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1.
BMC Health Serv Res ; 21(1): 542, 2021 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-34078380

RESUMEN

BACKGROUND: Advances in genetics and sequencing technologies are enabling the identification of more individuals with inherited cancer susceptibility who could benefit from tailored screening and prevention recommendations. While cancer family history information is used in primary care settings to identify unaffected patients who could benefit from a cancer genetics evaluation, this information is underutilized. System-level population health management strategies are needed to assist health care systems in identifying patients who may benefit from genetic services. In addition, because of the limited number of trained genetics specialists and increasing patient volume, the development of innovative and sustainable approaches to delivering cancer genetic services is essential. METHODS: We are conducting a randomized controlled trial, entitled Broadening the Reach, Impact, and Delivery of Genetic Services (BRIDGE), to address these needs. The trial is comparing uptake of genetic counseling, uptake of genetic testing, and patient adherence to management recommendations for automated, patient-directed versus enhanced standard of care cancer genetics services delivery models. An algorithm-based system that utilizes structured cancer family history data available in the electronic health record (EHR) is used to identify unaffected patients who receive primary care at the study sites and meet current guidelines for cancer genetic testing. We are enrolling eligible patients at two healthcare systems (University of Utah Health and New York University Langone Health) through outreach to a randomly selected sample of 2780 eligible patients in the two sites, with 1:1 randomization to the genetic services delivery arms within sites. Study outcomes are assessed through genetics clinic records, EHR, and two follow-up questionnaires at 4 weeks and 12 months after last genetic counseling contactpre-test genetic counseling. DISCUSSION: BRIDGE is being conducted in two healthcare systems with different clinical structures and patient populations. Innovative aspects of the trial include a randomized comparison of a chatbot-based genetic services delivery model to standard of care, as well as identification of at-risk individuals through a sustainable EHR-based system. The findings from the BRIDGE trial will advance the state of the science in identification of unaffected patients with inherited cancer susceptibility and delivery of genetic services to those patients. TRIAL REGISTRATION: BRIDGE is registered as NCT03985852 . The trial was registered on June 6, 2019 at clinicaltrials.gov .


Asunto(s)
Asesoramiento Genético , Neoplasias , Niño , Femenino , Pruebas Genéticas , Humanos , Recién Nacido , Neoplasias/genética , Neoplasias/terapia , New York , Embarazo , Atención Primaria de Salud
2.
Wei Sheng Yan Jiu ; 50(3): 460-465, 2021 May.
Artículo en Chino | MEDLINE | ID: mdl-34074369

RESUMEN

OBJECTIVE: To explore the relationship between dietary inflammatory index(DII), serum interleukin-6(IL-6) of late pregnant women and infant birth weight. METHODS: This study was conducted in late pregnant women who received antenatal care at the Maternal and Children& apos; s Hospital of Baiyun and Yuexiu District in Guangzhou, China between September 2010 and February 2011. Tree consecutive 24-h diet recalls, pre-pregnancy body mass index, maternal education level and etc were collected. DII score was calculated based on data of dietary surveys. Participant were dived into anti-inflammatory group(T1), neutral group(T2) and pro-inflammatory group(T3) according to the tertiles of DII score. Maternal and infant anthropometric profile(n=456) and level of maternal serum IL-6(n=308) were measured. Structrural equation modeling(SEM) was used to explore the relationship between DII, IL-6 and birth weight. RESULTS: In 456 women, the mean DII score was 0. 02±1. 08. Women performed anti-inflammatory diet had higher intake of grain and potato, vegetables, energy, fiber, minerals, vitamins and unsaturated fatty acids, but lower intakes of fruits, diary, fat(% energy) and protein from animal food(P& lt; 0. 05). Average infant birth weight and level of maternal serum IL-6 were(3238. 1±376. 4)g and 4. 05(2. 02, 10. 14) pg/mL respectively. DII of pregnant women was positively correlated with maternal serum IL-6(r=0. 144, P& lt; 0. 05), and IL-6 was negatively correlated with birth weight(r=-0. 184, P& lt; 0. 05). SEM indicated that maternal serum IL-6 may be a mediator in the association between DII and birth weight. CONCLUSION: The diet of pregnant women may change the serum level of IL6, and then affect infant birth weight.


