bluuebunny/crossref_metadata_2025 huggingface dataset:
Preeclampsia and long-term health outcomes: preliminary results from an umbrella review
Authors: Giannakou K , Pittara T , Lamnisos D
Published: October 2020

Background

Preeclampsia (PE) is a common pregnancy disease, linked with several complications during and after pregnancy. Although its pathogenesis is not completely understood, evidence suggests that PE has long-term health effects of both the mother and the offspring.

Methods

An umbrella review was performed to identify systematic reviews and meta-analyses on the association of PE with long-term health outcomes in women and infants born to pregnancies complicated with PE. We searched PubMed, EMBASE, Scopus and ISI Web of Science from inception to March 2019. For each meta-analysis we estimated the summary effect size by random-effects and fixed-effects models, the 95% confidence interval, the 95% prediction interval (PI), the between-study heterogeneity, evidence of small-study effects and evidence of excess significance bias. To evaluate the credibility of the published evidence we preferred state-of-the-art approaches of predefined criteria.

Results

Twenty-two eligible meta-analyses were identified providing data on 71 associations. Forty-nine (69%) associations had nominally statistically significant findings at P < 0.05, while nineteen (27%) remain significant at P < 10-6 under the random-effects model. Forty (56%) associations had large or very large heterogeneity. Evidence for small-study effects and excess significance bias was found in 4 (6%) and 7 (10%) associations, respectively. Only five associations presented robust evidence: cerebrovascular disease (cohort studies), cerebrovascular disease (overall), cardiac disease, cardiovascular mortality and attention deficit hyperactivity disorder (ADHD). These were supported by > 1000 cases, 95% PI excluding the null, no large heterogeneity, small-study effects, or excess of significance.

Conclusions

Our findings suggest an increased risk for women to develop cerebrovascular, cardiovascular and cardiac diseases after a pregnancy complicated by PE, while offspring exposed to PE are at higher risk for ADHD.

Key messages

Our findings highlight the importance of promoting ongoing patient assessment practices for prevention and early diagnosis of these comorbidities. More research is required for the elevated risks of the reported outcomes to improve maternal health.
Heath care utilization after birth in Brazil: a national study
Authors: Domingues R , Dias B , Bittencourt S , Dias M , Torres J , Cunha E , Leal M
Published: October 2020

Background

The Brazilian Ministry of Health recommends primary health care actions for women and babies in the first week after birth, with the aim of monitoring health status, screening for diseases, vaccination, support for breastfeeding and promoting contraception. However, data on these actions are not available at the national level. This study aims to estimate the use of outpatient health services in the postpartum period and to verify the demographic, socioeconomic and obstetric factors associated with this use.

Methods

National hospital-based study, conducted in 2011-2012, with an interview of 23,894 women. Estimates were calculated for eight indicators of health service use with performance assessed as “satisfactory” (75-100%), “partial” (50-74%) and “unsatisfactory” (<50%). Multiple logistic regression was performed to verify the association between women's characteristics and each of the analyzed indicators.

Results

”Demand for postpartum consultation” (73.9%; 95% CI: 72.4-75.3%), “demand for newborn consultation” (91.6%; 95% CI: 90.6% - 92.5%), “BCG vaccination” (99.0%; 95% CI 98.7% - 99.2%) and “Hepatitis B vaccination” (96.8%; 95% CI 96.0%-97.5%) were considered satisfactory. “Neonatal screening test in the first week of life” was considered partial (60.1%; 95% CI 57.6% - 62.6%), while “consultation of the woman in the first 15 days after delivery” (37.0% 95% CI 35.0-39.0%),”consultation of the newborn in the first seven days of life”(21.8% 95% CI 20.2% - 23.5%) and “receiving the result of neonatal screening in the first month of life” (29.8% CI 95% 27.6%-32.2%) were considered unsatisfactory. Regional and social inequalities were identified, with the worst performance of all indicators in the less developed North and Northeast regions and in the most vulnerable women.

Conclusions

There is a need for better organization and provision of services, aiming to increase the coverage of postpartum and childcare actions and to reduce health inequalities.

Key messages

Low coverage of postnatal actions limits access to effective health care practices, putting mothers and babies at greater risk of illness and death. Regional and social inequalities and worse performance of health actions that depend exclusively on primary care services suggest barriers to access and failures in the organization of services.
Maternal risk factors for childhood malnutrition in Pakistan: demographic health survey 2012-13
Authors: Zaheer S , Shah N , Safdar N
Published: October 2020

Background

In Pakistan, this is a catastrophe for 44% children combating with stunted growth; the third highest percentage of stunted children in the world and further 1 million children are underweight. Fifteen percent of children are wasted and half of them are anemic, and almost one-third of the children have iron deficiency anemia. The study aimed to collate all contributing factors that have been reported in the PDHS-2012-13 survey for child malnutrition.

