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1.
Thorax ; 02, 2023.
Article in English | EMBASE | ID: covidwho-2193942

ABSTRACT

We previously reported a decreasing incidence of paediatric asthma hospitalisations in Finland, but a rather stable trend in Sweden, between 2005 and 2014. We now aimed to investigate the incidence of paediatric asthma hospitalisations in these countries between 2015 and 2020, using Finland's National Hospital Discharge Register and Sweden's National Patient Register, which cover all hospitalisations in the respective countries. From 2015 to 2019, the incidence of paediatric asthma hospitalisations decreased by 36.7% in Finland and by 39.9% in Sweden and are increasingly approaching parity. In 2020, despite differences in COVID-19-related restrictions, asthma hospitalisations decreased by over 40%, thus warranting future research on the subject. Copyright © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

2.
British Journal of Oral and Maxillofacial Surgery ; 60(10):e58-e59, 2022.
Article in English | EMBASE | ID: covidwho-2176816

ABSTRACT

Introduction/Aims: The Junior Trainee Group (JTG) of the British Association of Oral and Maxillofacial Surgeons (BAOMS) represents everyone interested in OMFS from first day of university until entering specialty training. The JTG engages, supports and inspires the next generation of OMFS surgeons. Material(s) and Method(s): A retrospective data collection of the JTG Facebook page was carried from January 2018 to January 2022 utilising the insight and engagement function on the page. All member data was anonymised by Facebook. Results/Statistics: JTG Facebook members increased from 1213 to 1686 (39% increase) over 4 years to 2022. Members were from 79 countries, a majority (1335) in the UK. The balance between male (55%) and female members (45%) is closer to parity than any other group within OMFS. The most popular day to post is Wednesday between 4-7pm with average views of 781 per post. Posts can be broadly grouped into advice, job opportunities, education, and surveys/ audits with an 8% increase in education posts. Conclusions/Clinical Relevance: The JTG Facebook page has an extensive reach. Data shows that it engages the younger generation of potential OMFS surgeons. Although Facebook assists with recruitment retention through advice, jobs, and educational opportunities including online learning during COVID 19, it is a single social media platform. It can only be a small element of the work that the specialty needs to do to recruit students. Links within universities including to surgical societies should be a parallel approach to recruiting early and recruiting actively. Copyright © 2022

3.
BMC Pregnancy and Childbirth ; 22:1-7, 2022.
Article in English | ProQuest Central | ID: covidwho-2171259

ABSTRACT

Background Several common maternal or neonatal risk factors have been linked to meconium amniotic fluid (MAF) development;however, the results are contradictory, depending on the study. This study aimed to assess the prevalence and risk factors of MAF in singleton pregnancies. Methods This study is a retrospective cohort that assessed singleton pregnant mothers who gave birth at a tertiary hospital in Bandar Abbas, Iran, between January 1st, 2020, and January 1st, 2022. Mothers were divided into two groups: 1) those diagnosed with meconium amniotic fluid (MAF) and 2) those diagnosed with clear amniotic fluid. Mothers with bloody amniotic fluid were excluded. Demographic factors, obstetrical factors, and maternal comorbidities were extracted from the electronic data of each mother. The Chi-square test was used to compare differences between the groups for categorical variables. Logistic regression models were used to assess meconium amniotic fluid risk factors. Results Of 8888 singleton deliveries during the study period, 1085 (12.2%) were MAF. MAF was more common in adolescents, mothers with postterm pregnancy, and primiparous mothers, and it was less common in mothers with GDM and overt diabetes. The odds of having MAF in adolescents were three times higher than those in mothers 20–34 years old (aOR: 3.07, 95% CI: 1.87–4.98). Likewise, there were significantly increased odds of MAF in mothers with late-term pregnancy (aOR: 5.12, 95% CI: 2.76–8.94), and mothers with post-term pregnancy (aOR: 7.09, 95% CI: 3.92–9.80). Primiparous women were also more likely than multiparous mothers to have MAF (aOR: 3.41, 95% CI: 2.11–4.99). Conclusions Adolescents, primiparous mothers, and mothers with post-term pregnancies had a higher risk of MAF. Maternal comorbidities resulting in early termination of pregnancy can reduce the incidence of MAF.

4.
Seoul Journal of Economics ; 35(4):425-444, 2022.
Article in English | Scopus | ID: covidwho-2205170

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.

