Pandemic stress induces systemic immune changes and placental inflammation independently of SARS-CoV-2 infection in pregnancies

Problem: Environmental stress during pregnancy has known impacts on both maternal and fetal health. In terms of theCOVID-19 pandemic, the majority of published work has focused on the impact of the infection itself, without considering the potential immune impact of pandemic related-stress.We, therefore, assessed the impact of pandemic stress, independently of SARS-CoV-2 infection, on the circulating and placental immune profiles of pregnant individuals. Method(s): Placentas from 239 patients were collected at the Sainte- Justine Hospital, Montreal, Canada. Of these, 199 patients delivered during the pandemic and were exposed to pandemic stress with (+: 79) or without (-: 120) SARS-CoV-2 infection, the latter exposed to pandemic stress only. Pre-pandemic historic controls (uncomplicated pregnancies, Ctrl: 40), were also included. Placental biopsies were collected to assess cytokine levels by ELISAs and histopathological lesions. A sub-study with 35 pre-pandemic pregnancies (unexposed) and 20 who delivered during the pandemic (exposed) was also conducted. The latter (exposed/unexposed) were all uncomplicated pregnancies. We collected maternal blood prior to delivery for immunophenotyping, and plasma/peripheral blood mononuclear cells (PBMCs) were isolated. Inflammatory mediators in the plasma were quantified by ELISAs. Co-culture assays with PBMCs and human umbilical vein endothelial cells (HUVECs) were performed to assess endothelial activation. Demographical/obstetrical data were obtained through chart review. Result(s): SARS-CoV-2+ patients were multiethnic (63.4%), had higher pre-pregnancyBMI (28.9 vs. 24.8 inCtrl, P<.05), and elevated preterm birth rate (16.5% vs. 5.8% in SARS-CoV-2-, P < .05 and 0.0% in Ctrl, P < .01). In the placentas, we observed an increase in the levels of IL- 1Ra (P < .05) and CRP (P < .05) in both SARS-CoV-2 groups, while IL-6 (P = .0790) and MCP-1 (P < .001) were elevated solely in SARS-CoV- 2-. These changes were predominant in placentas with inflammatory lesions on histopathological analysis. Moreover, we observed elevated CD45+ cells (P < .001) in the placentas from both SARS-CoV-2 groups versus Ctrl. Considering that the differences we observed were important in the SARS-CoV-2- group, we performed a study solely on uncomplicated pregnancies, either exposed or unexposed to pandemic stress. At the systemic level, we observed a decrease in the percentage of Th2 cells (P < .001), leading to a pro-inflammatory Th1/Th2 imbalance in exposed individuals. Decreased Treg (P < .05) and Th17 (P < .05) versus unexposed was also observed. Surprisingly, decreased levels of circulating IL-6 (P < .05), MCP-1 (P < .01), and CRP (P<.05) were seen in exposed versus unexposed individuals. Finally,we observed increased secretion of ICAM, a marker of endothelial activation, solely in endothelial cells co-cultured with PBMCs from exposed individuals. Conclusion(s): Overall, placental inflammatory profiles differed between pregnant individuals exposed to pandemic stress with or without SARS-CoV-2 infection. Moreover, we observed that the pandemic stress exposed group presented a systemic pro-inflammatory bias. This highlights the need to understand the differences between the effects of pandemic-related stress and the added burden of SARS-CoV-2 infection itself on maternal and fetal health. Our work also supports an association between an increased risk of hypertension/ preeclampsia and SARS-CoV-2 infection that might be driven in part by pandemic-related stress.

Reproductive intentions of Russians with children at the beginning of COVID-19 pandemic

The paper studies the reproductive intentions of the Russians who already have at least one child before and during the quarantine restrictions (lockdowns) due to COVID-19. Binary choice logistic models and a set of machine learning models were evaluated on the data from the Person, Family, Society survey conducted in March—May 2020. Modeling of the respondents' intentions to have more children in the short term (3 years) and the long term (more than 3 years) showed that external shocks such as the COVID-19 pandemic and the strict quarantine regulations associated with it had an impact on fertility intentions, but only in the short term. These external shocks were less significant than such factors as age of the respondent;the number of children already born;availability of housing needed to expand the family;the maternity capital program availability, which includes the opportunity to improve housing conditions after the birth of children. As Russians with children showed the increase of the probability of having additional children after April 2020, we conclude that the effect of COVID-19 on reproductive intentions was acyclical. The estimation of models with heterogeneous effects showed that the pandemic had a stronger impact on respondents with above-average household incomes. © 2023, Russian Presidental Academy of National Economy and Public Administration. All rights reserved.

