Objectives
Given that approximately half of all pregnancies in the United States are unplanned, the authors sought to understand the relation between pregnancy intention and health behaviors.
Methods
...Mothers of live-born infants without major birth defects were interviewed as part of the National Birth Defects Prevention Study. The interview assessed pregnancy intention as well as exposures to vitamins, alcohol, tobacco, illicit drugs, occupational hazards, exogenous heat (e.g., hot tubs and saunas) and caffeine. Crude odds ratios and 95% confidence intervals were calculated and stratified analyses were performed to assess interaction. Multiple logistic regression was used to calculate adjusted odds ratios.
Results
Both before and after the diagnosis of pregnancy, women with unintended pregnancies were more likely to use illicit drugs, smoke, be exposed to environmental smoke, and not take folic acid or multivitamins. The degree to which women altered behaviors after they realized they were pregnant was also associated with their pregnancy intention status. For certain behaviors, maternal age or parity altered the association between pregnancy intention and changing behaviors after awareness of pregnancy.
Conclusion
Pregnancy intention status is a key determinant of pregnancy-related behavior. To improve reproductive outcomes, preconceptional and prenatal programs should consider a woman’s desire for pregnancy.
After returning from Europe to the United States, on March 1, 2020, a symptomatic teacher received positive test results for severe acute respiratory syndrome coronavirus 2. Of the 21 students ...exposed to the teacher in the classroom, serologic results suggested past infection for 2. Classroom contact may result in virus transmission.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Response to sudden epidemic infectious disease emergencies can demand intensive and specialized training, as demonstrated in 2014 when Ebola virus disease (EVD) rapidly spread throughout West Africa. ...The medical community quickly became overwhelmed because of limited staff, supplies, and Ebola treatment units (ETUs). Because a mechanism to rapidly increase trained healthcare workers was needed, the US Centers for Disease Control and Prevention developed and implemented an introductory EVD safety training course to prepare US healthcare workers to work in West Africa ETUs. The goal was to teach principles and practices of safely providing patient care and was delivered through lectures, small-group breakout sessions, and practical exercises. During September 2014-March 2015, a total of 570 participants were trained during 16 course sessions. This course quickly increased the number of clinicians who could provide care in West Africa ETUs, showing the feasibility of rapidly developing and implementing training in response to a public health emergency.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, ODKLJ, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
BACKGROUND
Congenital diaphragmatic hernia affects about 1000 United States infants a year. In most cases, the etiology of this condition is unknown. Treatment strategies have changed in recent ...years. We sought to calculate the birth prevalence, determine risk factors, examine associated defects, and assess trends in survival.
METHODS
We conducted a population‐based cohort study of all infants born during 1968–99 whose mothers resided in the five‐county metropolitan Atlanta area (n = 1,029,143). Infants with congenital diaphragmatic hernia were identified using the Metropolitan Atlanta Congenital Defects Program. To document vital status, we used data from hospital records, Georgia vital records, and the National Death Index.
RESULTS
The birth prevalence of congenital diaphragmatic hernia was 2.4 per 10,000 births. Infants with isolated congenital diaphragmatic hernia were more likely to be premature, macrosomic, and male than their birth cohort. About one‐third of affected infants had additional major defects. Of infants with congenital diaphragmatic hernia, 8% had known syndromes, most commonly chromosomal abnormalities. During the study period, the percentage of infants with congenital diaphragmatic hernia who survived to 1 year of age increased from 19% (1968–71) to about 54% (1996–99). During the last 10 years of the study, infants who were of low birth weight, had a syndrome, or were prenatally diagnosed were more likely to die than other infants with congenital diaphragmatic hernia.
CONCLUSIONS
Despite new treatments, the death rate from congenital diaphragmatic hernia remains substantial, highlighting the need to identify mechanisms for primary prevention. Birth Defects Research (Part A) 67:261–267, 2003. Published 2003 Wiley‐Liss, Inc.
BACKGROUND:In 2012, Oregon observed its highest numbers of reported pertussis cases since 1953. The greatest morbidity occurred among infants <6 months of age, with higher rates among Hispanics than ...non-Hispanics. To explain this disparity, we analyzed pertussis surveillance data.
METHODS:An analysis was conducted among infants <6 months of age in the Portland metropolitan area during 2010–2012. Characteristics examined were ethnicity (Hispanic or non-Hispanic), household size (>4 or ≤4 persons), pertussis vaccination status (upto-date or not up-to-date for age), child care center attendance (yes or no), infant birth weight (<2500 or ≥2500 g) and maternal age (<20 or ≥20 years).
