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1.
J Perinatol ; 42(6): 835-838, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35461330

RESUMO

The goal of regionalization of neonatal care is to improve infant outcomes by directing patients to hospitals where risk-appropriate care is available. Although evidence shows that regionalized, risk-appropriate neonatal care decreases mortality, especially for high-risk infants, the approach and success of regionalization efforts in the U.S. and around the world is highly variable. Barriers to regionalization exist on the patient, provider, hospital, state, and national levels, which highlight potential opportunities to improve regionalization efforts. Improving neonatal regionalized care delivery requires a collaborative approach inclusive of all stakeholders from patients to national professional organizations, expansion and adaptation of current policies, changes to financial incentives, cross-state collaboration, support of national policies, and partnership between neonatal and obstetric communities to promote comprehensive, regionalized perinatal care.


Assuntos
Atenção à Saúde , Assistência Perinatal , Criança , Feminino , Hospitais , Humanos , Recém-Nascido , Gravidez
2.
Laeknabladid ; 108(3): 137-142, 2022 Mar.
Artigo em Islandês | MEDLINE | ID: mdl-35230259

RESUMO

INTRODUCTION: This study investigated the use of fixed-wing air ambulance in Iceland between 2012 and 2020. MATERIAL: Medical records were filled out during each flight and information afterwards entered into an electronic database. METHODS: The annual number of patient transports nationwide; triage scale category; reason for transportation, age and gender; and departure and arrival airports were analyzed. Response time and total transport time were compared between years and locations. Poisson regression analysis was used to compare the yearly number of transports. One-way ANOVA was used to compare response time and total transport time by year and departure site. RESULTS: In total, 6011 patients were transported in fixed-wing air ambulances during the study period. Majority were male (54.3%). Median age was 64 years (range 0-99 years). Most patients were transported due to medical conditions; 15.8% due to trauma. Thirty percent of women aged 20 to 44 years were transported due to pregnancy or childbirth. Two-thirds of patients were transported to Reykjavik (n=3937), and one-fifth to Akureyri (n=1139). Median response time for acute transports was 84 minutes (range 0-2870 minutes). Median total transport time was 150 minutes (range 50-2930 minutes). Differences were found in total transport time from departure locations (F=32.19; DF 9, 2678; p<0,001). Egilsstaðir, Norðfjörður, Höfn, and, partly, Ísafjörður had the longest total transport times. CONCLUSION: Icelandic air ambulance flights are often long, likely affecting outcomes for patients with time-sensitive medical conditions. Access to specialized healthcare is unequal among places of residence, and it is important to address this.


Assuntos
Resgate Aéreo , Serviços Médicos de Emergência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ambulâncias , Criança , Pré-Escolar , Feminino , Humanos , Islândia/epidemiologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Adulto Jovem
3.
Cell Regen ; 11(1): 7, 2022 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-35254502

RESUMO

Early human brain development can be affected by multiple prenatal factors that involve chemical exposures in utero, maternal health characteristics such as psychiatric disorders, and cancer. Breast cancer is one of the most common cancers worldwide arising pregnancy. However, it is not clear whether the breast cancer might influence the brain development of fetus. Exosomes secreted by breast cancer cells play a critical role in mediating intercellular communication and interplay between different organs. In this work, we engineered human induced pluripotent stem cells (hiPSCs)-derived brain organoids in an array of micropillar chip and probed the influences of breast cancer cell (MCF-7) derived-exosomes on the early neurodevelopment of brain. The formed brain organoids can recapitulate essential features of embryonic human brain at early stages, in terms of neurogenesis, forebrain regionalization, and cortical organization. Treatment with breast cancer cell derived-exosomes, brain organoids exhibited enhanced expression of stemness-related marker OCT4 and forebrain marker PAX6. RNA-seq analysis reflected several activated signaling pathways associated with breast cancer, medulloblastoma and neurogenesis in brain organoids induced by tumor-derived exosomes. These results suggested that breast cancer cell-derived exosomes might lead to the impaired neurodevelopment in the brain organoids and the carcinogenesis of brain organoids. It potentially implies the fetus of pregnant women with breast cancer has the risk of impaired neurodevelopmental disorder after birth.