Methods

Pakistan Demographic and Health Survey, 2012-13 data was used (n = 1967). Forty five factors were extracted from PDHS 2012-13 and factor analysis was performed to reduce these factors into similar potential factors by using principle component (PC) decomposition. Malnutrition status of children of age < 5 years was assessed by using three indices: height-for-age, weight-for-height, and weight for age. To examine the associations between derived factors and childhood malnutrition, binary logistic regression was used.

Results

About 43% of under-five children are stunted, 26.9% are underweight and 12.6% are wasted. Multivariate adjusted results showed mothers who belong to poor quintile (OR: 1.50, p-value 0.02), who afraid of husband all the time (OR: 1.36, p-value 0.02), who had > 4 children (OR: 1.47, p-value <0.01), and who used tobacco (OR: 1.80, p-value 0.02) were more likely to have stunted children. However, mothers who had no education (OR: 1.82, p-value<0.01), who were poor dweller (OR: 1.55, p-value 0.03), who used unprotected water (OR: 1.62, p-value<0.01), mothers who had younger age at birth (OR: 1.37, p-value 0.02) were more likely have underweight children.

Conclusions

Maternal socio-demographics and environmental factors were more significantly associated with child malnutrition. This study will enable the public health professionals' workforce tier at a national level to gain expertise and formulate better planning in order to improve child health in Pakistan.

Key messages

This study will enable the public health professionals’ workforce tier to achieve gains in child health in Pakistan. Study findings may help to improved and to initiate evidence-based guidelines for maternal and child health.
Relationship between physical/sedentary activities and overweight/obesity in Modena primary schools
Authors: Paduano S , Greco A , Salvia C , Borsari L , Guadagnini I , Pinca J , Midili S , Tripodi A , Borella P
Published: October 2020

Background

Childhood overweight/obesity can be influenced by food habits, but also by poor physical activity and excessive use of screens. The aim of this study was to investigate physical exercise and sedentary behaviours of children attending the first year of primary schools in Modena, and their association with weight status of children and characteristics of family.

Methods

We involved 890 children attending the first classes of 15 primary schools in Modena. The physical and sedentary activities of child were examined through an anonymous questionnaire administered to the parents. Sociodemographic characteristics of family, weight and height of child and parents were also collected. Univariate logistic regression models, eventually adjusted for parents' sociodemographic characteristics, were used to analyse data.

Results

Filled questionnaires were 660 out of 890 families (74.2%), of which 72 without anthropometric data were excluded. The prevalence of overweight/obesity was 25.2% without difference of gender. Less than 25% of children did physical activity per ≥7 hours per week; most children (about 40%) did 2 to 4 hours per week. There was no association between time spent in physical activity and overweight/obesity of children. From multivariate analysis, the habit significantly affecting children's overweight/obesity was spending time on tablets, PCs, mobile phones, videogames (OR = 2.2, CI 95%: 1.4-3.6). Children screen time ≥2 hours daily (63.9%) was associated with parents' low education level and father's weight status.

Conclusions

Our results suggest the need of educational interventions aimed to increase time spent in physical activity, and to promote a responsible use of digital media, by actively involving both children and parents.

Key messages

Children screen time ≥2 hours daily is strongly associated with childhood overweight/obesity. High education level of parents can positively affect lifestyles of their children.
Cesarean Law: a turning point in the fight against the Brazilian epidemic of cesarean section?
Authors: Gervasio M , Malinverni C , Salim N , Cuenca A
Published: October 2020

In the opposite direction to the process that had been gradually changing birth forms and indicators in Brazil, in 2019 the State of São Paulo (located in southeastern Brazil) enacted Law 17. 137, which guarantees all pregnant women the choice of a cesarean section from the 39 weeks of pregnancy, regardless of the obstetric indication. That is a preliminary qualitative analysis of a doctoral investigation, we are looking for show some points of inflection of this law to combat the cesarean epidemic. Affiliated to the theoretical-methodological approach of discursive practices and the production of meanings in daily, it investigates the discourses that support the current policies to encourage humanized obstetric care based on scientific evidence, built over the last 20 years, and those who supported the approval of this legal norm, known as the Cesarean Law. One of the inflection points of Law concerns the quality of prenatal care and the way that women receive information about childbirth during pregnancy. Because lack of information and insecurity are important factors in the choice of women by the type of delivery. Iatrogenic prematurity is one of the biggest problems of Brazilian cesarean section epidemic. Thus, even after 39 weeks of pregnancy, there is no guarantee of baby's maturity. Since the 90's, the Brazilian government had been encouraging the insertion of midwives and nurse midwives in the childbirth care of all women at regular risk and encouraged the creating of childbirth centers as well an adequate classification of gestational risk. At this point, the law affronts the current organization of the system, as it prioritizes attendance by doctors over professional midwives. The cesarean rates and other health indicators are not available yet after the approval of the law in São Paulo state. However, we can postulate that it will mean a setback in the fight against the epidemic of cesarean sections in Brazil.