Asunto(s)
Peso al Nacer , Dieta , Interleucina-6 , Mujeres Embarazadas , China , Femenino , Humanos , Recién Nacido , Inflamación , Interleucina-6/sangre , Embarazo
3.
Neoreviews ; 22(6): e392-e397, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34074644

RESUMEN

Breast milk provides optimal nourishment for all infants and has special advantages in preterm infants. Breast milk is associated with lower rates of necrotizing enterocolitis and bronchopulmonary dysplasia and improved neurodevelopmental outcomes in the preterm population. Mothers in the NICU may experience multiple psychological, physical, and social/cultural barriers that impede successful breastfeeding. Professional lactation support is of crucial importance in this population. With the social distancing requirements of the pandemic, many clinicians have adopted novel methods of education and communication to ensure continued timely support for NICU mothers.


Asunto(s)
Lactancia Materna , Unidades de Cuidado Intensivo Neonatal , Lactancia , Derivación y Consulta , Telemedicina , Adulto , Femenino , Humanos , Recién Nacido
4.
BMC Ophthalmol ; 21(1): 249, 2021 Jun 05.
Artículo en Inglés | MEDLINE | ID: mdl-34090370

RESUMEN

BACKGROUND: ALG3-CDG is a rare autosomal recessive disease. It is characterized by deficiency of alpha-1,3-mannosyltransferase caused by pathogenic variants in the ALG3 gene. Patients manifest with severe neurologic, cardiac, musculoskeletal and ophthalmic phenotype in combination with dysmorphic features, and almost half of them die before or during the neonatal period. CASE PRESENTATION: A 23 months-old girl presented with severe developmental delay, epilepsy, cortical atrophy, cerebellar vermis hypoplasia and ocular impairment. Facial dysmorphism, clubfeet and multiple joint contractures were observed already at birth. Transferrin isoelectric focusing revealed a type 1 pattern. Funduscopy showed hypopigmentation and optic disc pallor. Profound retinal ganglion cell loss and inner retinal layer thinning was documented on spectral-domain optical coherence tomography imaging. The presence of optic nerve hypoplasia was also supported by magnetic resonance imaging. A gene panel based next-generation sequencing and subsequent Sanger sequencing identified compound heterozygosity for two novel variants c.116del p.(Pro39Argfs*40) and c.1060 C > T p.(Arg354Cys) in ALG3. CONCLUSIONS: Our study expands the spectrum of pathogenic variants identified in ALG3. Thirty-three variants in 43 subjects with ALG3-CDG have been reported. Literature review shows that visual impairment in ALG3-CDG is most commonly linked to optic nerve hypoplasia.


Asunto(s)
Trastornos Congénitos de Glicosilación , Degeneración Retiniana , Preescolar , Trastornos Congénitos de Glicosilación/genética , Ojo , Femenino , Secuenciación de Nucleótidos de Alto Rendimiento , Humanos , Lactante , Recién Nacido , Manosiltransferasas/genética , Fenotipo
5.
J Pak Med Assoc ; 71(5): 1388-1393, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34091620

RESUMEN

OBJECTIVE: To assess the growth pattern of children with coeliac disease after the introduction of a gluten-free diet. Method: The retrospective study was conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, and comprised data from January 2015 to December 2018 of children aged 2-16 years with biopsy-proven coeliac disease. Serial measurements of height-for-age and weight-for-age z-scores were recorded at 0, 4, 8, 12 and 16 months. Data on insulin-like growth factor-1 and insulin-like growth factor binding protein-3 obtained at diagnosis and during follow-up was retrieved. Clinical, demographic, and laboratory data was extracted from the patients' medical files. Data was analysed using SPSS 22. RESULTS: Of the 47 patients, 25(53.2%) were boys and 22(46.8%) were girls. The overall mean age was 8.7±3.4 years. There was a significant time effect for weight-for-age and height-for-age z-scores (p<0.001). There was significant increase in the secretion of insulin-like growth factor-1 and insulin-like growth factor binding protein-3 (p<0.05) during the first 8 months of a gluten-free diet. CONCLUSIONS: The administration of gluten-free diet for Saudi children with coeliac disease normalized growth parameters and improved the endogenous secretion of growth factors.


