[Health impact of COVID pandemic. SESPAS Report 2022]. / El impacto de la pandemia de COVID-19 sobre la salud. Informe SESPAS 2022.

OBJECTIVE: The World Health Organization declared the global SARS-CoV-2 infection a pandemic on March 11, 2020. The objective of this paper is to present its impact in terms of physical and mental health 22 months later. METHOD: We have reviewed results from published meta-analysis and systematic reviews, and some individual articles on specific aspects of special interest. National information on infection comes for the Red Nacional de Vigilancia Epidemiológica (RENAVE). RESULTS: Up to the end of October, more than 250 million infections and 5 million deaths had been reported globally. In Spain, 4.7 million infections have been documented although the real figure might be above 7 million. The pandemic has reduced life expectancy, and its effects have been especially dramatic in people with comorbidities and the elderly. There is a worsening of mental health in the general population. It is foreseeable that some groups, such as health professionals, mostly women, and front-line workers, may have a greater risk of developing mental health pathologies. The pandemic and the control measures have had other undesirable consequences such as a decrease in healthcare utilization, an increase in sedentary lifestyle or an increase in gender violence. In addition to its immediate effect on morbidity and mortality, the control measures have damaged the overall health status of the global population. CONCLUSIONS: Longitudinal studies are necessary to determine the mid and long consequences of the pandemic and the control measures, and to identify and evaluate effective health interventions.

Assessing the concordance and accuracy between hospital discharge data, electronic health records, and register books for diagnosis of inpatient admissions of miscarriage: A retrospective linked data study.

BACKGROUND: Despite the high prevalence of miscarriage, there are few studies which assess the concordance of a diagnosis of miscarriage in routinely collected health databases. OBJECTIVES: To determine agreement and accuracy for the diagnosis of miscarriage between electronic health records (EHR), the Hospital Inpatient-Enquiry (HIPE) system, and hospital register books in Ireland. METHODS: This is a retrospective study comparing agreement of diagnosis of miscarriage between three hospital data sources from January to June 2017. All inpatient admissions for miscarriage were reviewed from a single, tertiary maternity hospital in Ireland. Kappa, sensitivity, specificity, positive and negative predictive value were calculated. RESULTS: In this retrospective concordance study, EHR records confirmed 96.2% diagnosis of miscarriage of HIPE records, and 95.1% of register books records. A total of 95 records were not recorded in the register books but were recorded in HIPE and EHR. This study found a considerable variability when comparing definitions of type of miscarriage (i.e., missed miscarriage, incomplete, and complete) between the three data sources. CONCLUSION: Although this study found a high concordance in inpatient admissions for miscarriage between EHR, HIPE, and register books, a considerable discrepancy was found when classifying miscarriage between the three data sources.

Reproductive Health Knowledge About Miscarriage: A Cross-Sectional Study of University Students.

OBJECTIVE: To assess university students' knowledge of reproductive health information about miscarriage. METHODS: A single-centre, cross-sectional study was carried out using an online survey at a higher education institution in the Republic of Ireland between April and May of 2016. A total of 746 university students' responses were analysed. RESULTS: Approximately 60% and 70% of college students correctly identified features of first and second trimester miscarriage. After adjusting for confounders, male students were two times more likely to have a poor knowledge of features of miscarriage compared to females (aOR 2.0, 95% CI 1.3-3.0 and aOR 1.7, 95% CI 1.1-2.6 for first and second trimester respectively). Poor knowledge of features of first trimester miscarriage was less common among older students and students who were married, cohabiting or in a relationship (aOR 0.4, 95% CI 0.2-0.6 and aOR 0.4, 95% CI 0.3-0.8 respectively). Students who studied Medicine and Health were more likely to identify any type of treatment for miscarriage compared to students who studied other disciplines. Students who studied Arts and Social Science were more likely to overestimate the percentage of miscarriages with an identified cause compared to students who studied Medicine and Health. CONCLUSION: Our results provide additional information about the gap of knowledge in regards to reproductive health information about miscarriage, specifically among university students.

Miscarriage hospitalisations: a national population-based study of incidence and outcomes, 2005-2016.