2023 ABSTRACT: COVID-19 INFECTION in PREGNANCY - WHO IS MOST at RISK of ADVERSE OUTCOMES?

Background: COVID-19 infection during pregnancy is associated with increased rates of adverse perinatal outcomes. The mechanism by which this occurs is not understood. We have previously reported increased rates of placental histopathological lesions in these pregnancies. Aim(s): We hypothesise that, 1. trimester of infection, and 2. vaccination status, affects placental histopathology and neonatal outcomes. Method(s): Pregnant women infected with COVID-19 between January 2020 and May 2022 were retrospectively identified from Monash Health records. Maternal and neonatal data were collected alongside placental histopathological changes as categorised by the Amsterdam Criteria. Result(s): 942/21838 women had COVID-19 infection during pregnancy. Placental histopathology was available in 638 cases. Analysis of infection by trimester revealed that earlier infection was associated with increased preterm birth rate (13.5% vs. 10.3% vs. 4.5%, P = 0.0012), reduced birth weight (3108 vs. 3216 vs. 3345 g, P = 0.0061) and increased fetal loss rate (2.7% vs. 1.8% vs. 0%, P = 0.0023, in T1 vs. T2 vs. T3, respectively) (Table 1). Placental weight increased with trimester of infection (416 vs. 469 vs. 487 g, P = 0.0267). There were no differences in histopathological lesions. 300 patients were unvaccinated (>=1 dose) versus 642 double vaccinated (>=2 doses) against COVID-19 (Table 2). Double vaccination resulted in fewer placental histopathological lesions (59.0% vs. 69.9%, P = 0.0089), particularly maternal vascular malperfusion lesions (20.7% vs. 28.2%, P = 0.0127) but no difference in perinatal outcomes. Conclusion(s): COVID-19 infection earlier in pregnancy is associated with poorer perinatal outcomes. Vaccination reduced the rate of placental lesions but did not change adverse neonatal outcomes.

Reproductive intentions of Russians with children at the beginning of COVID-19 pandemic

The paper studies the reproductive intentions of the Russians who already have at least one child before and during the quarantine restrictions (lockdowns) due to COVID-19. Binary choice logistic models and a set of machine learning models were evaluated on the data from the Person, Family, Society survey conducted in March-May 2020. Modeling of the respondents ' intentions to have more children in the short term (3 years) and the long term (more than 3 years) showed that external shocks such as the COVID-19 pandemic and the strict quarantine regulations associated with it had an impact on fertility intentions, but only in the short term. These external shocks were less significant than such factors as age of the respondent;the number of children already born;availability of housing needed to expand the family;the maternity capital program availability, which includes the opportunity to improve housing conditions after the birth of children. As Russians with children showed the increase of the probability of having additional children after April 2020, we conclude that the effect of COVID-19 on reproductive intentions was acyclical. The estimation of models with heterogeneous effects showed that the pandemic had a stronger impact on respondents with above-average household incomes.

The Great War (1914-1918): a demographic catastrophe. Immediate and long-term consequences of the Second World War on the French population

Since the start of the third millennium, France has witnessed two significant mortality crises: the first, due to the period of excessively high temperatures experienced in August 2003;and the second, due to the still ongoing effects of the COVID-19 pandemic. These events have resulted in considerable numbers of excess deaths. But, compared with the demographic consequences of the First World War over the short, medium and long term, they appear almost anecdotal. This educational fact file looks in detail at the effects of the 1914-1918 war on the French population. The first part of the file paints a picture of the demographic situation in Metropolitan France just prior to the conflict, before we move on to look at the scale of the loss of life, which wiped out generations of young men (part 2), the significant reduction in fertility due to the separation of couples during the conflict (part 3), and the major and permanent consequences of excess deaths and a lower birth rate on the population pyramid of France (part 4). Lastly, in part 5, we conclude by putting the significance of the crises associated with the heatwave of 2003 and the COVID-19 pandemic into perspective. © 2022 Authors. All rights reserved.