Asunto(s)
Enfermedad Celíaca , Dieta Sin Gluten , Proliferación Celular , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Arabia Saudita/epidemiología
6.
J Pak Med Assoc ; 71(5): 1432-1437, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34091629

RESUMEN

OBJECTIVE: To determine the reasons of neonatal referrals from secondary-care to tertiary-care setting, and to assess neonatal outcomes for the referred cases. METHODS: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from July 2015 to June 2019 Related to all neonates born after 32 weeks of gestation at the satellite secondary-care centres in Kharadar, Garden and Karimabad who had been referred to the main tertiary care hospital. The reason for referral, need of mechanical ventilation, referral place and neonatal outcome were noted. Data was analysed using SPSS 22. RESULTS: Of the 348 cases, 211(60.6%) were boys. The overall mean gestational age was 36.42±2.61 weeks and the mean birth weight was 2.54±0.67 kg. The outcome was neonatal mortality in 42(12%) cases. Of the remaining 306(88%) cases, 284(92.81%) were discharged from the hospital and 22(7.18%) left against medical advice. Overall, mechanical ventilation was needed in 63(18.1%) patients. There was a significant association of mechanical ventilation with low Appearance, Pulse, Grimace, Activity, and Respiration score at 1 and 5 minutes (p<0.001), shorter duration of stay (p=0.007), and aggressive resuscitation requirement at birth (p<0.001). CONCLUSIONS: The most common reasons for referral of newborns to tertiary care hospital were respiratory diseases requiring respiratory support and surgical intervention.


Asunto(s)
Derivación y Consulta , Atención Secundaria de Salud , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Pakistán/epidemiología , Estudios Retrospectivos , Centros de Atención Terciaria
7.
J Pak Med Assoc ; 71(5): 1499-1502, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34091645

RESUMEN

Neurofibromatosis type 1 is an autosomal dominant, common genetic disorder that affects many systems, including the skeleton and neurocutaneous system. Skeletal involvement is seen in 38% of patients with NF1. Bowing deformity and pseudarthrosis are observed in 5.7% of the long bones, most of which are common in the tibia. A 13-year-old Somalian girl visited our orthopaedic clinic with complaints of deformity, inability to walk and pain in both legs. The deformity in both legs was present at birth and progressed further. A pathological fracture in the right tibia and a wide range of pseudarthrosis, hamartomatous bone tissues, medullary canal and diaphyseal narrowing towards the pseudoarthrosis range and cortical thickening were observed on her radiographs. Ilizarov technique was used for the case in this study.


Asunto(s)
Neurofibromatosis 1 , Seudoartrosis , Adolescente , Femenino , Humanos , Recién Nacido , Neurofibromatosis 1/complicaciones , Seudoartrosis/diagnóstico por imagen , Seudoartrosis/etiología , Seudoartrosis/cirugía , Radiografía , Tibia/diagnóstico por imagen , Tibia/cirugía , Caminata
8.
J Biomed Nanotechnol ; 17(5): 921-931, 2021 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-34082877

RESUMEN

Phenylketonuria (PKU) is a common disease associated with amino acid metabolism, and usually occurs in newborns. It can cause serious neurological diseases and even death. However, owing to inadequate-effective treatment, it can only be slowed by a low-phenylalanine (Phe) diet. In addition, PKU screening is essential for newborns in many countries. Therefore, rapid screening is crucial for preventing damage and meeting the large sample diagnosis demand. For confirmed patients, a convenient method to monitor their regular Phe levels is required. However, current clinical methods do not meet the rapid screening and convenient monitoring requirements. Herein, a rapid and facile electrochemical device based on platinum-doped reduced graphene oxide nanocomposites was developed to detect PKU biomarker-Phe. The results demonstrated that the developed electrode has great sensitivity, selectivity, and stability. The detection range was 0.0001 mM to 6 mM with a limit of detection of 0.01 µM. Therefore, this work offers a simple and rapid method for point-of-care PKU screening and daily monitoring.


Asunto(s)
Grafito , Nanocompuestos , Fenilcetonurias , Humanos , Recién Nacido , Oxidorreductasas , Fenilcetonurias/diagnóstico
9.
BMJ Case Rep ; 14(6)2021 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-34083196

RESUMEN

A 10-day-old newborn was taken to the paediatric emergency room due to scrotal swelling. Physical examination showed scrotal enlargement and palpable intrascrotal hard formations. Laboratory blood tests revealed no significant alterations. Testicular ultrasonography showed thickened and hypoechoic scrotal walls and bilateral intrascrotal isoechoic nodules with small internal calcifications. An abdominal X-ray confirmed evidence of bilateral scrotal microcalcifications and small calcifications in the left hypochondrium. Urgent laparotomy performed for scrotal exploration verified the presence of nodular formations on the vaginal tunic of both testicles; the nodules were removed. Bilateral orchidopexy was performed in the same surgical session. When dealing with an acute scrotum in a newborn both emergency radiologists and clinicians should consider the possibility of scrotal meconium pseudocyst as a rare but possible cause of periorchitis.


