ABSTRACT
Aims: The Covid-19 pandemic and subsequent restrictions impacted both health outcomes and clinical practice. We explored the impact on the diabetes antenatal clinic (DANC) attendance and outcomes. Method(s): Pre and during pandemic periods were defined as January 2019 to February 2020 and March 2020 to March 2022, respectively. DANC attendance, maternal and perinatal data were analysed. Adverse neonatal outcomes included stillbirth, neonatal hypoglycaemia, jaundice, shoulder dystocia and respiratory distress. Result(s): DANC attendance increased in the pandemic compared to the pre-pandemic period (297 (Interquartile range (IQR) 269-358) vs 196 (IQR 176-211) monthly, p < 0.001) with 36.7% (IQR 33-49) virtual appointments, representing a 34% overall increase. Body mass index (BMI) increased (29.7 kg/m2 (IQR 26.4-32.2) vs 31.4 kg/ m2 (IQR 26.5-34.2)) during the pandemic (p = 0.007), but maternal age and parity remained unchanged. There was no difference in gestational age at delivery;however, induction rates reduced from 58.5% to 37.5% (p = 0.0009) and spontaneous vaginal deliveries increased from 13.7% to 34.5% during the pandemic (p = 0.0004). Instrumental deliveries reduced from 21.5% to 11.3% (p = 0.03) but there was no change in number of caesarean sections including emergency ones. There was no difference in the rates of macrosomia or neonatal admissions. There was an overall reduction in adverse neonatal outcomes (37/102 (36.2%) vs 33/142 (23.2%) p = 0.03). Conclusion(s): Clinic numbers and maternal BMI increased during the pandemic. However, delivery and perinatal outcomes improved. Out data are reassuring and align with other studies indicating maternity outcomes did not deteriorate during the pandemic, possibly explained by improved care provision and organisation culture under crisis.
ABSTRACT
BACKGROUND: A comprehensive screening at delivery revealed that roughly 14% of pregnant women who tested positive for COVID-19 did not exhibit any symptoms. The SARS-CoV-2 antigen swab test is frequently utilized as a diagnostic technique. Inadequate implementation of health protocol compliance can enhance the vulnerability of a community to the COVID-19 virus, according to previous findings. This suggests that these health protocol compliance and the vaccination program are important for preventing and controlling the spread of the virus. AIM: This study aims to determine the relationship of vaccination history and health protocol compliance with positive antigen swab results among pregnant women at the Community Health Center in Medan. METHOD(S): This is a cross-sectional and observational study that was conducted in February 2022 at the Community Health Center in Medan, North Sumatra, Indonesia. Two hundred pregnant women who met the inclusion and exclusion criteria make up the sample population. Antigen sampling for SARS-CoV-2 was performed in the Pramita laboratory. Following the collection and processing of sample and antigen swab data, IBM SPSS version was utilized to conduct statistical analysis. RESULT(S): The result showed that four of the pregnant women were infected with COVID-19, and they accounted for 2% of the sample population. The health protocol carried out by pregnant women was not significantly related to the swab results. Therefore, vaccination history had no significant association with COVID-19 symptoms, but people who received vaccines had more negative swab test results compared to those who did not, where three out of four positive samples were unvaccinated. CONCLUSION(S): Based on the results, only 2% of pregnant women were infected with COVID-19 at the Community Health Centre in Medan, because this study was carried out when COVID-19 cases had decreased. The statistical analysis results showed that the history of vaccination was not significantly related to SARS-CoV-2 antigen swab results. However, there was a clinical tendency that vaccines can reduce the number of positive cases, where three out of four positive samples were not vaccinated.Copyright © 2023 Sarma Nursani Lumbanraja, Reni Hayati, Khairani Sukatendel, Johny Marpaung, Muhammad Rusda, Edy Ardiansyah.