4.
Arq. ciências saúde UNIPAR ; 26(1): 57-64, Jan-Abr. 2022.
Artigo em Português | LILACS | ID: biblio-1362673

RESUMO

Objetivou-se analisar o perfil epidemiológico e as causas da mortalidade neonatal e infantil, em uma Regional de Saúde, de janeiro/2018 a agosto/2020. Trata-se de pesquisa exploratória, descritiva, transversal, retrospectivo, com abordagem quantitativa. A coleta de dados ocorreu em agosto de 2020, por meio de questionário elaborado pelas pesquisadoras, com base nas declarações de óbito disponibilizadas no Sistema de Informações de Mortalidade. O instrumento abordou as variáveis, sexo, raça, cor, idade da criança, idade materna, escolaridade materna, via de parto, idade gestacional, peso ao nascer, causa do óbito. Os dados foram submetidos à análise estatística descritiva e distribuição de frequência, por meio do Statistical Package for the Social Sciences (SPSS), versão 25.0. Constatou-se o predomínio de óbitos no sexo masculino (56,5%), de raça branca (87,8%), com equivalência entre extremo baixo peso e adequado (31,3%), com a principal causa de óbito por septicemia (13,9%). Quanto aos dados maternos, prevaleceram idade entre 21 e 30 anos de idade (45,2%) com gestação única (85,21%) e parto cesariano (65,2 %). Desses, 47,87% ocorreram no ano de 2018. Analisar os aspectos da mortalidade neonatal e infantil possibilita o planejamento e a readequação de ações no atendimento à saúde da criança, durante o período mais vulnerável e mais crítico dela, contribuindo, assim, para redução do número de óbitos.


This study analyzed the epidemiological profile and the causes of neonatal and infant mortality in a Health Regional Area between January 2018 and August 2020. This is an exploratory, descriptive, cross-sectional, retrospective study with a quantitative approach. Data collection took place during August 2020 through a questionnaire prepared by the researchers, based on the death certificates available in the Mortality Information System. The instrument included the variables of sex, race, color, child's age, mother's age, maternal education, childbirth mode, gestational age, birth weight, cause of death. The data were submitted to descriptive statistical analysis and frequency distribution using the Statistical Package for the Social Sciences (SPSS) version 25.0. There was a predominance of deaths among boys (56.5%), Caucasian (87.8%), with equivalence between extreme low and adequate weight (31.3%), with the main cause of death being septicemia (13.9%). As for maternal data, age between 21 to 30 years old (45.2%) prevailed, and 85.21% had a single pregnancy, with C-section childbirth (65.2%). From these, 47.87% occurred in 2018. It can be concluded that analyzing the aspects of neonatal and child mortality enables the planning and adjustment of actions in child health care during its most vulnerable and most critical period, thus contributing to reducing the number of deaths.


Assuntos
Humanos , Recém-Nascido , Adulto , Regionalização da Saúde , Mortalidade Infantil , Mortalidade Neonatal Precoce , Peso ao Nascer , Causas de Morte , Morte , Atenção à Saúde , Sepse Neonatal/mortalidade , Pesquisa sobre Serviços de Saúde
5.
Eur J Pediatr ; 181(6): 2501-2511, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35333975

RESUMO

This study aimed to evaluate the association of neonatal transfer with the risk of neurodevelopmental outcomes at 3 years of age. Data were obtained from the Japan Environment and Children's Study. A general population of 103,060 pregnancies with 104,062 fetuses was enrolled in the study in 15 Regional Centers between January 2011 and March 2014. Live-born singletons at various gestational ages, including term infants, without congenital anomalies who were followed up until 3 years were included. Neurodevelopmental impairment was assessed using the Ages and Stages Questionnaire, third edition (ASQ-3) at 3 years of age. Logistic regression was used to estimate the adjusted risk and 95% confidence interval (CI) for newborns with neonatal transfer. Socioeconomic and perinatal factors were included as potential confounders in the analysis. Among 83,855 live-born singletons without congenital anomalies, 65,710 children were studied. Among them, 2780 (4.2%) were transferred in the neonatal period. After adjustment for potential confounders, the incidence of neurodevelopmental impairment (scores below the cut-off value of all 5 domains in the ASQ-3) was higher in children with neonatal transfer compared with those without neonatal transfer (communication: 6.5% vs 3.5%, OR 1.42, 95% CI 1.19-1.70; gross motor: 7.6% vs 4.0%, OR 1.26, 95% CI 1.07-1.49; fine motor: 11.3% vs 7.1%, OR 1.19, 95% CI 1.03-1.36; problem solving: 10.8% vs 6.8%, OR 1.29, 95% CI 1.12-1.48; and personal-social: 6.2% vs 2.9%, OR 1.52, 95% CI 1.26-1.83).   Conclusion: Neonatal transfer was associated with a higher risk of neurodevelopmental impairment at 3 years of age. What is Known: • Neonatal transfer after birth in preterm infants is associated with adverse short-term outcomes. • Long-term outcomes of outborn infants with neonatal transfer in the general population remain unclear. What is New: • This study suggests that neonatal transfer at birth is associated with an increased risk of neurodevelopmental impairment. • Efforts for referring high-risk pregnant women to higher level centers may reduce the incidence of neonatal transfer, leading to improved neurological outcomes in the general population.


