Objective
To characterise medical, obstetric and demographic risk factors associated with nulliparous, term, singleton, vertex (NTSV) caesarean birth.
Study design
Cross‐sectional study.
Setting
...United States delivery hospitalisations.
Population
NTSV births in 2016–18 US natality data.
Methods
This study analysed a national sample of natality data generated by the United States National Vital Statistics System. NTSV deliveries were identified. The primary outcome was caesarean birth. Risk factors including maternal age, body mass index (BMI) and pregestational diabetes were analysed. Multivariable log‐linear regression models analysed factors associated with NTSV caesarean with adjusted risk ratios (aRR) as measures of effect.
Results
Of 11 622 400 deliveries, 3 764 707 met NTSV criteria, and their caesarean section rate was 25.9%. Maternal age 35–39 years (aRR 1.51, 95% CI 1.50–1.52) and 40–54 years (aRR 2.03, 95% 2.00–2.05) compared with age 19–34 years; BMI 25 to <30 kg/m2 (aRR 1.32, 95% CI 1.31–1.33), 30 to <35 kg/m2 (aRR 1.57 95% CI 1.56–1.58), 35 to <40 kg/m2 (aRR 1.82, 95% CI 1.80–1.83) and ≥40 kg/m2 (aRR 2.17, 95% CI 2.15–2.19) compared with BMI 18.5–24.9 kg/m2; and pregestational diabetes (aRR 1.54, 95% CI 1.51–1.57) were all associated with increased risk. Risk factors allowed stratification of patients into high‐risk versus low‐risk groups. The NTSV caesarean rate was 37.9% in women who had one or more of the following characteristics: age ≥35 years, BMI ≥30 kg/m2 or pregestational diabetes. In comparison, the NTSV caesarean rate was 20.8% among women without any of these three risk factors (P < 0.01).
Conclusion
Among NTSV births, BMI, maternal age and medical conditions are important risk factors for caesarean delivery.
Tweetable
Older age and higher BMI are associated with increased nulliparous, term, singleton, vertex caesarean birth.
Introduction The COVID-19 pandemic profoundly affected the provision of and demand for routine health services in the world. The objective of this scoping review was to synthesize the influence of ...the COVID-19 pandemic on primary maternal and child health (MCH) services in sub-Saharan Africa. Methods The studies searched original studies reporting on the influence of the COVID-19 pandemic on primary MCH services. Four scientific databases (Pubmed, AJOL, CAIRN, CINAHL) and one gray literature database (Google Scholar) were used for this search. We also searched through the snowball citation approach and study reference lists. Results The influence of the COVID-19 pandemic on primary MCH services has been mixed in sub-Saharan Africa. Attendance at some health centers declined for antenatal care, deliveries, immunization, and pneumonia cases. Other health centers did not experience a significant influence of the pandemic on some of these services. In fact, antenatal care increased in a number of health centers. MCH service indicators which declined during COVID-19 were linked on the demand side to regulatory measures against COVID-19, the perceived unavailability of resources for routine services, the perceived negative attitude of staff in these facilities, the perceived transmission risk in primary health care facilities and the perceived anticipated stigma. On the supply side, factors included the lack of equipment in primary facilities, the lack of guidelines for providing care in the pandemic context, the regulatory measures against COVID-19 taken in these facilities, and the lack of motivation of providers working in these facilities. Conclusion This study recommends prioritizing the improvement of infection prevention measures in primary health care facilities for resilience of MCH indicators to epidemic crises. Improvement efforts should be tailored to the disparities in preventive measures between health centers. The identification of best practices from more resilient health centers could better guide these efforts.
As New York City became an international epicenter of the novel coronavirus disease 2019 (COVID-19) pandemic, telehealth was rapidly integrated into prenatal care at Columbia University Irving ...Medical Center, an academic hospital system in Manhattan. Goals of implementation were to consolidate in-person prenatal screening, surveillance, and examinations into fewer in-person visits while maintaining patient access to ongoing antenatal care and subspecialty consultations via telehealth virtual visits. The rationale for this change was to minimize patient travel and thus risk for COVID-19 exposure. Because a large portion of obstetric patients had underlying medical or fetal conditions placing them at increased risk for adverse outcomes, prenatal care telehealth regimens were tailored for increased surveillance and/or counseling. Based on the incorporation of telehealth into prenatal care for high-risk patients, specific recommendations are made for the following conditions, clinical scenarios, and services: (1) hypertensive disorders of pregnancy including preeclampsia, gestational hypertension, and chronic hypertension; (2) pregestational and gestational diabetes mellitus; (3) maternal cardiovascular disease; (4) maternal neurologic conditions; (5) history of preterm birth and poor obstetrical history including prior stillbirth; (6) fetal conditions such as intrauterine growth restriction, congenital anomalies, and multiple gestations including monochorionic placentation; (7) genetic counseling; (8) mental health services; (9) obstetric anesthesia consultations; and (10) postpartum care. While telehealth virtual visits do not fully replace in-person encounters during prenatal care, they do offer a means of reducing potential patient and provider exposure to COVID-19 while providing consolidated in-person testing and services. KEY POINTS: · Telehealth for prenatal care is feasible.. · Telehealth may reduce coronavirus exposure during prenatal care.. · Telehealth should be tailored for high risk prenatal patients..
