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1.
World J Gastroenterol ; 29(15): 2283-2293, 2023 Apr 21.
Artículo en Inglés | MEDLINE | ID: mdl-37124884

RESUMEN

Coronavirus disease 2019 (COVID-19) caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become a major global public health event, resulting in a significant social and economic burden. Although COVID-19 was initially characterized as an upper respiratory and pulmonary infection, recent evidence suggests that it is a complex disease including gastrointestinal symptoms, such as diarrhea, nausea, and vomiting. Moreover, it remains unclear whether the gastrointestinal symptoms are caused by direct infection of the gastrointestinal tract by SARS-CoV-2 or are the result of systemic immune activation and subsequent dysregulation of homeostatic mechanisms. This review provides a brief overview of the mechanisms by which SARS-CoV-2 disrupts the integrity of the gastrointestinal barrier including the mechanical barrier, chemical barrier, microbial barrier, and immune barrier.


Asunto(s)
COVID-19 , Enfermedades Gastrointestinales , Humanos , SARS-CoV-2 , Enfermedades Gastrointestinales/diagnóstico , Diarrea
2.
J Glob Health ; 13: 04039, 2023 May 05.
Artículo en Inglés | MEDLINE | ID: mdl-37143374

RESUMEN

Background: Children and pregnant women usually have multiple contacts with the health care system. While most conditions can be managed by primary health care (PHC) providers, hospitalisations are nevertheless common and often unjustified. The number of hospitalizations decreased in Romania at the start of the COVID-19 pandemic. While this is likely due to the disruption of health services and public health measures established to limit the spread of COVID-19, it also suggests that a proportion of hospitalisations prior to the pandemic were unnecessary. This healthcare system evaluation in Romania quantified unnecessary and unnecessarily prolonged hospitalisations in children, pregnant women and women hospitalised for delivery, and assessed antibiotic and polypharmacy practices in these groups. Methods: We conducted the healthcare system evaluation in 10 hospitals across the country. We extracted data from medical records of patients hospitalized between 2019 and 2020. In each hospital, we randomly selected 40 medical records for each of the following groups: children 2-59 months of age, pregnant women, and women hospitalised for delivery. Clinical data were compared against WHO standards indicating a need for inpatient treatment or antibiotic therapy. Results: Among 209 children and 349 pregnant women, unnecessary hospitalisations accounted for 57.9% and 56.2% of hospitalisations, respectively. Among necessary hospitalisations, a large proportion was unnecessarily prolonged, including 44.4% (n = 32/72) in children, 23.3% (n = 34/146) in pregnant women, and 45.8% (n = 110/240) in women after delivery. The proportion of unnecessary and unnecessarily prolonged hospitalisations did not differ between the pre-pandemic, the lockdown, and the post-lockdown periods. Antibiotics were prescribed to 53.1% (n = 43/81) of children with diarrhoea, while 50.8% (n = 61/120) of women with caesarean section received an unjustified prolonged course of antibiotics. Children and women were commonly prescribed unnecessary medications. Conclusions: Findings of this evaluation should inform evidence-based decisions and actions for strengthening PHC and the healthcare system structure and improving the management of common diseases in mothers, newborns, and children. The evaluation should be repeated periodically to monitor progress.


Asunto(s)
COVID-19 , Cesárea , Niño , Humanos , Recién Nacido , Femenino , Embarazo , Polifarmacia , Rumanía , Pandemias , COVID-19/epidemiología , Control de Enfermedades Transmisibles , Hospitalización , Atención Primaria de Salud
3.
J Glob Health ; 13: 06013, 2023 May 05.
Artículo en Inglés | MEDLINE | ID: mdl-37144478