Assuntos
Recém-Nascido Prematuro , Criança , Pré-Escolar , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Japão/epidemiologia , Gravidez
6.
BMJ Open ; 12(2): e049499, 2022 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-35135763

RESUMO

OBJECTIVE: The objective of this study was to determine the effectiveness of a set of multifaceted interventions designed to increase the access of rural women to antenatal, intrapartum, postpartum and childhood immunisation services offered in primary healthcare facilities. DESIGN: The study was a separate sample pretest-post-test quasi-experimental research. SETTING: The research was conducted in 20 communities and primary health centres in Esan South East and Etsako East Local Government Areas in Edo State in southern Nigeria PARTICIPANTS: Randomly selected sample of ever married women aged 15-45 years. INTERVENTIONS: Seven community-led interventions implemented over 27 months, consisting of a community health fund, engagement of transport owners on emergency transport of pregnant women to primary health centres with the use of rapid short message service (SMS), drug revolving fund, community education, advocacy, retraining of health workers and provision of basic equipment. PRIMARY AND SECONDARY OUTCOME MEASURES: The outcome measures included the number of women who used the primary health centres for skilled pregnancy care and immunisation of children aged 0-23 months. RESULTS: After adjusting for clustering and confounding variables, the odds of using the project primary healthcare centres for the four outcomes were significantly higher at endline compared with baseline: antenatal care (OR 3.87, CI 2.84 to 5.26 p<0.001), delivery care (OR 3.88, CI 2.86 to 5.26), postnatal care (OR 3.66, CI 2.58 to 5.18) and childhood immunisation (OR 2.87, CI 1.90 to 4.33). However, a few women still reported that the cost of services and gender-related issues were reasons for non-use after the intervention. CONCLUSION: We conclude that community-led interventions that address the specific concerns of women related to the bottlenecks they experience in accessing care in primary health centres are effective in increasing demand for skilled pregnancy and childcare in rural Nigeria.


Assuntos
Saúde da Criança , Serviços de Saúde Materna , Adolescente , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Nigéria , Gravidez , Gestantes , Cuidado Pré-Natal , População Rural , Adulto Jovem
7.
BJOG ; 129(6): 950-958, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-34773367

RESUMO

OBJECTIVE: Investigate maternal and neonatal outcomes following waterbirth. DESIGN: Retrospective cohort study, with propensity score matching to address confounding. SETTING: Community births, United States. SAMPLE: Medical records-based registry data from low-risk births were used to create waterbirth and land birth groups (n = 17 530 each), propensity score-matched on >80 demographic and pregnancy risk covariables. METHODS: Logistic regression models compared outcomes between the matched waterbirth and land birth groups. MAIN OUTCOME MEASURES: Maternal: immediate postpartum transfer to a hospital, any genital tract trauma, severe (3rd/4th degree) trauma, haemorrhage >1000 mL, diagnosed haemorrhage regardless of estimated blood loss, uterine infection, uterine infection requiring hospitalisation, any hospitalisation in the first 6 weeks. Neonatal: umbilical cord avulsion; immediate neonatal transfer to a hospital; respiratory distress syndrome; any hospitalisation, neonatal intensive care unit (NICU) admission, or neonatal infection in the first 6 weeks; and neonatal death. RESULTS: Waterbirth was associated with improved or no difference in outcomes for most measures, including neonatal death (adjusted odds ratio [aOR] 0.56, 95% CI 0.31-1.0), and maternal or neonatal hospitalisation in the first 6 weeks (aOR 0.87, 95% CI 0.81-0.92 and aOR 0.95, 95% CI 0.90-0.99, respectively). Increased morbidity in the waterbirth group was observed for two outcomes only: uterine infection (aOR 1.25, 95% CI 1.05-1.48) (but not hospitalisation for infection) and umbilical cord avulsion (aOR 1.57, 95% CI 1.37-1.82). Our results are concordant with other studies: waterbirth is neither as harmful as some current guidelines suggest, nor as benign as some proponents claim. TWEETABLE ABSTRACT: New study demonstrates #waterbirth is neither as harmful as some current guidelines suggest, nor as benign as some proponents claim. @TheUpliftLab @BovbjergMarit @31415926abc @NICHD_NIH.


