Four ways blue foods can help achieve food system ambitions across nations.

Blue foods, sourced in aquatic environments, are important for the economies, livelihoods, nutritional security and cultures of people in many nations. They are often nutrient rich1, generate lower emissions and impacts on land and water than many terrestrial meats2, and contribute to the health3, wellbeing and livelihoods of many rural communities4. The Blue Food Assessment recently evaluated nutritional, environmental, economic and justice dimensions of blue foods globally. Here we integrate these findings and translate them into four policy objectives to help realize the contributions that blue foods can make to national food systems around the world: ensuring supplies of critical nutrients, providing healthy alternatives to terrestrial meat, reducing dietary environmental footprints and safeguarding blue food contributions to nutrition, just economies and livelihoods under a changing climate. To account for how context-specific environmental, socio-economic and cultural aspects affect this contribution, we assess the relevance of each policy objective for individual countries, and examine associated co-benefits and trade-offs at national and international scales. We find that in many African and South American nations, facilitating consumption of culturally relevant blue food, especially among nutritionally vulnerable population segments, could address vitamin B12 and omega-3 deficiencies. Meanwhile, in many global North nations, cardiovascular disease rates and large greenhouse gas footprints from ruminant meat intake could be lowered through moderate consumption of seafood with low environmental impact. The analytical framework we provide also identifies countries with high future risk, for whom climate adaptation of blue food systems will be particularly important. Overall the framework helps decision makers to assess the blue food policy objectives most relevant to their geographies, and to compare and contrast the benefits and trade-offs associated with pursuing these objectives.

Harnessing global fisheries to tackle micronutrient deficiencies.

Micronutrient deficiencies account for an estimated one million premature deaths annually, and for some nations can reduce gross domestic product1,2 by up to 11%, highlighting the need for food policies that focus on improving nutrition rather than simply increasing the volume of food produced3. People gain nutrients from a varied diet, although fish-which are a rich source of bioavailable micronutrients that are essential to human health4-are often overlooked. A lack of understanding of the nutrient composition of most fish5 and how nutrient yields vary among fisheries has hindered the policy shifts that are needed to effectively harness the potential of fisheries for food and nutrition security6. Here, using the concentration of 7 nutrients in more than 350 species of marine fish, we estimate how environmental and ecological traits predict nutrient content of marine finfish species. We use this predictive model to quantify the global spatial patterns of the concentrations of nutrients in marine fisheries and compare nutrient yields to the prevalence of micronutrient deficiencies in human populations. We find that species from tropical thermal regimes contain higher concentrations of calcium, iron and zinc; smaller species contain higher concentrations of calcium, iron and omega-3 fatty acids; and species from cold thermal regimes or those with a pelagic feeding pathway contain higher concentrations of omega-3 fatty acids. There is no relationship between nutrient concentrations and total fishery yield, highlighting that the nutrient quality of a fishery is determined by the species composition. For a number of countries in which nutrient intakes are inadequate, nutrients available in marine finfish catches exceed the dietary requirements for populations that live within 100 km of the coast, and a fraction of current landings could be particularly impactful for children under 5 years of age. Our analyses suggest that fish-based food strategies have the potential to substantially contribute to global food and nutrition security.

Trade and foreign fishing mediate global marine nutrient supply.

Fish are an important source of bioavailable micronutrients and essential fatty acids, and capture fisheries have potential to substantially reduce dietary deficiencies. Vigorous debate has focused on trade and fishing in foreign waters as drivers of inequitable distribution of volume and value of fish, but their impact on nutrient supplies from fish is unknown. We analyze global catch, trade, and nutrient composition data for marine fisheries to quantify distribution patterns among countries with differing prevalence of inadequate nutrient intake. We find foreign fishing relocates 1.5 times more nutrients than international trade in fish. Analysis of nutrient flows among countries of different levels of nutrient intake shows fishing in foreign waters predominantly (but not exclusively) benefits nutrient-secure nations, an outcome amplified by trade. Next, we developed a nutritional vulnerability framework that shows those small island developing states and/or African nations currently benefiting from trade and foreign fishing, and countries with low adaptive capacity, are most vulnerable to future changes in nutrient supplies. Climate change exacerbates vulnerabilities for many nations. Harnessing the potential of global fisheries to address dietary deficiencies will require greater attention to nutrition objectives in fisheries' licensing deals and trade negotiations.

