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Adverse pregnancy and perinatal outcomes (APPOs), including pre-term birth, pre-eclampsia and gestational diabetes, can result in maternal and neonatal morbidity and mortality, parental anxiety and increased healthcare costs. A better understanding of the causes of APPOs is essential to inform lifestyle and pharmaceutical interventions for their prevention and management. Given the difficulty of undertaking randomised controlled trials in pregnant women, triangulating evidence from across methods with different sources of bias may improve causal inference for APPOs. The purpose of the Mendelian randomisation in pregnancy (MR-PREG) collaboration is to support such triangulation using genetic (eg, Mendelian randomisation (MR)) and non-genetic (eg, partner negative controls) approaches to investigate the causal effects of maternal exposures on a comprehensive set of APPOs.
The MR-PREG collaboration includes individual participant data from three birth cohorts (two from the UK and one from Norway) and UK Biobank, as well as summary data from FinnGen and publicly available genome-wide association studies (GWAS). Data have been harmonised across studies and currently include information on up to 35 APPOs in up to 707 797 women.
The main aims of MR-PREG are to strengthen the evidence base for (1) prevention, by advancing understanding of maternal lifestyle factors on APPOs, (2) the role of pre-conceptional health, by improving understanding of the effect of maternal pre-existing conditions on APPOs, and (3) treatments, by evaluating the efficacy and safety of existing medications used for pre-existing conditions, and by identifying and testing novel or repurposed therapies for APPOs. To date, our published work has mainly addressed aims 1 and 3. Examples include triangulation of evidence from MR, conventional multivariable regression and paternal negative control, showing that higher maternal body mass index increases the risk of multiple APPOs, as well as the identification of maternal circulating metabolites and proteins that may influence birth weight.
Future priorities include increasing diversity within the MR-PREG collaboration by expanding representation of participants from non-European ancestries. We are also integrating molecular data, including circulating protein levels and placental transcriptomics, to better characterise the molecular mechanisms underlying APPOs. Additionally, we are using whole-exome and whole-genome sequencing to identify novel causal genes and to inform the prioritisation of candidate therapeutic targets for APPOs.
Alcohol is causally related to more than 200 diseases and injuries. Alcohol health warning labels are a promising intervention to address alcohol-related harm with multiple possible roles, but research on its real-world impacts is lacking. This study aims to experimentally evaluate the impact of exposure to two types of content (responsibility and cancer message) and positioning of the message (front or back) on knowledge of alcohol causing cancer as the primary outcome and alcohol consumption behaviour, intentions, risk perception, emotional response, product appeal and policy support as secondary outcomes. The study also aims to assess the potential testing effect of pre-measurement on the primary outcome.
Participants (of the legal drinking age in Spain (18 years or older), purchased at least one alcoholic beverage (with alcohol by volume (ABV) ≥ 1.2% for their own consumption and speaking Catalan or Spanish) will be recruited outside of supermarkets in Barcelona after purchasing alcohol, randomly assigned into one of the eight experimental groups, complete a baseline questionnaire (with half of the sample answering baseline questions measuring knowledge) and receive label stickers displaying either responsibility or cancer message, and applied to either front or back of every alcohol container they have purchased. They will complete follow-up surveys measuring the primary and secondary outcomes 1 week and 1 month after the intervention, either online or via telephone. The key hypotheses are that the label containing a cancer message will have a greater impact on the primary and secondary outcomes compared with the responsibility label. To evaluate the impact of health warning labels on knowledge of alcohol causing cancer, logistic regression will be employed to model the probability of a correct response as a function of the key independent variables, with results reported as ORs. Secondary outcomes will be modelled through linear regressions for continuous variables, and through logistic regressions for dichotomic variables or categorical variables that will be dichotomised a priori. The target sample size is 1300 participants.
The study has been approved by the Ethical Committee for Research with Medicines (CEIm) IDIAP Jordi Gol (24/228-P) and the Ethical Research Committee of the WHO (ERC.0004213). The results will be disseminated in peer-reviewed journals, on social media and policy fora in national, European and global context, and will inform WHO and European Union-level policy recommendations.