Key messages

The Cesarean law approved in the state of São Paulo / BR presents inflection points in the fight against the cesarean section epidemic. The Cesarean law approved in the state of São Paulo / BR ignores important issues in the Brazilian obstetric scenario.
Determinants of use of gonadotropin formulations to treat female infertility in an Italian region
Authors: Rosa A , Belleudi V , Addis A , Ciardulli A , Pacchiarotti A , Davoli M , Kirchmayer U
Published: October 2020

Background

Gonadotropins (Gona) are commonly used for infertility treatment in women. They are available as urinary purified extracts (u-Gona) and recombinants (r-Gona). Objectives:We investigated if socio-demographic characteristics of treated women, year of dispensation and type of prescriber may play a role in the choice of a treatment with respect to the other.

Methods

From administrative healthcare databases, we collected claims of Gona for women, aged 18-45, enrolled in the health care system in the year preceding the first prescription (years 2009-2018). Treatment cycles were defined as a 21-day mobile time window. We identified three groups: u-Gona, r-Gona and treatment with both formulations (m-Gona). To identify determinants, we linked women with the socio-economic position (SEP), a composite deprivation index, based on the 2011 Italian Census data,categorized in 4 levels (high, medium-high, medium-low, low). We associated prescriptions with the type of prescriber, distinguishing between specialists and general practitioners.

Results

We retrieved 38,598 Gona treatment cycles prescribed to 23,412 women and distributed between formulations as follows: r-Gona 47.4%, u-Gona 26.3% and m-Gona 26.3%. The median age was 38 years for r-Gona and u-Gona, 39 for m-Gona. Comparing the type of prescriber, specialists were more likely to prescribe u-Gona instead of r-Gona (OR: 2.14; 95%CI: 2.02-2.27) than general practitioners. No relation was found between SEP and Gona formulations, except for patients with the highest level who were more likely to be prescribed with r-Gona instead of u-Gona (OR: 1.12; 95%CI: 1.03-1.21). Time trends showed that treatment choices changed over time.

Conclusions

In the Lazio region, the choice of gonadotropin formulations varied over time and was found to be related to the prescriber and partly to socio-economic position. An analysis of outcomes related to different treatments is under way.

Key messages

More and more women are using artificial insemination techniques; it is important to monitor fertility drug use patterns and determinants of the choice of a treatment. The use of fertility drugs is a multifactorial phenomenon and a matter of public health interest.
Exploring the views of undocumented migrant women on access to maternity services in the UK
Authors: Hargreaves S , Nellums L B , Powis J , Jones L , Miller A , Rustage K , Russell N , Friedland J
Published: October 2020

Background

Migrant women face inequalities in access to health-care services and are known to experience poorer maternal and child outcomes than women born in the UK. The development of more restrictive health policies in the UK and Europe, including being denied or charged for healthcare at maternity services, may be exacerbating these outcomes, particularly among undocumented migrant women without permission to reside. We investigated undocumented migrant women's experiences of accessing maternity services in the UK and their impact on health outcomes.

Methods

We did semi-structured in-depth qualitative interviews with a purposive sample of migrant women (born outside the UK) who were aged 18 and over, and had experiences of pregnancy in the UK whilst undocumented. Participants were recruited through the Doctors of the World UK clinic. Interviews were transcribed and analysed using thematic analysis.

Results

We did interviews with 20 undocumented women (age range 31-40 years; mainly from Africa and Asia). Among participants, of whom 13 were pregnant at the time of interview, 10 (50%) first accessed antenatal care late (after the national target of 13 weeks). Women described an ongoing cycle of precariousness, defined by their legal status, social isolation, and poor economic status. Women reported receiving bills of up to £11,500 for maternity services (range £3,072 to £11.500). The impact of their experiences meant that they were deterred from seeking timely health care and were reluctant to present to health services, with women reporting fear and loss of trust in the health system.

Conclusions

These women's narratives illustrated the potential deterrent and detrimental impact of increasingly restrictive health policies on women's access to care and their health. UK and European health policies must be equitable, non-discriminatory, and better align with our commitments to promote universal health coverage among all individual residing in the region.

Key messages

Increasingly restrictive health policies may have a deterrent and detrimental impact on migrant women’s access to health care. Undocumented migrant women in the UK reported fear and loss of trust in the health system.
Adolescent childbearing in a Brazilian border municipality: the new mother’s profile
Authors: Nampo F K , Fernandes C M , Souza S
Published: October 2020

Background

Adolescent childbearing is considered a public health problem, due to the often associated social impacts. Understanding the phenomenon is necessary to support intervention proposals aimed at reducing its incidence.

Methods

In this cross-sectional study we investigated all adolescent mothers living in Foz do Iguassu that gave birth in the 2013-2017 period. Data from a governmental database were used and descriptive analysis was performed.

Results

Between 2013 and 2017, 3,207 adolescent mothers gave birth to a live child, of which 135 aged 10 to 14 years and 3,072 aged 15 to 19 years. 51.3% of the mothers were white, and 22.1% had previous pregnancy experience. 68.4% had a vaginal delivery, and 80.6% had full-term pregnancies. Among the women aged 10 to 14 years, 57.8% started prenatal care in the first trimester and 47.4% had 7 or more prenatal consultations. Among women aged between 15 and 19 years, 73.7% started prenatal care in the first trimester and 53.4% had 7 or more prenatal consultations. Additionally, at least 49% of the adolescents were delayed in school.