The future of hyperdiverse tropical ecosystems.

The tropics contain the overwhelming majority of Earth's biodiversity: their terrestrial, freshwater and marine ecosystems hold more than three-quarters of all species, including almost all shallow-water corals and over 90% of terrestrial birds. However, tropical ecosystems are also subject to pervasive and interacting stressors, such as deforestation, overfishing and climate change, and they are set within a socio-economic context that includes growing pressure from an increasingly globalized world, larger and more affluent tropical populations, and weak governance and response capacities. Concerted local, national and international actions are urgently required to prevent a collapse of tropical biodiversity.

Trophic distribution of nutrient production in coral reef fisheries.

Coral reef fisheries supply nutritious catch to tropical coastal communities, where the quality of reef seafood is determined by both the rate of biomass production and nutritional value of reef fishes. Yet our understanding of reef fisheries typically uses targets of total reef fish biomass rather than individual growth (i.e. biomass production) and nutrient content (i.e. nutritional value of reef fish), limiting the ability of management to sustain the productivity of nutritious catches. Here, we use modelled growth coefficients and nutrient concentrations to develop a new metric of nutrient productivity of coral reef fishes. We then evaluate this metric with underwater visual surveys of reef fish assemblages from four tropical countries to examine nutrient productivity of reef fish food webs. Species' growth coefficients were associated with nutrients that vary with body size (calcium, iron, selenium and zinc), but not total nutrient density. When integrated with fish abundance data, we find that herbivorous species typically dominate standing biomass, biomass turnover and nutrient production on coral reefs. Such bottom-heavy trophic distributions of nutrients were consistent across gradients of fishing pressure and benthic composition. We conclude that management restrictions that promote sustainability of herbivores and other low trophic-level species can sustain biomass and nutrient production from reef fisheries that is critical to the food security of over 500 million people in the tropics.

Bright spots among the world's coral reefs.

Ongoing declines in the structure and function of the world's coral reefs require novel approaches to sustain these ecosystems and the millions of people who depend on them3. A presently unexplored approach that draws on theory and practice in human health and rural development is to systematically identify and learn from the 'outliers'­places where ecosystems are substantially better ('bright spots') or worse ('dark spots') than expected, given the environmental conditions and socioeconomic drivers they are exposed to. Here we compile data from more than 2,500 reefs worldwide and develop a Bayesian hierarchical model to generate expectations of how standing stocks of reef fish biomass are related to 18 socioeconomic drivers and environmental conditions. We identify 15 bright spots and 35 dark spots among our global survey of coral reefs, defined as sites that have biomass levels more than two standard deviations from expectations. Importantly, bright spots are not simply comprised of remote areas with low fishing pressure; they include localities where human populations and use of ecosystem resources is high, potentially providing insights into how communities have successfully confronted strong drivers of change. Conversely, dark spots are not necessarily the sites with the lowest absolute biomass and even include some remote, uninhabited locations often considered near pristine6. We surveyed local experts about social, institutional, and environmental conditions at these sites to reveal that bright spots are characterized by strong sociocultural institutions such as customary taboos and marine tenure, high levels of local engagement in management, high dependence on marine resources, and beneficial environmental conditions such as deep-water refuges. Alternatively, dark spots are characterized by intensive capture and storage technology and a recent history of environmental shocks. Our results suggest that investments in strengthening fisheries governance, particularly aspects such as participation and property rights, could facilitate innovative conservation actions that help communities defy expectations of global reef degradation.

Speaking across boundaries to explore the potential for interdisciplinarity in ecosystem services knowledge production.