Asunto(s)
Enfermedades de los Genitales Masculinos , Orquitis , Niño , Femenino , Enfermedades de los Genitales Masculinos/diagnóstico por imagen , Enfermedades de los Genitales Masculinos/etiología , Enfermedades de los Genitales Masculinos/cirugía , Humanos , Recién Nacido , Masculino , Meconio , Orquitis/diagnóstico por imagen , Orquitis/etiología , Escroto/diagnóstico por imagen , Escroto/cirugía
10.
Medicina (Kaunas) ; 57(6)2021 May 25.
Artículo en Inglés | MEDLINE | ID: mdl-34070249

RESUMEN

Background and Objectives: Prematurity is currently a serious public health issue worldwide, because of its high associated morbidity and mortality. Optimizing the management of these pregnancies is of high priority to improve perinatal outcomes. One tool frequently used to determine the degree of fetal wellbeing is cardiotocography (CTG). A review of the available literature on fetal heart rate (FHR) monitoring in preterm fetuses shows that studies are scarce, and the evidence thus far is unclear. The lack of reference standards for CTG patterns in preterm fetuses can lead to misinterpretation of the changes observed in electronic fetal monitoring (EFM). The aims of this narrative review were to summarize the most relevant concepts in the field of CTG interpretation in preterm fetuses, and to provide a practical approach that can be useful in clinical practice. Materials and Methods: A MEDLINE search was carried out, and the published articles thus identified were reviewed. Results: Compared to term fetuses, preterm fetuses have a slightly higher baseline FHR. Heart rate is faster in more immature fetuses, and variability is lower and increases in more mature fetuses. Transitory, low-amplitude decelerations are more frequent during the second trimester. Transitory increases in FHR are less frequent and become more frequent and increase in amplitude as gestational age increases. Conclusions: The main characteristics of FHR tracings changes as gestation proceeds, and it is of fundamental importance to be aware of these changes in order to correctly interpret CTG patterns in preterm fetuses.


Asunto(s)
Cardiotocografía , Frecuencia Cardíaca Fetal , Femenino , Feto , Edad Gestacional , Humanos , Recién Nacido , Embarazo , Segundo Trimestre del Embarazo
11.
Wei Sheng Yan Jiu ; 50(3): 466-471, 2021 May.
Artículo en Chino | MEDLINE | ID: mdl-34074370

RESUMEN

OBJECTIVE: To investigate the metabolic changes of umbilical cord blood in pregnant women with gestational diabetes mellitus(GDM) compared with pregnant women with normal glucose tolerance, and to analyze the effect of GDM on neonatal metabolism. METHODS: Pregnant women in the first trimester were recruited in the cohort study in Taicang District, Jiangsu Province from 2014 to 2016. Oral glucose tolerance test was used to diagnose GDM, at 24-28 weeks of gestation. Pregnant women with GDM were taken as the case group and normal pregnant women as the control group. Five mL of umbilical cord blood was collected from full-term newborns, and non-target metabolites in serum samples were detected by ultra high performance liquid chromatography-tandem mass spectrometry. The t test, principal component analysis and orthogonal partial least square analysis were used to analyze the difference of metabolites in umbilical cord blood between the two groups. The metabolic pathways involved in the markers were analyzed according to P& lt; 0. 05 and variable importance projection(VIP)& gt; 1. 0. The metabolic pathways involved in the markers were analyzed based on the KEGG database. RESULTS: According to the result of GDM diagnosis, 42 pregnant women with GDM and 39 control pregnant women were included. A total of 868 small molecular metabolites were detected in umbilical cord blood samples. The concentrations of 41 metabolites were different between groups(P& lt; 0. 05 and VIP& gt; 1. 0), including 18 kinds of amino acid metabolites, 9 kinds of lipid metabolites, 5 kinds of exogenous compounds, 4 kinds of nucleotide metabolites, 3 kinds of peptides, 1 kind of vitamin(pantothenic acid) and 1 kind of coenzyme(gulonic acid). γ-glutamylalanine in the GDM group was lower than that in the control group(P& lt; 0. 01), and other compounds in the GDM group were higher than those in the control group(P& lt; 0. 05). Combined with pathway analysis, the above metabolites are mainly involved in lysine degradation pathway and aminoacyl tRNA biosynthesis pathway. CONCLUSION: Compared with the newborns of pregnant women with normal blood glucose, the metabolites in cord serum from full-term newborns of pregnant women with GDM are mainly characterized by the increase of some amino acids and lipid metabolites.