Assuntos
Parto Normal , Morte Perinatal , Estudos de Coortes , Parto Obstétrico/métodos , Feminino , Humanos , Recém-Nascido , Parto Normal/métodos , Gravidez , Pontuação de Propensão , Estudos Retrospectivos
8.
Pediatr Res ; 91(3): 513-521, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-33828228

RESUMO

The aim of this review was threefold: (a) to retrieve all SARS-CoV-2 evidences published by Italian neonatologists working in maternity centers and NICUs during the pandemic; (b) to summarize current evidence for the management of term and preterm infants with a SARS-CoV-2-related illness; and (c) to provide an update for dealing with the second wave of COVID-19 and discuss open questions. A review was conducted using MEDLINE/PubMed and the national COVID-19 registry of the Italian Society of Neonatology including citations from December 1, 2019 to October 28, 2020. Sixty-three articles were included. Collected data were divided into the following topics: (a) antenatal management, (b) management in delivery room, (c) postnatal management, (d) mother-baby dyad and breastfeeding management, (e) neonatal emergency transport system reorganization, (f) parents' management and perspective during SARS-CoV-2 pandemic, and (g) future perspective. Evidences have evolved over the pandemic period and the current review can be useful in the management of the mother-neonate dyad during SARS-CoV-2 future waves. Italian neonatologists have played an active role in producing official guidelines and reporting data that have contributed to improve the care of neonates. A joint European action plan is mandatory to face COVID-19 in neonates with more awareness. IMPACT: A joint European action plan is mandatory to face COVID-19 in neonates with more awareness. This review summarizes the available evidences from neonatal COVID-19 management in Italy analyzing all the published paper in this specific field of interest. The current review can be useful in the management of the mother-neonate dyad during the SARS-CoV-2 future waves.


Assuntos
COVID-19/epidemiologia , Neonatologistas , Pandemias , SARS-CoV-2 , COVID-19/prevenção & controle , Teste para COVID-19 , Vacinas contra COVID-19 , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Itália/epidemiologia , Masculino , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Gravidez
9.
BJOG ; 129(1): 120-126, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34258859

RESUMO

OBJECTIVE: To determine the incidence of and risk factors for perioperative blood transfusions after urogenital fistula repairs in Uganda. DESIGN: A retrospective cohort study. SETTING: A community hospital in Masaka, Uganda. POPULATION: Women who underwent fistula repair at the Kitovu Hospital between 2013 and 2019. METHODS: Retrospective review of demographics and clinical perioperative characteristics of patients surgically treated for urogenital fistula. Patient characteristics were compared between those who did and those who did not require a blood transfusion. MAIN OUTCOME MEASURES: Need for perioperative blood transfusion and risk factors. RESULTS: A total of 546 patients treated for urogenital fistulas were included in this study. The median age was 31.1 ± 13.2 years. A vaginal surgical approach was used in the majority of patients (84.6%). Complications occurred in 3.5% of surgical repairs, and the incidence of blood transfusions was 6.2%. In multivariable analyses, for each gram per deciliter (g/dl) increase in preoperative haemoglobin, the odds of blood transfusion decreased by approximately 28% (adjusted OR 0.72, 95% CI 0.59-0.86). Women who had their fistula repaired abdominally were 3.4 times more likely to require transfusions (95% CI 1.40-8.08). CONCLUSIONS: The incidence of blood transfusions among urogenital fistula repairs in our population is twice that of developed nations. An abdominal surgical approach to urogenital fistula is a significant risk factor for perioperative blood transfusions. The timing of the repair may warrant further study. TWEETABLE ABSTRACT: One of the first studies to look at blood transfusion risk factors after fistula repair in a low-resource setting.