Conservation is likely to be most successful if it draws on knowledge from across the natural and social sciences. The ecosystem services concept has been called a boundary object in that it facilitates development of such interdisciplinary knowledge because it offers a common platform for researchers, policy makers, and practitioners. However, a question that remains is to what extent the interdisciplinary knowledge needed is provided by disciplinary diversity within the field. We asked where is knowledge on ecosystem services produced, how interdisciplinary is this knowledge, and which disciplines facilitate the greatest disciplinary integration? We defined interdisciplinarity as the extent to which published research draws on knowledge that crosses disciplinary borders and used citations as a quantitative indicator of communication among disciplines, based on journal classification. We used disciplinary diversity, richness, and heterocitation as measures of interdisciplinarity and betweenness centrality as a measure of disciplinary integration. Our data set contained 22,153 publications on ecosystem services, published from 1983 to 2018. We found that ecosystem services research matured; average yearly output growth was 33.8%, more than the 8-9% growth in scientific output across all fields. Over time, the network clustering coefficient, measuring connectedness of individual disciplines, rose from 0.388 to 0.727, suggesting increased density in the network of citations. Researchers in the field published more articles (3566 in 2018 alone) across more disciplines (77 unique disciplines in 2018). However, this growth was not mirrored by an increase in the diversity (stable at 0.7-0.9) or richness (averaging 0.35 unique disciplines per citation) of citation patterns. Heterocitation scores, or out-of-group citations, for arts, humanities, social sciences, and law ranged from 56% to 64%, which was lower than we expected, although this may serve to protect the integrity of social science disciplines and attract broader engagement from within. Ultimately, a small number of productive disciplines are central to supporting disciplinary integration. However, opportunities exist for conservation practice to draw on a broader field of research, to realize the potential that the diverse body of knowledge of interdisciplinary work offers.

Comunicación Más Allá de las Fronteras para Explorar el Potencial de la Interdisciplinariedad en la Producción de Conocimiento sobre los Servicios Ambientales Resumen Es probable que la conservación sea más exitosa si parte del conocimiento que proviene más allá de las ciencias naturales y sociales. El concepto de servicios ambientales ha sido considerado un objeto fronterizo pues facilita el desarrollo de dicho conocimiento interdisciplinario ya que ofrece una plataforma común para los investigadores, los formuladores de políticas y los profesionales. Sin embargo, todavía permanece la pregunta de cuánto del conocimiento interdisciplinario requerido es proporcionado por la diversidad de disciplinas dentro del campo. Preguntamos en dónde se produce el conocimiento sobre los servicios ambientales, cuán interdisciplinario es este conocimiento, y cuáles disciplinas facilitan la mayor integración disciplinaria. Definimos a la interdisciplinariedad como el grado al que los estudios publicados usan conocimiento que cruza las fronteras disciplinarias y usamos a las referencias como indicadores cuantitativos de la comunicación entre las disciplinas con base en la clasificación de revistas. Usamos la diversidad, riqueza y heterogeneidad de referencias de disciplinas como medidas de la interdisciplinariedad y la centralidad de la intermediación como medida de la integración de disciplinas. Nuestro conjunto de datos incluyó 22,153 publicaciones sobre los servicios ambientales, publicadas entre 1983 y 2018. Descubrimos que el estudio de los servicios ambientales maduró; el crecimiento de la producción anual promedio fue 33.8%, más que el crecimiento de 8-9% en la producción científica en todas las áreas de estudio. Con el tiempo, el coeficiente de agrupación de redes, medida de la conectividad entre las disciplinas individuales, creció de 0.388 a 0.727, lo que sugiere un incremento en la densidad dentro de la red de referencias. Los investigadores pertenecientes al área de estudio de los servicios ambientales publicaron más artículos (3,566 tan sólo en el 2018) en varias disciplinas (77 disciplinas únicas en 2018). Sin embargo, este crecimiento no fue igualado con un incremento en la diversidad (estable a 0.7-0.9) o en la riqueza (con un promedio de 0.35 disciplinas únicas por referencia) de los patrones de referencias. Los puntajes de heterogeneidad de referencias, o citas fuera de grupo, para las artes, humanidades, ciencias sociales y leyes variaron entre 56% y 64%, que fue menos de lo esperado, aunque esto tal vez funcione para proteger la integridad de las disciplinas de las ciencias sociales y atraer una participación más amplia desde adentro. Finalmente, un número pequeño de disciplinas productivas son centrales para el respaldo a la integración disciplinaria. Sin embargo, las oportunidades existen para que la práctica de la conservación considere a un campo más amplio de áreas de estudio y para que se revele el potencial que tiene el conjunto de conocimiento diverso que ofrece el trabajo interdisciplinario.

