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Background: Obesity in pregnancy is associated with fetal macrosomia, a raised neonatal fat mass and an increased risk of obesity and poor metabolic health in childhood which persists into adulthood. The offspring of obese women are more likely to be obese than the offspring of lean women when they become pregnant themselves, perpetuating a cycle of obesity and its associated negative metabolic consequences. Increasing physical activity during pregnancy could improve insulin sensitivity and reduce the risk of maternal and offspring adverse outcomes. The UK Pregnancy Better Eating and Activity Trial (UPBEAT) is a trial of a complex intervention designed to improve pregnancy outcomes through dietary changes and physical activity. Data from the pilot trial of 183 women were available for analysis. The relationship between the time spent at different physical activity levels and maternal and infant pregnancy outcomes was examined., Key Messages: Strong evidence exists that physical activity improves insulin sensitivity in non-pregnant populations, and lifestyle interventions of proven effectiveness in non-pregnant populations have been developed. Women who are active in pregnancy demonstrate better glucose control and favourable pregnancy outcomes. There is a lack of effective interventions to support obese pregnant women to be physically active., Conclusions: No difference was detected in objectively measured physical activity between women randomised to the intervention and control arms of the UPBEAT pilot trial. Light-intensity physical activity was lower in early pregnancy in women who delivered macrosomic infants. Maternal sedentary time at 35-36 weeks' gestation was positively associated and moderate-intensity physical activity was inversely associated with neonatal abdominal circumference. Maternal physical activity is associated with infant birth weight and abdominal circumference and is an appropriate target for intervention to improve infant outcomes. The challenge remains to develop an effective intervention to support obese pregnant women to be physically active., (© 2014 S. Karger AG, Basel.)

Objectives: Increased physical activity in pregnancy may reduce the risk of gestational diabetes and pre-eclampsia, which occur more commonly in overweight and obese women. There is limited assessment of physical activity questionnaires in pregnancy. This study compares self-reported physical activity using two questionnaire methods with objectively recorded physical activity using accelerometry in overweight and obese pregnant women., Study Design: 59 women with booking BMI≥25 kg/m(2) completed the Recent Physical Activity Questionnaire (RPAQ) and Australian Women's Activity Survey (AWAS) or recorded at least 3 days of accelerometry at median 12 weeks' gestation. Accelerometer thresholds of 100 counts/min and 1952 counts/min were used to define light and moderate or vigorous physical activity (MVPA) respectively., Results: 48% of women were in their first pregnancy and 41% were obese. Median daily self-reported MVPA was significantly higher for both AWAS (127 min, p<0.001) and RPAQ (81 min, p<0.001) than that recorded by accelerometer (35 min). There was low or moderate correlation between questionnaire and accelerometer estimates of total active time (AWAS ρ=0.36, p=0.008; RPAQ ρ=0.53, p<0.001) but no significant correlation between estimates of time spent in MVPA., Conclusions: These self-report questionnaires over-estimated MVPA and showed poor ability to discriminate women on the basis of MVPA. Accelerometry measurement was feasible and acceptable. Objective methods should be used where possible in studies measuring physical activity in pregnancy. Questionnaires remain valuable to define types of activity., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objective: to explore midwives' perceptions of their training and education requirements in relation to maternal obesity., Design: an interpretive constructionist approach used focus groups and broad discussion topics to allow midwives to identify their own personal and professional needs. Data analysis incorporated researcher and data triangulation (transcripts, debrief notes, and observers' notes), using a thematic content analysis approach., Setting and Participants: participants included 46 community and hospital-based midwives from all NHS Trusts providing maternity services in Northeast England, UK. Eleven focus groups took place in midwives' place of work. Sampling was determined by data saturation., Findings: three main themes were identified: discussing obesity, weight management, and practicalities of training. Midwives' justification for the need for training was centrally connected to all themes, and there were strong views on the need for training and education, and the potential benefits to their practice. Issues relating to obesity communication were most prominent. Midwives' uncertainty about effective obesity communication and management, and concerns of a negative impact on the midwife-woman relationship, are key barriers to their practice., Key Conclusions and Implications for Practice: the provision of a systematic approach to training and education is endorsed by midwives, and would provide the required level of knowledge and skills to deliver the recommended standard of care appropriate to their practice. It is clear that midwives require both training and education, although there are challenges to midwives' engagement with effective continuous professional development largely outside their control. Realistic models of training and education are required to address midwives' needs, and these should be thoroughly evaluated for impact on midwifery practice, and on obese women's health and well-being., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