Assuntos
Transfusão de Sangue/estatística & dados numéricos , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Complicações do Trabalho de Parto/cirurgia , Fístula Vesicovaginal/cirurgia , Adulto , Estudos de Coortes , Feminino , Acesso aos Serviços de Saúde , Humanos , Incidência , Área Carente de Assistência Médica , Gravidez , Estudos Retrospectivos , Fatores de Risco , Uganda/epidemiologia
10.
BMC Pregnancy Childbirth ; 21(1): 802, 2021 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-34856954

RESUMO

BACKGROUND: Antenatal care and skilled childbirth services are important interventions to improve maternal health and lower the risk of poor pregnancy outcomes and mortality. A growing body of literature has shown that geographic distance to clinics can be a disincentive towards seeking care during pregnancy. On the Thailand-Myanmar border antenatal clinics serving migrant populations have found high rates of loss to follow-up of 17.4%, but decades of civil conflict have made the underlying factors difficult to investigate. Here we perform a comprehensive study examining the geographic, demographic, and health-related factors contributing to loss to follow-up. METHODS: Using patient records we conducted a spatial and epidemiological analysis looking for predictors of loss to follow-up and pregnancy outcomes between 2007 and 2015. We used multivariable negative binomial regressions to assess for associations between distance travelled to the clinic and birth outcomes (loss to follow-up, pregnancy complications, and time of first presentation for antenatal care.) RESULTS: We found distance travelled to clinic strongly predicts loss to follow-up, miscarriage, malaria infections in pregnancy, and presentation for antenatal care after the first trimester. People lost to follow-up travelled 50% farther than people who had a normal singleton childbirth (a ratio of distances (DR) 1.5; 95% confidence interval (CI): 1.4 - 1.5). People with pregnancies complicated by miscarriage travelled 20% farther than those who did not have miscarriages (DR: 1.2; CI 1.1-1.3), and those with Plasmodium falciparum malaria in pregnancy travelled 60% farther than those without P. falciparum (DR: 1.6; CI: 1.6 - 1.8). People who delayed antenatal care until the third trimester travelled 50% farther compared to people who attended in the first trimester (DR: 1.5; CI: 1.4 - 1.5). CONCLUSIONS: This analysis provides the first evidence of the complex impact of geography on access to antenatal services and pregnancy outcomes in the rural, remote, and politically complex Thailand-Myanmar border region. These findings can be used to help guide evidence-based interventions to increase uptake of maternal healthcare both in the Thailand-Myanmar region and in other rural, remote, and politically complicated environments.


Assuntos
Acesso aos Serviços de Saúde , Perda de Seguimento , Serviços de Saúde Materna , Cuidado Pré-Natal , Migrantes , Área Programática de Saúde , Estudos de Coortes , Feminino , Geografia , Humanos , Mianmar/etnologia , Gravidez , Complicações na Gravidez/epidemiologia , Resultado da Gravidez/epidemiologia , Tailândia/etnologia , Viagem
11.
Med Sci Monit ; 27: e933029, 2021 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-34782591

RESUMO

BACKGROUND Even in the normal course of pregnancy, alarming symptoms and obstetric complications can occur, necessitating appropriate care. Medical rescue and Helicopter Emergency Medical Services (HEMS) teams are responsible for responding to emergencies and performing medical emergency procedures on scene and during patient transport to hospital. The purpose of our study was to present the characteristics of HEMS and Emergency Medical Service (EMS) interventions concerning pregnant women in Poland. MATERIAL AND METHODS The study involved a retrospective analysis of missions by HEMS and EMS crews of the Polish Medical Air Rescue concerning pregnant women in Poland. The analysis included all HEMS and EMS flights to cases of accidents and other emergencies and air transport missions where medical assistance had been provided to pregnant women between January 2011 and December 2020. RESULTS Polish Medical Air Rescue teams were most commonly dispatched to urban areas (79.46%) and for inter-hospital transport (75.85%). The mean patient age was 29.72 years, and the most common diagnosis, in accordance with the International Statistical Classification of Diseases and Related Health Problems (ICD-10), was premature labor (24.38%). CONCLUSIONS Pregnant patients aged 30 and older and those receiving HEMS and EMS assistance in urban areas were found to have a higher odds ratio for premature labor. A correlation was identified between the diagnosis associated with the Polish Medical Air Rescue intervention and the pregnant woman's age and location of call.


