Reproductive medical tourism is by some accounts a multibillion dollar industry globally. The seeking by clients in high income nations of surrogate mothers in low income nations, particularly India, presents a set of largely unexamined ethical challenges. In this paper, eight such challenges are elucidated to spur discussion and eventual policy development towards protecting the rights and health of vulnerable women of the Global South.

Healthcare providers should counsel their pregnant patients on GWG with advice that is concordant with the Institute of Medicine Guidelines.

Reproductive tourism, or “cross-border reproductive care”, is the phenomenon of people crossing international borders to access reproductive technologies. One of the fastest-growing categories of cross-border reproductive care is international surrogacy, the act of infertile clients traveling internationally to engage the paid services of foreign surrogates to carry their babies to term. It is a multibillion-dollar global industry presenting unique legal, ethical, and risk-management challenges. Clients tend to be price-sensitive, middle-income individuals seeking services from surrogates who in the global market are thought to be of quite low socioeconomic status. Risks are experienced by all parties involved in the transaction, including the client’s countries of origin and destination. The risks to the surrogate evolve from the potential to exploit her economic vulnerability in order to encourage both consent and unfair pricing. Opportunities for policy development are explored.

Gut dysfunction and microbial dysbiosis comorbidities are of particular interest in recent autism research, as gastrointestinal distress is present in up to 90% of autism spectrum disorder cases and therefore may play a key role in the pathogenesis of this disorder. This scoping review aims to integrate the results of studies conducted in the past 6 years examining the association between gut microbiota and autism spectrum disorder, specifically with regard to the characterization of autism spectrum disorder microbiota and potential therapeutic interventions. Studies related to the gastrointestinal microbiome of subjects with autism spectrum disorder were identified through PubMed, SCOPUS, PsycInfo, and Google Scholar databases. Studies were screened and selected based on defined inclusion and exclusion criteria; 19 studies were included. Research continues to report differences between microbiota of individuals with autism spectrum disorder and controls; however, the types and abundances of bacteria present remain inconsistent. Promising treatment interventions for autism spectrum disorder, including special diets, dietary supplementation, and of particular interest, microbiota transfer therapy, are also being explored. Research regarding the link between gut microbiota and autism spectrum disorder renders exciting results; however, it is still in its infancy of investigation. Rigorous methodologies are required to support and strengthen the reliability of existing results, and to further our understanding of the pathogenesis of autism spectrum disorder. Lay abstract Gastrointestinal distress and gut microbial imbalances are commonly found in children with autism spectrum disorder, and therefore may play a key role in the development of the disorder. This scoping review aimed to examine the extent, range and nature of research conducted in the past 6 years that focused on furthering our understanding of autism spectrum disorder and its association with gut microbiota. A literature review was performed with predetermined key words. Studies were screened and selected based on defined inclusion and exclusion criteria. A total of 19 studies were included for final analysis. While there are continuous reports of differences in gut microbiota between autism spectrum disorder and neurotypical individuals, knowledge about the consistency in the presence and abundance of bacterial species, as well as metabolites, remains deficient. Treatments such as special diets, vitamin, prebiotic, probiotic, and microbiota transfer therapy show promising therapeutic potential, yet are in their infancy of investigation. Overall, further research with rigorous methodologies is required to support and strengthen the reliability of existing findings. Future research should aim to increase sample sizes, eliminate biases, and subgroup autism spectrum disorder groups to help accommodate for inter-individual variation. As increasing evidence of a unique autism spectrum disorder microbiome and metabolome is acquired, autism spectrum disorder-specific biomarkers can be identified. These biomarkers have great implications in terms of elucidating the molecular mechanisms of autism spectrum disorder, preventing the onset of autism spectrum disorder, and improving treatments for individuals with autism spectrum disorder.