Asunto(s)
Diabetes Gestacional , Glucemia , Estudios de Cohortes , Diabetes Gestacional/diagnóstico , Femenino , Prueba de Tolerancia a la Glucosa , Humanos , Recién Nacido , Metabolómica , Embarazo , Mujeres Embarazadas
12.
Braz J Med Biol Res ; 54(9): e10220, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34076139

RESUMEN

Necrotizing enterocolitis (NEC) is a common condition in preterm infants. The risk factors that contribute to NEC include asphyxia, apnea, hypotension, sepsis, and congenital heart diseases (CHD). The objective of this study was to evaluate the association between the treatment (surgery or drainage) and unfavorable outcomes in neonates with NEC and congenital heart diseases (NEC+CHD). A 19-year retrospective cohort study was conducted (2000-2019). Inclusion criterion was NEC Bell II stage. Exclusion criteria were associated malformation or genetic syndrome and those who did not undergo echocardiography or had a Bell I diagnosis. We included 100 neonates: NEC (n=52) and NEC+CHD (n=48). The groups were subdivided into NEC patients undergoing surgery (NECS, n=31), NEC patients undergoing peritoneal drainage (NECD, n=19), NEC+CHD patients undergoing surgery (NECCAS, n=21), and NEC+CHD patients who were drained (NECCAD, n=29). Multivariate analysis was performed to estimate the relative risk of death and the length of stay. Covariates were birth weight and gestational age. The group characteristics were similar. The adjusted relative risk of death was higher in the drainage groups [NECD (Adj RR=2.70 (95%CI: 1.47; 4.97) and NECCAD (Adj RR=1.97 (95%CI: 1.08; 3.61)], and they had the shortest time to death: NECD=8.72 (95%CI: 3.10; 24.54) and NECCAD=5.32 (95%CI: 1.95; 14.44). We concluded that performing primary peritoneal drainage in neonates with or without CHD did not improve the number of days of life, did not decrease the risk of death, and was associated with a higher mortality in newborns with NEC and clinical instability.


Asunto(s)
Enterocolitis Necrotizante , Cardiopatías Congénitas , Brasil/epidemiología , Enterocolitis Necrotizante/complicaciones , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/cirugía , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Estudios Retrospectivos
13.
Braz Oral Res ; 35: e059, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34076186

RESUMEN

This study aimed to verify, through a longitudinal follow-up, the pre-, peri- and postnatal factors associated with the eruption of deciduous teeth. The study was nested in a Birth Cohort Study conducted in Pelotas, a Southern Brazilian city. Mothers were followed prenatally and their children were followed-up perinatally, at 3 and 12 months of age. The outcome was the number of teeth at 12 months, and exploratory variables included maternal habits and characteristics, anthropometric measures of children and mothers, and socioeconomic and demographic information. Data were collected through interviews with the mother and children's clinical exam. Poisson regression models were used for the analysis. Participants included 4,014 children with a mean number of erupted teeth at 12 months of 5.50. After adjustments, a lower mean number of teeth was observed in children from non-white mothers, early preterm children, and shorter children at birth and at 12 months. A higher number of teeth was observed for mothers with excessive weight gain during pregnancy, mothers who smoked during pregnancy, weightier children at birth and at 12 months, and for children with larger heads at birth and at 12 months. Our findings suggest that maternal and children characteristics influenced primary tooth eruption.


Asunto(s)
Erupción Dental , Diente Primario , Brasil/epidemiología , Niño , Estudios de Cohortes , Femenino , Humanos , Recién Nacido , Madres , Embarazo
14.
Medicina (Kaunas) ; 57(5)2021 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-34064567

RESUMEN

Background and Objectives: Pre-term premature rupture of membranes (PPROM) responds for one third of preterm births, and it is associated with other complications that increase the risk of maternal or fetal poor outcome. To reduce uncertainty and provide accurate information to patients, the analysis of the large series is of great importance. In order to learn about the evolution over the time of the obstetric and perinatal outcomes in cases of PPROM at, or before, 28 weeks (very early PPROM) managed with an expectant/conservative protocol, we have designed the present study. Materials and Methods: We retrospectively studied all cases of very early PPROM attended in Malaga University Regional Hospital from 2000 to 2020. Results: Among 119,888 deliveries assisted, 592 cases of PPROM occurred in pregnancies at or before 28 weeks (0.49% of all deliveries, 3.9% of all preterm births and 12.9% of all cases of PPROM). The mean duration of the latency period between PPROM and delivery was 13.5 days (range 0 to 88 days), enlarging over the years. The mean gestational age at delivery was 27 weeks (SD 2.9; range 17-34). The proportion of cesarean deliveries was 52.5%. The overall perinatal mortality rate was 26.5%, decreasing over the period with a significant correlation Pearson's coefficient -0.128 (p < 0.05). Conclusions: In the period 2000-2020, there was an improvement in the outcomes of very early PPROM cases and perinatal mortality showed a clear trend to decrease.