There is increasing evidence that pre-eclampsia, a principal cause of maternal morbidity, may also be a risk factor for future cardiovascular and cerebrovascular events. This review aimed to assess the current evidence and quantify the risks of cardiovascular disease (CVD), cerebrovascular events and hypertension associated with prior diagnosis of pre-eclampsia. Medline and Embase were searched with no language restrictions, as were core journals and reference lists from reviews up until January 2012. Case-control and cohort studies which reported cardiovascular and cerebrovascular diseases or hypertension diagnosed more than 6 weeks postpartum, in women who had a history of pre-eclampsia relative to women who had unaffected pregnancies, were included. Fifty articles were included in the systematic review and 43 in the meta-analysis. Women with a history of pre-eclampsia or eclampsia were at significantly increased odds of fatal or diagnosed CVD [odds ratio (OR) = 2.28, 95% confidence interval (CI): 1.87, 2.78], cerebrovascular disease (OR = 1.76, 95% CI 1.43, 2.21) and hypertension [relative risk (RR) = 3.13, 95% CI 2.51, 3.89]. Among pre-eclamptic women, pre-term delivery was not associated with an increased risk of a future cardiovascular event (RR = 1.32, 95% CI 0.79, 2.22). Women diagnosed with pre-eclampsia are at increased risk of future cardiovascular or cerebrovascular events, with an estimated doubling of odds compared to unaffected women. This has implications for the follow-up of all women who experience pre-eclampsia, not just those who deliver pre-term. This association may reflect shared common risk factors for both pre-eclampsia and cardiovascular and cerebrovascular disease.

Conditional cash transfer schemes, which use cash to incentivize uptake of basic health and educational services, are well established among social planners inlow- and middle-income countries and are now taking hold in high-income countries. We appraised these schemes within a social determinants framework and found some encouraging signs in their first decade of operation. Success, however, has been inconsistent, and it is unclear whether conditional cash transfer schemes can reliably secure meaningful improvements in participants' health and nutritional status or educational attainment. Conditional cash transfer schemes' objectives will not be met unless they are transformed in 3 ways: transferring power as well as resources, emphasizing entitlements alongside conditionality, and avoiding the trap of incoherent or residualized policy.

Childhood obesity is increasing in the United States; thus, physicians, nurses, and other health care professionals seek to refer patients to interventions that will reliably improve physical activity and nutrition behaviors. The present 12-week, two-session-per-week protocol, based on social cognitive theory, was given preliminary testing with 23 obese children (M(age) = 11.7 years) with risk factors for Type 2 diabetes. A significant within-group improvement in number of days per week of 60 or more minutes of voluntary physical activity was reported. Changes in measures of both task self-efficacy (beta = .39) and self-regulatory efficacy (beta = .44) significantly contributed to the significant portion of the variance explained in change in voluntary physical activity (R(2) = .40). Significant improvements in total cholesterol and body mass index (kg/m(2)) were also found. Correlations between changes in physical activity and changes in each physiological factor tested were each in the expected direction but did not reach statistical significance. Results suggest that replications and extensions of this pilot study, with greater experimental power, are warranted., (Copyright © 2010 Elsevier Inc. All rights reserved.)

In May 2009 the World Health Assembly passed a resolution on reducing health inequities through action on the social determinants of health, based on the work of the global Commission on Social Determinants of Health, 2005-2008. The Commission's genesis and findings raise some important questions for global health governance. We draw out some of the essential elements, themes, and mechanisms that shaped the Commission. We start by examining the evolving nature of global health and the Commission's foundational inspiration--the universal pattern of health inequity and the imperative, driven by a sense of social justice, to make better and more equal health a global goal. We look at how the Commission was established, how it was structured internally, and how it developed external relationships--with the World Health Organization, with global networks of academics and practitioners, with country governments eager to spearhead action on health equity, and with civil society. We outline the Commission's recommendations as they relate to the architecture of global health governance. Finally, we look at how the Commission is catalyzing a movement to bring social determinants of health to the forefront of international and national policy discourse., (© 2010 American Society of Law, Medicine & Ethics, Inc.)