Geodemographic classification of the North Caucasus Federal District Regions

Introduction. The dynamics of the vital movement of the population of the North Caucasus for 2005-2020 is investigated. Research methods and materials. Both traditional and the latest geographic research methods are used - comparative geographical, spatial analysis, statistical, GIS technologies, population surveys, etc. Research results. The conducted studies have shown that despite the apparent well-being, a tense demographic situation is developing in the North Caucasus. Favorable demographic results are obtained only at the expense of three subjects - Dagestan, Ingushetia and Chechnya. In other regions, narrowed and negative reproduction is observed. The natural increase is getting lower and lower. The small generation born in the 1990s reached the fertile age. COVID-19 restrictions and a crisis in the economy have led to an even greater decline in the birth rate and an increase in mortality. The conducted geodemographic classification of the regions of the North Caucasus showed that the most favorable situation is observed in Ingushetia, the situation is slightly worse in Chechnya and Dagestan, narrowed reproduction in Kabardino-Balkaria and Karachay-Cherkessia and the most tense situation is in North Ossetia and the Stavropol Territory. Conclusion. To improve the situation, a differentiated approach is needed to different regions in the demographic sphere, the creation of new workplaces. The outflow of the able-bodied population from the regions of the North Caucasus leads to a violation of the population age composition and, thereby, undermines the fertility of the population. This leads to a decrease in the birth rate and, accordingly, natural increase. Resume. The article presents the results of studies of the natural movement of the population of Russia and the North Caucasus Federal District. At the same time, the multi-scale method of research and geodemographic classification was taken as the basis. It has been established that relatively favorable results on the scale of Russia were achieved in the North Caucasus Federal District, and on the scale of the North Caucasian Federal District - in Ingushetia, Chechnya and Dagestan. It was determined that along with the traditional factors of mortality, the factor of infectious morbidity began to play a significant role. It is shown that at the same time, mortality in working age has increased. It was revealed that there is a significant territorial differentiation of the natural movement of the population both in Russia as a whole and in the North Caucasus Federal District. The results of the research can be useful in developing programs for further demographic development of the regions. © 2022 North Caucasian Institute of Mining and Metallurgy, State Technological University. All rights reserved.

Human welfare & emergencies: Education, natality, and violence

I identify changes in human action during emergencies such as heavy precipitation and shelter-in-place orders. In two chapters I explore the effects of precipitation on educational attainment and birth rates as residential broadband access increases. In my third chapter I identify the movement of pets in and out of the home as a trigger for domestic violence during the COVID-19 lockdown. I estimate difference-in-difference regressions with panel data, coming to three conclusions. First: educational attainment in Appalachia is stunted by precipitation, as students have difficulty getting to school in bad weather. As this historically under-educated region of the US gains internet access, the negative effects of rain and snow disappear. Second: there is little evidence that precipitation increases natality. What little evidence of this "blizzard baby" phenomenon I do find is negated by mobile internet access, which decreases births nine months after high precipitation. Third: during COVID-19 shelter-in-place orders, domestic violence decreases after pets are surrendered to local shelters and increases when pets are confiscated. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The post-pandemic re-organization of birth centres and its impact on perinatal asphyxia in the province of Reggio Emilia

Objective. The pandemic forced the re-organization of birth hospitals in the province of Reggio Emilia. In 2018 there were four difference birth centres, in 2021 only two out of four were still working. The OBJECTIVE of the study was to evaluate if the centralization of birth centres had worsened the stillbirth rate and perinatal asphyxia (PA) outcome during the SARSCoV- 2 pandemic period (years 2020-21) compared to the pre-pandemic period (years 2018-19). Materials and Methods. Retrospective review of birth rate, recovery for PA rate and stillbirth rate in the province of Reggio Emilia. Results. Statistical data showed a decrease of overall births from 2018 to 2021 (7516 newborns in 2018-19 to 6363 in 2020- 21), in accordance with the national trend. The percentage of newborns in the NICU in Reggio Emilia increased from the pre-pandemic period (59.66%) to the pandemic period (83.66%). Regarding the stillbirth rate, we observed a decrease from the pre-pandemic period (3.20%) to the pandemic period (2.36%). As far as concerned the PA rate, the percentage showed a reduction from the pre-pandemic (0.44%) to the pandemic period (0.36%). We also observed a decrease of the hypoxic-ischemic encephalopathy (HIE) rate from 0.16% to 0.12%. Finally, three different outcomes were evaluated in patients admitted for perinatal asphyxia: mortality, brain imaging lesions and seizures. During the pandemic we observed a significant decrease in all of these (Table 1). Conclusions. Centralization of birth centres did not worsen perinatal diseases as far as concerns stillbirth, PA and HIE rate. On the contrary, we observed an enhancing of patients' outcomes.

