n-3 fatty acid consumption during pregnancy is recommended for optimal pregnancy outcomes and offspring health. We examined characteristics associated with self-reported fish or n-3 supplement intake.

Pooled pregnancy cohort studies.

Cohorts participating in the Environmental influences on Child Health Outcomes (ECHO) consortium with births from 1999 to 2020.

A total of 10 800 pregnant women in twenty-three cohorts with food frequency data on fish consumption; 12 646 from thirty-five cohorts with information on supplement use.

Overall, 24·6 % reported consuming fish never or less than once per month, 40·1 % less than once a week, 22·1 % 1–2 times per week and 13·2 % more than twice per week. The relative risk (RR) of ever (v. never) consuming fish was higher in participants who were older (1·14, 95 % CI 1·10, 1·18 for 35–40 v. <29 years), were other than non-Hispanic White (1·13, 95 % CI 1·08, 1·18 for non-Hispanic Black; 1·05, 95 % CI 1·01, 1·10 for non-Hispanic Asian; 1·06, 95 % CI 1·02, 1·10 for Hispanic) or used tobacco (1·04, 95 % CI 1·01, 1·08). The RR was lower in those with overweight v. healthy weight (0·97, 95 % CI 0·95, 1·0). Only 16·2 % reported n-3 supplement use, which was more common among individuals with a higher age and education, a lower BMI, and fish consumption (RR 1·5, 95 % CI 1·23, 1·82 for twice-weekly v. never).

One-quarter of participants in this large nationwide dataset rarely or never consumed fish during pregnancy, and n-3 supplement use was uncommon, even among those who did not consume fish.

Millions of people visit US national parks annually to engage in recreational wilderness activities, which can occasionally result in traumatic injuries that require timely, high-level care. However, no study to date has specifically examined timely access to trauma centers from national parks. This study aimed to examine the accessibility of trauma care from national parks by calculating the travel time by ground and air from each park to its nearest trauma center. Using these calculations, the percentage of parks by census region with timely access to a trauma center was determined.

This was a cross-sectional study analyzing travel times by ground and air transport between national parks and their closest adult advanced trauma center (ATC) in 2018. A list of parks was compiled from the National Parks Service (NPS) website, and the location of trauma centers from the 2018 National Emergency Department Inventory (NEDI)-USA database. Ground and air transport times were calculated using Google Maps and ArcGIS, with medians and interquartile ranges reported by US census region. Percentage of parks by region with timely trauma center access—defined as access within 60 minutes of travel time—were determined based on these calculated travel times.

In 2018, 83% of national parks had access to an adult ATC within 60 minutes of air travel, while only 26% had timely access by ground. Trauma center access varied by region, with median travel times highest in the West for both air and ground transport. At a national level, national parks were unequally distributed, with the West housing the most parks of all regions.

While most national parks had timely access to a trauma center by air travel, significant gaps in access remain for ground, the extent of which varies greatly by region. To improve the accessibility of trauma center expertise from national parks, the study highlights the potential that increased implementation of trauma telehealth in emergency departments (EDs) may have in bridging these gaps.

In the current opioid epidemic, identifying high-risk patients among those with substance and opioid use may prevent deaths. The objective of this study was to determine whether frequent emergency department (ED) use and degree of frequent use are associated with mortality among ED patients with substance and opioid use.

This cohort study used linked population-based ED (National Ambulatory Care Reporting System) and mortality data from Alberta. All adults ≥ 18 years with substance or opioid use-related visits based on diagnostic codes from April 1, 2012, to March 31, 2013, were included (n = 16,389). Frequent use was defined by ≥ 5 visits in the previous year. Outcomes were unadjusted and adjusted (for age, sex, income) mortality within 90 days (primary), and 30 days, 365 days, and 2 years (secondary). To examine degree, frequent use was subcategorized into 5–10, 11–15, 16–20, and > 20 visits.

Frequent users were older, lower income, and made lower acuity visits than non-frequent users. Frequent users with substance use had higher mortality at 365 days (hazard ratio [HR] 1.36 [1.04, 1.77]) and 2 years (HR 1.32 [1.04, 1.67]), but not at 90 or 30 days. Mortality did not differ for frequent users with opioid use overall. By degree, patients with substance use and > 20 visits/year and with opioid use and 16–20 visits/year demonstrated a higher 365-day and 2-year mortality.

Among patients with substance use, frequent ED use and extremely frequent use (> 20 visits/year) were associated with long-term but not short-term mortality. These findings suggest a role for targeted screening and preventive intervention.

