Effect of infection with severe acute respiratory syndrome coronavirus 2 on the fetus in pregnant women who recovered from infection.

BACKGROUND: The effect of maternal infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the fetus is unclear, and there is no data from Saudi Arabia. OBJECTIVE: Assess the effect of maternal SARS-CoV-2 infection on fetal growth. DESIGN: Retrospective case-control SETTING: Tertiary care hospital, Riyadh, Saudi Arabia PATIENTS AND METHODS: We selected pregnant women who underwent an obstetric growth scan and umbilical artery Doppler ultra-sound examination between 28 and 41 weeks of pregnancy. Women with multiple pregnancy, fetal abnormalities, maternal body mass index >30, maternal hypertension, any other chronic diseases that might affect fetal growth or pregnant women suffering from cancer were excluded. Fetal growth parameters assessed included fetal biometry (biparietal diameter, head circumference, abdominal circumference and femur length). We also did an umbilical artery Doppler assessment, which includes the umbilical artery pulsatility index, resistive index and the systolic/diastolic ratio. MAIN OUTCOME MEASURE: Fetal biometry and biophysical profile SAMPLE SIZE: 48 SARS-CoV-2; 98 non-SARS-CoV-2 RESULTS: More women who had recovered from SARS-CoV-2 infection had small for gestational age fetuses compared with the control group (P=.001). CONCLUSION: Maternal SARS-CoV-2 infection during pregnancy was associated with a higher prevalence of small for gestational age (SGA) fetuses. LIMITATIONS: Retrospective, middle cerebral artery and uterine artery Doppler data were not included nor were the effect of tobacco use and socioeconomic status, the relationship between the date of infection with the date of conceiving or the relationship between the severity of infection in the mother and fetal biometry and growth. CONFLICT OF INTEREST: None.

Reimagining mental health care for newcomer children and families: a qualitative framework analysis of service provider perspectives.

BACKGROUND: Persistent disparities in access to mental health care for refugee and immigrant children and their families pose unique challenges to policy and practice. This study examined service provider perspectives on the barriers and opportunities for improving mental health supports for newcomer children and families in Canada. METHODS: Semi-structured individual and group interviews were conducted with 33 leadership and frontline staff from 14 organizations in the health, education, settlement, and social service sectors in Hamilton, Ontario. Interview data were analyzed using the framework method. RESULTS: Participants described barriers at the systems, provider, and individual and family levels that prevented newcomer families from accessing and benefiting from mental health supports. Structural barriers included inadequate services and funding, complexity of systems, cultural tensions, and, lack of prevention and early identification. Provider-level barriers included lack of representation, mental health knowledge and cultural competency, and staff shortages and burnout. Individual and family-level barriers included lack of mental health literacy, primacy of settlement needs, stigma, fear, and the high threshold for help-seeking. Participants' recommendations for "reimagining care" related to newcomer engagement, person- and family-centered care, cultural responsiveness, mental health promotion and prevention, workforce diversity and development, collaborative and integrated care, and knowledge generation and uptake. CONCLUSIONS: The intersection of structural, provider, and individual/family-level barriers reduce newcomer families' access to and effectiveness of mental health supports. Reducing disparities in mental health and access to care will require a paradigm shift in the way that mental health care is conceptualized and delivered to newcomer children and families.

Resettlement, mental health, and coping: a mixed methods survey with recently resettled refugee parents in Canada.

BACKGROUND: Resettlement experiences of refugee parents are under-researched despite evidence indicating higher risk of poor mental health. The current study integrates family systems and social determinants of refugee mental health frameworks to examine: (1) Refugee parents' experiences of resettlement stressors and mental health; (2) Perceived impacts of resettlement stressors on individual and family indicators of well-being; and (3) Refugee parents' coping strategies and resources. METHODS: The study draws on data from a mixed methods survey conducted with 40 Government-Assisted Refugee parents who had resettled to Hamilton, Canada within the past 4 years. Quantitative and qualitative data were analyzed separately and then integrated at the results stage using a weaving approach. RESULTS: Results indicate significant exposure to economic and social stressors across multiple domains of daily life, as well as high levels of parental psychological distress. Parents drew linkages between resettlement stressors and negative mental health impacts that were compounded by intersecting risk factors of ill health, caregiving burden, single parenthood, and low levels of education and literacy. Most parents rated themselves as coping well or very well and described various coping strategies such as positive reframing, problem solving, planning, and turning to religion. Quantitative and qualitative findings indicate high frequency of positive parent-child interaction and low frequency of family conflict, and highlight the importance of family as a protective resource for coping with adversity. Exploratory regression analyses suggest that longer stay in Canada, poorer self-rated health, higher levels of resettlement stressors, and more conflict between adults in the household may be associated with greater psychological distress. CONCLUSION: Study findings highlight both the resilience of refugee parents and the psychological toll of navigating their families through a new and challenging environment. Policies and programs to provide comprehensive social and economic supports to refugees beyond the first one to two years after arrival are necessary to mitigate the mental health impacts of displacement over time and strengthen individual and family resilience. Such programs should include culturally responsive and family-based models of mental health care that acknowledge collective experiences and impacts of adversity, as well as harness family resources to overcome past and present challenges.

Lifestyle factors influencing bone health in young adult women in Saudi Arabia.