Geodemographic classification of the North Caucasus Federal District Regions

Introduction. The dynamics of the vital movement of the population of the North Caucasus for 2005-2020 is investigated. Research methods and materials. Both traditional and the latest geographic research methods are used - comparative geographical, spatial analysis, statistical, GIS technologies, population surveys, etc. Research results. The conducted studies have shown that despite the apparent well-being, a tense demographic situation is developing in the North Caucasus. Favorable demographic results are obtained only at the expense of three subjects - Dagestan, Ingushetia and Chechnya. In other regions, narrowed and negative reproduction is observed. The natural increase is getting lower and lower. The small generation born in the 1990s reached the fertile age. COVID-19 restrictions and a crisis in the economy have led to an even greater decline in the birth rate and an increase in mortality. The conducted geodemographic classification of the regions of the North Caucasus showed that the most favorable situation is observed in Ingushetia, the situation is slightly worse in Chechnya and Dagestan, narrowed reproduction in Kabardino-Balkaria and Karachay-Cherkessia and the most tense situation is in North Ossetia and the Stavropol Territory. Conclusion. To improve the situation, a differentiated approach is needed to different regions in the demographic sphere, the creation of new workplaces. The outflow of the able-bodied population from the regions of the North Caucasus leads to a violation of the population age composition and, thereby, undermines the fertility of the population. This leads to a decrease in the birth rate and, accordingly, natural increase. Resume. The article presents the results of studies of the natural movement of the population of Russia and the North Caucasus Federal District. At the same time, the multi-scale method of research and geodemographic classification was taken as the basis. It has been established that relatively favorable results on the scale of Russia were achieved in the North Caucasus Federal District, and on the scale of the North Caucasian Federal District - in Ingushetia, Chechnya and Dagestan. It was determined that along with the traditional factors of mortality, the factor of infectious morbidity began to play a significant role. It is shown that at the same time, mortality in working age has increased. It was revealed that there is a significant territorial differentiation of the natural movement of the population both in Russia as a whole and in the North Caucasus Federal District. The results of the research can be useful in developing programs for further demographic development of the regions. © 2022 North Caucasian Institute of Mining and Metallurgy, State Technological University. All rights reserved.

Birth rate among women with fear of childbirth: a nationwide register-based cohort study in Finland.

PURPOSE: The association between fear of childbirth (FOC) and subsequent birth rate is not well studied. The aim of this study is to evaluate the birth rate, and risk for second pregnancy ending in delivery among women with FOC compared to women without FOC in their first pregnancy. METHODS: Data from the National Medical Birth Register were used to evaluate the birth rate after the first pregnancy in women with FOC. Cox regression model was used to evaluate the risk for the second pregnancy ending in delivery in women with FOC compared to reference individuals without FOC. The results were interpreted with adjusted hazard ratios (aHRs) and 95% confidence intervals (CI). RESULTS: In total, 375,619 women were included in this study. Of these, 9660 (2.6%) had FOC in the first pregnancy (exposed group), and 365,959 (97.4%) had no FOC (non-exposed group). In the exposed group, 3600 (37.3%) women had second pregnancy ending in delivery during the study period, and 206,347 (56.4%) had the second pregnancy ending in delivery in the non-exposed group. The risk for the second pregnancy ending in delivery was lower among women with FOC (aHR 0.61, CI 0.59-0.63). CONCLUSIONS: FOC complicates pregnancy and delivery and is strongly associated with lower likelihood to get pregnant again. Therefore, more research should be focused on the optimal prevention of FOC using a standardized procedure of care and treatment for women with FOC.