Asunto(s)
Rotura Prematura de Membranas Fetales , Femenino , Rotura Prematura de Membranas Fetales/epidemiología , Edad Gestacional , Humanos , Lactante , Recién Nacido , Mortalidad Perinatal , Embarazo , Estudios Retrospectivos
15.
Sensors (Basel) ; 21(10)2021 May 12.
Artículo en Inglés | MEDLINE | ID: mdl-34065847

RESUMEN

Electrohysterography (EHG) has emerged as an alternative technique to predict preterm labor, which still remains a challenge for the scientific-technical community. Based on EHG parameters, complex classification algorithms involving non-linear transformation of the input features, which clinicians found difficult to interpret, were generally used to predict preterm labor. We proposed to use genetic algorithm to identify the optimum feature subset to predict preterm labor using simple classification algorithms. A total of 203 parameters from 326 multichannel EHG recordings and obstetric data were used as input features. We designed and validated 3 base classifiers based on k-nearest neighbors, linear discriminant analysis and logistic regression, achieving F1-score of 84.63 ± 2.76%, 89.34 ± 3.5% and 86.87 ± 4.53%, respectively, for incoming new data. The results reveal that temporal, spectral and non-linear EHG parameters computed in different bandwidths from multichannel recordings provide complementary information on preterm labor prediction. We also developed an ensemble classifier that not only outperformed base classifiers but also reduced their variability, achieving an F1-score of 92.04 ± 2.97%, which is comparable with those obtained using complex classifiers. Our results suggest the feasibility of developing a preterm labor prediction system with high generalization capacity using simple easy-to-interpret classification algorithms to assist in transferring the EHG technique to clinical practice.


Asunto(s)
Trabajo de Parto Prematuro , Útero , Algoritmos , Electromiografía , Femenino , Humanos , Recién Nacido , Trabajo de Parto Prematuro/diagnóstico , Embarazo
16.
Artículo en Inglés | MEDLINE | ID: mdl-34070763

RESUMEN

BACKGROUND: During the COVID-19 pandemic, more than ever, optimal influenza vaccination coverage among healthcare workers (HCWs) is crucial to avoid absenteeism and disruption of health services, as well as in-hospital influenza outbreaks. The aim of this study is to analyze the 2020 influenza vaccination campaign, comparing it with the previous year's in a research and teaching hospital in Northern Italy. METHODS: adopting an approach based on combined strategies, three interventions were deployed: a promotional and educational campaign, vaccination delivery through both ad hoc and on-site ambulatories, and a gaming strategy. Personal data and professional categories were collected and analyzed using univariate logistic regression. Vaccinated HCWs were asked to fill in a questionnaire to describe their reasons for vaccination adherence. RESULTS: the vaccination coverage rate (VCR) was 43.1%, compared to 21.5% in 2019. The highest increase was registered among administrative staff (308.3%), while physicians represent the most vaccinated category (n = 600). Moreover, residents (prevalence ratio (PR): 1.12; 95% CI 1.04-1.20), as well as intensive care (PR: 1.44; 95% CI: 1.24-1.69) and newborn workers (PR: 1.41; 95% CI: 1.20-1.65) were, respectively, the categories most frequently vaccinated for the first time. CONCLUSION: the significant increase in vaccination coverage rate confirms the suitability of the combined strategy of delivering the flu vaccination campaign and represents a first step towards reaching WHO recommended vaccination rates.