5.
Journal of Public Health in Africa ; 13(s2) (no pagination), 2022.
Article in English | EMBASE | ID: covidwho-2163856

ABSTRACT

Postpartum depression is a phe-nomenon that occurs in the first postpartum days. Symptoms of postpartum depression peak on days 3 to 5 postpartum with a dura-tion ranging from a few hours to several days. Of course, this will be different during the Covid-19 pandemic. The aim of this study was to analyze the determinants that influence the incidence of post-partum depression in primary health during the pandemic. The method in this research is descriptive analysis with cross sectional approach with a total sample of 100 respon-dents. The research instrument used a standard instrument, namely the EPDS (Edinburgh Postnatal Depression Scale) instrument. The results of the study were the determinant factors of parity in primi-gravida and attitudes. From the results of this study, it can be concluded that the dom-inant factors that greatly influence the risk of post-partum depression in women in primary health during the pandemic are parity (primigravida) and the attitude of women who take it for granted when they know that they are at risk of post-partum depression. Copyright © the Author(s),2022.

6.
Journal of SAFOG ; 14(5):602-605, 2022.
Article in English | EMBASE | ID: covidwho-2144652

ABSTRACT

Objective: To analyze the risk factors associated with mortality in COVID-positive pregnant women. Material(s) and Method(s): The study was designed as a case-control study and was conducted at COVID-designated tertiary care hospital. It included 42 deceased and 96 RT-PCR-positive surviving pregnant women who developed severe forms of disease. All the affected patients were admitted and managed according to Indian national guidelines. Risk factors - age, residence, socioeconomic status, gestation age, parity, and comorbidities were evaluated for their association with mortality. Result(s): Advanced maternal age (>28 years), rural residence, diabetes, and comorbidities were found to be associated with increased risk of mortality among the COVID-affected pregnant women, the respective adjusted odds ratio was 15.45, 12.61, 2.65, and 4.77, respectively. Conclusion(s): Pregnant women are vulnerable to COVID infection. They were at higher risk of mortality with comorbidities, advanced age, and low access to healthcare in the rural areas. Copyright © The Author(s).

7.
Open Access Macedonian Journal of Medical Sciences ; Part B. 10:2180-2183, 2022.
Article in English | EMBASE | ID: covidwho-2143910

ABSTRACT

BACKGROUND: Iron-deficiency anemia (IDA) is caused by inadequate intake of iron or impaired erythrocyte formation due to chronic blood loss. AIM: This study aimed to obtain data on the prevalence of iron deficiency and IDA in the pandemic COVID-19 era and to investigate the relationship of infant nutritional status, maternal education, maternal occupation, maternal parity, and family income with the prevalence of iron deficiency and IDA in infants 9-12 months at the Cempaka Banjarbaru Community Health Center. METHOD(S): A cross-sectional analytic descriptive approach was used with a consecutive sampling technique to conduct this study. The sample consisted of 50 infants between 9 and 12 months old that had completed blood count and peripheral blood smear at measles immunization in May-September 2020 at the Cempaka Banjarbaru Community Health Center. RESULT(S): The results showed that the prevalence of iron deficiency, IDA, and hemolytic anemia was 16%, 28%, and 22%, respectively. Meanwhile, the data analysis was conducted using Chi-square and Fisher's exact test. The results showed a significant relationship between family income factors and the prevalence of iron deficiency and IDA (p = 0.023). CONCLUSION(S): Infants at the age of 9-12 months need to have a complete blood count examination to detect an earlier iron deficiency and IDA. Copyright © 2022 Harapan Parlindungan Ringoringo, Imanuella Yessy Natalia, Roselina Panghiyangani, Edi Hartoyo, Rahmiati Lao.