BACKGROUND: Early miscarriage is one of the most common obstetric causes of maternal morbidity early in pregnancy. However, data concerning non-fatal complications among hospitalisations for early miscarriage are lacking. The aim of this study was to determine whether there were changes in the incidence, management and outcomes of early miscarriage hospitalisations between 2005 and 2016. METHODS: This is a nationwide population-based study of 50,538 hospitalisations with a diagnosis of early miscarriage of all acute maternity hospitals in Ireland. Electronic health records were retrieved using the Hospital In-Patient Enquiry database. Main outcomes include the incidence rates of hospitalisations and management for early miscarriage, and rates of blood transfusion and length of stay over 2 days. RESULTS: Overall, 50,538 hospitalisations for early miscarriage were identified from 2005 to 2016. The risk of hospitalisation decreased from 70.6 per 1000 deliveries (95% CI 68.4 to 72.8) in 2005 to 49.7 per 1000 deliveries (95% CI 49.7 to 53.3) in 2016; however, the risk of blood transfusion increased over time (ratio: 2.0; 95% CI 1.6 to 2.4). Women of advanced maternal age had a higher risk of hospitalisations. There were less blood transfusions among women who undertook medical treatment (ratio: 0.3; 95% CI 0.1 to 0.5), but they had an increased risk of staying over 2 days at the hospital (ratio: 1.5; 95% CI 1.2 to 1.9) compared to evacuation of retained products of conception. CONCLUSIONS: Hospitalisation rates for early miscarriage decreased over time with an increase in risk of blood transfusion and an extended length of stay at the hospital. Women who underwent medical management did not have as many blood transfusions as those undergoing surgical management. However, they had an increased risk of an extended stay. Research is needed to explore both outpatient and inpatient settings in order to improve the management and care provided.

Risk factors for miscarriage among women attending an early pregnancy assessment unit (EPAU): a prospective cohort study.

BACKGROUND: Miscarriage is the most common adverse outcome in early pregnancy; however, high proportion of miscarriages are classified as unexplained. In addition, pregnant women attending early pregnancy assessment units might be more vulnerable. AIMS: The purpose of this study was to explore the risk factors that might be associated with miscarriage among women attending an early pregnancy assessment unit (EPAU). METHODS: A prospective cohort study was undertaken. The study was conducted on women attending an EPAU at a large, tertiary hospital. A detailed lifestyle questionnaire was completed. In addition, data from validated psychometric scales were collected. Participants were followed up to determine pregnancy outcome. The relative risk was calculated to estimate the probability of having a miscarriage for all independent variables. RESULTS: A total sample of 293 women were included in this study. Well-established risk factors for miscarriage were found in this group including advanced maternal age and high-risk pregnancy (i.e. threatened miscarriage and recurrent miscarriage). In addition, lack of emotional wellbeing did contribute to an increased risk of miscarriage. Conversely, presenting with nausea or low-medium energy levels early in pregnancy were associated with a decreased risk of miscarriage. Finally, our results did not find any association between stressful life events, general health and lifestyle factors in this group. CONCLUSIONS: Our findings indicated that maternal, psychological and obstetric factors may have an influence on miscarriage among women attending an EPAU. The insight of a relationship between emotional wellbeing and miscarriage opens a window for prevention in this area.

University students' awareness of causes and risk factors of miscarriage: a cross-sectional study.