To characterize symptoms and disease severity among pregnant women with coronavirus disease 2019 (COVID-19) infection, along with laboratory findings, imaging, and clinical outcomes.
Pregnant women ...with COVID-19 infection were identified at two affiliated hospitals in New York City from March 13 to April 19, 2020, for this case series study. Women were diagnosed with COVID-19 infection based on either universal testing on admission or testing because of COVID-19-related symptoms. Disease was classified as either 1) asymptomatic or mild or 2) moderate or severe based on dyspnea, tachypnea, or hypoxia. Clinical and demographic risk factors for moderate or severe disease were analyzed and calculated as odds ratios (ORs) with 95% CIs. Laboratory findings and associated symptoms were compared between those with mild or asymptomatic and moderate or severe disease. The clinical courses and associated complications of women hospitalized with moderate and severe disease are described.
Of 158 pregnant women with COVID-19 infection, 124 (78%) had mild or asymptomatic disease and 34 (22%) had moderate or severe disease. Of 15 hospitalized women with moderate or severe disease, 10 received respiratory support with supplemental oxygen and one required intubation. Women with moderate or severe disease had a higher likelihood of having an underlying medical comorbidity (50% vs 27%, OR 2.76, 95% CI 1.26-6.02). Asthma was more common among those with moderate or severe disease (24% vs 8%, OR 3.51, 95% CI 1.26-9.75). Women with moderate or severe disease were significantly more likely to have leukopenia and elevated aspartate transaminase and ferritin. Women with moderate or severe disease were at significantly higher risk for cough and chest pain and pressure. Nine women received ICU or step-down-level care, including four for 9 days or longer. Two women underwent preterm delivery because their clinical status deteriorated.
One in five pregnant women who contracted COVID-19 infection developed moderate or severe disease, including a small proportion with prolonged critical illness who received ICU or step-down-level care.
Laparoscopic port site metastases (PSMs) have an incidence of .5% to 2%. The management of an isolated PSM (iPSM), without evidence of recurrence elsewhere, remains unclear. The aim of this study was ...to elucidate practices regarding iPSMs.
A 23-item survey was created using commercially available survey software. Over the course of January 2016 the survey was e-mailed to the members of the Society of Gynecologic Oncology with 2 follow-up reminder e-mails. (Canadian Task Force classification III.) SETTING: Online survey.
Of the 709 surveys sent, 132 were returned. Providers practicing for <5 years saw fewer PSMs and those who performed more minimally invasive surgeries (MISs) saw more PSMs. Comparing providers who have or have not seen PSMs, no differences in pneumoinsufflation pressure, the mode of delivery of the specimen, the use of local anesthesia at port site incisions, or the method of deflation were seen. If an iPSM was suspected, most providers indicated they would obtain imaging (computed tomography, 51%, or positron emission tomography/computed tomography, 43%) followed by an interventional radiology-guided biopsy (29%) or resection of the mass. Tendency for treatment is to surgically resect the lesion followed by adjuvant therapy.
After controlling for time in practice, we did not find a strong risk factor for iPSMs other than performing >75% of oncologic surgeries by MIS. Most respondents performed imaging when suspecting iPSMs and use systemic adjuvant therapy after confirming iPSMs.
Material overall mechanical behaviour varies significantly under rapid straining as compared to quasi-static loading. Analysing the damaged elastic behaviour of composite materials under dynamic ...loading requires theoretical tools and experimental approaches integrating the strain rate effects. This work is concerned with development and optimisation of an experimental methodology devoted to the micro and macroscopic characterisation of composites mechanical behaviour under high-speed loadings. The applied experimental procedure has been optimised in an attempt to isolate the inherent inertial disturbances attributed to the test system. The optimisation aims at minimizing the amplitude of measurements perturbation in order to give rise to homogeneous stress/strain fields within the tested specimen. Using a servo-hydraulic machine, monotonic and interrupted tensile tests were performed at different strain rates and coupled to scanning electronic microscope observations. The developed approach has been applied at strain rates up to 200
s
−1 for two composite materials: SMC-R26 and a woven carbon-epoxy laminate.