The solvation of large hydrophobic solutes, modeled as repulsive and attractive Gay-Berne oblate ellipsoids, is characterized in several modified water liquids using the SPC/E model as the reference water fluid. We find that small amounts of attraction between the Gay-Berne particle and any model fluid result in wetting of the hydrophobic surface. However, significant differences are found among the modified and SPC/E water models and the critical distances in which they dewet the hydrophobic surfaces of pairs of repulsive Gay-Berne particles. We find that the dewetting trends for repulsive Gay-Berne particles in the various model liquids correlate directly with their surface tensions, the widths of the interfaces they form, and the openness of their network structure. The largest critical separations are found in liquids with the smallest surface tensions and the broadest interfaces as measured by the Egelstaff-Widom length.

This article describes trends in population birthweight distribution in the north of England between 1982 and 2000, and reviews the international literature on recent birthweight trends in industrialized populations. Two contrasting trends were observed: an increase in low birthweight from 7.0% to 7.7% of all births, and an increase in births weighing 3500 g or more, consistent with an increase in mean birthweight. The rate of multiple births increased over the study period, and multiple births accounted for about half of the increase in low birthweight. Multiple births are rising due to increasing maternal age, and the development and use of assisted reproductive technologies. Low birthweight increased in both multiple and singleton births, due entirely to increased low-birthweight live births. There was a substantial reduction in low-birthweight stillbirths. The rise in low-birthweight live births is multifactorial, but changes in registration practice and increased elective delivery are likely contributory factors. The increase in high birthweights is likely to reflect reductions in smoking during pregnancy, and increased maternal height and weight. The dramatic recent rise in maternal body mass index (BMI) at booking is likely to have a substantial impact on birthweight and adverse perinatal outcomes in coming decades.

We summarize results obtained by a combination of ab initio and classical computer simulations of dialkylimidazolium ionic liquids in different states of aggregation, from crystals to liquids and clusters. Unusual features arising from the competition between electrostatic, dispersion, and hydrogen-bonding interactions are identified at the origin of observed structural patterns. We also discuss the way Brønsted acids interact with ionic liquids leading to the formation of hydrogen-bonded anions.

We have been using atomistic simulation for the last 10 years to study properties of imidazolium-based ionic liquids. Studies of dissolved molecules show the importance of electrostatic interactions in both aromatic and hydrogen-bonding solutes. However, the local structure strongly depends upon ion-ion and solute-solvent interactions. We find interesting local alignments of cations at the gas-liquid and solid-liquid interfaces, which give a potential drop through the surface. If the solid interface is charged, this charge is strongly screened over distances of a few nanometres and this screening decays on a fast time scale. We have studied the sensitivity of the liquid structure to force-field parameters and show that results from ab initio simulations can be used in the development of force fields.

The redox potentials of the organic compounds tetrathiafulvalene (TTF) and thianthrene (TH) in an explicit aprotic polar solvent, acetonitrile, have been computed using ab initio molecular dynamics simulation based on a Gaussian basis set methodology. The density functional description of the pure solvent yields a diffuse and mobile liquid, with structural and dynamical properties that are in good agreement with earlier classical models and experiment. Molecular dynamics simulation of both solute species in their neutral and radical cation states combined with free energy difference calculations result in estimates for the redox potentials of the reactions TH*+ + TTF --> TH + TTF*+ and TH2+ + TTF*+ --> TH*+ + TTF2+. The obtained values are 0.95 +/- 0.06 and 1.09 +/- 0.06 V, respectively, in excellent agreement with experimental data of 0.93 and 1.08 V. Our computational approach is based on Marcus theory, assuming quadratic free energy surfaces. We show that this approximation can still be accurate in systems, such as TH, that undergo a significant change in geometry upon oxidation. Furthermore, despite the different localization of the spin density in the radical cations, results based on self-interaction-corrected functionals and on standard generalized gradient approximations are identical to within 10 meV.