Effect of an Intensive Nurse Home Visiting Program on Adverse Birth Outcomes in a Medicaid-Eligible Population: A Randomized Clinical Trial

Mortality, morbidity, and childhood developmental challenges can all result fromadverse birth outcomes. In regard to these outcomes, the United States exhibits significant racial and socioeconomic inequities, and effective interventions targeting lowincome pregnant people are necessary. A recommendation for expanding home visiting programs has been provided with the hope of improving newborn andmaternal outcomes, and substantial federal funding is granted to these programs via theMaternal, Infant, and Early Childhood Home Visiting program. The Nurse-Family Partnership program is a nurse home visiting service targeting nulliparous low-income families during pregnancy and early childhood. The state of South Carolina's preterm birth rate in 2016 was the sixth highest in the United States, which motivated the state to offer program services to Medicaid-eligible nulliparous women through aMedicaid waiver. This study's objective was to determine effects of intensive nurse home visiting programs on the composite outcome of small for gestational age, low birth weight, preterm birth, and perinatal mortality. This randomized clinical trial assigned participants in a 2:1 ratio to either a control group or an intervention group, which was offered access to the program. The control group was offered a list of community-based resources available to them, and all participants received usual care for South Carolina. Inclusion criteria were nulliparous pregnancy of less than 28 weeks' gestation, income-eligible for Medicaid during pregnancy, and residence in a program-served county. Self-referral, or referral through schools, clinicians, and Medicaid led patients to 1 of 9 program-implementing sites. The intervention, which consisted of a prenatal and early childhood home visiting program, was carried out by nurses conducting home visits with participants from pregnancy through the first 2 years of the child's life. The nurses used activities tailored to the clients' strengths, preferences, and risks via educational tools, motivational interviews, goal setting related to prenatal health, health assessments, maternal life course, and child health and development. Utilization of health care was encouraged when needed, coupled with referrals to health and social services. Ideal visits ranged from weekly 60- to 90-minute sessions for 4 weeks following enrollment and then every other week leading up to delivery. Nurse training encouraged flexible support of clients for more or fewer visits as necessary, with services provided in both Spanish and English, with other translation options. Enrollment for the study began on April 1, 2016, but concerns for the COVID-19 pandemic led to a recruitment halt on March 17, 2020. However, 95% of the target recruitment goal had already occurred, and the remaining home visits were conducted via telehealth. A total of 3319 patients were eligible and opted for enrollment. Upon time of enrollment, 18% of participants were younger than 19 years, with 54.8% of them between 19 and 24 years old. Self-reported race and ethnicity statistics were reported as 55.2% non-Hispanic Black, and 22.4% had not completed high school. Body mass index of greater than 30 kg/m2 was present in 34.5%, and smoking 3 months before pregnancy was reported in 25.8% of participants. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Ocular Evaluation of Newborns Whose Mother Died Due to Sars-Cov-2 (Covid-19) Infection

BACKGROUND AND AIM: In the pregnancies of severe SARS-CoV-2, which resulted in maternal death, the fetus is more vulnarable in terms of being affected by systemic complications. The aim of this study is to evaluate the ocular findings of newborns whose mothers passed away due to SARS-CoV-2, by considering possible different modes of involvement. METHOD(S): Single-center retrospective observational study. A total of 9 newborns were evaluated ophthalmologically. Demographic data, polymerase chain reaction(PCR) test results and ophthalmological findings were collected. RESULT(S): Gestational age at ranged from 27 to 37 weeks (mean 31,55 +/- 3,16 weeks), and the birth weights varied from 990 g to 2160 g (mean 1481+/-397g). Mean ICU stay was 28.7 days. Positive PCR was positive for SARS-CoV-2 in 2 newborns.Ocular examination was performed within the first 30 days. Neonatal conjunctivitis (n=2), corneal edema (n=1), retinopathy of prematurity (ROP) (n=6) (treatment requiring ROP n=3) and intraretinal bleeding(n=2)was observed.One of the babies with a positive result had ROP that did not require treatment, and the other had conjunctivitis with intraretinal hemorrhage. CONCLUSION(S): Despite numerous studies, the impact of SARS-CoV-2 on the fetus remains unclear in many ways. Case reports indicate that maternal-fetal vertical transmission is not common.Exposure to intrauterine inflammation and placental changes may cause multisystemic problems in the neonatal period in exposed infants.The need for intensive care in the mother increases the possibility of fetal vascular malperfusion, premature birth rate and related problems.The detected ocular pathologies are not specific to SARS-CoV-2 infection.Additional controlled studies are required to correlate the findings with the disease. (Figure Presented).

