Single-Centre Retrospective Cohort Study of Demographic Characteristics and Perinatal Outcomes in Pregnant Refugee Patients in Toronto, Canada.

Pregnant refugee patients are especially vulnerable to adverse perinatal outcomes. Detailed characterization of this heterogenous population will identify risk factors and thus guide contextualized initiatives for improved patient care. A retrospective cohort study of obstetrical refugee patients at a tertiary-care hospital in Toronto, Ontario. Of 196 pregnant refugees, 48% were fluent English speaking, 57% had poor social support, and 42% lived in a shelter. Eighty-seven percent started prenatal care after the first trimester, which was associated with delivery of a large-for-gestational-age infant (p = 0.043). Sixteen percent experienced family violence, which was associated with poor fetal aggregate outcomes (p = 0.03). There were significantly higher rates of pre-eclampsia and Cesarean sections in refugee versus non-refugee patients (p < 0.05). Pregnant refugees are at risk for psychosocial challenges and experience significantly worse obstetrical outcomes compared with non-refugees. Quality improvement initiatives should focus on access to early prenatal care, stable housing, and support for victims of family violence.

Reframing How Early Pregnancy Loss Is Viewed in the Emergency Department.

Women experiencing early pregnancy loss frequently seek care in emergency departments or early pregnancy clinics. The existing qualitative literature on the experience of miscarriage has yet to address how to connect how these women perceive their care experience and the prevailing structures which may be at the root of why their experience continues to be challenging. This study aimed to look deeper into the sources of negative experiences of early pregnancy loss for insight into how to rethink where to make impactful changes to care. Phenomenologically informed interviews with 59 women revealed several points of tension in the framing of early pregnancy loss, including the view of miscarriage as common, of it as a medical versus emotional experience, and the assumptions around care needs. Our work suggests that these tensions need to be dismantled through more patient-centered approaches to patient-provider relationships, policies, models of care, and medical discourse.

Proportion of Female Speakers at Academic Medical Conferences Across Multiple Specialties and Regions.

Importance: Women in medicine have been underrepresented at medical conferences; however, contributing factors have not been well studied. Objective: To examine the distribution of invited conference speakers by gender and factors associated with representation of women as speakers. Design, Setting, and Participants: This cross-sectional analysis used medical conference programs from March 2017 to November 2018 across 20 specialties in 5 regions (Australasia, Canada, Europe, the UK, and the US) that were obtained online or from conference conveners. Exposures: Gender of invited lecturers, panelists, and planning committee members for each conference based on name or picture and publicly available data on compositions of specialties by gender for included regions. Main Outcomes and Measures: Outcomes included the proportion of female speakers (invited lecturers and panelists), the number of single-gender panels, and the proportion of female speakers compared with the specialties' gender composition. Correlations between the gender composition of conference planning committees and the proportion of female speakers were assessed. Multivariable regression models were used to evaluate factors independently associated with the proportion of female speakers at conferences. Results: A total of 8535 sessions (panels and invited lectures) with 23 440 speakers across 98 conferences were identified. Women accounted for 7064 (30.1%) of speakers; 1981 of 5409 panels (36.6%) consisted of men only, and 363 (6.7%) consisted of women only. The proportion of women speakers varied by region and specialty from 5.8% to 74.5%. In general, specialties with low baseline proportions of women (<20%) had a ratio of female speakers to female specialists greater than 1, whereas specialties with high baseline proportions of women (>40%) had a ratio of female speakers to female specialists less that 1. There was a strong positive correlation between the proportion of women on planning committees and conference representation of female speakers (r = 0.67; P < .001). The association remained statistically significant after controlling for other variables, including the regional gender balance of the specialty (odds ratio, 1.10; 95% CI, 1.04-1.15; P < .001 for every 10% increase in the proportion of women on the planning committee). Conclusions and Relevance: In this cross-sectional study, the proportion of female speakers at medical conferences was lower than that of male speakers, and more than one-third of panels were composed of men only. Increasing the number of women on planning committees may help address gender inequities.