ABSTRACT
Objectives: Severe acute respiratory syndrome-coronavirus 2/COVID-19 infection is still a global concern, with pregnant women are considered as vulnerable population. Until now, the characteristics of pregnant women in Indonesia who are infected with COVID-19, as well as pregnancy and neonatal outcomes, are still unknown. This study aims to obtain national data, which are expected to be useful for the prevention and management of COVID-19 in pregnant women in Indonesia. Method(s): There were 1,427 patients recruited in this retrospective multicenter study. This study involved 11 hospitals in 10 provinces in Indonesia and was carried out using secondary patient data from April 2020 to July 2021. COVID-19 severity was differentiated into asymptomatic-to-mild symptoms and moderate-to-severe symptoms. The collected data include maternal characteristics, laboratory examinations, imaging, pregnancy outcomes, and neonatal outcomes. Result(s): Leukocyte, platelets, basophil, neutrophils segment, lymphocytes, monocytes, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), urea, and creatinine were found to be significantly associated with severity differences (p < 0.05). Moderate-severe symptoms of COVID-19 also shown to have suggestive pneumonia findings on chest X-ray findings. Patients with asymptomatic-to-mild symptoms had significantly (p < 0.001) higher recovery rate, shorter hospital stay, less intensive care unit (ICU) admission, and had more vaginal delivery. Neonates from mother with mild symptoms also had significantly (p < 0.001) higher survival rate, higher birth weight, and higher APGAR score. Conclusion(s): Several laboratory and radiology components, as well as maternal and neonatal outcomes are related to the severity of COVID-19 in pregnant women in Indonesia.Copyright © The Author(s). 2023.
ABSTRACT
Introduction: Critically-ill obstetric patients admitted to general intensive care units (ICU) are a rare and unique population for whom excellent care is essential to prevent devastating physical and psychological morbidity. Admissions are often unanticipated and can present challenges to obstetric and intensive care MDTs. 2018 Enhanced Maternal Care (EMC) Guidelines provide standards for caring for these women, and the 2022 Ockenden review exposed the association of peripartum ICU admission with undertreated psychological trauma and a desire for individualised debriefing [1,2]. We audited the care of obstetric admissions to general ICUs in our quaternary centre. We sought evidence of psychological morbidity to improve follow-up pathways in line with 2022 Ockenden actions. Method(s): Retrospective online case note review of maternity admissions to general ICUs between 1/1/2021-1/1/2022 compared to EMC audit standards. Exclusion criteria: <22/40 gestation, >6/52 postpartum and admissions to our level 2 labour ward high dependency unit. Result(s): 25 patients were admitted to general ICUs over 12 months. Median age was 35-39 years, mean parity was 1. The commonest indication was obstetric haemorrhage (n = 10). 15 of 25 patients required level 3 care, median length of stay was 1.5 days. Documentation of daily obstetric MDT ward round was variable, as was mother-baby contact. 0 of 25 women were seen in obstetric anaesthesia clinic after discharge, only 1 received outpatient ICU follow-up. 50% of postnatal admissions (n = 14) had documentation of significant psychological distress. In response a local checklist was developed with key colleagues to support collaborative working and standardise quality care. It includes automatic referral into obstetric anaesthesia clinic and access to a novel perinatal mental health service. Discussion(s): A peripartum admission to ICU is highly likely to be experienced as traumatic [2]. The incidence of obstetric ICU admissions may increase in the context of greater clinical complexity of the UK pregnant population and COVID-19, whilst the non-anaesthetic ICU workforce may have little obstetric training. Obstetric anaesthetists are therefore uniquely skilled to facilitate quality resuscitation and referral to ICU, but gold-standard holistic care extends beyond admission. We believe regular audit and dedicated local care pathways which incorporate proactive debriefing and psychological health can improve the care of this important group of women.Copyright © 2023 Elsevier Ltd
ABSTRACT
Objectives: We aimed to demonstrate the difference between the premenopausal and postmenopausal women in respect of the clinical course and outcome of the Covid-19 disease. In addition, we investigated the epidemiological and hormonal factors which may have an influence on the progression, severity and mortality of the disease. Study design: A cross-sectional study. Main Outcome Measure(s): Our primary outcome was to demonstrate the poor clinical course and outcome of the Covid-19 disease in the postmenopausal women. Our secondary outcome was to establish the contribution of the hormonal status of the patients to the clinical course of the Covid-19 disease. Result(s): In our cohort, 86 women had mild, 128 women had moderate and 53 women had severe Covid-19 disease. 