768 research outputs found
Nutritional supplementation and artificial reproductive technique (ART) outcomes
No full textApproximately one in six couples suffer from subfertility, and many seek treatment with artificial reproductive technologies (ART). Despite improvements in laboratory techniques and ovarian stimulation, ongoing pregnancy rates per cycle remain at ~25%. Couples wanting to improve their chances may turn to adjuvant therapies, such as nutritional supplements. There is growing evidence that periconceptional nutritional status is a key determinant of fertility and long-term health of the offspring, and a lucrative market has developed to meet the demand based on these benefits. However, the practice of routine dietary supplementation before and during IVF treatment has not been subject to well-powered prospective randomised trials. In this article, the potential roles of specific nutritional supplements in the context of improving IVF outcomes are reviewed and an assessment is made of the evidence base supporting their clinical use in this context. Finally, current research needs in the field are outline
Interprofessional education with medical and midwifery students: a prospective evaluation
No full textBackground/Aims Interprofessional working is essential for safe, high-quality obstetric and midwifery care. This study aimed to design, implement and test an interprofessional education activity bringing together two healthcare professions at the University of Southampton to explore opportunities for students' learning and problem solving. Methods A total of 30 student midwives and four rotations of 70 medical students attended a 1-hour facilitated online education activity (four total) and completed an online evaluation. Results Overall, 16 of the 86 students positively evaluated the activities, valuing the chance to learn about each other's profession and sharing knowledge through small group discussions. Conclusions Interprofessional education supports learners through reflective practice to consider differences in professional scope and responsibilities essential in obstetric and midwifery care. Implications for practice Future enhancements to existing curricula could include a year-long clinical case study as well as half-day simulations. Students could present their experiences via an interprofessional case conference at the end of the year.</p
A randomised controlled trial of a preconceptional dietary intervention in women undergoing IVF treatment (PREPARE trial)
No full textBACKGROUND: In vitro fertilisation (IVF) treatment provides an opportunity to study early developmental responses to periconceptional dietary interventions. Retrospective studies have suggested links between preconception diet and fertility, and more recently, a "Mediterranean" diet has been reported to increase pregnancy rates by up to 40%. In addition, a prospective study examining increased intake of omega-3 polyunsaturated fats demonstrated a quickened rate of embryo development after IVF. However, up to now, few prospective randomised controlled trials have investigated the impact of periconceptional dietary interventions on fertility outcomes.METHODS AND DESIGN: The study is a randomised controlled trial of a dietary intervention consisting of olive oil for cooking, an olive oil based spread, and a daily supplement drink enriched with Vitamin D (10 microgram daily) and marine omega-3 fatty acids (2 g daily) for 6 weeks preconception versus a control diet of sunflower seed oil for cooking, a sunflower oil based spread, and a daily supplement drink without added Vitamin D or marine omega-3 fatty acids. Couples undergoing IVF will be randomised to either the intervention or control group (55 in each arm). The primary endpoint is embryo developmental competency in vitro, measured by validated morphokinetic markers. Secondary outcomes will include the effect of the dietary intervention on the nutritional content of the intrauterine environment.DISCUSSION: This approach will enable rigorous examination of the impact of the dietary intervention on early embryo development, together with the influence of the peri-implantation intra-uterine nutritional environment
Amino acid composition of human uterine fluid: association with age, lifestyle and gynaecological pathology
No full textThis work was funded by the NIHR, the Medical Research Council (G0701153) and the University of Southampton and was supported by the NIHR BRC in Nutrition and Southampton University NHS Foundation Trust. The authors declare no conflicts of interest
The fatty acid composition of human follicular fluid is altered by a 6-week dietary intervention that includes marine omega-3 fatty acids