Assuntos
Resgate Aéreo/estatística & dados numéricos , Complicações na Gravidez/terapia , Adulto , Aeronaves , Feminino , Humanos , Polônia , Gravidez , Gestantes , Estudos Retrospectivos , População Rural , População Urbana
13.
Prehosp Emerg Care ; : 1-10, 2021 Oct 20.
Artigo em Inglês | MEDLINE | ID: mdl-34505811

RESUMO

Objective: Linking emergency medical services (EMS) data to hospital outcomes is important for quality assurance and research initiatives. However, non-linkage due to missing or incomplete patient information may increase the risk of bias and distort findings. The purpose of this study was to explore if an optimization strategy, in addition to an existing linkage process, improved the linkage rate and reduced selection and information bias.Methods: 4,150 transported patients in a metropolitan EMS system in Alberta, Canada from 2016/17 were linked to two Emergency Department (ED) databases by a standard strategy using a unique health care number, date/time of ED arrival, and hospital name. An optimized strategy added additional linkage steps incorporating last name, year of birth, and a manual search. The strategies were compared to assess the rate of linkage, and to describe event and patient-level characteristics of unlinked records.Results: The standard strategy resulted in 3,650 out of 4,150 (88.0%) linked records (95% CI 86.9%-88.9%). Of the 500 non-linked records, an additional 381 were linked by the optimized strategy (n = 4,031/4,150 [97.1%; 95% CI: 96.6%-97.6%]). There were no false positive linkages. The highest linkage failure was in 25 to 34 year-old patients (n = 93/478, 19.5%), males (n = 236/1975, 12.0%), Echo level events (n = 15/77, 19.5%), and emergency transport (45/231, 19.5%). The optimized strategy improved linkage in these groups by 68.8% (64/93), 79.2% (187/236), 40.0% (6/15), and 51.1% (23/45) respectively. For dispatch card, the highest linkage failure occurred in Card 24-Pregnancy/Childbirth/Miscarriage (n = 30/44, 68.2%), Card 27-Stab/Gunshot/Penetrating Trauma (n = 6/17, 35.3%), and Card 9-Cardiac/Respiratory Arrest/Death (n = 12/46, 26.1%). The optimized strategy improved linkage by 10.0% (3/30), 83.3% (5/6), and 41.7% (5/12) respectively. For the 119 unlinked records, 71 (59.7%) had sufficient information for linkage, but no appropriately matching records could be found.Conclusion: An optimized sequential deterministic strategy linking EMS data to ED outcomes improved the linkage rate without increasing the number of false positive links, and reduced the potential for bias. Even with adequate information, some records were not linked to their ED visit. This study underscores the importance of understanding how data are linked to hospital outcomes in EMS research and the potential for bias.

14.
Med Care ; 59(Suppl 5): S434-S440, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34524240

RESUMO

BACKGROUND AND OBJECTIVES: The aim was to explore the association between community health centers' (CHC) distance to a "maternity care desert" (MCD) and utilization of maternity-related health care services, controlling for CHC and county-level factors. MEASURES: Utilization as: total number of CHC visits to obstetrician-gynecologists, certified nurse midwives, family physicians (FP), and nurse practitioners (NP); total number of prenatal care visits and deliveries performed by CHC staff. RESEARCH DESIGN: Cross-sectional design comparing utilization between CHCs close to MCDs and those that were not, using linked 2017 data from the Uniform Data System (UDS), American Hospital Association Survey, and Area Health Resource Files. On the basis of prior research, CHCs close to a "desert" were hypothesized to provide higher numbers of FP and NP visits than obstetrician-gynecologists and certified nurse midwives visits. The sample included 1261 CHCs and all counties in the United States and Puerto Rico (n=3234). RESULTS: Results confirm the hypothesis regarding NP visits but are mixed for FP visits. CHCs close to "deserts" had more NP visits than those that were not. There was also a dose-response effect by MCD classification, with NP visits 3 times higher at CHCs located near areas without any outpatient and inpatient access to maternity care. CONCLUSIONS: CHCs located closer to "deserts" and NPs working at these comprehensive, primary care clinics have an important role to play in providing access to maternity care. More research is needed to determine how best to target resources to these limited access areas.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Centros Comunitários de Saúde/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Saúde da Mulher/estatística & dados numéricos , Adulto , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Feminino , Geografia , Ginecologia/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Humanos , Área Carente de Assistência Médica , Tocologia/estatística & dados numéricos , Profissionais de Enfermagem/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Médicos de Família/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Estados Unidos
15.
J Int Med Res ; 49(8): 3000605211033193, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34344218