Evaluating outcomes of conservation with multidimensional indicators of well-being.

Many conservation interventions are hypothesized to be beneficial for both the environment and people's well-being, but this has rarely been tested rigorously. We examined the effects of adoption or nonadoption of a conservation intervention on 3 dimensions of people's well-being (material, relational, and subjective) over time. We focused on a fisheries bycatch management initiative intended to reduce environmental externalities associated with resource extraction. We collected panel data from fishers (n = 250) in villages with (adopters and nonadopters) and without (control) the conservation intervention 3 times over 2 years. We found no evidence that adoption reduced any of the 3 dimensions of well-being in the local populations affected by the intervention. There were modest improvements in material (t = -1.58) and subjective livelihood well-being (p = 0.04) for adopters relative to nonadopters over time. The variations in well-being experiences (in terms of magnitude of change) among adopters, nonadopters, and controls across the different domains over time affirmed the dynamic and social nature of well-being.

Evaluación de los Resultados de la Conservación mediante Indicadores Multidimensionales de Bienestar Resumen Se plantea que muchas intervenciones de conservación son benéficas tanto para el ambiente como para el bienestar de las personas, pero esto rara vez ha sido analizado rigurosamente. Examinamos los efectos de la adopción o no adopción de una intervención de conservación sobre tres dimensiones del bienestar de las personas (material, relacional, subjetivo) a lo largo del tiempo. Nos enfocamos en la iniciativa de manejo de la captura accesoria de una pesquería cuya intención es reducir las externalidades asociadas con la extracción de recursos. Recolectamos datos de panel de los pescadores (n = 250) en aldeas con (adoptantes y no adoptantes) y sin (control) la intervención de conservación tres veces durante dos años. No encontramos evidencia de que la adopción redujera cualquiera de las tres dimensiones del bienestar en las poblaciones locales afectadas por la intervención. Con el tiempo, notamos que hubo mejoras modestas en el bienestar de sustento material (t = −1.58) y subjetivo (p = 0.04) para los adoptantes en comparación con los no adoptantes. Las variaciones en las experiencias de bienestar (en cuanto a la magnitud del cambio) entre los adoptantes, no adoptantes y los controles a lo largo de los diferentes dominios a través del tiempo reafirmaron la naturaleza dinámica y social del bienestar.

Gravity of human impacts mediates coral reef conservation gains.

Coral reefs provide ecosystem goods and services for millions of people in the tropics, but reef conditions are declining worldwide. Effective solutions to the crisis facing coral reefs depend in part on understanding the context under which different types of conservation benefits can be maximized. Our global analysis of nearly 1,800 tropical reefs reveals how the intensity of human impacts in the surrounding seascape, measured as a function of human population size and accessibility to reefs ("gravity"), diminishes the effectiveness of marine reserves at sustaining reef fish biomass and the presence of top predators, even where compliance with reserve rules is high. Critically, fish biomass in high-compliance marine reserves located where human impacts were intensive tended to be less than a quarter that of reserves where human impacts were low. Similarly, the probability of encountering top predators on reefs with high human impacts was close to zero, even in high-compliance marine reserves. However, we find that the relative difference between openly fished sites and reserves (what we refer to as conservation gains) are highest for fish biomass (excluding predators) where human impacts are moderate and for top predators where human impacts are low. Our results illustrate critical ecological trade-offs in meeting key conservation objectives: reserves placed where there are moderate-to-high human impacts can provide substantial conservation gains for fish biomass, yet they are unlikely to support key ecosystem functions like higher-order predation, which is more prevalent in reserve locations with low human impacts.