Emergency department use by pregnant women in Ontario: a retrospective population-based cohort study.

BACKGROUND: Peripregnancy emergency department use may be common, but data specific to health care systems like that in Canada are lacking. As prior research was limited to livebirths, omitting pregnancies ending in miscarriage or induced abortion, the current study quantified and characterized emergency department use among women in Ontario with a recognized pregnancy. METHODS: This retrospective population-based cohort study included all recognized pregnancies among Ontario residents aged 10-55 years with an estimated date of conception between Apr. 1, 2002, and Mar. 31, 2017. We defined peripregnancy emergency department use as any emergency department visit during pregnancy or within 42 days after pregnancy. We used modified Poisson regression with a robust error variance to generate relative risks (RRs) and 95% confidence intervals (CIs) for the outcome of any peripregnancy emergency department use in association with maternal age, parity, residential income quintile, location of residence, immigrant status, antenatal care provider and number of comorbidities within 120 days before the clinical start of the pregnancy (expressed as total number of Aggregated Diagnosis Groups [ADGs] obtained with the Johns Hopkins Adjusted Clinical Group System). All RRs, except for number of comorbidities, were further adjusted for number of ADGs. RESULTS: Peripregnancy emergency department use occurred in 1 075 991 (39.4%) of 2 728 236 recognized pregnancies, including 35.8% of livebirths, 47.3% of stillbirths, 73.7% of miscarriages and 84.8% of threatened abortions. A peripregnancy emergency department visit was more likely among women who were less than 25 years of age (adjusted RR 1.16, 95% CI 1.16-1.17), were nulliparous (adjusted RR 1.13, 95% CI 1.13-1.13), resided in the lowest income quintile area (adjusted RR 1.16, 95% CI 1.15-1.16) or in a rural area (adjusted RR 1.50, 95% CI 1.50-1.51), were Canadian-born (adjusted RR 1.22, 95% CI 1.22-1.23), were not seen by an obstetrician (adjusted RR 1.66, 95% CI 1.54-1.80) or had a greater number of ADGs. Emergency department use peaked in the first trimester and in the first week postpartum. Compared to women residing in urban areas, those residing in rural areas had an odds ratio (OR) of 3.44 (95% CI 3.39-3.49) for 3 or more emergency department visits. Women with 3-4 (OR 1.99, 95% CI 1.97-2.01), 5-6 (OR 3.55, 95% CI 3.49-3.61), or 7 or more (OR 7.59, 95% CI 7.39-7.78) prepregnancy comorbidities were more likely to have 3 or more peripregnancy emergency department visits than were those with 2 or fewer comorbidities. INTERPRETATION: Peripregnancy emergency department use occurred in nearly 40% of pregnancies, notably in the first trimester and early in the postpartum period. Efforts are needed to streamline rapid access to ambulatory obstetric care during these peak periods, when women are susceptible to miscarriage or a complication after a livebirth.

Mediated nuclear import and export of TAZ and the underlying molecular requirements.

Nucleocytoplasmic distribution of Yap/TAZ is regulated by the Hippo pathway and the cytoskeleton. While interactions with cytosolic and nuclear "retention factors" (14-3-3 and TEAD) are known to control their localization, fundamental aspects of Yap/TAZ shuttling remain undefined. It is unclear if translocation occurs only by passive diffusion or via mediated transport, and neither the potential nuclear localization and efflux signals (NLS, NES) nor their putative regulation have been identified. Here we show that TAZ cycling is a mediated process and identify the underlying NLS and NES. The C-terminal NLS, representing a new class of import motifs, is necessary and sufficient for efficient nuclear uptake via a RAN-independent mechanism. RhoA activity directly stimulates this import. The NES lies within the TEAD-binding domain and can be masked by TEAD, thereby preventing efflux. Thus, we describe a RhoA-regulated NLS, a TEAD-regulated NES and propose an improved model of nucleocytoplasmic TAZ shuttling beyond "retention".