Maternal and perinatal health research during emerging and ongoing epidemic threats: a landscape analysis and expert consultation.

INTRODUCTION: Pregnant women and their offspring are often at increased direct and indirect risks of adverse outcomes during epidemics and pandemics. A coordinated research response is paramount to ensure that this group is offered at least the same level of disease prevention, diagnosis, and care as the general population. We conducted a landscape analysis and held expert consultations to identify research efforts relevant to pregnant women affected by disease outbreaks, highlight gaps and challenges, and propose solutions to addressing them in a coordinated manner. METHODS: Literature searches were conducted from 1 January 2015 to 22 March 2022 using Web of Science, Google Scholar and PubMed augmented by key informant interviews. Findings were reviewed and Quid analysis was performed to identify clusters and connectors across research networks followed by two expert consultations. These formed the basis for the development of an operational framework for maternal and perinatal research during epidemics. RESULTS: Ninety-four relevant research efforts were identified. Although well suited to generating epidemiological data, the entire infrastructure to support a robust research response remains insufficient, particularly for use of medical products in pregnancy. Limitations in global governance, coordination, funding and data-gathering systems have slowed down research responses. CONCLUSION: Leveraging current research efforts while engaging multinational and regional networks may be the most effective way to scale up maternal and perinatal research preparedness and response. The findings of this landscape analysis and proposed operational framework will pave the way for developing a roadmap to guide coordination efforts, facilitate collaboration and ultimately promote rapid access to countermeasures and clinical care for pregnant women and their offspring in future epidemics.

'My body is out to wreck everything I have': a qualitative study of how women with endometriosis feel about their bodies.

OBJECTIVE: There is a distinct lack of research regarding the relationship with the body in women with endometriosis, despite the condition involving significant changes to appearance and impaired bodily functionality. The current study aimed to understand how women with endometriosis feel about their body. METHODS AND MEASURES: Participants completed an online survey with open-ended questions on how they feel about their body, physical appearance, and level of daily functioning. RESULTS: Responses from 315 women with endometriosis were analysed using reflexive thematic analysis, generating three themes: 1) 'It makes me feel broken and inadequate' (Sense of being defective); 2) 'I feel like I'm in a war with it' (Sense of conflict); and 3) 'I feel like my body isn't mine; it's out of control' (Sense of alienation). CONCLUSION: The findings provide support for the notion that the relationship between the body and sense of self is particularly problematic for women with endometriosis and warrants therapeutic intervention. Future research should verify the efficacy of appreciation and self-compassion-based interventions for people with endometriosis.

Endometriosis and body image: Comparing people with and without endometriosis and exploring the relationship with pelvic pain.

Qualitative studies have shown that people with endometriosis report feeling discontent with their bodies relating to the visual and functional effects of the disease. However, few studies exist which compare people with endometriosis to those without, leaving it largely unknown as to whether this discontentment differs from that regularly experienced by women. The current study therefore aimed to 1) quantitatively assess body image, namely appearance satisfaction and functionality appreciation, in people with and without endometriosis, and 2) explore the relationship between endometriosis-related pelvic pain and body image. Australians aged 18 and over were recruited for two groups: those with endometriosis (n = 312, 99 % female, Mage = 30.78, SDage = 7.40) and a control group without suspected or diagnosed endometriosis (n = 74, 100 % female, Mage = 32.38, SDage = 8.84). Participants completed an online survey consisting of measures of appearance satisfaction, functionality appreciation, and pelvic-pain impact. The endometriosis group demonstrated significantly poorer body image when compared to the control group, and endometriosis-related pelvic pain was shown to negatively correlate with body image. These findings demonstrate the likely negative effects endometriosis and pelvic pain have on body image and provide much needed insight to help develop interventions tailored to endometriosis.

The impact of different responses to negative body talk on body satisfaction, shame, and future negative body talk likelihood: A UK sample.

A recent online experiment found that, following a negative body talk induction task, receiving a response of ignoring the comment, compared with reassuring, reciprocating, and challenging, led to worse body satisfaction and socio-emotional outcomes for Australian women. The current online study aimed to replicate and extend this study by examining the effects of these four negative body talk responses on body satisfaction, shame, and future negative body talk likelihood in UK-based women. Participants (N = 156, Mage = 25.29, SDage = 5.64, rangeage = 18-40) recalled a scenario in which they engaged in negative body talk and were randomly assigned to receive one of four responses. Contrary to hypotheses, there were no significant differences in body satisfaction, shame, or future negative body talk likelihood across the four groups. Preferred negative body talk response data were mixed, with challenge and reassurance responses preferred at comparable rates, and just under a quarter of participants preferring a response outside of the original four. Possible explanations, including that the responses used in the original Australasian study may not perfectly correspond with UK women's experiences of social interactions and heterogeneous motivations for engaging in negative body talk necessitate more nuanced and sophisticated responses, are explored.