8.
Journal of Women's Health ; 31(10):A20, 2022.
Article in English | EMBASE | ID: covidwho-2134733

ABSTRACT

Background: The persistence of the COVID-19 pandemic and mitigation strategies have shaped a new environment in which we live and work. Objective(s): To evaluate academic medicine faculty members' work stress, home stress, productivity, and self-care in the spring of 2021 compared with the spring of 2020. Method(s): A 93-question survey was distributed in March 2020 and again in March 2021. Data were collected on demographic, family, and academic characteristics;work distribution and productivity before and during the pandemic;perceived stress related to work and home activities;and self-care. Differences were assessed using chi-square and Fisher's exact tests. Result(s): There were 231 (n = 141 women, n = 90 men) faculty members who responded in the spring of 2020 and 118 (n = 60 women, n = 58 men) faculty members who responded in the spring of 2021. A greater proportion of women compared with men reported increased work stress in both surveys. By the spring of 2021, work stress had decreased significantly for men but not for women. A significantly higher proportion of women reported increased stress related to securing funding for research, scholarly productivity, teaching, advising, administrative responsibilities, and clinical responsibilities compared with men. Although research productivity had increased for both genders by the spring of 2021, a larger proportion of women reported disturbed sleep and diet. Caring for young children increased home stress regardless of faculty members' gender. Conclusion(s): Faculty members who are men have more likely adapted to the ''new normal'' by lowering work stressors and increasing productivity, whereas women more likely have adapted by decreasing self-care. The lingering effects of the pandemic have maintained higher work stress, particularly for women and especially for faculty members with young children. Institutional efforts to support those disproportionately affected and ensure well-being of faculty members are critically needed to promote gender parity post-pandemic..

10.
American Journal of Transplantation ; 22(Supplement 3):796, 2022.
Article in English | EMBASE | ID: covidwho-2063514

ABSTRACT

Purpose: The SARS-CoV-2 or coronavirus disease 2019 (COVID-19) pandemic has disproportionately impacted racial and ethnic minority groups in the United States. Although, kidney transplant procedures decreased following onset of the pandemic, the differential impact of the pandemic on racial and ethnic minority groups remains unknown. Method(s): We examined kidney-alone procedures captured in the national Scientific Registry of Transplant Recipients (SRTR) analytic files and compared the change in deceased donor kidney transplant (DDKT) and living donor kidney transplant (LDKT) pre- and post- pandemic and the associated factors. Result(s): We found that the counts of LDKT declined more for Black patients in the 12 months following onset of the pandemic, March 2020 to Feb 2021, compared with counts in the same period in the preceding 12 months. LDKT counts among Black patients fell by 42.6% compared with 33.3% in White patients (P=0.02). This pattern of decrease in LDKT counts among Black patients occurred in all geographic areas of the country (based on current UNOS COVID-19 reporting) except for the Northeast and South Midwest (Figure 1). Along with recipient race, other factors associated with a significant decline in LDKT counts included public insurance, Black living donor race, and location of residence. In contrast, DDKT counts for both Black and White candidates declined initially (10% vs. 5.9% lower respectively, P=0.11) during the pandemic and then recovered closer to pre-pandemic levels. Conclusion(s): The COVID-19 pandemic disproportionately impacted Black patients' access to LDKT. While the current rate of DDKT procedures has recovered in 2021, it is unclear whether LDKT rates will recover to parity. As locoregional surge conditions can have differential effects, ongoing attention to transplant disparities resulting from the pandemic, with appropriately targeted interventions, is warranted.

11.
American Journal of Transplantation ; 22(Supplement 3):555, 2022.
Article in English | EMBASE | ID: covidwho-2063371

ABSTRACT

Purpose: We sought to evaluate racial disparities in access to deceased donor kidney transplant (DDKT) following changes to kidney allocation system (KAS) implemented in 2014. We also aimed to identify candidate factors that were responsible for reducing African American (AA) access to transplant. Method(s): This study used Scientific Registry of Transplant Recipient Data, and included all adult candidates for DDKT on the waitlist between Jan. 1, 2015 and Mar. 12, 2020 (n=233,033). Candidates were classified as African American (AA) or non-African American (non-AA) and categorical differences in waitlist activity and clinical factors were evaluated by chi-square tests. Univariable (e.g. AA race only) and multivariable (e.g. race and combinations of clinical factors) Cox models with the outcome of time to transplant were constructed to evaluate the impact of AA race on access to transplant. Sub-analysis were performed to account for potential confounding from inactive time and the COVID-19 era. Result(s): Of the 233,033 waitlisted candidates during the study period, 76,576 (32.9%) were AA. There were differences in the clinical profiles of AA and non-AA candidates. For instance, AA were more likely to have the following characteristics: higher BMI, blood type B, female, and have higher cPRA (all with p < 0.0001). AA had longer wait times and slower access to the waitlist after initiating dialysis (p < 0.0001). Our most complete multivariable model showed that AA were 16.3% less likely to receive DDKT, [HR: 0.837, (95% CI: 0.821, 0.852)] (Figure 1). Adjusting for dialysis time prior to listing [HR: 0.863 (95% CI: 0.849, 0.877)] and the combination of dialysis time prior to listing and ethnicity [HR: 0.807 (95% CI: 0.793, 0.822)] resulted in the biggest change in HR from the unadjusted model. Conclusion(s): AA have reduced access to DDKT when compared to non-AA in adjusted analyses. Dialysis time prior to listing and ethnicity are the biggest contributors to the disparity in access. The KAS provides increased access for patients with longer time on the waiting list, therefore, the unadjusted model has closer parity between AA and non-AA. However, even the unadjusted model still shows some disparity meaning that changes may still be necessary in the system by with DDK are allocated to candidates. (Figure Presented).