Changing the narrative on fisheries subsidies reform: Enabling transitions to achieve SDG 14.6 and beyond.

The World Trade Organization (WTO) is in the final stages of negotiating an agreement to prohibit harmful fisheries subsidies, thereby achieving UN Sustainable Development Goal (SDG) 14.6. An effective agreement should be viewed as an opportunity for nations to proactively transition towards sustainable and equitable fisheries and pave the path for other SDGs. Supporting fishers does not require harmful subsidies, and we provide evidence-based options for reform that highlight equity needs while reducing environmental harm. Subsidy reforms need clear goals, co-design, transparency, and fair implementation. An agreement on SDG 14.6 could be a turning point for the oceans and for the well-being of those that depend on the oceans for livelihoods and nutrition. Responsible seafood production will require international cooperation not only at WTO, but among governments, fisher organizations, civil society, and the wider public.

A novel telecoupling framework to assess social relations across spatial scales for ecosystem services research.

Access to ecosystem services and influence on their management are structured by social relations among actors, which often occur across spatial scales. Such cross-scale social relations can be analysed through a telecoupling framework as decisions taken at local scales are often shaped by actors at larger scales. Analyzing these cross-scale relations is critical to create effective and equitable strategies to manage ecosystem services. Here, we develop an analytical framework -i.e. the 'cross-scale influence-dependence framework'- to facilitate the analysis of power asymmetries and the distribution of ecosystem services among the beneficiaries. We illustrate the suitability of this framework through its retrospective application across four case studies, in which we characterize the level of dependence of multiple actors on a particular set of ecosystem services, and their influence on decision-making regarding these services across three spatial scales. The 'cross-scale influence-dependence framework' can improve our understanding of distributional and procedural equity and thus support the development of policies for sustainable management of ecosystem services.

Social, institutional, and knowledge mechanisms mediate diverse ecosystem service benefits from coral reefs.

Ecosystem services are supplied by nature but, by definition, are received by people. Ecosystem service assessments, intended to influence the decisions people make regarding their interactions with nature, need to understand how people benefit from different ecosystem services. A critical question is therefore, What determines the distribution of ecosystem service benefits between different sections of society? Here, we use an entitlements approach to examine how people perceive ecosystem service benefits across 28 coral reef fishing communities in four countries. In doing so, we quantitatively show that bundles of benefits are mediated by key access mechanisms (e.g., rights-based, economic, knowledge, social, and institutional). We find that specific access mechanisms influence which ecosystem services people prioritize. Social, institutional, and knowledge mechanisms are associated with the largest number and diversity of benefits. However, local context strongly determines whether specific access mechanisms enable or constrain benefits. Local ecological knowledge enabled people to prioritize a habitat benefit in Kenya, but constrained people from prioritizing the same benefit in Madagascar. Ecosystem service assessments, and their resultant policies, need to include the broad suite of access mechanisms that enable different people to benefit from a supply of ecosystem services.

Linking ecosystem services and human-values theory.

Understanding why people make the decisions they do remains a fundamental challenge facing conservation science. Ecosystem service (ES) (a benefit people derive from an ecosystem) approaches to conservation reflect efforts to anticipate people's preferences and influence their environmental behavior. Yet, the design of ES approaches seldom includes psychological theories of human behavior. We sought to alleviate this omission by applying a psychological theory of human values to a cross-cultural ES assessment. We used interviews and focus groups with fish workers from 28 coral reef fishing communities in 4 countries to qualitatively identify the motivations (i.e., human values) underlying preferences for ES; quantitatively evaluate resource user ES priorities; and identify common patterns among ES motivations and ES priorities (i.e., trade-offs and synergies). Three key findings are evident that align with human values theory. First, motivations underlying preferences for individual ESs reflected multiple human values within the same value domain (e.g., self-enhancement). Second, when averaged at community or country scales, the order of ES priorities was consistent. However, the order belied significant variation that existed among individuals. Third, in line with human values theory, ESs related to one another in a consistent pattern; certain service pairs reflected trade-off relationships (e.g., supporting and provisioning), whereas other service pairs reflected synergistic relationships (e.g., supporting and regulating). Together, these findings help improve understanding of when and why convergence and trade-offs in people's preferences for ESs occur, and this knowledge can inform the development of suitable conservation actions.