RESUMO

OBJECTIVE: We aimed to explore the effect of individualized medical nutrition guidance on pregnancy outcomes among older pregnant women. METHODS: This was a prospective study using a randomized controlled trial design. We selected 820 older pregnant women and randomly divided them into a study group and control group (410 women each). The control group was given routine health education and nutrition guidance; the study group was provided individualized medical nutrition guidance. Gestational diabetes mellitus, hypertensive disorders of pregnancy, vaginal delivery rate, postpartum hemorrhage rate, gestational body weight, neonatal birth weight, and neonate transfer to the neonatal intensive care unit (NICU) were compared between the groups. RESULTS: The incidence of gestational diabetes in the study group was significantly lower and the rate of vaginal delivery was significantly higher than those in the control group. The incidence of macrosomia, rate of neonatal transfer to the NICU, and rate of neonatal hyperbilirubinemia were significantly lower in the study group than those in the control group. CONCLUSIONS: Individualized nutritional intervention for older pregnant women can effectively reduce the incidence of complications during pregnancy and childbirth and improve maternal and child outcomes.


Assuntos
Diabetes Gestacional , Resultado da Gravidez , Idoso , Peso ao Nascer , Criança , Diabetes Gestacional/epidemiologia , Feminino , Humanos , Recém-Nascido , Gravidez , Gestantes , Estudos Prospectivos
16.
BMC Pregnancy Childbirth ; 21(1): 531, 2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34315416

RESUMO

BACKGROUND: There is convincing evidence that birth in hospitals with high birth volumes increases the chance of healthy survival in high-risk infants. However, it is unclear whether this is true also for low risk infants. The aim of this systematic review was to analyze effects of hospital's birth volume on mortality, mode of delivery, readmissions, complications and subsequent developmental delays in all births or predefined low risk birth cohorts. The search strategy included EMBASE and Medline supplemented by citing and cited literature of included studies and expert panel highlighting additional literature, published between January/2000 and February/2020. We included studies which were published in English or German language reporting effects of birth volumes on mortality in term or all births in countries with neonatal mortality < 5/1000. We undertook a double-independent title-abstract- and full-text screening and extraction of study characteristics, critical appraisal and outcomes in a qualitative evidence synthesis. RESULTS: 13 retrospective studies with mostly acceptable quality were included. Heterogeneous volume-thresholds, risk adjustments, outcomes and populations hindered a meta-analysis. Qualitatively, four of six studies reported significantly higher perinatal mortality in lower birth volume hospitals. Volume-outcome effects on neonatal mortality (n = 7), stillbirths (n = 3), maternal mortality (n = 1), caesarean sections (n = 2), maternal (n = 1) and neonatal complications (n = 1) were inconclusive. CONCLUSION: Analyzed studies indicate higher rates of perinatal mortality for low risk birth in hospitals with low birth volumes. Due to heterogeneity of studies, data synthesis was complicated and a meta-analysis was not possible. Therefore international core outcome sets should be defined and implemented in perinatal registries. SYSTEMATIC REVIEW REGISTRATION: PROSPERO: CRD42018095289.


Assuntos
Salas de Parto , Hospitais com Alto Volume de Atendimentos , Hospitais com Baixo Volume de Atendimentos , Resultado da Gravidez/epidemiologia , Gravidez , Feminino , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Mortalidade Materna , Morbidade , Mortalidade Perinatal
17.
BMC Health Serv Res ; 21(1): 538, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34074286

RESUMO

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.


Assuntos
Serviços de Saúde Materna , Criança , Feminino , Hospitais , Humanos , Recém-Nascido , Missouri , Pennsylvania , Gravidez , Estudos Retrospectivos
18.
J Obstet Gynecol Neonatal Nurs ; 50(6): 774-788, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34166650

RESUMO

Specialty care for preterm and critically ill infants has evolved over many years. Neonatal intensive care nurseries were developed, and physicians and nurses learned how to provide intensive care for these infants. Neonatal and maternal (in utero) transport to tertiary centers became common in regionalized systems of care to facilitate the specialized care of high-risk neonates when childbirth occurred in settings without specialized personnel or equipment. Annually, nearly 70,000 neonatal transports occur in the United States. Although specialty care helps reduce rates of neonatal mortality, racial disparities and disparities between urban and rural areas exist. The purpose of this article is to review the progress achieved in neonatal and maternal transport over the past 50 years. The knowledge developed can be used to improve the care provided to women, their fetuses, and infants.