12.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S324, 2022.
Article in English | EMBASE | ID: covidwho-2057806

ABSTRACT

In 2020, telehealth (TH) in pediatric gastroenterology (GI) practice experienced unprecedented, meteoric growth, despite undefined best practices for the subspecialty. Use of synchronous video for TH first occurred in 1964, it was increasingly described in the literature from the 1970s to 1990s, and then catapulted to the forefront during the COVID-19 Public Health Emergency (PHE) beginning March 2020. Due to the sudden need for increased TH utilization by nearly all health care providers TH became essential to clinical practice. TH broadly encompasses most remote activities of clinical care, provider and patient education, and general health services. Prior to the COVID-19 PHE, surveys indicate that only 50% of North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) membership had any experience with telehealth. Although experience has grown dramatically, best practices for TH in pediatric GI, hepatology, and nutrition remain undefined and non-standardized. Key areas for review include: historical perspective, general and subspeciality usage, health care disparities, quality of the provider-patient interaction, modes of health care delivery, logistics and operations, licensure and liability, reimbursement and insurance coverage, research and quality improvement priorities, and future use of telehealth in pediatric GI with a call for advocacy. This present position paper from the Telehealth Special Interest Group of NASPGHAN provides recommendations for pediatric GI-focused telehealth best practices, reviews areas for research and quality improvement growth, and presents advocacy opportunities. Summary of Recommendations * The decision of when and how to use telehealth should be shared between patients-families and providers with the goals to achieve quality medical care and excellent patient experience * Telehealth is convenient for patients-families, affords a high degree of satisfaction and may improve access to high-value subspecialty care * Digital disparities exist for telehealth and providers need to be mindful of inequity in telehealth access and healthcare delivery * Individual providers carry the responsibility of licensed, secure, and HIPAA-compliant telehealth delivery in accordance with governmental regulations * Advocacy for permanent insurance coverage, reimbursement parity and universal licensure is urgently needed.

13.
J Dent Educ ; 86(9): 1144-1173, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2047681

ABSTRACT

PURPOSE: The purpose of this manuscript is to provide an overview of the significant role that women play in providing global health care, barriers encountered to achieving gender equality in global health leadership, and to propose key recommendations for advancing gender equality in global health decision-making through the integration of gender mainstreaming, gender-based analysis, and gender transformative leadership (GTL) approaches. METHOD: Data were evaluated to determine the participation rate of women in global health care and social sector roles in comparison to men. Gender equality data from the United Nations, World Health Organization, Organization for Economic Co-operation and Development, International Labour Organization, and other resources were analyzed to assess the impact of the coronavirus disease 2019 pandemic on gender equality with an emphasis on women in global health leadership positions, the health care and social sector, and gender equality measures for girls and women throughout the world. The literature was examined to identify persistent barriers to gender equality in global health leadership positions. Additionally, a review of the literature was conducted to identify key strategies and recommendations for achieving gender equality in global health decision-making; integrating gender mainstreaming; conducting gender-based analysis; and adopting GTL programs, incentives, and policies to advance gender equality in global health organizations. FINDINGS: Women represent 70% of the health and social care sector global workforce but only 25% of senior global health leadership roles. Since 2018, there has been a lack of meaningful change in the gender equality policy arenas at global health organizations that has led to significant increases in women serving in global leadership decision-making senior positions. During the pandemic in 2020, there were nearly 100 open vacancies-one-quarter of CEO and board chair positions-at global health organizations, but none were filled by women. Women disproportionately provide caregiving and unpaid care work, and the pandemic has increased this burden with women spending 15 hours a week more on domestic labor than men. A lack of uniform, state-sponsored paid parental leave and support for childcare, eldercare, and caregiving, which is overwhelmingly assumed by women, serve as major barriers to gender parity in global health leadership and the career advancement of women. CONCLUSION: The pandemic has adversely impacted women in global health care and social sector roles. During the pandemic, there has been a widening of the gender pay gap, a lack of gains for women in global health leadership positions, an increase in caregiving responsibilities for women, and more women and girls have been pushed back into extreme poverty than men and boys. Globally, there is still resistance to women serving in senior leadership roles, and social and cultural norms, gender stereotypes, and restrictions on women's rights are deeply intertwined with barriers that reinforce gender inequality in global health leadership. To ensure comprehensive human rights and that equitable workforce opportunities are available, the concept of gender equality must be expanded within the global health community to consistently include not only women and girls and men and boys, but also persons who identify as nonbinary and gender nonconforming. Efforts to eliminate remnants of systemic and structural gender discrimination must also incorporate gender mainstreaming, gender-based analysis, and gender transformative approaches to achieve gender equality throughout global health systems and organizations.