Conclusions

In Foz do Iguassu, adolescent mothers are predominantly white. At least half are delayed in school, and more than 1 in 5 already had previous pregnancy experience. Parturients between 15 and 19 years old start prenatal earlier and attend more prenatal consultations than parturients aged 10 to 14 years. Prematurity is more frequent among adolescents.

Key messages

Adolescents receive poor prenatal care, especially the younger ones. Adolescent pregnancy is not a synonym to unintended pregnancy, and its relationship should be further investigated.
Sickness absence in relation to first childbirth by occupational group: a Swedish cohort study
Authors: Laszlo K , Björkenstam C , Orellana C , Lidwall U , Lindfors P , Voss M , Svedberg P , Alexanderson K
Published: October 2020

Background

Childbirth has been suggested to increase sickness absence (SA) and disability pension (DP). This may vary by occupation; however, knowledge in this field remains limited. We explored SA and DP in the years before and after childbirth among women in four occupational groups and among those without any occupation.

Methods

We conducted a register-based study of nulliparous women aged 18-39 years, living in Sweden on December 31, 2004 (n = 492,504). Women were categorized into five skill-level based occupational groups and three childbirth groups; no childbirths within three years (B0), first childbirth in 2005 with no childbirth within three years (B1), and first childbirth in 2005 with at least one more birth within three years (B1+). We compared crude and standardized annual mean SA (in spells>14 days) and DP net days in the three years before and three years after first childbirth date.

Results

Women in the highest skill level occupations and managers had generally lower mean SA/DP days e.g., B0: 11.3, B1: 11.6, B1+: 6.8 during the third year after first childbirth than the lowest skill level occupations group; B0: 28.1, B1: 22.8, B1+: 15.2 days. In B1 and B1+, absolute differences in mean SA/DP, particularly in SA, among occupational groups were highest during the year before childbirth. DP was most common in B0, regardless of group and year.

Conclusions

We found that women's mean SA/DP days before and after first childbirth were higher with decreasing skill-level of the occupational group, with these differences being most pronounced in the year before childbirth. DP was most common among women not giving birth, regardless of occupational group.

Key messages

Women’s mean SA/DP days before and after first childbirth increased with decreasing skill-level of the occupational group and these differences were most pronounced in the year before childbirth.
Physical activity during pregnancy in Italy: prevalence, intensity and associated factors
Authors: Fioretti E , Palandri L , Fantuzzi G , Facchinetti F , Righi E
Published: October 2020

Background

Recently the Italian Ministry of Health, following WHO and ACOG example, recommend that healthy pregnant women practice at least 150 minutes per week of moderate intensity activity (3-6 METs). The study aimed to evaluate if women meet guidelines and to identify potential target groups for public health intervention.

Methods

From November 2015 to November 2017, 390 women completed, just after delivery at an Italian hospital, a questionnaire about sports and exercise before and during pregnancy. Physical activity (PA) was classified according to intensity in Metabolic Equivalent Task (MET). Women were considered sufficiently active when reaching the recommended PA levels.

Results

52% of women practiced any sport at anytime during pregnancy, with a higher prevalence in the II trimester (45%), while only 30% of women kept exercising throughout all trimesters. When including time and sport intensity, only 4,6%, 6,4% and 4,6% of women reached the recommended PA levels in the I, II and III trimester. Sufficiently active women practiced mainly swimming and walking, two highly recommend sports in pregnancy. Factors favour PA practice were Italian nationality, higher educational level, work, BMI, attending birthing classes and being active before pregnancy. However, even without contraindications, 26% of women active before pregnancy stopped exercising in pregnancy and only 15% achieved recommended PA levels. 58% of sedentary women before pregnancy, kept being sedentary in pregnancy.

Conclusions

Although half of women practiced sport during pregnancy, only a few were sufficiently regular and active. As pregnancy is an ideal time to adopt or to reinforce a healthy lifestyle, public health interventions should be strengthen considering also specific target groups.

Key messages

Effective public health policies should be identified and implemented to favour an active lifestyle during pregnancy. Specific target groups less prone to meet PA guidelines should also be addressed.
Involvement of perinatal health professionals to reduce the exposure of pregnant women to chemicals
Authors: Sauvant-Rochat M , Bernard L , Pelissier M , Marie C , Lémery D , Vendittelli F
Published: October 2020

Background

During pregnancy, reducing exposure to chemicals is obvious to many pregnant women (PW), and also perinatal health professionals (PHP), but few of them are aware that these substances are present in everyday products (cleaning products, DIY products, gardening products, personal health care products, cosmetics, food plastic wrappers etc.).

AIM

This study aimed to estimate the perception of risks related to chemicals by PW, and also to describe the advice provided by PHP to PW.

