Metabolic insights at the finish line: deciphering physiological changes in ultramarathon runners through breath VOC analysis.

Exhaustive exercise can induce unique physiological responses in the lungs and other parts of the human body. The volatile organic compounds (VOCs) in exhaled breath are ideal for studying the effects of exhaustive exercise on the lungs due to the proximity of the breath matrix to the respiratory tract. As breath VOCs can originate from the bloodstream, changes in abundance should also indicate broader physiological effects of exhaustive exercise on the body. Currently, there is limited published data on the effects of exhaustive exercise on breath VOCs. Breath has great potential for biomarker analysis as it can be collected non-invasively, and capture real-time metabolic changes to better understand the effects of exhaustive exercise. In this study, we collected breath samples from a small group of elite runners participating in the 2019 Ultra-Trail du Mont Blanc ultra-marathon. The final analysis included matched paired samples collected before and after the race from 24 subjects. All 48 samples were analyzed using the Breath Biopsy Platform with GC-Orbitrap™ via thermal desorption gas chromatography-mass spectrometry. The Wilcoxon signed-rank test was used to determine whether VOC abundances differed between pre- and post-race breath samples (adjustedP-value < .05). We identified a total of 793 VOCs in the breath samples of elite runners. Of these, 63 showed significant differences between pre- and post-race samples after correction for multiple testing (12 decreased, 51 increased). The specific VOCs identified suggest the involvement of fatty acid oxidation, inflammation, and possible altered gut microbiome activity in response to exhaustive exercise. This study demonstrates significant changes in VOC abundance resulting from exhaustive exercise. Further investigation of VOC changes along with other physiological measurements can help improve our understanding of the effect of exhaustive exercise on the body and subsequent differences in VOCs in exhaled breath.

Interpregnancy care.

The aim of interconception care is to provide women who have had a prior adverse pregnancy outcome with optimal care in order to reduce risks that may affect the woman׳s health and any future birth she may choose to have. National recommendations call for action, and evidence supports specific clinical interventions. The need for interconception care is documented in national and state survey and surveillance data. Chronic diseases and behavioral risks affect the health of millions of U.S. women of childbearing age. Interconception care demonstration projects have used a "disease management" approach that includes medical care and case management. The increasing use of postpartum visits, as a gateway to interconception interventions, is essential. The Affordable Care Act emphasis on preventive services and expanded health coverage for women offers new opportunities to finance interconception care. Improved and enhanced clinical practices, along with the engagement of women, in interconception care have the potential to improve birth outcomes and reduce disparities.

A national action plan for promoting preconception health and health care in the United States (2012-2014).

Preconception health and health care (PCHHC) has gained increasing popularity as a key prevention strategy for improving outcomes for women and infants, both domestically and internationally. The Action Plan for the National Initiative on Preconception Health and Health Care: A Report of the PCHHC Steering Committee (2012-2014) provides a model that states, communities, public, and private organizations can use to help guide strategic planning for promoting preconception care projects. Since 2005, a national public-private PCHHC initiative has worked to create and implement recommendations on this topic. Leadership and funding from the Centers for Disease Control and Prevention combined with the commitment of maternal and child health leaders across the country brought together key partners from the public and private sector to provide expertise and technical assistance to develop an updated national action plan for the PCHHC Initiative. Key activities for this process included the identification of goals, objectives, strategies, actions, and anticipated timelines for the five workgroups that were established as part of the original PCHHC Initiative. These are further described in the action plan. To assist other groups doing similar work, this article discusses the approach members of the PCHHC Initiative took to convene local, state, and national leaders to enhance the implementation of preconception care nationally through accomplishments, lessons learned, and projections for future directions.

Managed care is here to stay: implications for obstetrics and gynecology practice.

PURPOSE OF REVIEW: This article provides an overview of types and trends in managed care, as well as insights into how obstetrician/gynecologists can work with managed care plans to improve process and outcomes for patients. RECENT FINDINGS: Although studies of managed care between 1990 and 2005 generally did not show clear positive impact on cost or outcomes of care for women, more recent literature indicates the emergence of new models of care with greater success. Promising practices often focus on quality assurance and improvement. SUMMARY: Managed care is the predominant form of healthcare delivery in the United States, including millions of women with public or private health coverage.

Louisiana Birth Outcomes Initiative: improving birth outcomes with interventions before, during, and after pregnancy.

