Objective: New findings, that relate poor foetal growth to long-term outcomes, highlight the need to understand more about the nature of women's diets before and during pregnancy. This study examines the influence of sociodemographic and anthropometric factors on the quality of the diets of young women in the UK. Design: Diet was assessed by an interviewer-administered food frequency questionnaire. A single diet score was calculated for each woman using the first component defined by principal components analysis. Setting: Southampton, UK. Subjects: A total of 6125 non pregnant women aged 20-34 y. Results: The diets of women with low diet scores were characterised by low intakes of fruit and vegetables, wholemeal bread, rice and pasta, yogurt, and breakfast cereals, but high intakes of chips and roast potatoes, sugar, white bread, red, and processed meat and full-fat dairy products. Educational attainment was the most important factor related to the diet score. In all, 55% (95% CI 50-59%) of women with no educational qualifications had scores in the lowest quarter of the distribution, compared with only 3% (95% CI 2-4%) of those who had a degree. Smoking, watching television, lack of strenuous exercise, and living with children were also associated with lower diet scores. After taking these factors into account, no other factor including social class, the deprivation score of the neighbourhood, or receipt of benefits added more than 1% to the variance in the diet score. Conclusions: Poor achievement at school defines a substantial group of women in the UK who may be vulnerable. Many of these women have poor diets that are not simply a result of the level of deprivation in their neighbourhood, or of living at a level of poverty that entitles them to benefits. We suggest that it is a priority to identify and to address the barriers that prevent these women from improving the quality of their diets.

Premenstrual symptoms were common in this cohort. Use of hormonal contraceptive methods was associated with a lower prevalence of these symptoms.

Over the last decade, the Centers for Medicare & Medicaid Services (CMS) has implemented national value-based payment programs that aim to incentivize hospitals to deliver higher quality of care. Black adults face systemic barriers in health care access and often receive care at a limited set of underresourced hospitals. 1 Although recent changes have been made to some value-based programs to reduce the burden of penalties on safety-net hospitals that serve low-income patients, 2-4 whether these initiatives disparately affect hospitals that care for a high proportion of Black patients remains unclear.Therefore, we evaluated whether hospitals that care for a high proportion of Black patients are more likely than other hospitals to be penalized by value-based programs.Methods | We identified all hospitals that participated in the Hospital Value-Based Purchasing Program (HVBP), Hospital Readmission Reduction Program (HRRP), or Hospital-Acquired Condition Reduction Program (HACRP) in fiscal year 2019 (eAppendix in the Supplement). 3 To identify hospitals' penalty-bonus status and the magnitude of these payment adjustments under each program, we used CMS Hospital Compare. We determined the proportion of Medicare hospitalizations for Black patients using MedPAR files (2015)(2016)(2017)(2018)-institutions in the highest quintile were categorized as high-proportion Black hospitals. The American Hospital Association and CMS Impact Files (2018) were used to determine hospitals' characteristics and safety-net status (eAppendix in the Supplement).We calculated the proportion of high-proportion Black hospitals and other hospitals that received a penalty (or bonus) under each value-based payment program. We then determined the adjusted difference between these proportions using multivariable logistic regression, adjusting for hospital characteristics (bed size, teaching status, urban vs rural) and safety-net status. The mean payment adjustment was also determined. Comparisons were performed using 2-sided t tests or χ 2 tests. A 2-sided P < .05 defined statistical significance. Analyses were performed using R version 3.5.2. Institutional review board approval was not required by Beth Israel Deaconess Medical Center because the study used publicly available data. Table. Value-Based Payment Adjustments for Hospitals With a High Proportion of Black Patients vs Other Hospitals Total No. of hospitals High-proportion Black hospitals Other hospitals % (95% CI) Difference Adjusted difference a Hospital Value-Based Purchasing Program No. 2786 544 2242 Received penalty, No. (%) 1229 (44.1) 303 (55.7) 926 (41.3) 14.4 (9.8 to 19.0) 8.0 (2.9 to 13.2) Received bonus, No. (%) 1557 (55.9) 241 (44.3) 1316 (58.7) −14.4 (−19.0 to −9.8) −8.0 (−13.2 to −2.9