101 women were at premenopausal state while 152 women were at postmenopausal state. There was a statistically significant difference between the patients with mild, moderate and severe Covid-19 disease with respect to age, BMI, gravidity, parity, smoking, co-morbidities, being in pre-menopausal period, O2 saturation, diastolic blood pressure, parameters of complete blood count, biochemical tests, LH, FSH, E2, DHEA-S, length of hospital stay, body temperature, and the percentage of patients with dyspnea. In the total group, being one year younger decreased the odds of having severe Covid-19 disease 0.338 fold relative to the mild disease (CI: 0.164-0.697, p=0.003). Even though statistically less significant, younger age has a positive impact for the postmenopausal group (OR: 0.378, CI: 0.157-0.910, p=0.030). In the total group, the decrease in the serum DHEA-S level was associated with a 2.604 fold increase in the odds of having severe Covid-19 disease relative to the mild disease (CI:1.254-5.410, p=0.010). For the pre-menopausal group of patients, the decrease in serum DHEA-S level increased the odds of having severe disease by 3.864 fold (CI: 1.269-11.764, p=0.017). In the total group, 1 unit increase in the level of serum LH increased the odds of having mild disease compared to severe disease by 2.821 fold (CI:1.002-5.410, p=0.050). Conclusion(s): The prognosis of Covid-19 disease is more favorable in the premenopausal women with higher serum E2 levels compared to the postmenopausal women. The age and serum levels of DHEA-S and LH are important predictors of the severity of Covid-19 infection for women.Copyright © 2023
ABSTRACT
Background: A steep increase in the use of delivery of virtual care occurred during the COVID-19 public health emergency (PHE) because of easing up of payment and coverage restrictions. With the end of PHE, there is uncertainty regarding continued coverage and payment parity for the virtual care services. Methods: On November 8, 2022, The Mass General Brigham held the Third Annual Virtual Care Symposium: Demystifying Clinical Appropriateness in Virtual Care and What's Ahead for Pay Parity. Results: In one of the panels, experts from Mayo Clinic led by Dr. Bart Demaerschalk discussed key issues related to "Payment and Coverage Parity for Virtual Care and In-Person Care: How Do We Get There?" The discussions centered around current policies around payment and coverage parity for virtual care, including state licensure laws for virtual care delivery and the current evidence base regarding outcomes, costs, and resource utilization associated with virtual care. The panel discussion ended with highlighting next steps targeting policymakers, payers, and industry groups to help strengthen the case for parity. Conclusions: To ensure the continued viability of virtual care delivery, legislators and insurers must address the coverage and payment parity between telehealth and in-person visits. This will require a renewed focus on research on clinical appropriateness, parity, equity and access, and economics of virtual care.
ABSTRACT
This chapter explores the organizations, campaigns, and movements that advocate for gender equity in medicine, equity in specialties with the highest percentages of individuals who identify as women, and those which support women in pediatrics such as the work of the Federation of Pediatric Organizations (FOPO). It discusses these in the context of disparities in compensation, promotions, and research, the disproportionate effects of COVID on women in medicine, as well as the compounded effects of intersectionality in pediatrics. It also reviews studies that raise awareness of gender-based concerns in pediatrics like the Pediatric Life and Career Experience Study (PLACES) study and delves into one of the most recently launched pediatric advocacy groups, ADVANCE PHM. Through these avenues, there has been an increase in the awareness of gender equity and humanization of a profession that has historically had standards that are difficult to live up to and do not reflect the full potential of women who enter the profession. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
ABSTRACT
COVID-19 has affected the population worldwide drastically with a tremendous impact on obstetric population which has led to serious concerns regarding maternal and fetal outcomes. Although there are recommended guidelines regarding delivery and management of complications, due to changes in characteristics of COVID-19 infection, they are constantly changing and evolving. Method(s): Prospective cohort study done during the covid pandemic from 1st April 2020 to 15th Feb 2022 in the department of Obstetrics & Gynecology, SKIMS MCH Srinagar J&K. The parameters measured were severity of covid disease, maternal age, gestational age, parity, blood investigations, mode of delivery, APGAR score, neonatal infection status and post-delivery complications. Result(s): A total of 311 pregnant covid 19 positive patients were included in the study who were actively managed.239 (76.85%) were delivered by casearean section and 72 (23.15%) by NVD. 92% patients had mild symptoms only, 8% had severe symptoms with 1.6% rate of ICU admission and 1.2% mortality rate. 83% delivered at term, 17% had preterm deliveries.8% patients had pneumonitis with positive findings on CT scan.24% patients had anemia, 12% had GDM, 10% had PIH, 10% had IHCOP, 5% had PPH, 1.6% had APH. All the neonates were negative for covid 19. 80% babies had an APGAR score of >= 8/10 at 1 min of birth with a mean birth weight of 2400 g +/- 500. No postdelivery complication was noted. Conclusion(s): Our study concludes that SARS-CoV-2 infection can lead to unfavorable maternal and perinatal outcomes.
