Incidence and clinical features of pediatric ocular trauma in a population-based cohort.

PURPOSE: To report the incidence and clinical characteristics of pediatric ocular and adnexal injuries diagnosed over a 10-year period in Olmsted County, Minnesota. METHODS: This multicenter retrospective, population-based cohort study included all patients <19 years of age in Olmsted County diagnosed with ocular or adnexal injuries from January 1, 2000, through December 31, 2009. RESULTS: A total of 740 ocular or adnexal injuries occurred during the study period, yielding an incidence of 203 (95% CI, 189-218) per 100,000 children. Median age at diagnosis was 10.0 years, and 462 (62.4%) were males. Injuries presented to the emergency department or urgent care setting most frequently (69.6%) and often occurred while outdoors (31.6%) during summer months (29.7%). Common injury mechanisms included blunt force (21.5%), foreign bodies (13.8%), and sports activities (13.0%). Isolated anterior segment injuries occurred in 63.5% of injuries. Ninety-nine patients (13.8%) had visual acuity of 20/40 or worse at initial examination, and 55 patients (7.7%) had visual acuity of 20/40 or worse at final examination. Twenty-nine injuries (3.9%) required surgical intervention. Significant risk factors for reduced visual acuity and/or the development of long-term complications include male sex, age ≥12 years, outdoor injuries, sport and firearm/projectile injury mechanism, and hyphema or posterior segment injury (P < 0.05). CONCLUSIONS: Most pediatric eye injuries are minor anterior segment injuries with infrequent long-lasting effects on visual development.

Incidence and clinical characteristics of paediatric keratitis.

BACKGROUND/AIMS: To report the incidence and clinical characteristics of paediatric keratitis diagnosed over a 10-year period in a well-defined population. DESIGN: Retrospective, population-based study. METHODS: Setting: multicentre. POPULATION: patients (<19 years) diagnosed with keratitis as residents of Olmsted County from 1 January 2000, through 31 December 2009. MAIN OUTCOME MEASURES: calculated annual age-specific and gender-specific incidence rates, demographic information and initial and final visual acuity. RESULTS: A total of 294 diagnoses of keratitis occurred in 285 children during the 10-year period, yielding an incidence of 78.0 per 100 000 younger than 19 years (95% CI 69.0 to 87.1) or approximately 1 in 1282 children. The incidence increased throughout the 10-year study period (p<0.001). The mean age at diagnosis was 15.3 years (range, 0.2-18.9) and 172 (60.4%) were women. The observed forms included keratitis due to contact lens wear in 134 (45.6%), infectious keratitis in 72 (24.5%), keratitis not otherwise specified in 65 (22.1%) and keratitis sicca in 23 (7.8%). The visual acuity was reduced to ≤20/40 in 61 (21.4) of the 285 patients at the initial examination and in 24 (8.4%) at the final examination. Children with infectious keratitis had the poorest presenting vision and the best final vision, whereas the reverse was true for those with keratitis sicca. CONCLUSIONS: Keratitis, regardless of aetiology, was observed in approximately 1 in 1300 children by 19 years of age in this population-based cohort. Nearly half were related to contact lens wear and a decrease in vision to ≤ 20/40 occurred in 1 in 12 patients.

"I had so many life-changing decisions I had to make without support": a qualitative analysis of women's pregnant and postpartum experiences during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has posed profound challenges for pregnant patients and their families. Studies conducted early in the pandemic found that pregnant individuals reported increased mental health concerns in response to pandemic-related stress. Many obstetric practices changed their healthcare delivery models, further impacting the experiences of pregnant patients. We conducted a survey study to explore the ways in which COVID-19 impacted the lives of pregnant and newly postpartum people. METHODS: A mixed-methods survey was distributed to all patients ≥18 years old who were pregnant between January 1st, 2020 - April 28, 2021 in a large Midwest health system. Open-ended survey responses were analyzed for common themes using standard qualitative methodology. RESULTS: Among the 1182 survey respondents, 647 women provided an open-ended response. Of these, 77% were in the postpartum period. The majority of respondents identified as white, were partnered or married, and owned their own home. Respondents reported feeling greater uncertainty, social isolation, as though they had limited social and practical support, and negative mental health effects as a result of the pandemic. Many cited sudden or arbitrary changes to their medical care as a contributing factor. Though in the minority, some respondents also reported benefits from the changes to daily life, including perceived improvements to medical care, better work-life balance, and opportunities for new perspectives. CONCLUSIONS: This large qualitative dataset provides insight into how healthcare policy and lifestyle changes impacted pregnant and postpartum people. Respondents expressed similar levels of uncertainty and mental health concerns compared to other cohorts but less overall positivity. Our findings suggest greater attention be given to the impact of pandemic-related stress on pregnant and postpartum women. As the pandemic continues, these data identify areas where investment in additional support may have the greatest impact.

Pregnant and Postpartum Patients' Views of COVID-19 Vaccination.

Perinatal patients were faced with the decision to receive a COVID-19 vaccination in the absence of clinical trial data on COVID-19 vaccine safety and efficacy in pregnant and lactating patients. We used the Coronavirus Perinatal Experiences Impact Survey to explore the impact of the COVID-19 pandemic on the lives of perinatal patients. The mixed-method survey was distributed to all patients ≥ 18 years old who were pregnant between January 1st, 2020 - April 28, 2021 at a large academic health system in the upper Midwest. Open-ended responses were qualitatively analyzed. Of the 1182 respondents who completed the survey, 647 answered at least one open-ended question. Among these 647 participants, 85 discussed COVID-19 vaccination and were secondarily analyzed. The responses illustrated a wide range of perspectives regarding COVID-19 vaccination, with many citing concerns over the consequences of maternal vaccination on their child. Others highlighted the lack of information surrounding COVID-19 vaccination in perinatal women. Respondents also discussed challenges discussing their vaccination status with their healthcare provider and the impact of family member's vaccination decisions on postpartum support and childcare. The unprompted discussion of concerns about COVID-19 vaccination suggests this decision weighed on many participants, especially in the context of lack of information early in the pandemic. Our findings support the need for open discussion of perinatal patients with their providers on COVID-19 vaccination during the pregnancy and postpartum period.