BACKGROUND: Spontaneous miscarriage is the most common complication of pregnancy, occurring in up to 20% of pregnancies. Despite the prevalence of miscarriage, little is known regarding peoples' awareness and understanding of causes of pregnancy loss. The aim of this study was to explore university students' understanding of rates, causes and risk factors of miscarriage. METHODS: A cross-sectional study including university students. An online questionnaire was circulated to all students at the University College Cork using their university email accounts in April and May 2016. Main outcomes included identification of prevalence, weeks of gestation at which miscarriage occurs and causative risk factors for miscarriage. RESULTS: A sample of 746 students were included in the analysis. Only 20% (n = 149) of students correctly identified the prevalence of miscarriage, and almost 30% (n = 207) incorrectly believed that miscarriage occurs in less than 10% of pregnancies. Female were more likely to correctly identify the rate of miscarriage than men (21.8% versus 14.5%). However, men tended to underestimate the rate and females overestimate it. Students who did not know someone who had a miscarriage underestimated the rate of miscarriage, and those who were aware of some celebrities who had a miscarriage overestimated the rate. Almost 43% (n = 316) of students correctly identified fetal chromosomal abnormalities as the main cause of miscarriage. Females, older students, those from Medical and Health disciplines and those who were aware of a celebrity who had a miscarriage were more likely to identify chromosomal abnormalities as a main cause. However, more than 90% of the students believed that having a fall, consuming drugs or the medical condition of the mother was a causative risk factor for miscarriage. Finally, stress was identified as a risk factor more frequently than advanced maternal age or smoking. CONCLUSION: Although almost half of the participants identified chromosomal abnormalities as the main cause of miscarriage, there is still a lack of understanding about the prevalence and most important risk factors among university students. University represents an ideal opportunity for health promotion strategies to increase awareness of potential adverse outcomes in pregnancy.

Ectopic pregnancy hospitalisations: A national population-based study of rates, management and outcomes.

OBJECTIVE: To determine whether there were changes in the incidence, management and outcomes of ectopic pregnancy hospitalisations in Ireland during 2005-2016. STUDY DESIGN: Population-based study was carried out from January 2005 to December 2016. A total of 12,098 women hospitalised due to ectopic pregnancy. All acute maternity hospital settings in the Republic of Ireland. Electronic health records were retrieved using the Hospital In-Patient Enquiry database. Rates ratios were calculated to estimate trends, risk of blood transfusion and risk of extended stay at the hospital. RESULTS: The rate of hospitalisation for ectopic pregnancy increased over the 12-year study period from 12.8/1,000 deliveries in 2005 to 17.7/1,000 deliveries in 2016. Risk of blood transfusion reduced over time (aIRR 0.8; 95%CI 0.6-0.9). Women aged at least 40 years had double the risk of hospitalisation and double the risk of blood transfusion. Women undergoing open surgical procedures were more likely to need a blood transfusion than those undergoing laparoscopic salpingectomy. Similar results were found for length of stay over two days. Blood transfusion was rare for patients who underwent medical management (aIRR 0.1; 95%CI 0.05-0.2). CONCLUSION: Advanced maternal age increased risk of hospitalisation for ectopic pregnancy. While the overall rate of hospitalisations increased over time, there was a reduction in the risk of blood transfusion and length of stay over two days. Type of management significantly affected the risk of blood transfusion and length of stay over two days at the hospital.

Psychological and support interventions to reduce levels of stress, anxiety or depression on women's subsequent pregnancy with a history of miscarriage: an empty systematic review.

OBJECTIVE: The aim of this systematic review was to assess the effect of interventions to reduce stress in pregnant women with a history of miscarriage. DESIGN: A systematic review of randomised controlled trials (RCTs). DATA SOURCE: A total of 13 medical, psychological and social electronic databases were searched from January 1995 to April 2016 including PUBMED, CENTRAL, Web of Science and EMBASE. ELIGIBILITY CRITERIA: This review focused on women in their subsequent pregnancy following miscarriage. All published RCTs which assessed the effect of non-medical interventions such as counselling or support interventions on psychological and mental health outcomes such as stress, anxiety or depression when compared with a control group were included. Stress, anxiety or depression had to be measured at least preintervention and postintervention. RESULTS: This systematic review found no RCT which met our initial inclusion criteria. Of the 4140 titles screened, 17 RCTs were identified. All of them were excluded. One RCT, which implemented a caring-based intervention, included pregnant women in their subsequent pregnancy; however, miscarriage was analysed as a composite variable among other pregnancy losses such as stillbirth and neonatal death. Levels of perceived stress were measured by four RCTs. Different types of non-medical interventions, time of follow-up and small sample sizes were found. CONCLUSION: Cohort studies and RCTs in non-pregnant women suggest that support and psychological interventions may improve pregnant women's psychological well-being after miscarriage. This improvement may reduce adverse pregnancy-related outcomes in subsequent pregnancies. However, this review found no RCTs which met our criteria. There is a need for targeted RCTs that can provide reliable and conclusive results to determine effective interventions for this vulnerable group.