ABSTRACT
The aim of the article is to present the position of the Czech government and the society of this country towards the war in Ukraine. The text is an attempt to conduct a comparative analysis of the position of the Czech government and the part of society that has been opposing the government's policy towards Ukraine for some time. The author presented the main consequences of the Czech government's support for Ukraine, which are related to the post-pandemic crisis. These include, above all, problems with the supply of oil, natural gas and nuclear fuel for Czech nuclear power plants. Social problems include high inflation, rising interest rates and rising prices ofbasic commodities. In the summary, synthetic conclusions were drawn that confirm the discrepancies between the government's policy and the position of that part of society.
ABSTRACT
Period poverty is a global community health dilemma that has long been overlooked. This condition is described as having insufficient access to menstrual products, education, and sanitation facilities. Briefly, period poverty means that millions of women are subjected to injustice and inequity due to menstruation. This review aimed to explore the definition, challenges, and effects of period poverty on the community, especially among women at their productive ages. In addition, suggestions to minimize the impact of period poverty are discussed. A search strategy was applied using the keywords "period poverty," "period equity," "period poverty," and "menstrual hygiene" in Google Scholar, ScienceDirect, SpringerLink, MEDLINE, and PubMed electronic databases, journals, and articles on relevant topics. Trained researchers conducted a keyword search from January 2021 to June 2022. Based on the reviewed studies, it has been proven that many countries are still affected by the period stigma and taboo, inadequate exposure to menstrual health and its management, lack of education about menstruation, and shortage of access to menstrual products and facilities. The next step is to reduce and slowly eliminate the period poverty issue by conducting more research to increase clinical evidence and future references. This narrative review could inform policymakers of the magnitude of the burden related to this issue and guide them to develop effective strategies to minimize the impact of poverty, especially during the challenging years of the post-coronavirus disease 2019 era.
ABSTRACT
This study proposes a principal alpha-style factor integrated risk parity strategy that can diversify style risk factors and the stock selection risk of external managers in Fund-of-Funds (FoFs) portfolios. First, we separated the style risk factors and stock-specific sources held by each individual fund. Stock-specific sources, referred to as principal alpha portfolios, are extracted through principal component analysis, where the sources are utilized for risk parity in the alpha division. As the parity portfolio was integrated into both the alpha and style factor divisions, we used a Basin-Hopping two-phase optimization technique, which can mitigate the local optimal trap by exploring the surroundings of the sequential quadratic programming solution secondarily. Through this, a more stable integrated risk parity portfolio can be realized. Finally, the suggested integrated risk parity portfolios were simulated with a global fund dataset. The simulation results from 2006 through June 2022 show a more stable risk-return profile than an independently constructed strategy using style risk factors or principal alpha sources, especially in high volatility and down-market periods, such as a global financial crisis or unexpected events like COVID-19. This study can be applied to various areas covering other FoFs and asset allocation strategies by integrating alpha and factor divisions. © 2023 Elsevier Inc.