Methods

A cross-sectional survey was performed among French PW. Interviewers, using a standardized questionnaire, collected data anonymously. Data focused on socio-demographic and occupational characteristics, perception of environmental risks, identification of chemicals by PW, and preventive advices performed by PHP. Statistical analysis (univariate analysis - logistic regression) were done with Modalisa® 8.0 software (Kynos, Paris).

Results

300 PW (29.5 +/- 5 years old) were included. They report a relatively high level of sensitivity to environmental issues (SE Score = 6.3 ± 1.7, on a Likert 0-10 scale). When asked about the level of risk associated with 15 environmental risks, pregnant women placed exposure to chemicals in only twelfth position. Two thirds of PW were interested by the composition of everyday products, and looked at the ingredients mentioned on the labels, but most of them declared that the information present on the labels were not comprehensible. An interest for organic products was noted. These behaviors were related to the age, socio-occupational status, perception of environmental risks. For most of PW, the main sources of information on chemicals were the Internet and medias. Only 5% PW identified PHP as potential interlocutors on this topic.

Conclusions

For most PW, everyday products were not identified as health risk products. To date, it is important to strengthen the information provided to PW by PHP on the risks linked o chemicals during pregnancy.

Key messages

Exposures to chemicals present in everyday products (DIY, cleaning products, cosmetics, food plastic wrappers etc.) are not well identified by pregnant women and by perinatal health professionals. Exposure to chemicals must be reduced during pregnancy and health promotion messages must integrate this advice to promote healthy behaviors.
Breast self-examination: knowledge and practices among women in Sousse, Tunisia
Authors: Bannour I , Bannour B , Frigui R , Bannour R , Khairi H
Published: October 2020

Backgrounds and aims

Breast cancer is a major public health problem. In Tunisia, breast cancer is the first leading cause of cancer-related deaths. Different organizations and professionals advise women to learn how to perform breast self-examination (BSE) so that they can detect the slightest change as soon as it intervenes.

Objective

This study aims to determine the prevalence of women performing breast self-examination and to evaluate their practices.

Materials and Methods

A cross-sectional descriptive study was performed about women's knowledge, attitude and practice of breast cancer screening and breast self-examination. The study was conducted in the Reproductive Health Center of Sousse spread over a period of 2 months (February, March 2018). Self administered questionnaires were distributed to women.

Results

The mean age of the participants was 34 years with extremes ranging from 18 to 64 years. 47% of women surveyed have already performed breast self examination at least once during the last year. 14% of participants practiced breast cancer screening less than once a year. The first source of learning for breast cancer screening was health professionals in 27% of cases. The score of the practice of women surveyed was average; mostly, women have intermediate results for the technique of self-examination breast. No woman had a score of 15/15.

Conclusions

A better education of the practice of self-examination is essential in order to improve the screening program for breast cancer. The role of the gynecologist, general practitioner or midwife is therefore essential in education and training.

Key messages

A better education of the practice of self-examination is essential in order to improve the screening program for breast cancer. The role of the gynecologist, general practitioner or midwife is therefore essential in education and training.
The risk and protective factors for risky sexual behaviors among school-aged adolescents in Indonesia
Authors: Setio K , Pardosi J , Beek K , Razee H
Published: October 2020

Background

Indonesia's 65 million young people aged 10-24 comprise 28% of its total population. Studies revealed that adolescents who engage in early sexual activity are prone to sexually transmitted diseases, unwanted pregnancy, and unsafe abortion. This study examined the prevalence and associated factors of risky sexual behaviors among Indonesian secondary school adolescents using the 2015 Indonesia Global School-based Student Health Survey (GSHS).

Methods

A total of 11,142 students filled the self-administered questionnaire. Risky sexual behaviors measured included 1) ever had sexual intercourse, 2) multiple partners, 3) condom use. The determinant factors were sociodemographic characteristics, mental health-related factors, interpersonal variables, socioeconomic, and parental understanding. A multivariate logistic regression model was used to estimate the adjusted odds ratio and 95% CI.

Results

The prevalence of ever had sex was 5.3%; 1.2% of students had sexual intercourse with multiple partners; The prevalence of condom use was 34%. Results from the multivariate logistic regression indicated that ever-had sex had the strongest association with suicide ideation (aOR= 4.636; 95% CI = 4.542-4.732) and significantly lower among respondents who have a parental understanding (aOR = 0.318; 95% CI = 0.310-0.326). Having sex with multiple partners had the highest correlation with smoking behavior (aOR= 9.967; 95% CI = 9.816-10.12), significantly lower among respondents who have a parental understanding (aOR=0.644; 95% CI = 0.632-0.656). Having parental understanding had the strongest correlation with condom use (aOR= 6.597; 95% CI = 6.291-6.918), while loneliness had the lowest relation. (aOR= 0.706; 95% CI = 0.669-0.745).

Conclusions

Adolescent sexual reproductive health programs should employ a holistic approach involving mental health promotion and tobacco control programs. It is also essential to engage parents in any adolescent sexual reproductive health program.