Subject(s)
Gender Equity , Leadership , COVID-19/epidemiology , Female , Global Health , Humans , Male , Women's Rights
14.
Voprosy Ginekologii, Akusherstva i Perinatologii ; 21(3):28-35, 2022.
Article in Russian | EMBASE | ID: covidwho-2033519

ABSTRACT

Objective. To assess the effectiveness of different preventive measures for novel coronavirus infection in pregnant women. Patients and Methods. This study included 125 pregnant women hospitalized with moderate to severe laboratory-confirmed SARS-CoV-2 infection between September and November 2021 (the fourth pandemic wave), and 175 pregnant women who were not infected with COVID-19 during the same period. All women in these two groups were comparable for gestational age (II–III trimesters, 24–39 weeks), age (20–40 years), social status, parity, body mass index, and had no known COVID-19 risk factors. Results. Our findings revealed that vaccination 3-5 months before pregnancy (OR = 4.12;95% CI 1.28–13.27;χ2 = 0.022), inconsistent use and/or non-timely replacement of face masks (OR = 5.71;95% CI 2.83–11.51) were associated with the increased risk of COVID-19 in the second and third trimesters of gestation. It was showed that systematic (once in the morning at 24–48-hour intervals) intranasal administration of recombinant interferon alpha-2b (IFN-α;Grippferon) as compared with a single application after exposure to COVID-19 reduced the disease incidence rate and there was no evident risk of illness (OR = 0.08;95% CI 0.05–0.14;19.2% vs 74,3%, p < 0.001). This can be explained by the fact that women were mostly infected in unpredictable conditions (e.g., 29.2% of pregnant women were infected from family members, 23.9% had unknown source of exposure). The use of umifenovir, not currently authorised for the medication-assisted prevention of COVID-19 in pregnant women, and rectal administration of IFN-α suppositories did not reduce the disease incidence rate. Rectal use of IFN-α suppositories by pregnant women off-label increased the incidence (32.0 vs 15.4%, p = 0.001) and risk of developing novel coronavirus infection (OR = 2.58;95% CI 1.48–4.50). Conclusion. There is a need to improve awareness among pregnant women about the mandatory and timely vaccination against COVID-19 during pregnancy and the importance of strict adherence to wearing face masks. Increased efforts should be made to monitor and inform pregnant women about the use of only authorised medication-assisted preventive measures of SARS-CoV-2 infection, such as intranasal administration of recombinant IFN α-2b (Grippferon). During the epidemic rise in COVID-19 cases, the systematic intranasal administration of recombinant interferon-based medication Grippferon (once in the morning at 24–48-hour intervals) is recommended for pregnant women.

15.
Medical Journal of Malaysia ; 77:24, 2022.
Article in English | EMBASE | ID: covidwho-2006780

ABSTRACT

Introduction: Morbidly adherent placenta (MAP) refers to any placental implantation with abnormally firm adherence to myometrium. The American College of Obstetricians and Gynecologists cites the incidence be as high as 1 in 533 deliveries. There are three degrees of morbidly adherent placenta: placenta accreta, increta and percreta. The rate of morbidly adherent placenta with previous caesarean section scar and unscarred uterus also increased significantly. Previous caesarean section and co-existing placenta previa remained the major risk factors. We report a case of an adherent placenta in the absent of prior risk factors and discuss modalities of management options available. Case Description: A 46-years-old female patient without history of scarred uterus, gravida 8, para 7, pregnant at 39 weeks admitted for Covid-19 positive in active phase of labour with foetal distress, hence the indication for an emergency caesarean section. The diagnosis of adherent placenta is made during the caesarean. She was successfully managed surgically with subtotal hysterectomy in view of age and parity of the patient. Discussion: Morbidly adherent placenta often associated with severe maternal morbidity and mortality. Hence, early detection, high index of clinical suspicion and timely decision may reduce patient morbidity as the surgeon strategizes on the best management of the case, mainly in anticipating the difficulty that may be encountered during surgery.