ABSTRACT
The understanding of housing insecurity in the context of poverty reduction remains an important area, especially in the conceptualisation emanating from the animal with multiple head metaphor. Poverty is argued to be viewed as an animal with multiple heads in its multidimensional conceptualisation. We contend that a misdiagnosis in the Multidimensional poverty index (MPI) recognises housing insecurity as a leg of living standards (the other two in the MPI are education and health). The argument that housing should be considered as a dimension or a head, according to the Household Housing Insecurity Index (HHII), emanates from the basic needs understanding, where housing stands among food and health, even higher than education. This paper first presents the Household Housing Insecurity Index (HHII) in the context of multidimensional poverty. Then it uses components of the HHII with available data from Statistics South Africa's general household survey to analyse the housing insecurity profile of households in South Africa collected during the covid-19 pandemic. This helps to paint an initial picture of the impact of the pandemic. Initial because there are still lagged effects unfolding beyond the immediate short-run implications. The Regression analysis results show that total household income, the material used for the construction of the house, crowding, gender and population group are significant predictors of household housing insecurity.
ABSTRACT
Background Vaginal bleeding is a common complication that may occur at any time during pregnancy. Up to 22% of women asked at delivery reported that vaginal bleeding occurred at some time during pregnancy. Preterm delivery is the delivery before 37 weeks of gestation, which involves approximately 12% of all pregnancies. If vaginal bleeding happens during pregnancy, some adverse outcomes including mortality before and after birth, low birth weight and preterm delivery will be increased. Vaginal bleeding is associated with two-fold increased risk of preterm delivery. Methods This prospective cohort study included 60 cases of pregnant female with first or second trimester vaginal bleeding at Obstetrics& Gynecology Department, Faculty of Medicine, of Damanhur Medical National Institute. The duration of the study was from April 2021 to April 2022. In the study 4 cases refused to complete the study and other 56 completed. Results There was significant decrease in birth weight and Apgar score with increase severity of vaginal bleeding. There was significant increase in neonatal intensive care unit (NICU) admission, intrauterine growth restriction (IUGR) occurrence and preterm labor with increase severity of vaginal bleeding. There was significant positive correlation between vaginal bleeding and IUGR and NICU admission. There was significant negative correlation between vaginal bleeding and Birth weight and APGAR score. Conclusion It seems that previous COVID-19 infection does not affect greatly pregnancy outcomes associated with vaginal bleeding. Vaginal bleeding was the main parameter affecting pregnancy outcomes.Copyright © 2022 Authors. All rights reserved.
ABSTRACT
From the perspectives of IT Affordances, this paper attempts to explore the influence of the characteristics of live streaming on purchase intention, and to consider the elements required for live streaming service and customers' perceptions thereof in post-COVID-19. Through empirical research, this study establishes a framework emphasizing the major factors promoting customer immersion and the moderating effect of situational involvement that contributes to customer purchase intention in a live stream commerce context. The research model was tested using structural equation model analysis. Based on 428 valid responses, we identify that the quality of live streaming has a direct significant effect on customers' purchase intention. Specifically, relationship between platform stability, customer relationship, anchors' professional knowledge, and purchase intention is significant positive from the Affordance perspectives. The results emphasize the importance of platform stability which allows real-time communication, in-depth interaction, and real scenes for the benefits of sellers using such internet platforms. © 2022 Authors. All rights reserved.
ABSTRACT
The coronavirus disease 2019 (Covid-19), that was later declared pandemic by World Health Organization, had led to panic and fear worldwide. Like many outbreaks caused by viruses, in cheif reason for fear was the infectious agent's potential to be transmitted from pregnant women to their fetuses and newborns. In our study, the hospital records of 117 pregnant women who delivered stillbirths in our clinic between 01.01.2015 and 31.12.2020 were examined. The pregnancy characteristics and perinatal outcomes were examined by making retrospective analysis of the records. Considering six year of the study data, it was observed that the stillbirth rates increased in the pandemic period. One hundred seventeen stillbirth cases that occurred in the last six years were analyzed. The mean age of the pregnant women was 29.64+6 (18-44) and parity was 2.54+1.58 (1-8). Body mass index was calculated as 21.36+3.40 (16-27) average and smoking consumption rate was 9.40% (11/117). Maternal diabetes was detected in 8.54% of the patients (10/117) and pregnancies were complicated by maternal hypertension in 5.12% of the patients (6/117). The average birth weight was 1597+1038 (500-4700) gram. Sixty percent of the deliveries (n=71) were performed by vaginally. Fetal sex was 52.1% male (n=61). The number of deliveries in the past six years was 11780. Almost 1% of the deliveries occurred as stillbirths (117/11780). The unusual stillbirth ratio during the pandemic was 3.1 times higher than the average of pre-pandemic period (2.5vs0.80). In our study, we investigated stillbirth rates before and during the pandemic. Although vertical transmission of Covid-19 has not been reported, the adverse pregnancy and neonatal outcomes have been provided in many studies. Undoubtedly, in obstetrical practice stillbirth is one of the most destructive consequences for pregnant women. Considering the increase in stillbirth rates, we think that pregnant women with adverse perinatal outcomes should be routinely tested for Covid-19, especially during the outbreak.Copyright © 2021 Necati Ozpinar. All rights reserved.