Clinical Characteristics and Outcomes of 104 Pregnant Women with Coronavirus Disease 2019 during delta wave, single-center observational study

Background. Pregnancy is one of the risk factor associated with the severity of Coronavirus Disease 2019 (COVID-19). The perinatal complications also known to be increased when pregnant women become infected with COVID-19. However, there were not enough studies involving pregnant women with severe COVID-19, especially in Korea. The purpose of this study was to analyze the cases of pregnant women with COVID-19 infection with various severities, and to compare and describe the clinical course and the effects on pregnancy and perinatal prognosis according to severity. Methods. We retrospectively analyzed the medical records of adults 18 years of age or older who were PCR-confirmed COVID-19 and proved pregnancy, from February 1, 2020 to January 31, 2022. Through the epidemiological investigation report, the patient's medical history, obstetric history, date of diagnosis and variants of COVID-19, and vaccination history were collected. Clinical symptoms, oxygen demand, chest imagings, treatment, perinatal complications, fetal conditions, delivery results, and complications were collected through medical records. Results. A total of 104 pregnant women with PCR-confirmed COVID-19 were hospitalized. The age at the time of diagnosis was 33 +/-4.24 (Mean +/- SD) years, and 4 patients (3.8%) were vaccinated with the COVID-19 vaccine. During hospital stay, the most common complaints were cough (99 patients, 95.2%) and fever (85 patients, 81.7%). Oxygen was applied in 40 patients (38.5%), and in 19 patients (18.3%) in severe cases. Thirty-seven patients (35.6%) delivered during isolation treatment. Critical COVID-19 patients group has statisticaly significant higher rate of preterm delivery compared with mild COVID-19 patient group (31.6 % versus 6.3 %, p=0.009). One patient died from septic shock caused by multidrug-resistant Acinetobacter baumannii during treatment. A total of 39 babies were born, of which 4 received postnatal oxygen therapy. Conclusion. Pregnant women with COVID-19 had higher mortality rates, aggravation rates, and premature birth rates compared to non-pregnant patients of the same age. In a situation where effective and safe COVID-19 treatments for pregnant women are limited, it is necessary to increase the vaccination rate to prevent undesired outcomes in both mother and child.

Trends of the health and demographic indicators in the arctic regions of the Republic of Sakha (Yakutia) over 20 year (2000–2020)

BACKGROUND: The implementation of the major federal projects in the Arctic region of the Russian Federation claims particular attention to the indicators of the quality of life and the state of population health in these regions. Health and demographic indicators can be one of the available tools for public health monitoring. AIM: To analyze the main trends of the health and demographic processes in the arctic regions of the Republic of Sakha (Yakutia) over 20 year (2000–2020). MATERIAL AND METHODS: The data of the Territorial Body of the Federal State Statistics Service in the Republic of Sakha (Yakutia), YARMIATS for 2000–2020 were analyzed. An approximate 95% confidence interval was calculated over 20 years (2000–2019), the average population growth rate was estimated by a chain method for time series (data for 2020 year are presented separately due to the deformation of the pattern of demographic indicators due to the epidemic SARS-CoV-2). A linear regression analysis of IBM SPSS Statistics 26 was performed to assess the birth and mortality rate trends. RESULTS: From 2000–2020, the population of the Arctic region of the Republic of Sakha (Yakutia) decreased by 22% due to migration and high mortality rates. Deaths by external causes occupy approximately 20% of the structure of the all-cause mortality rate. Dynamically, the decrease in the number of infant mortalities was noticed due to the effective routing of preg-nant women and improvement of the maternity service in the region. CONCLUSION: The analysis of the medical and demographic indicators showed positive and negative trends in the Arctic regions’ public health of the Republic of Sakha (Yakutia). The system of the healthcare organization in the regions is to be im-proved. Also, these regions, which possess all the features of the healthcare systems with low-density population territories, can become a model for the regional and federal projects approbated in the field of Arctic medicine. © Authors, 2022.

Generations: Does When You Are Born Shape Who You Are? Bobby Duffy, Atlantic Books, London, 2021, 336 pp., hbk £20, ISBN 13: 9781786499721

First published by Atlantis Book in September 2021, this book aims to explore current intergenerational ageism and stereotyping, promoting thorough analyses of current societal issues. Chapters Four to Six include discussions of mental health concerns across the population, health behaviours, and decline of marriage and birth rate across new and old generations. [...]in its closing chapters (Chapters Ten and Eleven), the author reflects on the segregation between young and old, and on the human tendency to organise experience in a way that it is easy to comprehend, where cognitive shortcuts and shortcomings are often causes for biased views of our experience (Chapter Eleven).