16.
Journal of the Medical Association of Thailand ; 105(8):690-699, 2022.
Article in English | EMBASE | ID: covidwho-1998178

ABSTRACT

Objective: Chonburi province is ranked fourth in Thailand in terms of COVID-19 cases. The objective was to compare neonatal and maternal outcomes among pregnant women with and without COVID-19 infection delivered in Chonburi hospital. Materials and Methods: The present study was a retrospective matched cohort study that included all pregnant women who delivered between January 1 and August 31, 2021, at Chonburi Hospital, Thailand. The exposure group comprised women with a current or previous positive COVID-19 PCR test, while the comparators were the PCR negative group. The matching ratio was 1:4, based on gestational and maternal age, parity, and the closest delivery date. Clinical data were obtained from medical records. Results: Forty-six pregnant women had a positive COVID-19 PCR, 24 (52.17%) were Thai and 22 (47.83%) were of other ethnicities. Most (60.87%) were asymptomatic or required no medical assistance. Three (6.52%) had severe pneumonia and required respiratory support. Neither maternal death nor vertical transmission was detected. Compared with 184 COVID-19-negative pregnant women, no significant differences in low APGAR score of less than 7, and preeclampsia in the 46 COVID-19-positive pregnant women were observed. However, COVID-19-positive pregnant women showed an increased rate of neonatal respiratory distress (RD) (relative risk [RR] 2.55;95% confidence interval [CI] 1.04 to 6.21] and clinical early-onset neonatal sepsis (RR 3.60;1.55 to 8.36). Additionally, a higher cesarean section rate was observed in the COVID-19 positive group (RR 1.45, 1.11 to 1.85). Conclusion: There were no significant differences in neonates with APGAR of less than 7 between the cohort of 46 pregnant women who tested positive for COVID-19 and those who tested negative. However, a higher rate of cesarean delivery, presumed early-onset neonatal septicemia, and RD in the COVID-19 positive group were noted and should be monitored.

17.
International Journal of Obstetric Anesthesia ; 50:62, 2022.
Article in English | EMBASE | ID: covidwho-1996258

ABSTRACT

Introduction: The recent increase in the rate of massive obstetric haemorrhage (MOH) has been associated with an increase in maternal age, body mass index, rate of caesarean sections (CS) and associated co-morbidities [1]. Timely and effective management of MOH is essential for ensuring the safety of both mother and baby. Most literature is aimed at identifying risk factors for MOH and triggers for transfusion. In this service evaluationwe aim to characterise the MOH patients that did not require a blood transfusion and identify any areas for improvement that can be extrapolated to the patients who received transfusions. Methods:We conducted an electronic patient data search (K2 system) to identify all parturients with more than 1500 mL peripartum blood loss, between March 2020 and April 2021. All patientswere included in the service evaluation. We collected demographic data, BMI, parity, cause of haemorrhage, mode of delivery and type of anaesthesia, treatment, initial and post 24 h haemoglobin results, fibrinogen results and COVID-19 status. Approval was requested from the Audit department and the Caldicott Guardian. Results: Data were collected for 139 patients. Mean (±SD) patient age was 31.5 (±5.4) and 38% of patients were ASA1. (Table Presented) Discussion: Patients with an estimated blood loss (EBL) less than 1500 mL were not included as we usually manage them conservatively. Our data support the recommendations of the Royal College of Obstetricians that antenatal anaemia needs investigating and treating appropriately to reduce the morbidity associated with PPH and the need for transfusions [2]. There was higher incidence of CS and atony in the group requiring transfusion suggesting that improved patient information on the use of uterotonics and restricting CS to clear clinical indications could further reduce transfusion rates.