ABSTRACT
Background: The covid-19 pandemic affected family planning management and the sexual and reproductive rights of couples. Objective(s): To determine the factors associated with the interruption of the use of contraceptive methods during the quarantine by COVID-19 in Peruvian women. Method(s): Analytical and cross-sectional study, which included 342 women who used a contraceptive method before the COVID-19 quarantine, to whom a virtual questionnaire disseminated on social networks was applied. Pearson's chi-square evaluated associations between method discontinuation and the factors studied. Result(s): Of the total number of women, 45% discontinued the use of contraceptive methods during the COVID-19 quarantine. The predominant age range was from 18 to 34 years (93.9%). The factors associated with this interruption were age (p = 0.044), marital status (p < 0.001), parity (p < 0.001), sexual relations (p < 0.001), and searching for information by digital means (p = 0.044). The main reason for stopping use was fear of contagion by COVID-19 (42.8%). Conclusion(s): About half of contraceptive method users interrupted their use during the COVID-19 quarantine, and the factors associated with said interruption were personal, reproductive, and informa-tional. Therefore, health personnel must provide comprehensive care for women, especially in health emergencies.Copyright © 2023 Bentham Science Publishers.
ABSTRACT
Aim: There are several methods to diagnose COVID-19. Early diagnosis and treatment are important in pregnant women with COVID-19. This study aims to investigate whether the APRI score is a method that can be used in the diagnosis of COVID-19 in pregnancy. Material(s) and Method(s): A cross-sectional retrospective study was conducted between March 2020 and November 2020. Pregnant women who were found to be COVID-19 positive by the RT-PCR test were included in the study. The same number of healthy pregnant women who were matched for age, BMI, and gestational week without any systemic disease were included as a control group. Age, gravida, parity, gestational week, BMI, mode of delivery, complete blood count, liver function tests, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and APRI scores were evaluated. The sensitivity and specificity of NLR, PLR, and APRI score in the diagnosis of COVID-19 were investigated. Result(s): Gravida, parity, gestational week, body mass index, and rate of previous vaginal delivery were similar between PCR-positive and negative patients. PCR-positive patients had significantly higher APRI scores (0.4+/-0.3 vs 0.2+/-0.0), NLR scores (7.7+/-5.3 vs 4.2+/-1.9) and PLR scores (217.3+/-105.7 vs 140.8+/-57.6) than PCR negative patients. The sensitivity of the NLR to detect COVID-19 was 69.44%, the specificity was 77.5%, the sensitivity of the PLR to detect COVID-19 was 58.33% (CI = 40.8-74.5), and the specificity was 87.5%. The APRI score sensitivity was 80.56%, and specificity was 80.0%. Discussion(s): The APRI score can be useful in predicting COVID-19 infection in pregnant women.Copyright © 2022, Derman Medical Publishing. All rights reserved.