No full textThe fatty acid composition of human follicular fluid is important for oocyte development and for pregnancy following in vitro fertilization (IVF). This study investigated whether a dietary intervention that included an increase in marine omega-3 fatty acids, olive oil and vitamin D alters the fatty acid composition of human follicular fluid. The association of lifestyle factors with follicular fluid fatty acid composition was also investigated. Fifty-five couples awaiting IVF were randomized to receive the 6-week treatment intervention of olive oil for cooking, an olive oil-based spread, and a daily supplement drink enriched with vitamin D and the marine omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) and 56 couples were randomized to receive placebo equivalents. Dietary questionnaires were completed, and samples of blood were taken before and after the intervention. Follicular fluid was collected at oocyte retrieval and the fatty acid profile assessed using gas chromatography. In the control group, individual fatty acids in red blood cells and follicular fluid were significantly correlated. Furthermore, a healthier diet was associated with a lower percentage of follicular fluid arachidonic acid. The follicular fluid of women in the treatment group contained significantly higher amounts of EPA and DHA compared to the control group, while the omega-6 fatty acids linoleic, γ-linolenic, dihomo-γ-linolenic, and arachidonic were lower. This is the first report of a dietary intervention altering the fatty acid composition of follicular fluid in humans. Further research is required to determine whether this intervention improves oocyte quality
Systematic review and meta-analysis of female lifestyle factors and risk of recurrent pregnancy loss
No full textIt is known that lifestyle factors affect sporadic miscarriage, but the extent of this on RPL (recurrent pregnancy loss) is less well known. A systematic review and meta-analysis was performed to assess the associations between lifestyle factors and RPL. Studies that analysed RPL in the context of BMI, smoking, alcohol and caffeine intake were included. The primary and secondary outcomes were odds of having RPL in the general population and odds of further miscarriage, respectively. Underweight and women with BMI > 25 are at higher odds of RPL in the general population (OR 1.2, 95% CI 1.12-1.28 and OR 1.21, 95% CI 1.06-1.38, respectively). In women with RPL, having BMI > 30 and BMI > 25 has increased odds of further miscarriages (OR 1.77, 95% CI 1.25-2.50 and OR 1.35, 95% CI 1.07-1.72, respectively). The quality of the evidence for our findings was low or very low. Being underweight and BMI > 25 contributes significantly to increased risk of RPL (general population). BMI > 25 or BMI > 30 increases the risk of further miscarriages (RPL population). Larger studies addressing the effects of alcohol, cigarette smoking and caffeine on the risk of RPL with optimisation of BMI in this cohort of women are now needed.</p
The effect of pregnancy vitamin D supplementation on maternal blood pressure: real-world data analysis within the MAVIDOS randomised placebo-controlled trial
No full textPurpose: observational studies have suggested negative associations between maternal 25-hydroxyvitamin D (25(OH)D) status and risk of hypertensive disorders of pregnancy [pregnancy-induced hypertension (PIH) and preeclampsia (PET)]. Data from intervention studies are limited. We hypothesised that vitamin D supplementation would lower maternal blood pressure (BP) during pregnancy and reduce the incidence of hypertensive disorders of pregnancy.Methods: the Maternal Vitamin D Osteoporosis Study (MAVIDOS) was a randomised placebo-controlled trial. Pregnant women with a baseline 25(OH)D of 25–100 nmol/l were randomized to either 1000 IU/day cholecalciferol or placebo from 14 to 17 weeks’ gestation until delivery. BP recordings documented during routine clinical pregnancy care were obtained from clinical records and grouped into gestational windows based on the schedule for routine antenatal care in the United Kingdom (23+0–24+6, 27+0–28+6, 33+0–35+6, 37+0–38+6, 39+0–40+6 and ≥ 41+0 weeks+days). Systolic and diastolic BP measurements in these gestational windows were compared between randomisation groups. Diagnoses of PIH or PET (in accordance with national guidelines) and the use of antihypertensive agents were also noted and compared between groups.Results: data for 734 women (366 cholecalciferol, 368 placebo) were included. Maternal mean systolic and diastolic BP did not differ between the randomization groups at any of the gestations studied. The incidences of PIH (placebo 1.6%, cholecalciferol 3.6%, p = 0.10) and PET (placebo 3.3%, cholecalciferol 3.8%, p = 0.68) were similar between the two groups.Conclusions: gestational vitamin D supplementation with 1000 IU/day from 14 to 17 weeks gestation did not lower maternal BP or reduce the incidences of PIH or PET in this trial
Stages for the More Sustainable Farm