RESUMEN

Background: Recent evidence revealed significant gaps in the quality of maternal and newborn care in the World Health Organization (WHO) European Region (EUR) countries. Collecting and analyzing women's views on their needs and priorities is crucial for developing actions to improve the quality of maternal and newborn care. With this study from the IMAgiNE EURO Project, we aimed to add to previous quantitative studies by analysing emerging themes from women's suggestions on how to improve the quality of maternal and newborn care during facility-based birth in Italy during the COVID-19 pandemic. Methods: We collected data from mothers giving birth during the coronavirus 2019 (COVID-19) pandemic using a validated online anonymous WHO standard-based questionnaire consisting of open-ended questions. Using a word co-occurrence network (WCON), we analysed responses in Italian from women who gave birth between March 2020 and March 2022. This approach entails a graphical representation of word pairings that frequently co-occur across sentences and compose clusters. Results: The texts, produced by 2010 women participating in the study, consisted of 79 204 words and 3833 sentences. Eight clusters emerged with WCON, the three largest of which were related to companionship during childbirth, breastfeeding support, and physical resources. The term "swab", associated with other terms in the COVID-19 domain, had the highest degree of centrality, thus representing a core topic. Conclusions: The key emerging themes from women's suggestions can be used to shape policies to improve the quality of care for mothers and newborns. Our WCON analysis offers a valid approach to quickly screen large textual data on quality of care, providing a first set of major themes identified by clusters. As such, it could be used to improve documentation of service users' suggestions promoting the engagement of both researchers and policymakers. Registration: ClinicalTrials.gov: NCT04847336.


Asunto(s)
COVID-19 , Pandemias , Embarazo , Femenino , Recién Nacido , Humanos , COVID-19/epidemiología , Parto Obstétrico , Madres , Lactancia Materna
4.
BMC Pregnancy Childbirth ; 23(1): 320, 2023 May 05.
Artículo en Inglés | MEDLINE | ID: mdl-37147605

RESUMEN

BACKGROUND: Fetal loss is one of the most serious adverse outcomes of pregnancy. Since the onset of the COVID-19 pandemic, Brazil has recorded an unprecedented number of hospitalizations of pregnant women due to acute respiratory distress (ARD), thereby, we aimed to assess the risk of fetal deaths associated to ARD during pregnancy in Bahia state, Brazil, in the context of the COVID-19 pandemic. METHODS: This is an observational population-based retrospective cohort study, developed with women at or after 20 weeks of pregnancy, residents in Bahia, Brazil. Women who had acute respiratory distress (ARD) in pregnancy during the COVID-19 pandemic (Jan 2020 to Jun 2021) were considered 'exposed'. Women who did not have ARD in pregnancy, and whose pregnancy occurred before the onset of the COVID-19 pandemic (Jan 2019 to Dec 2019) were considered 'non-exposed'. The main outcome was fetal death. We linked administrative data (under mandatory registration) on live births, fetal deaths, and acute respiratory syndrome, using a probabilistic linkage method, and analyzed them with multivariable logistic regression models. RESULTS: 200,979 pregnant women participated in this study, 765 exposed and 200,214 unexposed. We found four times higher chance of fetal death in women with ARD during pregnancy, of all etiologies (adjusted odds ratio [aOR] 4.06 confidence interval [CI] 95% 2.66; 6.21), and due to SARS-CoV-2 (aOR 4.45 CI 95% 2.41; 8.20). The risk of fetal death increased more when ARD in pregnancy was accompanied by vaginal delivery (aOR 7.06 CI 95% 4.21; 11.83), or admission to Intensive Care Unit (aOR 8.79 CI 95% 4.96; 15.58), or use of invasive mechanical ventilation (aOR 21.22 CI 95% 9.93; 45.36). CONCLUSION: Our findings can contribute to expanding the understanding of health professionals and managers about the harmful effects of SARS-CoV-2 on maternal-fetal health and alerts the need to prioritize pregnant women in preventive actions against SARS-CoV-2 and other respiratory viruses. It also suggests that pregnant women, infected with SARS-CoV-2, need to be monitored to prevent complications of ARD, including a careful assessment of the risks and benefits of early delivery to prevent fetal death.