RESULTS:Eighty-two infants <6 months of age with pertussis were identified. Twenty-eight case-infants (34%) were Hispanic, and 54 (66%) were non-Hispanic. By ethnicity, infants with pertussis were similar in illness confirmation method, sex, age, hospitalization status, vaccination status, child care center attendance, infant birth weight and maternal age. Hispanic infants were more likely than non-Hispanic infants to live in households with >4 persons. Univariate analysis showed Hispanic infants had approximately 2.3 times the risk for pertussis, compared with non-Hispanic infants, and infants living in households >4 persons had approximately 2.4 times the risk for illness, compared with those in households with <4 persons; stratified risk ratios did not differ between Hispanic (2.4; confidence interval1.0–5.7) and non-Hispanic infants (2.0; confidence interval1.2–3.5).
CONCLUSIONS:A household size of >4 persons is a potential risk factor for pertussis; the magnitude of this risk is similar for Hispanic and non-Hispanic infants.
Congenital Zika virus infection can cause microcephaly and severe brain abnormalities (1). Congenital Zika syndrome comprises a spectrum of clinical features (2); however, as is the case with most ...newly recognized teratogens, the earliest documented clinical presentation is expected to be the most severe. Initial descriptions of the effects of in utero Zika virus infection centered prominently on the finding of congenital microcephaly (3). To assess the possibility of clinical presentations that do not include congenital microcephaly, a retrospective assessment of 13 infants from the Brazilian states of Pernambuco and Ceará with normal head size at birth and laboratory evidence of congenital Zika virus infection was conducted. All infants had brain abnormalities on neuroimaging consistent with congenital Zika syndrome, including decreased brain volume, ventriculomegaly, subcortical calcifications, and cortical malformations. The earliest evaluation occurred on the second day of life. Among all infants, head growth was documented to have decelerated as early as 5 months of age, and 11 infants had microcephaly. These findings provide evidence that among infants with prenatal exposure to Zika virus, the absence of microcephaly at birth does not exclude congenital Zika virus infection or the presence of Zika-related brain and other abnormalities. These findings support the recommendation for comprehensive medical and developmental follow-up of infants exposed to Zika virus prenatally. Early neuroimaging might identify brain abnormalities related to congenital Zika infection even among infants with a normal head circumference (4).
Coronavirus disease 2019 (COVID-19) was first detected in the United States in January 2020 (1), and by mid-July, approximately 3.4 million cases had been reported in the United States (2). ...Information about symptoms among U.S. COVID-19 patients is limited, especially among nonhospitalized patients. To better understand symptom profiles of patients with laboratory-confirmed COVID-19 in the United States, CDC used an optional questionnaire to collect detailed information on a convenience sample of COVID-19 patients from participating states. Symptom data were analyzed by age group, sex, hospitalization status, and symptom onset date relative to expansion of testing guidelines on March 8, 2020 (3). Among 164 symptomatic patients with known onset during January 14-April 4, 2020, a total of 158 (96%) reported fever, cough, or shortness of breath. Among 57 hospitalized adult patients (aged ≥18 years), 39 (68%) reported all three of these symptoms, compared with 25 (31%) of the 81 nonhospitalized adult patients. Gastrointestinal (GI) symptoms and other symptoms, such as chills, myalgia, headache, and fatigue, also were commonly reported, especially after expansion of testing guidelines. To aid prompt recognition of COVID-19, clinicians and public health professionals should be aware that COVID-19 can cause a wide variety of symptoms.
Afghanistan has one of the highest maternal and perinatal mortality rates in the world. Lack of a health information system presented obstacles to efforts to improve the quality of care and reduce ...mortality. To rapidly overcome this deficit in a large women’s hospital, staff implemented a facility-based maternal and perinatal surveillance system known as “BABIES,” which is specially designed for intervention and evaluation in low-resource settings. During a 12-month period, 15,509 deliveries resulted in 28 maternal deaths and a perinatal mortality rate of 56 per 1000 births. When stratified by birth weight and perinatal period of death, fetuses weighing at least 2500 g who died during the antepartum period contributed the most cases of perinatal death. This finding suggests that the greatest reduction in perinatal mortality would be realized by increasing access to high-quality antepartum care. Among fetuses weighing at least 2500 g, 93 deaths occurred during the intrapartum period. These deaths will continue to be monitored to ensure that the chosen interventions are improving intrapartum care for mothers and newborns. Because of its simplicity, flexibility, and ability to identify interventions, BABIES is a valuable tool that enables clinicians and program managers to prioritize resources.
The International Health Regulations (IHR), an international law under the auspices of the World Health Organization (WHO), mandates that countries notify other countries of "travelers under public ...health observation." Between November 10, 2014, and July 12, 2015, the US Centers for Disease Control and Prevention (CDC) made 2,374 notifications to the National IHR Focal Points in 114 foreign countries of travelers who were monitored by US health departments because they had been to an Ebola-affected country in West Africa. Given that countries have preidentified focal points as points of contacts for sharing of public health information, notifications could be made by CDC to a trusted public health recipient in another country within 24 hours of receipt of the traveler's information from a US health department. The majority of US health departments used this process, offered by CDC, to notify other countries of travelers intending to leave the United States while being monitored in their jurisdiction.
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