Managing nutrition-biodiversity trade-offs on coral reefs.

Coral reefs support an incredible abundance and diversity of fish species, with reef-associated fisheries providing important sources of income, food, and dietary micronutrients to millions of people across the tropics. However, the rapid degradation of the world's coral reefs and the decline in their biodiversity may limit their capacity to supply nutritious and affordable seafood while meeting conservation goals for sustainability. Here, we conduct a global-scale analysis of how the nutritional quality of reef fish assemblages (nutritional contribution to the recommended daily intake of calcium, iron, and zinc contained in an average 100 g fish on the reef) relates to key environmental, socioeconomic, and ecological conditions, including two key metrics of fish biodiversity. Our global analysis of more than 1,600 tropical reefs reveals that fish trophic composition is a more important driver of micronutrient concentrations than socioeconomic and environmental conditions. Specifically, micronutrient density increases as the relative biomass of herbivores and detritivores increases at lower overall biomass or under high human pressure. This suggests that the provision of essential micronutrients can be maintained or even increase where fish biomass decreases, reinforcing the need for policies that ensure sustainable fishing, and that these micronutrients are retained locally for nutrition. Furthermore, we found a negative association between micronutrient density and two metrics of fish biodiversity, revealing an important nutrition-biodiversity trade-off. Protecting reefs with high levels of biodiversity maintains key ecosystem functions, whereas sustainable fisheries management in locations with high micronutrient density could sustain the essential supply of micronutrients to coastal human communities.

Enhancing Human Health and Wellbeing through Sustainably and Equitably Unlocking a Healthy Ocean's Potential.

A healthy ocean is essential for human health, and yet the links between the ocean and human health are often overlooked. By providing new medicines, technologies, energy, foods, recreation, and inspiration, the ocean has the potential to enhance human health and wellbeing. However, climate change, pollution, biodiversity loss, and inequity threaten both ocean and human health. Sustainable realisation of the ocean's health benefits will require overcoming these challenges through equitable partnerships, enforcement of laws and treaties, robust monitoring, and use of metrics that assess both the ocean's natural capital and human wellbeing. Achieving this will require an explicit focus on human rights, equity, sustainability, and social justice. In addition to highlighting the potential unique role of the healthcare sector, we offer science-based recommendations to protect both ocean health and human health, and we highlight the unique potential of the healthcare sector tolead this effort.

Sense of place as a determinant of people's attitudes towards the environment: implications for natural resources management and planning in the Great Barrier Reef, Australia.

Integrating people's values and perceptions into planning is essential for the successful management of natural resources. However, successful implementation of natural resources management decisions on the ground is a complex task, which requires a comprehensive understanding of a system's social and ecological linkages. This paper investigates the relationship between sense of place and people's attitudes towards their natural environment. Sense of place contributes towards shaping peoples' beliefs, values and commitments. Here, we set out to explore how these theoretical contributions can be operationalized for natural resources management planning in the Great Barrier Reef region of Australia. We hypothesise that the region's diverse range of natural resources, conservation values and management pressures might be reflected in people's attachment to place. To tests this proposition, variables capturing socio-demographics, personal wellbeing and a potential for sense of place were collected via mail-out survey of 372 residents of the region, and tested for relationships using multivariate regression and redundancy orientation analyses. Results indicate that place of residence within the region, involvement in community activities, country of birth and the length of time respondents lived in the region are important determinants of the values assigned to factors related to the natural environment. This type of information is readily available from National Census and thus could be incorporated into the planning of community engagement strategies early in the natural resources management planning process. A better understanding of the characteristics that allow sense of place meanings to develop can facilitate a better understanding of people's perceptions towards environmental and biodiversity issues. We suggest that the insights gained from this study can benefit environmental decision making and planning in the Great Barrier Reef region; and that sense of place is a concept worthy of further investigation elsewhere.