Key messages

Risky sexual behaviors have a strong correlation with mental health. It is essential to engage parents in any adolescent sexual reproductive health program.
Flubromazolam-Derived Designer Benzodiazepines: Toxicokinetics and Analytical Toxicology of Clobromazolam and Bromazolam
Authors: Wagmann Lea , Manier Sascha K , Felske Christina , Gampfer Tanja M , Richter Matthias J , Eckstein Niels , Meyer Markus R
Published: October 2020

Flubromazolam is widely known as highly potent designer benzodiazepine (DBZD). Recently, the two flubromazolam-derived new psychoactive substances (NPS) clobromazolam and bromazolam appeared on the drugs of abuse market. Since no information concerning their toxicokinetics in humans is available, the aims of the current study were to elucidate their metabolic profile and to identify the isozymes involved in their phase I and phase II metabolism. In vitro incubations with pooled human liver S9 fraction were performed and analyzed by liquid chromatography coupled to orbitrap-based high-resolution tandem mass spectrometry (LC–HRMS-MS). Biosamples after the ingestion of bromazolam allowed the identification of metabolites in human plasma and urine as well as the determination of bromazolam plasma concentrations by LC–HRMS-MS using the standard addition method. In total, eight clobromazolam metabolites were identified in vitro as well as eight bromazolam metabolites in vitro and in vivo. Predominant metabolic steps were hydroxylation, glucuronidation and combinations thereof. Alpha-hydroxy bromazolam glucuronide and bromazolam N-glucuronide are recommended as screening targets in urine. Bromazolam and its alpha-hydroxy metabolite are recommended if conjugate cleavage is part of the sample preparation procedure. The bromazolam plasma concentrations were determined to be 6 and 29 μg/L, respectively. Several cytochrome P450 (CYP) and uridine 5'-diphospho-glucuronosyltransferase (UGT) isozymes were shown to catalyze their metabolic transformations. CYP3A4 was involved in the formation of all phase I metabolites of both NPS, while UGT1A4 and UGT2B10 catalyzed their N-glucuronidation. Several UGT isoforms catalyzed the glucuronidation of the hydroxy metabolites. In conclusion, the determined bromazolam plasma concentrations in the low micrograms per liter range underlined the need for sensitive analytical methods and the importance of suitable urine screening procedures including DBZD metabolites as targets. Such an analytical strategy should be also applicable for clobromazolam.
Wheely good result for BMW in the Patents Court
Authors: Strath Janet
Published: October 2020

Bayerische Motoren Werke AG v Premier Alloy Wheels (UK) Ltd [2020] EWHC 2094 (Pat), 30 July 2020
Efficiency—What Else?
Authors: Mistelis Loukas
Published: October 2020

This chapter focuses on the value of efficiency in international arbitration. It also briefly discusses the tension between party autonomy and the desire of various authors to attribute to arbitration systemic qualities and features of private ordering. While efficiency did not feature as a typical feature of international arbitration some twenty odd years ago, serious concerns were expressed about the cost and length of proceedings. Paradoxically, at the same time, arbitration was seen as a method of dispute resolution which saves money and time for the users. However, in the last ten years, or perhaps a bit longer, there has been a marked awareness and indeed demand for a higher level of efficiency in the arbitral process. The chapter looks at the origins of the quest for efficiency in international arbitration and its establishment as a value of international arbitration, before exploring the role of arbitrators and arbitral institutions in ensuring efficiency.
Artificial Intelligence in International Arbitration
Authors: Gicquello Myriam
Published: October 2020

This chapter assesses the introduction of artificial intelligence in international arbitration. The contention is that it would not only reinstate confidence in the arbitral system—from the perspective of the parties and the general public—and participate in the development of the rule of law, but also engage with broader systemic considerations in enhancing its legitimacy, fairness, and efficiency. Yet, before addressing the why, what, and how of this proposition, a definition of artificial intelligence is warranted. It should be noted at the outset that this concept has a variety of meanings. Despite the lack of consensus on its meaning, the chapter will thus treat artificial intelligence as encompassing both semi-autonomous and autonomous computer systems dedicated to assisting or replacing human beings in decision-making tasks. It presents the conclusions of two extensive research programs respectively dealing with the performance of statistical models and naturalistic decision-making. From that behavioural analysis, the introduction of artificial intelligence in international arbitration be discussed against the general considerations of international adjudication and the specific goals pertaining to international arbitration.
Empirical Findings on International Arbitration
Authors: Drahozal Christopher R.
Published: October 2020