This study aimed to (1) determine to what degree prenatal care was able to be transitioned to telehealth at prenatal practices associated with two affiliated hospitals in New York City during the ...novel coronavirus disease 2019 (COVID-19) pandemic and (2) describe providers' experience with this transition.
Trends in whether prenatal care visits were conducted in-person or via telehealth were analyzed by week for a 5-week period from March 9 to April 12 at Columbia University Irving Medical Center (CUIMC)-affiliated prenatal practices in New York City during the COVID-19 pandemic. Visits were analyzed for maternal-fetal medicine (MFM) and general obstetrical faculty practices, as well as a clinic system serving patients with public insurance. The proportion of visits that were telehealth was analyzed by visit type by week. A survey and semistructured interviews of providers were conducted evaluating resources and obstacles in the uptake of telehealth.
During the study period, there were 4,248 visits, of which approximately one-third were performed by telehealth (
= 1,352, 31.8%). By the fifth week, 56.1% of generalist visits, 61.5% of MFM visits, and 41.5% of clinic visits were performed via telehealth. A total of 36 providers completed the survey and 11 were interviewed. Accessing technology and performing visits, documentation, and follow-up using the telehealth electronic medical record were all viewed favorably by providers. In transitioning to telehealth, operational challenges were more significant for health clinics than for MFM and generalist faculty practices with patients receiving public insurance experiencing greater difficulties and barriers to care. Additional resources on the patient and operational level were required to optimize attendance at in-person and video visits for clinic patients.
Telehealth was rapidly implemented in the setting of the COVID-19 pandemic and was viewed favorably by providers. Limited barriers to care were observed for practices serving patients with commercial insurance. However, to optimize access for patients with Medicaid, additional patient-level and operational supports were required.
· Telehealth uptake differed based on insurance.. · Medicaid patients may require increased assistance for telehealth.. · Quick adoption of telehealth is feasible..
The effect of particle clustering on the effective response and damage evolution in particle reinforced Al/SiC composites is studied numerically and analytically. A probability of material failure is ...determined on the basis of the model of a composite as an array of subdomains, and with the use of the probabilistic analysis of failure of matrix ligaments between particles. It was found that the clustered particle arrangement leads to the three times higher probability of specimen failure than the random uniform particle arrangement. Mesomechanical finite element simulations of damage evolution in the composite with clustered and uniform particle arrangements, and different amounts, sizes and volume contents of SiC particles have been carried out. Tensile stress–strain curves and the fraction of failed particles plotted versus the applied far-field strain curves were determined numerically for all the microstructures. It was shown that the failure stress of composites increases with increasing the average nearest-neighbor distance between the particles in the composite, and with decreasing the degree of clustering of particles.
L’optineurine (OPTN) est une protéine multifonctionnelle jouant un rôle crucial en tant que récepteur dans l’autophagie sélective. Les mutations du gène OPTN sont liées à des maladies telles que le ...glaucome à tension normale et la sclérose latérale amyotrophique. L’OPTN exerce une fonction essentielle dans la dégradation sélective des mitochondries endommagées. Ce processus est requis pour empêcher leur accumulation, la production d’espèces réactives de l’oxygène et la libération de facteurs pro-apoptotiques. Le contrôle de la qualité de la mitophagie est orchestré par la kinase PINK1 et la ligase de l’ubiquitine cytosolique Parkin, dont les mutations sont associées à la maladie de Parkinson. Cette revue met en lumière des perspectives récentes soulignant le rôle de l’OPTN dans la mitophagie et son implication potentielle dans les maladies neurodégénératives.
Optineurin (OPTN) is a multifunctional protein playing a crucial role as a receptor in selective autophagy. OPTN gene mutations are linked to diseases such as normal-tension glaucoma and amyotrophic lateral sclerosis. Recognized as a critical receptor for mitophagy, OPTN is pivotal in selectively degrading damaged mitochondria. This process is essential to prevent their accumulation, the generation of reactive oxygen species, and the release of pro-apoptotic factors. Mitophagy’s quality control is governed by the PINK1 kinase and the cytosolic ubiquitin ligase Parkin, whose mutations are associated with Parkinson’s disease. This review highlights recent insights emphasizing OPTN’s role in mitophagy and its potential involvement in neurodegenerative diseases.
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