Eligibility for cervical cancer screening exit: Comparison of a national and safety net cohort.

OBJECTIVE: To determine eligibility for discontinuation of cervical cancer screening. METHODS: Women aged 64 with employer-sponsored insurance enrolled in a national database between 2016 and 2018, and those aged 64-66 receiving primary care at a safety net health center in 2019 were included. Patients were evaluated for screening exit eligibility by current guidelines: no evidence of cervical cancer or HIV-positive status and no evidence of cervical precancer in the past 25 years, and had evidence of either hysterectomy with removal of the cervix or evidence of fulfilling screening exit criteria, defined as two HPV screening tests or HPV plus Pap co-tests or three Pap tests within the past 10 years without evidence of an abnormal result. RESULTS: Of the 590,901 women in the national claims database, 131,059 (22.2%) were eligible to exit due to hysterectomy (1.6%) or negative screening (20.6%). Of the 1544 women from the safety net health center, 528 (34.2%) were eligible to exit due to hysterectomy (9.3%) or negative screening (24.9%). Most women did not have sufficient data available to fulfill exit criteria: 382,509 (64.7%) in the national database and 875 (56.7%) in the safety net hospital system. Even among women with 10 years of insurance claims data, only 41.5% qualified to discontinue screening. CONCLUSIONS: Examining insurance claims in a national database and electronic medical records at a safety net institution led to remarkably similar findings: two thirds of women fail to qualify for screening exit. Additional steps to ensure eligibility prior to screening exit may be necessary to decrease preventable cervical cancers among women aged >65. CLINICAL TRIAL REGISTRATION: N/A.

Impact of circadian rhythms on female reproduction and infertility treatment success.

PURPOSE OF REVIEW: In recent years, new studies have investigated the role and influence of sleep on female fertility and early pregnancy outcomes, providing a growing body of knowledge demonstrating how regulation by sleep of hormones are important to reproduction, and how disruptions in sleep, circadian rhythms, and genes regulating circadian rhythmicity can negatively impact fertility and early pregnancy outcomes. This review aims to summarize the most recent research on the relationship among circadian rhythms, fertility, and early pregnancy outcomes in women, and to explore possible fertility interventions. RECENT FINDINGS: Recent studies have found altered levels of FSH, LH, and prolactin with sleep disturbance or circadian dysrhythmia. Disruption of circadian rhythms in the form of shift work, jet lag, and daylight savings time changes have been associated with poorer fertility and early pregnancy outcomes. Alterations in the expression of circadian rhythm-regulating circadian locomotor output cycles kaput (CLOCK) genes have been associated with decreased fertility and increased rates of miscarriage. SUMMARY: Overall, undisrupted sleep and circadian rhythmicity appear to optimize fertility and early pregnancy outcomes and may play an important role in the success of fertility treatment.

The impact of different responses to fat talk on body image and socioemotional outcomes.

Fat talk, the act of making disparaging comments about one's own appearance, has been associated with an extensive range of negative body image outcomes. Despite this well-established body of literature highlighting the prevalence and consequences, scant research exists on the impact of different responses to fat talk in situ. The current online experiment aimed to explore four different responses to fat talk and their impact on body satisfaction, shame, and feelings of support. Female participants (N = 191, Mage = 23.52, SDage = 4.54, rangeage = 18-40) recalled or imagined an experience of engaging in fat talk before being randomly assigned to receive a set response (where their fat talk was either challenged, ignored, reassured, or reciprocated). Largely in line with hypotheses, the Ignore condition led to the lowest level of body satisfaction and perceived support, and the highest level of shame. The Challenge condition resulted in positive outcomes for both perceived support and feelings of shame. The findings demonstrate that ignoring fat talk is associated with negative outcomes, providing evidence to inform practical guidelines aimed at tackling the social phenomenon.

Nature and consequences of positively-intended fat talk in daily life.

The current study used ecological momentary assessment to explore the frequency, trait predictors, and momentary consequences of positively-intended fat talk, a specific sub-type of fat talk that involves making negative comments about one's own appearance with the view to making someone else feel better. A total of 135 women aged 18-40 completed trait measures of appearance-based comparisons, thin-ideal internalisation, body shame, and body surveillance, before completing a state-based component, involving six short surveys delivered via a smartphone app at random points during the day for seven days. Findings indicate that both self- and other-fat talk are common in daily social interactions, and that individuals with higher levels of trait negative body image were more likely to engage in fat talk. Self-fat talk negatively impacted state body satisfaction levels. Possible theoretical and practical implications are outlined.