The costs of poor birth outcomes to the United States in both human and fiscal terms are large and a continuing concern. Louisiana has among the worst birth outcomes in our nation, which include preterm and low birth weight births, and maternal and infant mortality. In response to these poor birth outcomes, the Louisiana Department of Health and Hospitals is implementing a statewide, multi-faceted Birth Outcomes Initiative at the level of the secretary. The Birth Outcomes Initiative aims to adopt evidence-based and best practices along the continuum of care for women and infants. Of particular importance is ending all non-medically indicated deliveries prior to 39 weeks, administration of the hormone 17-hydroxyprogesterone to eligible women for prematurity prevention, optimal behavioral health counseling and referral for reproductive aged women, and ensuring optimal health for women between pregnancies. Opportunities exist to improve outcomes for primary care and obstetrical providers. Louisiana is the first state to aim at improving birth outcomes with interventions before, during, and after pregnancy.

Women's health and health reform: implications of the Patient Protection and Affordable Care Act.

PURPOSE OF REVIEW: An overview of provisions in the 2010 health reform legislation with implications for women's health and obstetrician-gynecologists. RECENT FINDINGS: Between now and 2014, provisions of the Patient Protection and Affordable Care Act (ACA) will expand access to health coverage, primary care, and preventive services. Other provisions relate to federal abortion funding, medical liability, and disparities. SUMMARY: From a life-course perspective, ACA makes it feasible to link preconception, prenatal, family planning, and other care in a seamless continuum for women of childbearing age. Now is the time to implement a comprehensive well woman standard of care.

Geographic access to family planning facilities and the risk of unintended and teenage pregnancy.

OBJECTIVES: This study tested the hypotheses that greater geographic access to family planning facilities is associated with lower rates of unintended and teenage pregnancies. METHODS: State Pregnancy Risk Assessment Monitoring System (PRAMS) and natality files in four states were used to locate unintended and teenage births, respectively. Geographic availability was measured by cohort travel time to the nearest family planning facility, the presence of a family planning facility in a ZIP area, and the supply of primary care physicians and obstetric-gynecologists. RESULTS: 83% of the PRAMS cohort and 80% of teenagers lived within 15 min or less of a facility and virtually none lived more than 30 min. Adjusted odds ratios did not demonstrate a statistically significant trend to a higher risk of unintended pregnancies with longer travel time. Similarly there was no association with unintended pregnancy and the presence of a family planning facility within the ZIP area of maternal residence, or with the supply of physicians capable of providing family planning services. Both crude and adjusted relative rates of teenage pregnancies were significantly lower with further distance from family planning sites and with the absence of a facility in the ZIP area of residence. In adjusted models, the supply of obstetricians-gynecologists and primary care physicians was not significantly associated with decreased teen pregnancies. CONCLUSIONS: This study found no relationship between greater geographic availability of family planning facilities and a risk of unintended pregnancies. Greater geographic availability of family planning services was associated with a higher risk of teenage pregnancy, although these results may be confounded by facilities locating in areas with greater family planning needs.

Accessibility of family planning services: impact of structural and organizational factors.

OBJECTIVES: This study sought to determine whether selected structural and organizational characteristics of publicly available family planning facilities are associated with greater availability. METHODS: A survey was sent to 726 publicly available family planning facilities in four states. These included local health departments, federally qualified health centers (FQHC), Planned Parenthood sites, hospital outpatient departments, and freestanding women's health centers. Usable responses were obtained from 526 sites for a response rate of 72.5%. Availability variables included the provision of primary care services; the contraceptives offered; professional staffing; scheduling, waiting time, and transportation; and cultural congruence and competency. The structural and organizational variables were state, type of organization, and funding source. RESULTS: Some states were more likely to offer emergency contraception while others were more likely to have weekend hours. FQHCs were most likely to provide primary care and Planned Parenthood sites most likely to offer emergency contraception. Title X funding was associated with increased likelihood of providing emergency contraception and staffing by midlevel practitioners and registered nurses. CONCLUSIONS: This study found that availability varied by structural and organizational variables, many of which are determined by federal and state policies. Revising some of these policies might increase utilization of family planning facilities.

Public finance policy strategies to increase access to preconception care.

Policy and finance barriers reduce access to preconception care and, reportedly, limit professional practice changes that would improve the availability of needed services. Millions of women of childbearing age (15-44) lack adequate health coverage (i.e., uninsured or underinsured), and others live in medically underserved areas. Service delivery fragmentation and lack of professional guidelines are additional barriers. This paper reviews barriers and opportunities for financing preconception care, based on a review and analysis of state and federal policies. We describe states' experiences with and opportunities to improve health coverage, through public programs such as Medicaid, Medicaid waivers, and the State Children's Health Insurance Program (SCHIP). The potential role of Title V and of community health centers in providing primary and preventive care to women also is discussed. In these and other public health and health coverage programs, opportunities exist to finance preconception care for low-income women. Three major policy directions are discussed. To increase access to preconception care among women of childbearing age, the federal and state governments have opportunities to: (1) improve health care coverage, (2) increase the supply of publicly subsidized health clinics, and (3) direct delivery of preconception screening and interventions in the context of public health programs.