This chapter surveys the existing empirical literature on international arbitration. It focuses on quantitative rather than qualitative empirical studies, and covers studies both of international commercial arbitration and international investment arbitration. The chapter first describes empirical research on the use of arbitration to resolve transnational disputes—in particular, the extent to which parties use arbitration clauses in international contracts, why they do so, and the frequency of international commercial and investment arbitration proceedings. Empirical studies have also examined an array of topics about the procedures in international arbitration. The empirical evidence typically comes from surveys or observational studies of commercial and investment arbitration proceedings. The chapter then considers empirical insights on selected topics such as the cost and length of arbitration proceedings, the size of arbitral tribunals, interim measures, multi-party disputes, challenges to arbitrators, the role of tribunal secretaries, and the use of mediation. It also looks at empirical studies on the applicable law in international commercial arbitration; the demographics of international arbitrators; and compliance with and enforcement of international arbitration awards.
The Creation of Investor–State Arbitration
Authors: St. John Taylor
Published: October 2020

This chapter explores the creation of investor–state arbitration. There is no shortage of antecedents for investor–state arbitration. So why is it perceived as ‘dramatically different’ from what had gone before? In the second half of the twentieth century, consent to investor–state arbitration was provided prospectively (before disputes arose) and pursuant to generalized jurisdiction (for any treaty breach); this is profoundly different from previous practices. Two institutional developments were crucial for creating prospective, generalized consent. First, the ICSID Convention emerged. Second, provisions providing consent to investor–state arbitration were added to investment treaties. The chapter then focuses on these two developments. It reconstructs the choices that officials faced, their constraints, and the reasons why they made the choice for investor–state arbitration against other alternatives. To do so, it uses primary documents from five archives: the American, British, German, and Swiss national archives as well as the World Bank archives.
Safeguarding Intangible Cultural Heritage
Authors: Blake Janet
Published: October 2020

This chapter assesses the drafting of the 2003 Convention on Intangible Cultural Heritage (ICH), the result of three decades of consideration within UNESCO. For many UNESCO Member States—especially in the African, Asia-Pacific, and Latin American regions—ICH constitutes a major part of their cultural heritage. The contribution that it can make to social and economic development in such societies was an important factor in the desire to strengthen international safeguarding of this heritage. UNESCO’s 2003 Convention was developed within two main international law and policy contexts: human-centred and sustainable development and the growing importance accorded to cultural rights. The 2003 Convention makes clear the role of cultural heritage in preserving cultural diversity; ensuring truly sustainable development models; protecting human rights and the cultural identities of individuals, social groups, and communities; and protecting the right of communities to be themselves socially and economically sustainable through their heritage.
Indigenous Peoples and Cultural Heritage
Authors: Dorough Dalee Sambo , Wiessner Siegfried
Published: October 2020

This chapter explores Indigenous peoples’ culture and cultural heritage, a global treasure in urgent need for safeguarding and space for flourishing. It arrives at four conclusions. First, Indigenous peoples’ rights are essentially culturally grounded and culturally bounded. They are intended to sustain and intensify the colours of the tapestry of global cultural diversity. Second, Indigenous cultural heritage encompasses a wide variety of tangible and intangible elements. To effectively safeguard them, a holistic definition is needed. Third, the right to self-determination empowers Indigenous peoples to define their identity through their own interpretation, continuation, or modification of their ways of life. Lastly, access to and use of their traditional lands, territories, and resources is essential to the survival and flourishing of Indigenous cultural heritage. Other manifestations of their culture are to be safeguarded as well, cherishing their traditions and values in the quest for an inclusive world order of human dignity.
Cultural Heritage and Intellectual Property
Authors: Burri Mira
Published: October 2020

This chapter examines the protection of both cultural heritage and intellectual property. The relationship between cultural heritage and intellectual property evolves in a profoundly complex setting—with many institutions and actors involved, often with very different or even divergent interests, and within a fragmented legal regime. Although intellectual property law has developed sophisticated rules with regard to a variety of intellectual property forms, it is based on certain author-centred and mercantilist premises that do not work so well with the protection of traditional knowledge (TK) and traditional cultural expressions (TCE). Nevertheless, in the fields of patent, trademark, and copyright protection, there are tools that may provide some, albeit imperfect, protection of TK and TCE. The chapter maps the mismatches and the gaps and asks whether these can be addressed in some viable way—be it through adjusting the existing rules or through the creation of new tailored models of protection.
National Treasures at the Intersection between Cultural Heritage and International Trade Law
Authors: Voon Tania
Published: October 2020

This chapter analyses the extent to which international trade law accommodates the export and import control measures that States commonly adopt in order to prevent illicit trade in cultural property in accordance with the 1970 UNESCO Convention. It examines the exception for ‘national treasures’ found in World Trade Organization (WTO) law and other international economic agreements. The definition of cultural property in the relevant UNESCO treaty is not necessarily identical to the meaning of national treasures in WTO law. Moreover, the WTO Appellate Body has shown reluctance to apply non-WTO law in determining WTO disputes, so a conflict between UNESCO and WTO provisions or domestic regulations might not necessarily be resolved as expected. This conclusion provides one example of the limitations of the current Appellate Body approach to international law and suggests, with respect to cultural property, that closer alliance in treaty drafting may be required to enhance coherence.
Alternative Dispute Settlement Mechanisms
Authors: Chechi Alessandro
Published: October 2020