Asunto(s)
Vacunas contra la Influenza , Gripe Humana , Actitud del Personal de Salud , Personal de Salud , Hospitales de Enseñanza , Humanos , Programas de Inmunización , Recién Nacido , Gripe Humana/epidemiología , Gripe Humana/prevención & control , Italia/epidemiología , Pandemias/prevención & control , Encuestas y Cuestionarios , Vacunación
17.
Artículo en Inglés | MEDLINE | ID: mdl-34072815

RESUMEN

As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues its spread all over the world, data on perinatal management of the maternal-infant dyad are urgent. We performed an observational study to describe the effects of the early separation of the maternal-infant dyad, in case of maternal SARS-CoV-2 infection. We reported the medical records for 37 neonates born to 37 SARS-CoV-2 positive mothers in a setting of separation of the dyad after birth. Data on neonatal infection, clinical condition, and breastfeeding rate were recorded until the first month of life. No maternal deaths were recorded; 37.8% of women had at least one pregnancy-related complication. We reported a high adherence to recommended safety measures after discharged with 84.8% of the mothers using at least one personal protective device and 51.5% using all the protective devices. We reported one case of vertical transmission and no cases of horizontal transmission. However, the separation of the dyad had a negative impact on breastfeeding because only 23.5% of the newborns received exclusively human milk during the first month of life. Despite early separation of the dyad protecting the newborns from possible horizontal transmission of SARS-CoV-2, it negatively affects breastfeeding during the first months of life.


Asunto(s)
Complicaciones Infecciosas del Embarazo , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa , Madres , Embarazo
18.
J Headache Pain ; 22(1): 49, 2021 Jun 01.
Artículo en Inglés | MEDLINE | ID: mdl-34074243

RESUMEN

BACKGROUND: Headache disorders are highly prevalent worldwide, but not well investigated in adolescents. Few studies have included representative nationwide samples. This study aimed to present the prevalence and burden of recurrent headache in Australian adolescents. METHODS: The prevalence of recurrent headache, headache characteristics (severity and frequency) and burden on health-related quality of life in Australian children aged 10-17 years were presented, using nationally representative data from the Longitudinal Study of Australian children (LSAC). The LSAC, commencing in 2004, collects data every 2 years from a sample of Australian children of two different age cohorts: B 'baby' cohort, aged 0-1 years and K 'kindergarten' cohort, aged 4-5 years at the commencement of the study. Face-to-face interviews and self-complete questionnaires have been conducted with the study child and parents of the study child (carer-reported data) at each data collection wave, with seven waves of data available at the time of the current study. Wave 7 of the LSAC was conducted in 2016, with B cohort children aged 12-13 years and K cohort children aged 16-17 years. For the current study, data were accessed for four out of seven waves of available data (Wave 4-7) and presented cross-sectionally for the two cohorts of Australian children, for the included age groups (10-11 years, 12-13 years, 14-15 years and 16-17 years). All available carer-reported questionnaire data pertaining to headache prevalence, severity and frequency, general health and health-related quality of life, for the two cohorts, were included in the study, and presented for male and female adolescents. Carer-reported general health status of the study child and health-related quality of life scores, using the parent proxy-report of the Paediatric Quality of Life Inventory™ 4.0, were compared for male and female adolescents with recurrent headache and compared with a healthy group. Finally, health-related quality of life scores were compared based on headache frequency and severity. RESULTS: The LSAC study initially recruited 10,090 Australian children (B cohort n = 5107, K cohort n = 4983), and 64.1% of the initial sample responded at wave 7. Attrition rates across the included waves ranged from 26.3% to 33.8% (wave 6 and 7) for the B cohort, and 16.3% to 38.0% (wave 4-7) for the K cohort. Recurrent headache was more common in females, increasing from 6.6% in 10-11 years old females to 13.2% in 16-17 years old females. The prevalence of headache in males ranged from 4.3% to 6.4% across the age groups. Health-related quality of life scores were lower for all functional domains in adolescents with recurrent headache, for both sexes. Headache frequency, but not severity, was significantly associated with lower health-related quality of life scores, in both males and females. CONCLUSIONS: Recurrent headache was common among Australian adolescents and increased in prevalence for females, across the age groups. Frequent recurrent headache is burdensome for both male and female adolescents. This study provides information regarding the prevalence and burden of recurrent headache in the adolescent population based on findings from the Longitudinal Study of Australian Children.


Asunto(s)
Cefalea , Calidad de Vida , Adolescente , Australia/epidemiología , Niño , Femenino , Cefalea/epidemiología , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Prevalencia , Encuestas y Cuestionarios
19.
BMC Health Serv Res ; 21(1): 538, 2021 Jun 02.
Artículo en Inglés | MEDLINE | ID: mdl-34074286