ABSTRACT
Background: Ovarian torsion is a gynecologic emergency that requires surgical intervention to avoid functional loss of the ovary. Our objective was to determine predictors of ovarian preservation in the setting of torsion, primarily time from initial presentation to surgery. Method(s): We conducted a retrospective cohort study of women aged 12-40 who presented to the Emergency Department (ED) at a single institution between 2008 and 2021 and had surgical confirmation of torsion. Cases were identified using diagnosis codes for ovarian torsion, and we performed chart review to confirm inclusion criteria. We compared ovarian preservation by time to surgery after ED presentation. Covariates included age, parity, sonographic doppler flow, presence of ovarian mass, intraoperative attempt at detorsion, intraoperative concern for necrosis, and night or weekend presentation. We considered the potential effect of COVID-19 pandemic on time to surgery. We assessed predictive factors for ovarian preservation based on preoperative sonographic findings and patient characteristics using multivariable logistic regression. Institutional IRB approved a waiver of consent. Result(s): We identified 60 surgical cases of confirmed ovarian torsion, of which 25 underwent oophorectomy (42%). The median time from initial presentation in ED to surgery was 8.6 hours (IQR: 5.9-12.9;8.3 hours in preserved versus 8.7 in removed;p=0.68). When time to surgery was < 4 hours (n=6), the ovary was preserved in 83% of cases, compared to 56% when time to surgery was >=4 hours (n=54;p=0.39). When time to surgery was < 8 hours (n=28), 61% had ovarian preservation compared to 56% at >=8 hours (n=32;p=0.73) (Figure). The COVID-19 pandemic was not associated with a longer time to surgery (n=7). Ovarian preservation was significantly more likely with present doppler flow on sonographic exam (60% vs 27%;p=0.02). Preservation was less likely with necrosis suspected intraoperatively (20% vs 84%;p< 0.01). Detorsion was attempted in 64% of cases, resulting in preservation of 35% of necrotic-appearing ovaries. 76% of cases underwent oophorectomy based on intraoperative concern for necrosis;however, only 48% of ovarian specimens had necrosis confirmed on pathology. Age, parity and night or weekend ED admission were not associated with ovarian preservation. Conclusion(s): Predictors with the greatest likelihood of ovarian preservation after torsion include surgical goal time of < 4 hours after ED presentation, present doppler flow on sonographic exam, and attempt at detorsion intraoperatively despite necrotic appearance. Intraoperative methods to confirm ovarian viability would reassure surgeons. The surgical decision for oophorectomy may be based on factors unrelated to functional loss of the ovary. Supporting Figures or Tables https://www.abstractscorecard.com/uploads/Tasks/upload/19245/RGXGDRUQ-1375800-1-ANY(2).docxCopyright © 2023
ABSTRACT
Rationale: Recruitment for a NIH/ECHO-supported multi-center birth cohort, "Childhood Allergy and the NeOnatal Environment” (CANOE) stopped due to the COVID-19 pandemic. Redesign of study procedures emphasized virtual and socially distanced activities. We hypothesized that "virtual” recruitment methods (social media, websites, email) would surpass "traditional” methods (in-clinic, telephone, flyers/print materials) and increase enrollment of families from diverse backgrounds and communities. Methods: Pregnant women (n=439, target 500) were recruited from four academic medical centers in Detroit MI, Madison WI, Nashville TN, and St. Louis MO. We collected demographic and social information by questionnaires and examined race, ethnicity, age, parity, and employment status in relation to recruitment method using chi-square tests. Results: In-clinic and telephone recruitment comprised 55% of enrollment, followed by print materials (17%), and social media and email (15%). The cohort includes families self-identifying as Caucasian/White (63%), African American/Black (27%), Hispanic/Latino (3.3%), Asian (3.5%), and mixed races (1.2%). This reflects site demographics for White and Black patients, while other populations are not as well recruited into this cohort. Recruitment method success did not vary by race, ethnicity, maternal age, or employment status (p=ns for each comparison). Most (63%) multigravida mothers (9.1% of participants) were recruited in clinic, while primigravida participants were recruited more evenly via all methods. Conclusions: "Virtual” recruitment methods comprised a smaller proportion of cohort enrollment than hypothesized and study recruitment method did not vary by race/ethnicity;however, consideration of combined, varied, and novel recruitment methods may add to the development of best practices for more representative research study recruitment.
ABSTRACT
This study revisits the dynamics of dollar/euro exchange rate in response to the US monetary policy shock at the zero lower bound (ZLB) including the COVID-19 pandemic. The key findings are as follows. First, the exchange rate behavior indicates Dornbusch (1976)'s overshooting hypothesis at the states classified as beginning and ending of the ZLB. Second, the revived ZLB induced by the COVID-19 pandemic has a larger impact on the exchange rate than that induced by the global financial crisis. Third, the responses of the exchange rates demonstrate the uncovered interest rate parity and the overshooting. © 2022,Seoul Journal of Economics. All Rights Reserved.