This chapter examines existing ‘Alternative Dispute Resolution’ (ADR) options—such as negotiation, mediation, conciliation, and arbitration—with a view to assessing their efficacy in relation to cultural heritage disputes. Indeed, even a cursory consideration of the practice reveals that the vast majority of restitution claims arising in the past few decades have been settled through such means. Admittedly, this is due to the fact that ADR procedures combine important virtues. The first advantage of ADR resides in the parties’ power to tailor the settlement process according to their interests and the circumstances of the dispute. Second, private settlement is likely to be speedier and cheaper. Third, these mechanisms provide for flexibility and creativity. Fourth, since disputes are resolved out of the public eye, extra-curial resolution ensures confidentiality. Lastly, ADR entails neutrality and fairness.
Codes of Ethics
Authors: Frigo Manlio
Published: October 2020

This chapter addresses the role of ethical rules in the field of art law and international protection of cultural heritage. The examination of the legal nature of the codes of ethics and of their effectiveness is preceded by the analysis of their role which is frequently twofold. On the one hand, ethical codes can inspire market regulation by establishing or by confirming a catalogue of good practices in this field. This is the case of the CINOA (International Confederation of Art and Antique Dealers) Code of Ethics and the ICOM (International Council for Museums) Code of Ethics. In such cases, the codes of ethics may have a direct and/or an indirect effect to the functioning of the commercial transactions in this sector. Ethical codes may also represent a source of inspiration for the development of law rules, at both national and international levels.
Africa
Authors: Shyllon Folarin
Published: October 2020

This chapter describes cultural heritage law and management in Africa. Whether in the field of tangible and intangible heritage or the domain of movable and immovable cultural heritage, sub-Saharan Africa legislation and administration of cultural property have been blighted by the colonial past. Independence has not always been used as opportunity for a breaking off or breaking forth with the cultural heritage protection system installed by the former colonial power. It appears that the formulation and elaboration of cultural heritage laws are often designed on European concepts of the protection of cultural property. The laws are, therefore, not often adapted to the present African realities. This is a legacy of the colonial past. The chapter then considers the AFRICA 2009 programme, which has helped in many ways to enhance in manifold ways the conservation of immovable cultural heritage in sub-Saharan Africa through a sustainable development process.
Central and South America
Authors: Lixinski Lucas
Published: October 2020

This chapter discusses the protection of cultural heritage in Central and South America. The key defining features of Central and South American regional efforts in the field of heritage are the use of heritage as a tool for development and the connection between heritage and indigeneity. With respect to development, the main approach is policy-driven, explained both by the nature of the objective (economic) and by the fact that most organizations engaging in this area have reduced mandates for rule-making with respect to heritage. With indigeneity, rule-making is stronger, engaging a proud tradition of international lawmaking in the region, which started as part of a Pan-American reliance on the rules of international law to shield Central and South American nations from European colonialism and US neo-colonialism. In the specific area of heritage, there is certainly a conversation between the regional and the global that needs to be accounted for.
Europe
Authors: Smith Rachael Craufurd
Published: October 2020

This chapter examines the protection of cultural heritage in Europe. Within Europe, the Council of Europe (CoE) and the European Union (EU) have played a central role in supporting, coordinating, and supplementing domestic initiatives in the cultural field. Both organizations arose out of the devastation of the two world wars and the determination of key European leaders to put in place systems of cooperation that would prevent further armed conflict, yet only one had an explicit cultural remit. This chapter explores the evolving structures and powers of the two institutions and the initiatives they have taken to preserve and enhance cultural heritage. Though the EU is an increasingly confident player in the cultural field at both international and European levels, the CoE’s wider membership and extensive experience means that it is likely to play a pivotal role in shaping cultural policy at the regional level well into the future.
Dynamical modelling of disc vertical structure in superthin galaxy ‘UGC 7321’ in braneworld gravity: an MCMC study
Authors: Komanduri Aditya , Banerjee Indrani , Banerjee Arunima , Sengupta Soumitra
Published: October 2020

Low surface brightness (LSBs) superthins constitute classic examples of very late-type galaxies, with their disc dynamics strongly regulated by their dark matter haloes. In this work, we consider a gravitational origin of dark matter in the braneworld scenario, where the higher dimensional Weyl stress term projected on to the three-brane acts as the source of dark matter. In the context of the braneworld model, this dark matter is referred to as the ‘dark mass’. This model has been successful in reproducing the rotation curves of several LSB and high surface brightness galaxies. Therefore, it is interesting to study the prospect of this model in explaining the vertical structure of galaxies which has not been explored in the literature so far. Using our two-component model of gravitationally coupled stars and gas in the external force field of this dark mass, we fit the observed scale heights of stellar and atomic hydrogen (H i) gas of superthin galaxy ‘UGC7321’ using the Markov Chain Monte Carlo approach. We find that the observed scale heights of ‘UGC7321’ can be successfully modelled in the context of the braneworld scenario. In addition, the model predicted rotation curve also matches the observed one. The implications on the model parameters are discussed.