Assuntos
Parto Obstétrico , Terapia Intensiva Neonatal , Feminino , Humanos , Lactente , Recém-Nascido , Gravidez , Estados Unidos
19.
Pediatr Pulmonol ; 56(8): 2604-2610, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34171179

RESUMO

BACKGROUND: Among infants needing urgent transfer after birth, very preterm infants are a high-risk sub-group requiring special attention. This study aimed to assess trends in early respiratory management in a large series of very preterm infants undergoing postnatal transfer. METHODS: Trends in patient characteristics and early respiratory management were assessed in 798 very preterm infants who were transferred by the Eastern Veneto Neonatal Emergency Transport Service in 2000-2019. Trends were analyzed using joinpoint regression analysis and summarized as annual percentage changes (APCs). RESULTS: Proportion of neonates with birth weight less than 1 kg decreased from 33% to 16% (APC -3.82%). Use of nasal-continuous-positive-airway pressure increased (at call: APC 15.39%; during transfer: APC 15.60%), while use of self-inflating bag (at call: APC -12.09%), oxygen therapy (at call: APC -13.00%; during transfer: APC -23.77%) and mechanical ventilation (at call: APC -2.71%; during transfer: APC -2.99%) decreased. Use of oxygen concentrations at 21% increased (at call: APC 6.26%; during transfer: APC 7.14%), while oxygen concentrations above 40% decreased (at call: APC -5.73%; at transfer APC -8.89%). Surfactant administration at call increased (APC 3%-10%), while surfactant administration when arriving at referring hospital remained around 7-11% (APC 2.55%). CONCLUSION: Relevant trends toward "gentle" approaches in early respiratory management of very preterm infants undergoing postnatal transfer occurred during the last twenty years. In addition, the proportion of transferred extremely low birth weight infants halved. Clinicians and stakeholders should consider such information when allocating assets to both hospitals and transfer services and planning regional perinatal programs.


Assuntos
Doenças do Prematuro , Surfactantes Pulmonares , Síndrome do Desconforto Respiratório do Recém-Nascido , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Humanos , Lactente , Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido , Recém-Nascido Prematuro , Gravidez , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico
20.
J Clin Invest ; 131(13)2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34014840

RESUMO

BACKGROUNDThe significant risks posed to mothers and fetuses by COVID-19 in pregnancy have sparked a worldwide debate surrounding the pros and cons of antenatal SARS-CoV-2 inoculation, as we lack sufficient evidence regarding vaccine effectiveness in pregnant women and their offspring. We aimed to provide substantial evidence for the effect of the BNT162b2 mRNA vaccine versus native infection on maternal humoral, as well as transplacentally acquired fetal immune response, potentially providing newborn protection.METHODSA multicenter study where parturients presenting for delivery were recruited at 8 medical centers across Israel and assigned to 3 study groups: vaccinated (n = 86); PCR-confirmed SARS-CoV-2 infected during pregnancy (n = 65), and unvaccinated noninfected controls (n = 62). Maternal and fetal blood samples were collected from parturients prior to delivery and from the umbilical cord following delivery, respectively. Sera IgG and IgM titers were measured using the Milliplex MAP SARS-CoV-2 Antigen Panel (for S1, S2, RBD, and N).RESULTSThe BNT162b2 mRNA vaccine elicits strong maternal humoral IgG response (anti-S and RBD) that crosses the placenta barrier and approaches maternal titers in the fetus within 15 days following the first dose. Maternal to neonatal anti-COVID-19 antibodies ratio did not differ when comparing sensitization (vaccine vs. infection). IgG transfer ratio at birth was significantly lower for third-trimester as compared with second trimester infection. Lastly, fetal IgM response was detected in 5 neonates, all in the infected group.CONCLUSIONAntenatal BNT162b2 mRNA vaccination induces a robust maternal humoral response that effectively transfers to the fetus, supporting the role of vaccination during pregnancy.FUNDINGIsrael Science Foundation and the Weizmann Institute Fondazione Henry Krenter.


Assuntos
Anticorpos Antivirais/sangue , Vacinas contra COVID-19/imunologia , Vacinas contra COVID-19/farmacologia , COVID-19/imunologia , COVID-19/prevenção & controle , Troca Materno-Fetal/imunologia , SARS-CoV-2/imunologia , Adulto , Estudos de Coortes , Feminino , Sangue Fetal/imunologia , Humanos , Imunização Passiva , Imunoglobulina G/sangue , Recém-Nascido , Masculino , Gravidez , Adulto Jovem
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