The behavior of a model ionic liquid (IL) confined between two flat parallel walls was studied at various interwall distances using computer simulations. The results focus both on structural and dynamical properties. Mass and charge density along the confinement axis reveal a structure of layers parallel to the walls that leads to an oscillatory profile in the electrostatic potential. Orientational correlation functions indicate that cations at the interface orient tilted with respect to the surface and that any other orientational order is lost thereafter. The diffusion coefficients of the ions exhibit a maximum as a function of the confinement distance, a behavior that results from a combination of the structure of the liquid as a whole and a faster molecular motion in the vicinity of the walls. We discuss the relevance of the present results and elaborate on topics that need further attention regarding the effects of ILs in the functioning of IL-based dye-sensitized solar cells.

Ab initio molecular dynamics simulations have been performed for the first time on the room-temperature organic ionic liquid dimethyl imidazolium chloride [DMIM][Cl] using density functional theory. The aim is to compare the local liquid structure with both that obtained from two different classical force fields and from neutron scattering experiments. The local structure around the cation shows significant differences compared to both the classical calculations and the neutron results. In particular, and unlike in the gas-phase ion pair, chloride ions tend to be located near a ring C-H proton in a position suggesting hydrogen bonding. The results are used to suggest ways in which the classical potentials may be improved.

Background: Research on the potential impact of air pollution on the health of adults and children has grown rapidly over the last decade. Recent studies have suggested that air pollution could also be associated with adverse effects on the developing fetus. This systematic review evaluates the current level of epidemiologic evidence on the association between ambient particulate air pollution and fetal health outcomes. We also suggest further research questions., Methods: Using database searches and other approaches, we identified relevant publications published between 1966 and 2001 in English. Articles were included if they reported original data on birthweight, gestational age at delivery, or stillbirth related to directly measured nonaccidental exposure to particulate matter., Results: Twelve studies met the inclusion criteria. There was little consistency in the evidence linking particulate air pollution and fetal outcomes. Many studies had methodologic weaknesses in their design and adjustment for confounding factors. Even in well-designed studies, the reported magnitude of the effects was small and inconsistently associated with exposure at specific stages of pregnancy., Conclusions: The currently available evidence is compatible with either a small adverse effect of particulate air pollution on fetal growth and duration of pregnancy or with no effect. Further research should be directed toward clarifying and quantifying these possible effects and generating testable hypotheses on plausible biologic mechanisms.

This study reports changes in the prevalence and outcome of Down's syndrome pregnancies within a 15-year period in a defined geographical population in the north of England. Cases of Down's syndrome in births and terminations of pregnancy occurring between 1985 and 1999, were identified from the Northern Congenital Abnormality Survey. The total prevalence for the 15 years was 15.2 per 10 000 births and terminations of pregnancy [95% CI 14.2, 16.2]. Total prevalence showed an upward trend over time, due largely to increasing maternal age. Sixty-seven per cent of cases resulted in live births, and the overall live birth prevalence was 10.3 per 10 000 live births [95% CI 9.4, 11.1]. The proportion of cases resulting in termination of pregnancy rose from 15% in 1985-89 to 38% in 1995-99; the rate of increase was greater in women aged < 35 years. Forty-five per cent of live born infants had an additional anomaly recorded. Survival at 1 year was 78% for those with an additional anomaly recorded, and 96% for those without. There was a non-significant trend towards improved survival in all infants with Down's syndrome, from 87% in 1985-94 to 92% in 1995-99. Despite increasing termination of Down's syndrome pregnancies resulting from the greater availability of antenatal screening and diagnosis, there has been no significant reduction in live birth prevalence. These infants have high rates of co-existing structural anomalies and are at high risk of death in the first year of life. There is a continuing need to address the reasons for poor survival for Down's syndrome infants, and to plan for their complex health and social care needs. These findings are useful for parents deciding on prenatal screening, as well as for clinicians and health service managers.