RESUMEN

BACKGROUND: The goal of regionalized perinatal care, specifically levels of maternal care, is to improve maternal outcomes through risk-appropriate obstetric care. Studies of levels of maternal care are limited by current approaches to identify a hospital's level of care, often relying on hospital self-reported data, which is expensive and challenging to collect and validate. The study objective was to develop an empiric approach to determine a hospital's level of maternal care using administrative data reflective of the patient care provided and apply this approach to describe the levels of maternal care available over time. METHODS: Retrospective cohort study of mother-infant dyads who delivered in California, Missouri, and Pennsylvania hospitals from 2000 to 2009. Linked mother-infant administrative records with an infant born at 24-44 weeks' gestation and a birth weight of 400-8000 g were included. Using the American College of Obstetricians and Gynecologists and the Society for Maternal Fetal Medicine descriptions of levels of maternal care, four levels were classified based on the appropriate location of care for patients with specific medical or pregnancy conditions. Individual hospitals were assigned a level of maternal care annually based on the volume of patients who delivered reflective of the four classified levels as determined by International Classification of Diseases and Current Procedural Terminology. RESULTS: Based on the included 6,895,000 mother-infant dyads, the obstetric hospital levels of maternal care I, II, III and IV were identified. High-risk patients more frequently delivered in hospitals with higher level maternal care, accounting for 8.9, 10.9, 13.8, and 16.9% of deliveries in level I, II, III and IV hospitals, respectively. The total number of obstetric hospitals decreased over the study period, while the proportion of hospitals with high-level (level III or IV) maternal care increased. High-level hospitals were located in more densely populated areas. CONCLUSION: Identification of the level of maternal care, independent of hospital self-reported variables, is feasible using administrative data. This empiric approach, which accounts for changes in hospitals over time, is a valuable framework for perinatal researchers and other stakeholders to inexpensively identify measurable benefits of levels of maternal care and characterize where specific patient populations receive care.


Asunto(s)
Servicios de Salud Materna , Niño , Femenino , Hospitales , Humanos , Recién Nacido , Missouri , Pennsylvania , Embarazo , Estudios Retrospectivos
20.
Epidemiol Psychiatr Sci ; 30: e42, 2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-34085616

RESUMEN

AIMS: To determine whether age, gender and marital status are associated with prognosis for adults with depression who sought treatment in primary care. METHODS: Medline, Embase, PsycINFO and Cochrane Central were searched from inception to 1st December 2020 for randomised controlled trials (RCTs) of adults seeking treatment for depression from their general practitioners, that used the Revised Clinical Interview Schedule so that there was uniformity in the measurement of clinical prognostic factors, and that reported on age, gender and marital status. Individual participant data were gathered from all nine eligible RCTs (N = 4864). Two-stage random-effects meta-analyses were conducted to ascertain the independent association between: (i) age, (ii) gender and (iii) marital status, and depressive symptoms at 3-4, 6-8, and 9-12 months post-baseline and remission at 3-4 months. Risk of bias was evaluated using QUIPS and quality was assessed using GRADE. PROSPERO registration: CRD42019129512. Pre-registered protocol https://osf.io/e5zup/. RESULTS: There was no evidence of an association between age and prognosis before or after adjusting for depressive 'disorder characteristics' that are associated with prognosis (symptom severity, durations of depression and anxiety, comorbid panic disorderand a history of antidepressant treatment). Difference in mean depressive symptom score at 3-4 months post-baseline per-5-year increase in age = 0(95% CI: -0.02 to 0.02). There was no evidence for a difference in prognoses for men and women at 3-4 months or 9-12 months post-baseline, but men had worse prognoses at 6-8 months (percentage difference in depressive symptoms for men compared to women: 15.08% (95% CI: 4.82 to 26.35)). However, this was largely driven by a single study that contributed data at 6-8 months and not the other time points. Further, there was little evidence for an association after adjusting for depressive 'disorder characteristics' and employment status (12.23% (-1.69 to 28.12)). Participants that were either single (percentage difference in depressive symptoms for single participants: 9.25% (95% CI: 2.78 to 16.13) or no longer married (8.02% (95% CI: 1.31 to 15.18)) had worse prognoses than those that were married, even after adjusting for depressive 'disorder characteristics' and all available confounders. CONCLUSION: Clinicians and researchers will continue to routinely record age and gender, but despite their importance for incidence and prevalence of depression, they appear to offer little information regarding prognosis. Patients that are single or no longer married may be expected to have slightly worse prognoses than those that are married. Ensuring this is recorded routinely alongside depressive 'disorder characteristics' in clinic may be important.


Asunto(s)
Antidepresivos , Depresión , Adulto , Antidepresivos/uso terapéutico , Ansiedad , Depresión/diagnóstico , Depresión/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estado Civil , Pronóstico
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