Hemodynamic changes in patients with SARS-CoV-2 infection presenting for cesarean delivery under spinal anesthesia: a retrospective case-control study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with adverse maternal and neonatal outcomes. Early studies suggested that COVID-19 was associated with a higher incidence of hypotension following neuraxial anesthesia in parturients. We explored the hemodynamic response to spinal anesthesia for cesarean delivery in pregnant severe respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) positive patients, using a retrospective case-control design. METHODS: We searched our electronic medical records for patients who received spinal anesthesia for cesarean delivery, and were SARS-CoV-2 positive or recovered at delivery, and used historical and SARS-CoV-2 negative controls from two tertiary care hospitals. We compared the demographic, clinical, and hemodynamic variables between patients who were SARS-CoV-2 positive at delivery, those who were positive during pregnancy and recovered before delivery, and controls. Analyses were stratified by normotensive versus hypertensive status of the patients at delivery. RESULTS: We identified 22 SARS-CoV-2 positive, 73 SARS-CoV-2 recovered, and 1517 controls. The SARS-CoV-2 positive, and recovered pregnant patients, had on average 5.6 and 2.2 mmHg, respectively, higher post-spinal mean arterial pressures (MAPs) than control patients, adjusting for covariates. Additionally, the lowest post-spinal MAP was negatively correlated with the number of daysbetween the onset of COVID-19 symptoms and delivery in patients with hypertension (correlation -0.55, 95% CI -0.81 to -0.09). CONCLUSIONS: Patients with SARS-CoV-2 infection during pregnancy exhibit less spinal hypotension than non-infected patients. While the clinical significance of this finding is unknown, it points to important cardiovascular effects of the virus.

Age and sex differences in health habits and beliefs of schoolchildren.

All children in Grades 3 through 12 of one school system completed a survey about health habits and beliefs including smoking and eating habits, perceptions of exercise, weight, and parental involvement in health. The surveys were factor-analyzed within grade and sex, and the overall factors that emerged were Smoking Habits, Family Discussion of Health, Family Thinking About Health, Nutritional Habits, and Health Locus of Control. Analysis of variance of each factor revealed that girls generally reported healthier food habits than did boys. However, girls reported more smoking and less exercise. There are also changes in habits and belief with age; junior high school is a particularly important time for the development of several habits. The findings are discussed in relation to theories of child development and the implications for the content and timing of future health education intervention programs with children.

Weight loss competitions at the worksite: how they work and how well.

Three studies were conducted to evaluate the effectiveness of competition as a method of weight loss at the worksite. Study 1 found team competitions more effective than either cooperation or individual competition for men, and more effective than individual competition for women. Study 2 replicated the effectiveness of team competitions at 10 worksites. The influence of four variables [gender, age, type of employment (blue-collar vs white-collar), and method of assignment to teams] upon four outcomes (recruitment, attrition, weight loss, and cost/effectiveness), was assessed. This study showed that the results of competition were robust and widely generalizable. Recruitment was high, attrition very low, weight losses large, and cost/effectiveness favorable. Study 3, however, found only limited maintenance of weight loss following competitions.

The role of parents and older peers in school-based cardiovascular prevention programs: implications for program development.

This article describes a set of studies which compare the effectiveness of innovative interventions led by older peers and which included a parent component with teacher-led interventions for nutrition, blood pressure, and smoking prevention. Information about the agreement between parents' and children's (grades six through eight) perception of the children's health behavior and family interaction was also found, by surveying parents and children in 1051 households. Both teacher-led and older peer-led interventions were successful in increasing behavioral capabilities for nutrition and blood pressure, measured one year after the interventions. Results of the parent-child survey showed reasonable agreement between parents and children for reports of the child's exercise, dieting, and fast food consumption, but poorer agreement for smoking and perceptions of family interaction. Results are discussed in relation to the planning of future programs designed to address the importance of peer and parental role models.

Experimentation with smokeless tobacco and cigarettes by children and adolescents: relationship to beliefs, peer use, and parental use.

Experimentation with both cigarettes and smokeless tobacco by children in grades 3-12 in a school district in Pennsylvania was related to peer experimentation, parental use, and personal beliefs about the harm of the product for both males and females. Experimentation with both products had begun as early as the third grade and increased with age, with a major increase in experimentation during junior high school. Nearly half the males in grades 7-12 did not believe smokeless tobacco was harmful.

Comparison of three worksite weight-loss competitions.

Competition is an effective means of promoting weight loss in worksite programs. This study was designed to determine the most effective structure of competition through a comparison of two kinds of competition within one worksite. Two competitions were between teams and one was among individuals. While all three competitions produced significant weight loss and lower attrition than previous worksite programs, the team competitions produced significantly lower attrition rates and significantly greater weight loss than the individual competition. Patterns of loss over time and the distribution of losses for groups also differed, with a smaller proportion of successful participants in the individual competition. The results suggest that team support as well as competition is a necessary component of effective worksite weight loss competitions.

Measuring community change in disease prevention and health promotion.

This report describes the use of the Community Resource Inventory to measure change in community health activities. The inventory consists of a survey of all organizations within a geographical area that might be mobilized for risk factor reduction. The inventory was utilized prior to, and again 3 years after, implementation of a health promotion campaign in a rural county and in a matched reference county. It revealed an increase in health promotion activities in key community institutions in the experimental county during a period when these activities were declining in the reference county. The Community Resource Inventory is a promising method of measuring community change and can be useful in monitoring the progress of programs in which there is a long period of latency between program initiation and measurement of outcomes, such as reduction in cardiovascular mortality.

Health promotion at the worksite. I. A process for establishing programs.

A 14-step process for establishing health promotion programs at the worksite is described. During a period of 3 years, it has been used to establish 58 such programs in 12 small industries that employ 4,200 persons in a rural county in Pennsylvania. Few problems have been encountered; the most serious is the very limited record-keeping system of industries. The process is flexible and can be readily generalized to different settings. The major strengths of the process are the sense of ownership it gives to employees, and the modesty of its costs and the costs of the resulting programs.

Weight loss competitions at the work site: impact on weight, morale and cost-effectiveness.

Three weight loss competitions were held in business/industrial settings. One competition was between three banks; the other two were within industries, either between employee teams selected at random or between divisions of the industry. Attrition in the competitions was less than 1 per cent and weight loss averaged 5.5 kg. Both employees and management reported positive changes in morale and employee/management relations, and both considered the competition important to the success of the program. The cost-effectiveness ratio ($ 2.93 per 1 per cent reduction in percentage overweight) is the best yet reported.

The evaluation of a community-based group program for low-income diabetics and hypertensives.

Two studies compared the effectiveness of a community-based, behavioral group program versus an individual patient-education program with low-income diabetic and hypertensive patients, respectively. The dependent variables measured patients' knowledge, disease management skills, and clinical outcomes. Patients in the group programs demonstrated greater gains in knowledge and disease management skills than did the control patients. However, there was no clinically significant change in weight, blood pressure, or urinalysis results for any group of patients. The data suggest that group management is an effective mechanism for patient education but is not sufficiently reinforcing to induce change of habits, particularly when there are competing sources of reinforcement within the community.