CYP2D6 Allelic Variants *34, *17-2, *17-3, and *53 and a Thr309Ala Mutant Display Altered Kinetics and NADPH Coupling in Metabolism of Bufuralol and Dextromethorphan and Altered Susceptibility to Inactivation by SCH 66712.

Metabolic phenotype can be affected by multiple factors, including allelic variation and interactions with inhibitors. Human CYP2D6 is responsible for approximately 20% of cytochrome P450-mediated drug metabolism but consists of more than 100 known variants; several variants are commonly found in the population, whereas others are quite rare. Four CYP2D6 allelic variants-three with a series of mutations distal to the active site (*34, *17-2, *17-3) and one ultra-metabolizer with mutations near the active site (*53), along with reference *1 and an active site mutant of *1 (Thr309Ala)-were expressed, purified, and studied for interactions with the typical substrates dextromethorphan and bufuralol and the inactivator SCH 66712. We found that *34, *17-2, and *17-3 displayed reduced enzyme activity and NADPH coupling while producing the same metabolites as *1, suggesting a possible role for Arg296 in NADPH coupling. A higher-activity variant, *53, displayed similar NADPH coupling to *1 but was less susceptible to inactivation by SCH 66712. The Thr309Ala mutant showed similar activity to that of *1 but with greatly reduced NADPH coupling. Overall, these results suggest that kinetic and metabolic analysis of individual CYP2D6 variants is required to understand their possible contributions to variable drug response and the complexity of personalized medicine.

Socially Responsible Surgery: Building Recognition and Coalition.

IMPORTANCE: Socially responsible surgery (SRS) integrates surgery and public health, providing a framework for research, advocacy, education, and clinical practice to address the social barriers of health that decrease surgical access and worsen surgical outcomes in underserved patient populations. These patients face disparities in both health and in health care, which can be effectively addressed by surgeons in collaboration with allied health professionals. OBJECTIVE: We reviewed the current state of surgical access and outcomes of underserved populations in American rural communities, American urban communities, and in low- and middle-income countries. EVIDENCE REVIEW: We searched PubMed using standardized search terms and reviewed the reference lists of highly relevant articles. We reviewed the reports of two recent global surgery commissions. CONCLUSION: There is an opportunity for scholarship in rural surgery, urban surgery, and global surgery to be unified under the concept of SRS. The burden of surgical disease and the challenges to management demonstrate that achieving optimal health outcomes requires more than excellent perioperative care. Surgeons can and should regularly address the social determinants of health experienced by their patients. Formalized research and training opportunities are needed to meet the growing enthusiasm among surgeons and trainees to develop their practice as socially responsible surgeons.

Fat talk and its relationship with body image disturbance.

Although past studies have highlighted fat talk as relevant to body image disturbance, the majority of these have only investigated the link between fat talk and body esteem, to the exclusion of other body image constructs. One hundred and ninety-nine women completed an online survey measuring levels of appearance-based comparisons, body surveillance, thin ideal internalization, body esteem, and fat talk (FT-body concerns and FT-body comparisons). Results showed that fat talk made a significant contribution in explaining additional variance in body esteem above the other three body image factors, with FT-body concerns in particular making the highest unique contribution. Hierarchical regression analyses suggest that fat talk should be viewed as an independent psychosocial predictor of body esteem in both theoretical and therapeutic contexts. Future research should explore these relationships from a longitudinal perspective, and also clarify the nuances in the relationships by investigating the nature of women's everyday body image experiences.

Does the burden of the experience sampling method undermine data quality in state body image research?

Despite growing popularity of experience sampling methodology (ESM) for evaluations of state-based components of body image, there have been concerns that the frequent repeated measurement might encourage problematic responding resulting in low data quantity and/or quality. Using a sample of 105 women (mean age=24.84), this study used multilevel modelling to investigate whether (a) there were changes in compliance or response variability across a 7-day period, and (b) whether such changes are explained by participant characteristics. Present findings suggest that demands of ESM protocol undermine quantity more so than quality of obtained data. Decline in procedural compliance across the testing period correlated with BMI and body shame, whereas reduced variability in state-based assessments did not adversely impact the strength of association between state body satisfaction ratings and other variables in the dataset. The authors make several recommendations for ensuring the quality of ESM-based data in future studies.

A multiple additive regression tree analysis of three exposure measures during Hurricane Katrina.

This paper analyses structural and personal exposure to Hurricane Katrina. Structural exposure is measured by flood height and building damage; personal exposure is measured by the locations of 911 calls made during the response. Using these variables, this paper characterises the geography of exposure and also demonstrates the utility of a robust analytical approach in understanding health-related challenges to disadvantaged populations during recovery. Analysis is conducted using a contemporary statistical approach, a multiple additive regression tree (MART), which displays considerable improvement over traditional regression analysis. By using MART, the percentage of improvement in R-squares over standard multiple linear regression ranges from about 62 to more than 100 per cent. The most revealing finding is the modelled verification that African Americans experienced disproportionate exposure in both structural and personal contexts. Given the impact of exposure to health outcomes, this finding has implications for understanding the long-term health challenges facing this population.