No full textCurrently, agricultural farm units are faced with a double and most times contradictory challenge, in order to be successful: on the one hand the invested capital has to be profitable and the economic performance has to be maximised. On the other hand, given the socio-environmental situation, it is necessary to preserve and to protect the environment and natural resources. Given the potential conflict of the two aims, since the satisfaction of one implies the underperformance of the other (and vice versa), the question then is: which is the solution to choose? We intend, in this work, to formulate a farm plan with the purpose of reconciling the criteria of environmental sustainability with that of economic competitiveness. For this achievement we proceed to the comparative study of sustainability of different groups of farms identified in the study area (first evaluation cycle) through MESMIS (“Marco para la Evaluación de Sistemas de Manejo de Recursos Naturales Mediante Indicadores de Sustentabilidad” - Framework for Evaluation of Natural-Resource Systems Handling through Sustainability Indicators) methodology, that allowed to select the more sustainable group of farms. Based on the found potentialities and weakness on these production systems, we stepped to the planning of a production unit of bovine meat, which obeys simultaneously to economic and environmental objectives, using Multicriteria Decision. We finished the work with the sustainability evaluation between groups of farms identified previously and the planned farms (second evaluation cycle), based, again, in the MESMIS methodology, to confirm (or not) the greatest sustainability of the last ones. Analyses of the results allow us to confirm the greatest relative sustainability of the planned farm, for the diverse traced scenarios.Decision taking, planning, sustainability, Environmental Economics and Policy, Farm Management,
TRAGIC NOISE AND RHETORICAL FRIGIDITY IN LYCOPHRON'S ALEXANDRA
No full textAbstract This paper seeks to shed fresh light on the aesthetic and stylistic affiliations of Lycophron's Alexandra , approaching the poem from two distinct but complementary angles. First, it explores what can be gained by reading Lycophron's poem against the backdrop of Callimachus’ poetry. It contends that the Alexandra presents a radical and polemical departure from the Alexandrian's poetic programme, pointedly appropriating key Callimachean images while also countering Callimachus’ apparent dismissal of the ‘noisy’ tragic genre. Previous scholarship has noted links between the openings of the Aetia and of the Alexandra , but this article demonstrates that this relationship is only one part of a larger aesthetic divide between the two poets: by embracing the raucous acoustics of tragedy, Lycophron's poem offers a self-conscious and agonistic departure from Callimachus’ aesthetic preferences. Second, this article considers another way of conceiving the aesthetics of the poem beyond a Callimachean frame, highlighting how Lycophron pointedly engages with and evokes earlier Aristotelian literary criticism concerning the ‘frigid’ style: the Alexandra constructs its own independent literary history centred around the alleged name of its author, ‘Lycophron’. The article proposes that this traditional attribution is best understood as a pen name that signposts the poem's stylistic affiliations, aligning it not so much with the Ptolemaic playwright Lycophron of Chalcis but rather with Lycophron the sophist and a larger rhetorical tradition of stylistic frigidity. Ultimately, through these two approaches, the article highlights further aspects of the Alexandra 's aesthetic diversity
Effect of a 6-week “Mediterranean” dietary intervention on in vitro human embryo development: the Preconception Dietary Supplements in Assisted Reproduction double-blinded randomized controlled trial
No full textObjective: To study the impact of increased dietary intake of omega-3 fatty acids, vitamin D, and olive oil for 6 weeks before in vitro fertilization (IVF) or IVF–intracytoplasmic sperm injection (ICSI) on morphokinetic markers of early embryo development. Design: A double-blinded randomized controlled trial. Setting: Academic IVF unit. Patient(s): A total of 111 couples undergoing IVF or IVF-ICSI were recruited. Interventions(s): Fifty-five couples received the 6-week study intervention of a daily supplement drink enriched with omega-3 fatty acids and vitamin D plus additional olive oil and olive oil–based spread, and 56 couples received the control intervention. Main Outcome Measure(s): The primary end point for the study was the time taken for completion of the second cell cycle after fertilization (CC2). Secondary end points included time to complete the third and fourth cell cycles (CC3 and CC4), the synchrony of the second and third cell cycles (S2 and S3), and the day 3 and day 5 Known Implantation Data Scores (KIDScores). Result(s): There was no difference in CC2 between the two groups. However, CC4 was accelerated in the study group compared with the control group, and a significantly shortened S3 as well as an increase in KIDScore on day 3 were observed, indicating improved embryo quality in the study group. Conclusion(s): This study demonstrates that a short period of dietary supplementation alters the rate of embryo cleavage. Further research is required to investigate the mechanisms that regulate this effect, and whether the impact on embryo development translates into improved clinical outcomes. Clinical Trial Registration Number: ISRCTN50956936</p
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