Evaluation of the impact of COVID-19 pandemia on pediatric urological operations and the number of outpatient clinic patients in a province with, the highest birth rate Turkey

Investigation of the effect of Covid-19 pandemic on pediatric urology operations in Şanliurfa province, where the birth rate is the highest in Turkey : Objective: The aim of this study is to investigate the effect of the COVID-19 pandemic on pediatric urology operations. Materials and Methods: Hospital records of pediatric patients who applied to Harran University Medical Faculty Pediatric Urology Clinic during the pandemic period (19 March-22 December 2020) and pre-pandemic period (19 March-22 December 2019) and were operated with precautions were retrospectively analyzed. The number of outpatient clinic patients during and before the pandemic period, the number of operations and indications, and the types of surgery were compared. The names and numbers of surgical procedures are listed according to the European Association of Urology (EAU) priority classification. Results: During the COVID-19 pandemic period, the number of pediatric patients admitted to the outpatient clinic was 2361, while it was 5214 in the same period before the pandemic. It was observed that the number of patients who applied to the outpatient clinic decreased by 54.8% during the pandemic period. While the total number of pediatric operations was 316 during the pandemic period, it was 741 before the pandemic period. When the pandemic period was compared with the pre-pandemic period, a 58.4% reduction was observed in pediatric urology operations. The number of emergency operations was 69 during the pandemic period and 85 in the pre-pandemic period. During the pandemic period, the reduction in emergency operations was 18.8%. No complications were observed due to COVID-19 in any of the operated patients. Conclusion: During the COVID-19 epidemic, it was observed that the number of pediatric urology outpatient clinic admissions and surgeries in our hospital decreased. In cases where urgent interventions were required, adequate precautions were taken, and surgical operations could be applied without any contamination and mortality. Keywords: Coronavirus, coronavirus disease 2019, pandemic hospital, pediatric urological surgery.Alternate :et Amaç: Bu çalışmada COVID-19 pandemisinin pediatrik üroloji ameliyatlarına etkisini araştırmayı amaçladık. Materyal ve metod: Tıp Fakültesi Pediatrik Üroloji Kliniği’ne pandemi döneminde (19 Mart-22 Aralık 2020) ve pandemi öncesi dönemde (19 Mart-22 Aralık 2019) polikliniğe başvuran ve önlemler eşliğinde ameliyat edilen pediatrik hastaların hastane kayıtları retrospektif incelendi. Pandemi dönemi ve öncesi poliklinik hasta sayıları, ameliyat sayıları ve endikasyonları, ameliyat türleri karşılaştırıldı. Cerrahi prosedürlerin isimleri ve sayılar Avrupa Üroloji Derneği (EAU) öncelik sınıflandırmasına göre listelendi. Bulgular: COVID-19 pandemisi döneminde polikliniğe pediatrik hasta başvuru sayısı 2361 iken pandemi öncesi aynı dönemde 5214 idi. Pandemi döneminde polikliniğe başvuran hasta sayısının % 54,8 azaldığı görüldü. Pandemi döneminde toplam pediatrik ameliyat sayısı 316, pandemi dönemi öncesi 741 idi. Pandemi dönemi, pandemi öncesi ile karşılaştırıldığında pediatrik üroloji ameliyatlarında %58,4 azalma olduğu görüldü. Pandemi döneminde acil ameliyat sayısı 69, pandemi öncesi dönemde 85 idi. Pandemi döneminde acil ameliyatlardaki azalma %18,8 idi. Opere edilen hiçbir hastada COVID-19 nedeniyle komplikasyon izlenmedi. Sonuç: COVID-19 salgını sırasında hastanemizdeki pediatrik üroloji poliklinik başvurusu ve ameliyat sayısının azalmış olduğu görüldü. Acil müdahalelerin gerekli olduğu olgularda yeterli önlemler alınarak, herhangi bir kontaminasyon ve mortalite olmaksızın cerrahi operasyonlarının uygulanabilirliği görüldü.