The clearinghouse concept: a model for geospatial data centralization and dissemination in a disaster.

The disaster clearinghouse concept originates with the earthquake community as an effort to coordinate research and data collection activities. Though prior earthquake clearinghouses are small in comparison to what was needed in response to Hurricane Katrina, these seminal structures are germane to the establishment of our current model. On 3 September 2005, five days after Katrina wrought cataclysmic destruction along the Gulf Coast, FEMA and Louisiana State University personnel met to establish the LSU GIS Clearinghouse Cooperative (LGCC), a resource for centralization and dissemination of geospatial information related to Hurricane Katrina. Since its inception, the LGCC has developed into a working model for organization, dissemination, archiving and research regarding geospatial information in a disaster. This article outlines the formation of the LGCC, issues of data organization, and methods of data dissemination and archiving with an eye towards implementing the clearinghouse model as a standard resource for addressing geospatial data needs in disaster research and management.

Geospatial approaches for disease risk communication in marginalized communities.

BACKGROUND: After Hurricane Katrina, Louisiana State University (LSU) collaborated with the Federal Emergency Management Agency (FEMA) to create the LSU GIS Clearinghouse Cooperative (LGCC) to disseminate geospatial data. From this experience of serving community geospatial data needs for risk communication, particularly in marginalized areas, and through working with the World Health Organization Collaborating Center for Remote Sensing and GIS for Public Health (WHOCC), we identified several useful geospatial technologies (GT) and methods for their implementation in risk communication strategies. OBJECTIVES: This article provides an assessment of the benefits and limitations of these technologies for risk communication in marginalized communities. METHODS: Several GT have been employed for risk communication and general data dissemination in communities throughout rural coastal Louisiana. From experimentation with these technologies for risk communication, they can be classed into three groups: lightweight GIS, map dissemination tools, and interactive GT. RESULTS: Lightweight GIS and map dissemination tools will, at some point in their application, require the assistance of a GIS expert or GIS data provider to develop and customize the tool for its intended uses. Interactive GT, however, has rapidly developed options that allow user-friendly operation without reliance on expert assistance. Google Maps, however, is showing the greatest potential for community-based health participation. CONCLUSIONS: Classifying the available GT based on functionality is critical to help specialists provide the most effective method for spatial risk communication and to assist community users in creating accessible data for their local health needs.

Katrina and vulnerability: the geography of stress.

The immediate aftermath of Katrina focused the world's attention on the vulnerability of the urban poor and racial/ethnic minority groups in New Orleans. This vulnerability can be viewed in terms of site, the proximity of a neighborhood to a hazard, and situation, the social context of that neighborhood. Vulnerabilities, associated with demographic characteristics such as being poor, being a member of a racial/ethnic minority group, and being female, will strengthen the force of a disaster. This paper uses a site and situation approach to show how maps of the five main sources of disaster-related stress in New Orleans can be used to predict where counseling resources should be targeted.

Spatial confidentiality and GIS: re-engineering mortality locations from published maps about Hurricane Katrina.

BACKGROUND: Geographic Information Systems (GIS) can provide valuable insight into patterns of human activity. Online spatial display applications, such as Google Earth, can democratise this information by disseminating it to the general public. Although this is a generally positive advance for society, there is a legitimate concern involving the disclosure of confidential information through spatial display. Although guidelines exist for aggregated data, little has been written concerning the display of point level information. The concern is that a map containing points representing cases of cancer or an infectious disease, could be re-engineered back to identify an actual residence. This risk is investigated using point mortality locations from Hurricane Katrina re-engineered from a map published in the Baton Rouge Advocate newspaper, and a field team validating these residences using search and rescue building markings. RESULTS: We show that the residence of an individual, visualized as a generalized point covering approximately one and half city blocks on a map, can be re-engineered back to identify the actual house location, or at least a close neighbour, even if the map contains little spatial reference information. The degree of re-engineering success is also shown to depend on the urban characteristic of the neighborhood. CONCLUSION: The results in this paper suggest a need to re-evaluate current guidelines for the display of point (address level) data. Examples of other point maps displaying health data extracted from the academic literature are presented where a similar re-engineering approach might cause concern with respect to violating confidentiality. More research is also needed into the role urban structure plays in the accuracy of re-engineering. We suggest that health and spatial scientists should be proactive and suggest a series of point level spatial confidentiality guidelines before governmental decisions are made which may be reactionary toward the threat of revealing confidential information, thereby imposing draconian limits on research using a GIS.