18.
Hepatology International ; 16:S195, 2022.
Article in English | EMBASE | ID: covidwho-1995915

ABSTRACT

Objectives: The COVID-19 pandemic has brought tremendous impact on healthcare, including screening for hepatitis B in pregnant women. Of 19,234 pregnant women, there were 2.38% identified as hepatitis B in 2017-2019. This study was aimed to investigate its current prevalence during pandemic. Materials and Methods: A cross-sectional study was conducted among pregnant women between April 2020 and September 2021 in 3 public health centers in Cirebon Regency, Indonesia. History of chronic liver disease was excluded in this study. Data were collected from annual report of Department of Health, Cirebon Regency, Indonesia, including demographic characteristics, obstetric history, the presence of jaundice. The status of hepatitis B was detected by immunochromatographic, rapid assay HBsAg test kit. Results: Of 2210 subjects, there were 21 found positive (0.95%). Median age of subjects were 28 years old (15-48). Among subjects, as many as 37.42% were primigravida and 47.19% were in first trimester. None of subjects had symptoms. The highest hepatitis B prevalence was identified in mother aged<35 year and multiple parities. Conclusion: Prevalence of hepatitis B among pregnant women in Cirebon Regency during pandemic was 0.95% and markedly reduced compared with previous prevalence.

19.
Hepatology International ; 16:S199, 2022.
Article in English | EMBASE | ID: covidwho-1995907

ABSTRACT

Background: Hepatitis B is a disease that attacks the liver and is a world health problem, especially in developing countries, including Indonesia. Hepatitis B (HBV) infection in pregnant women has become a worldwide concern because transmission is the most common throughout the world, especially in endemic areas. In addition to horizontal transmission, one of the biggest causes is vertical transmission from mother to child or also called the mother to child transmission (MTCT) where a mother who is HBsAg positive will transmit it to the fetus she is carrying. Methods: This study used the Case-Control method with a retrospective approach involving 133 cases and 534 controls with multiple logistic regression analysis. Results: Statistical tests showed that education level (p-value = 0.027;OR = 2.705;95% CI: 1.197-6.113), parity (p-value = 0.023;OR = 2.846;95% CI: 1.228-6.697), and sexual partners (p-value = 0.031;OR = 9.333;95% CI: 1.121-77.704) is a risk factor for the incidence of hepatitis B in pregnant women. Meanwhile, the age group (p-value = 0.177) and type of work (p-value = 0.059) were not risk factors for the incidence of hepatitis B in pregnant women. Another study states that the way to avoid the transmission of this infection, one of which is the Antenatal Care (ANC) examination. Conclusions: Education level, parity, and sexual partners are risk factors for hepatitis B incidence in pregnant women. Among all the risk factors found, a sexual partner is the most risk factor for the incidence of hepatitis B in pregnant women. Therefore, it is very important for pregnant women to carry out Antenatal Care (ANC) examinations.

20.
Per Med ; 19(5): 411-422, 2022 09.
Article in English | MEDLINE | ID: covidwho-1974551

ABSTRACT

Aim: The COVID-19 pandemic forced medical practices to augment healthcare delivery to remote and virtual services. We describe the results of a nationwide survey of cardiovascular professionals regarding telehealth perspectives. Materials & methods: A 31-question survey was sent early in the pandemic to assess the impact of COVID-19 on telehealth adoption & reimbursement. Results: A total of 342 clinicians across 42 states participated. 77% were using telehealth, with the majority initiating usage 2 months after the COVID-19 shutdown. A variety of video-based systems were used. Telehealth integration requirements differed, with electronic medical record integration being mandated in more urban than rural practices (70 vs 59%; p < 0.005). Many implementation barriers surfaced, with over 75% of respondents emphasizing reimbursement uncertainty and concerns for telehealth generalizability given the complexity of cardiovascular diseases. Conclusion: Substantial variation exists in telehealth practices. Further studies and legislation are needed to improve access, reimbursement and the quality of telehealth-based cardiovascular care.


As the COVID-19 pandemic was just beginning, the American College of Cardiology administered a survey to cardiology professionals across the USA regarding their preparedness for telehealth and video-visits. The results demonstrated rapid adoption of video based telehealth services, however revealed uncertainty for how to best use these services in different practice settings. Many providers expressed concerns about how these visits will be compensated, but fortunately federal agencies have dramatically changed the way telehealth is reimbursed as the pandemic has progressed. Further studies are needed to explore the impact of telehealth on healthcare inequality, however we hope that rather it serves to increase healthcare access to all.


Subject(s)
COVID-19 , Cardiology , Telemedicine , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Pandemics , Telemedicine/methods , United States/epidemiology
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