGGS.

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CREDIT: "OOCYTE WITH ZONA PELLUCIDA" BY ZEISS MICROSCOPY

Low birth rates have become a serious problem in many developed countries throughout the world, with Japan being a prime example. In Japan particularly, aging and stress have led to a massive rise in infertility, which now affects one in every 4.4 couples. To find a workaround this condition, many couples have now turned to assisted reproduction technologies (ARTs) and in vitro fertilization (IVF) for conception. However, even though ARTs and IVF methods are well-established and have been widely used for over four decades, birth rates post IVF in Japan are still critically low, peaking at a meager 10.2%.

One of the reasons behind the low success of IVF is closely related to the quality of the eggs or ‘oocytes’ collected from the ovaries. Today, there are two main approaches in clinical practice to obtain oocytes — the first being the stimulated cycle method and the other being the natural cycle method. In the stimulated cycle method, the patient is administered ovulation-inducing agents orally or through multiple injections. This enables doctors to extract multiple mature oocytes in one go. In contrast, the natural cycle method avoids or uses minimal administration of inducing agents, and typically only one or two oocytes can be collected per month as a part of the natural ovulation cycle. However, there is an ongoing debate regarding which method is better. This is important because not only does this impact couples differently, but also, there is no firm evidence on whether the ovulation inducing method affects the quality of the embryo.

 

Now, to address this knowledge gap, a research team from Japan conducted a study using an animal model to pry into the differences between oocytes collected using natural and stimulated approaches. This study was published online on 18 March 2024 in the Journal of Reproduction and Development and was conducted by Professor Kazuo Yamagata from the Faculty of Biology-Oriented Science and Technology (BOST), Kindai University, embryologist Mayuko Kurumizaka from Yokohama City University, Dr. Tatsuma Yao from Fuso Pharmaceutical Industries, Ltd., and Dr. Mikiko Tokoro from Asada Ladies Clinic.

Sharing the motivation behind their study, Prof. Yamagata explains, “Although the influence of ovarian stimulation on embryo quality has been described, this issue remains controversial. Here, we analyzed the influence of ovarian stimulation on developmental speed and chromosome segregation using live-cell imaging.”

 

The experimental protocol involved establishing two groups of female mice to collect oocytes from. The ‘stimulated group’ was treated with ovulation-inducing agents whereas the other ‘non-stimulated group’ was not given any drugs. Next, all the viable oocytes were fertilized using sperm obtained from a single male mouse, and the development of the embryos were monitored by live-cell imaging.

Initial experiments confirmed that the stimulated mice produced roughly 1.4 times more viable oocytes than the non-stimulated mice. Then, to assess developmental abnormalities in the fertilized oocytes, the researchers employed a novel live-cell imaging technique, which had been previously developed by the team to perform long-term observations of preimplantation embryos. By injecting the embryos with small amounts of RNA encoding a fluorescent protein, intracellular processes of some embryos could be observed. This approach enabled the visualization of embryonic development in a near-natural state.

 

Detailed observations of the developing embryos revealed no significant differences between both groups, suggesting that stimulation did not adversely affect the formation and distribution of chromosomes, or the process of cell multiplication. Interestingly, the researchers noted that initial cellular divisions were slightly faster in embryos produced from stimulated oocytes, leading to faster development. This is important since faster initial development can translate into higher chances of successful implantation.

Taken together, the results indicate that the stimulated cycle method is a viable technique to collect more number of oocytes than the natural cycle method and has no adverse effect on the quality of eggs. Although further research is needed in this domain, the research team expects their findings to have important implications in the future of fertility science. “Our study provides fertility clinics and patients with useful information that will help them decide whether to pursue ovarian stimulation or not,” concludes Prof. Yamagata.

We surely hope that this study paves the way for further research that may improve the process and success of ARTs.

Assessing the impact of ovulation-inducing drugs on the chromosome segregation of eggs 

Some experts advocate the use of ovulation-inducing agents to collect multiple eggs from the ovaries in one go. However, there is an ongoing debate on whether this approach can produce high-quality eggs for in vitro fertilization. In this study, researchers used a mouse model and a state-of-the-art live-cell imaging technique to observe the development and chromosome segregation of fertilized eggs.

CREDIT

Kazuo Yamagata from Kindai University

JOURNAL

Journal of Reproduction and Development

DOI

10.1262/jrd.2023-089 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Effect of ovarian stimulation on developmental speed of preimplantation embryo in a mouse model