Prevalence and Bother of Postvoid Dribbling and Urine Spraying or Splitting: Survey of a General Gynecology Population.

IMPORTANCE: Postvoid dribbling is described well for men in urologic literature but is poorly defined for women, especially in those not presenting for urogynecologic care. OBJECTIVE: The objective was to assess prevalence and bother of postvoid dribbling, urine spraying (ie, deviation of the urine stream), and other bothersome voiding/storage symptoms in a general gynecology population. STUDY DESIGN: This was an anonymous cross-sectional survey study of women presenting to academic general gynecology practices for benign gynecologic care or well-woman visits; patients were not presenting for urinary incontinence or voiding dysfunction. A questionnaire was used to assess the presence and perceptions of voiding behavior and urinary symptoms with an emphasis on postvoid dribbling and urine spraying. The questionnaire included both the validated Questionnaire for Urinary Incontinence Diagnosis and nonvalidated questions. RESULTS: Nonpregnant adult women (N = 355) were surveyed. The median age was 43 years (interquartile range, 33-51 years). The sample was 45% White, 23% Black, 3% Asian, and 13% other. Furthermore, 39% were Latina; 68%, parous; and 28%, postmenopausal. The prevalence (95% confidence interval) of immediate postvoid dribbling was 186 of 327 or 57% (51-62%), and of these, it was at least somewhat bothersome in 37% but moderately-to-quite-a-bit bothersome in 8%. Urine spraying occurred in 222 of 333 or 67% (61-72%), and of these, it was at least somewhat bothersome in 53% but moderately-to-quite-a-bit bothersome in 17%. Approximately 20% reported stress and/or urgency urinary incontinence; both postvoid dribbling and urine spraying were highly associated with these symptoms. CONCLUSIONS: This study of women seeking benign gynecologic care shows a high prevalence of postvoid dribbling and urine spraying symptoms. However, moderate-or-greater bother was relatively uncommon.

Climate change exacerbates nutrient disparities from seafood.

Seafood is an important source of bioavailable micronutrients supporting human health, yet it is unclear how micronutrient production has changed in the past or how climate change will influence its availability. Here combining reconstructed fisheries databases and predictive models, we assess nutrient availability from fisheries and mariculture in the past and project their futures under climate change. Since the 1990s, availabilities of iron, calcium and omega-3 from seafood for direct human consumption have increased but stagnated for protein. Under climate change, nutrient availability is projected to decrease disproportionately in tropical low-income countries that are already highly dependent on seafood-derived nutrients. At 4 oC of warming, nutrient availability is projected to decline by ~30% by 2100 in low income countries, while at 1.5-2.0 oC warming, decreases are projected to be ~10%. We demonstrate the importance of effective mitigation to support nutritional security of vulnerable nations and global health equity.

Managing fisheries for maximum nutrient yield.

Wild-caught fish are a bioavailable source of nutritious food that, if managed strategically, could enhance diet quality for billions of people. However, optimising nutrient production from the sea has not been a priority, hindering development of nutrition-sensitive policies. With fisheries management increasingly effective at rebuilding stocks and regulating sustainable fishing, we can now begin to integrate nutritional outcomes within existing management frameworks. Here, we develop a conceptual foundation for managing fisheries for multispecies Maximum Nutrient Yield (mMNY). We empirically test our approach using size-based models of North Sea and Baltic Sea fisheries and show that mMNY is predicted by the relative contribution of nutritious species to total catch and their vulnerability to fishing, leading to trade-offs between catch and specific nutrients. Simulated nutrient yield curves suggest that vitamin D, which is deficient in Northern European diets, was underfished at fishing levels that returned maximum catch weights. Analysis of global catch data shows there is scope for nutrient yields from most of the world's marine fisheries to be enhanced through nutrient-sensitive fisheries management. With nutrient composition data now widely available, we expect our mMNY framework to motivate development of nutrient-based reference points in specific contexts, such as data-limited fisheries. Managing for mMNY alongside policies that promote access to fish could help close nutrient gaps for coastal populations, maximising the contribution of wild-caught fish to global food and nutrition security.