AIM: To analyze risk factors leading to osteopenia and osteoporosis among young female students. METHODS: Quantitative Ultrasonography measurements were performed in the calcaneal region of 101 young Saudi females. Dietary habits, exercising and sun exposure were assessed using questionnaires. The association between the different studied factors was assessed by Pearson test and multiple linear regression model. RESULTS: Participants diagnosed with either osteopenia or osteoporosis (>33%.) showed significant higher soft drinks consumption, reduced exercise, limited intake of milk and dairy products, calcium and vitamin D supplementation compared to the healthy group. Multiple regression analysis showed that T-score and Z-score were negatively associated with soft drink intake and positively associated with exercising, milk and dairy products consumption, and calcium and vitamin D supplementation use (p <0.05). CONCLUSION: High soft drink intake, lack of exercising and limited calcium and vitamin D supplementation are the combined lifestyle factors leading to osteopenia and osteoporosis among young Saudi females. These findings might serve as a basis of nutrition education intervention to promote healthy bones among this population.

Measurements of bone mineral density and stiffness index in young Saudi females.

OBJECTIVE: To examine the ability to use Quantitative Ultrasonography (QUS) densitometer for screening of osteoporosis and osteopenia by comparing QUS values obtained at the calcaneus region to bone mineral density (BMD) values measured at the spine and the neck of the femur using Dual Energy X-ray Absorbemetry (DXA). METHODS: QUS (in the calcaneus region) and DXA (the spine and the neck of femur respectively) measurements were performed in 101 females. RESULTS: The precision of the QUS parameters varied from 1.77-1.78, whereas the reliability ranged from 92.2%-98.6%. For the QUS parameters variability between subjects was greater than that within subjects. Positive correlation were found between stiffness index (SI) and BMDspine and BMDN.femur (r= 0.29 & r=0.25 respectively, P < 0.05) and a strong positive correlation between T-scorecalcaneus and both T-scoreSpine and T-scoreN.femur (r= 0.5 & r=0.58 respectively, P < 0.01). CONCLUSIONS: QUS is a reliable technique to be used in combination with DXA for the investigation of osteopenia and osteoporosis.

Bone mineral density in university aged Saudi females.

OBJECTIVE: The aim of the study was to investigate bone mineral density (BMD) in young Saudi females (20-25 years) using Dual-energy x-ray absorptiometry (DXA), as it is a widely utilized modality for the measurement of BMD, used for the diagnosis of osteoporosis and osteopenia. METHODS: BMD measurements were performed in the spine and the neck of the femur in 101 young females. RESULTS: 37% and 34% patients had osteopenia in the spine and the neck of the femur respectively, BMD values = 0.98 and 0.81 gm/cm(2) respectively). Whereas 5% had osteoporosis in the spine area, BMD values = 0.82 gm/cm(2)). Of the 101 subjects, 53 (52.5%) young females did not suffer from osteopenia in either both site, whereas 23 (22.7%) females had osteopenia in both sites, the remaining 25 subjects (25% of the subject included) had either osteopenia or osteoporosis in one of the sites. A strong association between BMD values with weight was found. CONCLUSIONS: We found that one third of the young Saudi females sampled suffer from osteopenia. Additionally, body weight has a positive relationship with bone mineral density.

Measurement and comparison of skin dose using OneDose MOSFET and Mobile MOSFET for patients with acute lymphoblastic leukemia.

BACKGROUND: Total body irradiation is a protocol used to treat acute lymphoblastic leukemia in patients prior to bone marrow transplant. It is involved in the treatment of the whole body using a large radiation field with extended source-skin distance. Therefore measuring and monitoring the skin dose during the treatment is important. Two kinds of metal oxide semiconductor field effect transistor (OneDose MOSFET and mobile MOSEFT) dosimeter are used during the treatment delivery to measure the skin dose to specific points and compare it with the target prescribed dose. The objective of this study was to compare the variation of skin dose in patients with acute lymphatic leukemia (ALL) treated with total body irradiation (TBI) using OneDose MOSFET detectors and Mobile MOSFET, and then compare both results with the target prescribed dose. MATERIAL/METHODS: The measurements involved 32 patient's (16 males, 16 females), aged between 14-30 years, with an average age of 22.41 years. One-Dose MOSFET and Mobile MOSFET dosimetry were performed at 10 different anatomical sites on every patient. RESULTS: The results showed there was no variation between skin dose measured with OneDose MOSFET and Mobile MOSFET in all patients. Furthermore, the results showed for every anatomical site selected there was no significant difference in the dose delivered using either OneDose MOSFET detector or Mobile MOSFET as compared to the prescribed dose. CONCLUSIONS: The study concludes that One-Dose MOSFET detectors and Mobile MOSFET both give a direct read-out immediately after the treatment; therefore both detectors are suitable options when measuring skin dose for total body irradiation treatment.

Some effects of sustained compression on ulcerated tissues.

Sustained leg compression is the first line of treatment for patients with chronic venous ulcers. The success rates of this treatment vary, and the mode(s) of action are not well understood. In this study, tissue oxygen tension (TcPO2), surface pH, and reactive hyperemia measurements were made to observe changes associated with sustained compression in patients with chronic venous ulcers. Patients with chronic venous ulcers (n = 20, 13 F, 7 M, median age 65.5 years, median ulcer size 13.9 cm2) were assigned to the same treatment, wound dressings, and 4-layer bandaging during a 24-week period. Duplex ultrasound, venous refilling time, skin tissue oxygen, and ulcer surface pH were measured at defined time points. Ulcer areas were calculated from contour traces done at regular dressing changes. The difference between ulcer surface pH and control values measured proximally on the same leg diminished with healing (p = 0.02), which occurred despite the evidence of deep venous reflux. Ulcers with smaller initial areas healed quicker (p = 0.003). A greater likelihood of healing was observed in women (p = 0.017). Sustained compression may potentiate healing by acting on the microcirculation in ulcerated tissues.