‘DASH for Asthma’ (n 90) was a 6-month randomized controlled trial that demonstrated potential benefits of a DASH (Dietary Approaches to Stop Hypertension) behavioural intervention for improving diet quality and asthma control by comparing intervention to usual care in adults with uncontrolled asthma. The present study examined acceptability and feasibility of the intervention from the perspective of intervention participants and lifestyle coaches.

Grounded in Social Cognitive Theory, the 3-month intensive stage, including three individual and eight group sessions, focused on diet modifications and behavioural self-regulation. The 3-month maintenance stage contained telephone consultations. Participants and lifestyle coaches completed surveys including 5-point Likert scales and open-ended questions. We analysed data using descriptive and inductive content analyses.

Forty-six intervention participants (survey response rate was 65–72 %) and two lifestyle coaches.

Participants and lifestyle coaches were highly satisfied (all mean ratings >4) with individual and group sessions. Participants identified mastery of knowledge and skills (awareness, goal setting, self-monitoring, problem solving), social learning (class members sharing experiences and ideas) and good coaching skills (reflective listening, empathy, motivational counselling) as important contributors to self-efficacy and programme satisfaction. Participants also valued personalized feedback received in individual sessions. Lifestyle coaches viewed participant engagement as a facilitator to effective sessions. Finally, participants and lifestyle coaches identified food tasting as beneficial for observational learning and facilitation of participant engagement. High class attendance and self-monitoring rate also reflected the high engagement among participants.

The DASH behavioural intervention was feasible and highly acceptable to participants with uncontrolled asthma and lifestyle coaches.

To determine adherence to nutritional guidelines by pregnant women in New Zealand and maternal characteristics associated with adherence.

A cohort of the pregnant women enrolled into New Zealand’s new birth cohort study, Growing Up in New Zealand.

Women residing within a North Island region of New Zealand, where one-third of the national population lives.

Pregnant women (n 5664) were interviewed during 2009–2010. An FFQ was administered during the face-to-face interview.

The recommended daily number of servings of vegetables and fruit (≥6) were met by 25 % of the women; of breads and cereals (≥6) by 26 %; of milk and milk products (≥3) by 58 %; and of lean meat, meat alternatives and eggs (≥2) by 21 %. One in four women did not meet the recommendations for any food group. Only 3 % met all four food group recommendations. Although adherence to recommendation for the vegetables/fruit group did not vary by ethnicity (P=0·38), it did vary for the breads/cereals, milk/milk products and meat/eggs groups (all P<0·001). Adherence to recommendations for the vegetables/fruit group was higher among older women (P=0·001); for the breads/cereals group was higher for women with previous children (P<0·001) and from lower-income households (P<0·001); and for the meat/eggs group was higher for women with previous children (P=0·003) and from lower-income households (P=0·004).

Most pregnant women in New Zealand do not adhere to nutritional guidelines in pregnancy, with only 3 % meeting the recommendations for all four food groups. Adherence varies more so with ethnicity than with other sociodemographic characteristics.

Understanding ambulance utilization patterns is essential to assessing prehospital system capacity and preparedness at the national level.

To describe the characteristics of patients transported to US emergency departments (EDs) by ambulance and to determine predictors of ambulance utilization.

Data were obtained from the National Hospital Ambulatory Medical Care Survey using mode of arrival, demographic and visit information, ICD-9-CM E and V-codes, and classified reasons for the visit.

The rates for ED visits of persons conveyed by ambulence were stable between 1997 and 2003, consisting of approximately one in every seven ED visits (14%). In 2003, there were 16.2 million ED visits for which an ambulance was used in the US. However, for patients with mental health visits, nearly one in three ED presentations (31%) arrived by ambulance. Significantly higher rates of ambulance use were associated with: (1) mental health visits; (2) older age; (3) African-Americans; (4) Medicare or self-pay insurance status; (5) urban ED location; (6) US regions outside of the South; (7) presentation between 12 midnight to 0800 hours; (8) injury-related visits; (9) urgent visit status; and/or (10) those resulting in hospital admission. Among mental health patients, older age, self-pay insurance status, urban ED location, regions outside the southern US, and urgent visit classification predicted ambulance use. Ambulance usage within the mental health group was highest for suicide and lowest for mood and anxiety disorder-related visits.

Reliance on ambulance services varies by age, insurance status, geographic factors, time of day, urgency of visit, subsequent admission status, and type of mental health disorder. Even after controlling for many confounding factors, mental health problems remain an important predictor of ambulance use.