European Commission, Directorate General for Health and Food Safety, SANTE/2022/SI2.883729.
by Ariene Silva do Carmo, Paulo César Pereira de Castro Júnior, Thais Cristina Marquezine Caldeira, Daniela Silva Canella, Rafael Moreira Claro, Luiza Delazari Borges, Larissa Loures Mendes
The present study analyzed the prices of food sold in canteens of Brazilian private schools and described price-based marketing strategies, according to the NOVA food classification system. This is a mixed methods study combining a cross-sectional component and time series analysis, with data from 2,241 canteens in private elementary and secondary schools in the 26 capitals of Brazil and the Federal District, collected between June 2022 and June 2024. Price data collected for unprocessed, minimally processed, or processed foods and culinary preparations based on these foods (UMPCP), and ultra-processed foods and culinary preparations based on these foods (UpCP) sold in school canteens and from the National System of Consumer Price Indices (SNIPC), were used to create a data set containing deflated monthly prices for food and beverages sold between August 2022 and July 2024. Calculations were made for adjusted prices (R$/100 g or ml) and absolute prices (R$ per portion), and frequency of use of strategies such as combos and promotions. UMPCP showed lower adjusted price, but higher absolute price than UpCP, especially for solid foods. About 27% of the study canteens implemented pricing strategies for both food groups. Most of these strategies did not exclusively favor healthy foods, indicating that promotions and combos were used without distinction. The affordability of healthy foods is disadvantaged in school canteens when considering the price per portion, which may negatively influence students’ food choices. The findings show that current prices for food sold in most canteens discourage the purchase of healthy items, but favor the purchase of unhealthy ones. These results reinforce the importance of interventions for promoting healthy foods and making them more affordable.To evaluate the predictive capacity of the Integrated Care for Older People screening tool for the risk of falls in older people receiving care at a healthcare service.
A cross-sectional study.
This study was conducted in a geriatric healthcare service in the southeast region of Brazil. The convenience sample included older people aged 60 and over living at home. The study used the Fall Risk Score to assess the risk of falls and the Integrated Care for Older People screening tool to track intrinsic capacity. The data was analysed using logistic regression to analyse the association between the six Intrinsic Capacity domains, for the early detection of impairment and risk of falls.
A total of 253 older adults participated in the study, most of whom were identified as having a high risk of falls. Logistic regression analysis across six association models revealed that the models including the Intrinsic Capacity domains of locomotion and hearing had a significant association with having a higher risk of falls. Care plans should prioritise the domains most strongly associated with fall risk, guiding targeted strategies to enhance older adults' safety.
The Integrated Care for Older People screening tool, in the locomotion and hearing domains, is associated with the risk of falls in older people from the community receiving care in a geriatric healthcare service. Future longitudinal studies could show whether other domains of intrinsic capacity can predict the occurrence of falls.
This study highlights the Integrated Care for Older People screening tool as essential in nursing practice, especially for assessing the locomotion and hearing domains of intrinsic capacity. Early detection of impairments helps identify increased fall risk in older adults, enabling nurses to implement targeted, person-centred interventions that enhance safety, autonomy and overall quality of life.
No patient or public contribution.
This study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies.
Introducción: En la atención del parto es primordial brindar cuidado humanizado a la madre, garantizando de esta forma el respeto a su dignidad, bienestar y cultura. Objetivo: Describir la atención y cuidados que brinda el personal de enfermería durante el parto a mujeres hablantes de lengua náhuatl y comparla con la percepción de las y los enfermeros. Materiales y método: Investigación cualitativa, con ocho mujeres hablantes de la lengua náhuatl de Uxtuapan, a quienes se les realizó una entrevista semiestructurada mediante grupo focal y una segunda entrevista individualizada en domicilio. También se entrevistaron a 11 profesionales de enfermería con grabadora de voz. Se transcribieron las entrevistas, se identificaron unidades de significado, se recategorizó y se describieron los resultados a través de la conformación de categorías: Cuidado, Entorno, Cultura, Relación ayuda-confianza. Se respetó la confidencialidad de los datos. Resultados: La falta de comunicación, tiempo e interacción en la relación enfermera-paciente favorece una percepción errónea de las pacientes ante su cuidado, denotando maltrato, soledad, falta de empatía. Conclusión: Para asegurar el cuidado humanizado en la atención del parto, se requiere mantener una conexión con las mujeres y cuidadores, donde se respeta su cultura y se favorece la seguridad de la vida humana.
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