Objectives Canadians have reason to care about indoor air quality as they spend over 90% of the time indoors. Although indoor radon causes more deaths than any other environmental hazard, only 55% of Canadians have heard of it, and of these, 6% have taken action. The gap between residents' risk awareness and adoption of actual protective behaviour presents a challenge to public health practitioners. Residents' perception of the risk should inform health communication that targets motivation for action. In Canada, research about the public perception of radon health risk is lacking. The aim of this study was to describe residents' perceptions of radon health risks and, applying a theoretical lens, evaluate how perceptions correlate with protection behaviours. Methods We conducted a mixed online and face-to-face survey (N = 557) with both homeowners and tenants in Ottawa-Gatineau census metropolitan area. Descriptive, correlation, and regression analyses addressed the research questions. Results Compared to the gravity of the risk, public perception remained low. While 32% of residents expressed some concern about radon health risk, 12% of them tested and only 3% mitigated their homes for radon. Residents' perceptions of the probability and severity of the risk, social influence, care for children, and smoking in home correlated significantly with their intention to test; these factors also predicted their behaviours for testing and mitigation. Conclusion Health risk communication programs need to consider the affective aspects of risk perception in addition to rational cognition to improve protection behaviours. A qualitative study can explore the reasons behind the gap between testing and mitigation. Résumé Objectifs Les Canadiens ont de bonnes raisons de se préoccuper de la qualité de l'air intérieur, car ils passent plus de 90 % de leur temps à l'intérieur. Bien que le radon domiciliaire (RD) cause plus de décès que tout autre risques environnementaux, seulement 55 % des Canadiens en ont déjà entendu parler, et d'entre eux seulement 6 % ont pris des mesures concrètes pour l'éradiquer. L'écart entre la sensibilisation aux risques et la prise de mesures de protection réelles par les résidents constitue un défi pour les professionnels de la santé publique. La perception des résidents face aux risques associés au RD devrait guider la communication en matière de santé pour cibler la motivation. Au Canada, très peu d'études portant sur les perceptions de la population face aux risques associés au RD ont été réalisées. Le but de cette étude est de décrire les perceptions qu'entretiennent

Children with cerebral palsy associated with periventricular leukomalacia frequently develop unprovoked epileptic seizures. This article reports an analysis of risk factors for epilepsy in children with radiologically confirmed periventricular leukomalacia. This cohort was screened for epilepsy and for an array of clinical and demographic factors. Of 154 subjects with radiologically confirmed periventricular leukomalacia, 40 (26.0%) had epilepsy. In the epileptic group, radiologic pathology other than periventricular leukomalacia was uncommon. Significant associations were found between epilepsy and cerebral palsy patterns other than spastic diparesis, mental handicap, cortical visual impairment, neonatal seizures, and severe periventricular leukomalacia. Only the presence of neonatal seizures was significantly associated with epilepsy once other risk factors were controlled in the regression model. Some previous studies have shown an association between neonatal seizures and later epilepsy for cerebral palsy in general. This is the first report of such an association for a single predominant type of cerebral pathology.

Objectives:India is fast becoming the most prominent player in the global industry of reproductive tourism, in which infertile people cross international borders to seek assisted reproduction technologies. This study was conducted to better understand the extent and manner in which Indian clinics seek foreign clients.Methods:A systematic search of official Indian assisted reproduction technologies clinic Websites was undertaken, and instances noted where foreign clients were overtly targeted, and where maternal surrogacy was overtly offered.Results:A total of 159 clinics with Web addresses were identified, though only 78 had functioning Websites. All were published in English, with the majority clustered in the states of Maharashtra (14) and Gujarat (9). Of the 78 functioning Websites, 53 (68%) featured some mention of maternal surrogacy services, and 42 (54%) made overt overtures to foreign clients. Qualitative appeals to foreigners included instructions for international adoption, visa application, and the legal parental disposition of the surrogate. All Maharashtran clinic Websites that mentioned surrogacy also overtly featured reproductive tourism. Preimplantation diagnosis services were not offered disproportionately by clinics mentioning reproductive tourism.Conclusions:Based upon clinic online profiles, reproductive tourism comprises a substantial fraction of India’s assisted reproduction technologies clinics’ business focus, clustering around its most tourist-friendly locales, and surrogacy may be a strong motivator for international clientele.

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