Population Growth and Population Aging in Alberta Municipalities

Between 2011 and 2021, a significant number of Alberta’s towns, villages and rural areas experienced population stagnation or decline, while the cities and many nearby municipalities continued to grow. As smaller municipalities’ populations shrink or fail to grow, they also become disproportionately older—trends that can threaten tax bases and community involvement. This demographic trend has two main causes. First, Alberta’s cities offer increasing employment opportunities in the rapidly growing service sector, while many smaller communities have seen declines in employment in the resource and manufacturing sectors important to their economies and struggle to attract new industries. Thus, as in the rest of the country, towns, villages and municipal districts lose residents, especially young people, to where the jobs are. Second, while the province’s birth rate continues to decline, and overall growth has come to depend almost as much on international immigration as on natural growth, newcomers to the province tend to prefer the major urban areas. Following Alberta’s boom years, the last decade saw decreased migration from other provinces into Alberta and a declining fertility rate. The province’s economy is now on the mend, with the highest employment rate in Canada;however, the once-high birth rates and elevated rates of internal migration from other provinces are unlikely to return. The pace of growth will depend on Alberta’s ability to attract a healthy share of the many new immigrants Canada intends to welcome over the decade ahead. Alberta’s smaller municipalities, in turn, need strategies to attract immigrants. For this, they will require employment opportunities and dedicated resources to assist newcomers. Manitoba has had success in doing this and may offer Alberta an example of how to proceed. Some emerging economic and social trends may work to the benefit of smaller municipalities. For example, industries that require large amounts of land or significant storage facilities often opt to locate outside the big cities. New developments in agriculture and energy, especially in geothermal and hydrogen, may open new opportunities for growth in towns and rural areas. While Alberta is unlikely to replicate B.C.’s success in attracting retirees, the popularity of outdoor recreation provides a chance for many municipalities to attract new residents. Although changes in work practices brought about by the COVID-19 pandemic make future trends difficult to predict, as people continue to work at a distance from their places of employment, it is possible that Alberta could see a demographic shift away from the urban centres. Smaller municipalities may attract both city dwellers and immigrants seeking the benefits of life away from the cities, including bigger and less costly properties. Nevertheless, slower growth and population aging are likely to continue, and communities must use the coming years to prepare, putting in place necessary services, especially those related to health care. This is especially vital in communities far from the urban centres.

FEATURES OF MODERN OBSTETRICS

The paper shows the changes that have determined the features of modern obstetrics. A sharp decline in birth rates and the elements of depopulation in the country have created new conditions for reforming healthcare and modern obstetrics. Each pregnancy and each child have acquired a special value. In the country, prenatal diagnosis has been introduced and neonatology has evolved. The obstetric strategy has become more active;surgical delivery has increased significantly. Caesarean sections are performed 8—10 times more often. The intensive care and rehabilitation of premature and sick newborns are being actively improved. Maternal and infant mortalities have decreased by 8—10 and 5—6 times, respectively. However, there have been new problems: an increase in the number of bleedings due to placenta previa and placenta increta in pregnant women who have undergone a caesarean section. Antibiotics have become less effective;the number of postpartum infectious diseases has increased. More and more babies are being born premature. The role of extragenital diseases in obstetric pathology has increased;this is especially clearly manifested during the coronavirus pandemic. Treatment for infertility has been improved;assisted reproductive technologies, including in vitro fertilization, are being actively developed. In recent years, much has been done to improve and develop the foundation of obstetrics;93 perinatal centers are functioning, all obstetric facilities have been provided with modern diagnostic and medical equipment. Conclusion: Modern obstetrics has a perinatal direction. Obstetricians are actively involved in solving the demographic problems facing the country. Modern obstetric strategies can reduce maternal and infant morbidity and mortality.

Answering to social issues – Delivery of mRNA vaccines and therapeutics

Pandemic of coronavirus infectious diseaseCOVID-19 has exerted serious impacts on society and medical serves. Two messenger RNAmRNAvaccines were approved within one year after the outbreak of COVID-19, providing a hopeful solution to this issue. Meanwhile, Japan lags behind in vaccine development, which imposes economic burden and causes limited supply of vaccines. Along with vaccines for preventing infectious diseases, other medical fields are potential targets of mRNA therapeuticssuccessful outcomes have been reported in clinical trials of cancer vaccines and immunotherapy, genome editing, and protein replacement therapy, which will help to address medical issues associated with the declining birthrate and the aging population in the future. Japan has huge potentials to contribute to the field of mRNA vaccines and therapeutics, especially by utilizing its original technologies in drug delivery systemDDS. Notably, DDS, as well as chemical modification of mRNA, has played substantial roles in the development of mRNA COVID-19 vaccines. This review focuses on mRNA delivery systems, including synthetic nanoparticles from lipids and polymers and nature-derived systems, such as extracellular vesicles and naked mRNA.