Asunto(s)
COVID-19 , Complicaciones Infecciosas del Embarazo , Síndrome de Dificultad Respiratoria , Femenino , Embarazo , Humanos , COVID-19/epidemiología , SARS-CoV-2 , Brasil/epidemiología , Estudios Retrospectivos , Estudios de Cohortes , Pandemias , Complicaciones Infecciosas del Embarazo/epidemiología , Muerte Fetal/etiología , Nacimiento Vivo , Resultado del Embarazo/epidemiología
5.
Sci Rep ; 13(1): 7972, 2023 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-37198202

RESUMEN

The COVID-19 pandemic negatively impacted the mental health of children, youth, and their families which must be addressed and prevented in future public health crises. Our objective was to measure how self-reported mental health symptoms of children/youth and their parents evolved during COVID-19 and to identify associated factors for children/youth and their parents including sources accessed for information on mental health. We conducted a nationally representative, multi-informant cross-sectional survey administered online to collect data from April to May 2022 across 10 Canadian provinces among dyads of children (11-14 years) or youth (15-18 years) and a parent (> 18 years). Self-report questions on mental health were based on The Partnership for Maternal, Newborn & Child Health and the World Health Organization of the United Nations H6+ Technical Working Group on Adolescent Health and Well-Being consensus framework and the Coronavirus Health and Impact Survey. McNemar's test and the test of homogeneity of stratum effects were used to assess differences between children-parent and youth-parent dyads, and interaction by stratification factors, respectively. Among 933 dyads (N = 1866), 349 (37.4%) parents were aged 35-44 years and 485 (52.0%) parents were women; 227 (47.0%) children and 204 (45.3%) youth were girls; 174 (18.6%) dyads had resided in Canada < 10 years. Anxiety and irritability were reported most frequently among child (44, 9.1%; 37, 7.7%) and parent (82, 17.0%; 67, 13.9%) dyads, as well as among youth (44, 9.8%; 35, 7.8%) and parent (68, 15.1%; 49, 10.9%) dyads; children and youth were significantly less likely to report worsened anxiety (p < 0.001, p = 0.006, respectively) or inattention (p < 0.001, p = 0.028, respectively) compared to parents. Dyads who reported financial or housing instability or identified as living with a disability more frequently reported worsened mental health. Children (96, 57.1%), youth (113, 62.5%), and their parents (253, 62.5%; 239, 62.6%, respectively) most frequently accessed the internet for mental health information. This cross-national survey contextualizes pandemic-related changes to self-reported mental health symptoms of children, youth, and families.


Asunto(s)
COVID-19 , Salud Mental , Recién Nacido , Adolescente , Humanos , Femenino , Masculino , COVID-19/epidemiología , Estudios Transversales , Pandemias , Canadá/epidemiología , Relaciones Padres-Hijo
6.
Air Med J ; 42(3): 196-200, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37150574

RESUMEN

OBJECTIVE: The coronavirus disease 2019 pandemic has resulted in unprecedented burnout in frontline health care providers. However, the impact of the pandemic on interfacility pediatric and neonatal transport team members has not been studied. The current study uses a survey design to document the impact of the pandemic on pediatric and neonatal transport team members with a focus on staffing and resilience promotion strategies. METHODS: Data for this study came from a short cross-sectional survey distributed to members of the American Academy of Pediatrics Section on Transport Medicine. RESULTS: Sixty-six teams responded (around 45%). Forty-one respondents (62%) reported vacancies on their transport teams, with 35 (53.8%) reporting more vacancies during the pandemic. Forty percent of highly trained registered nurses and respiratory therapists from specialty teams left their positions for those with better compensation during the pandemic. Forty-two percent of respondents were not trained to recognize burnout, stress, or compassion fatigue. CONCLUSION: Our study shows that half of the respondents had more vacancies during the pandemic than in previous years and reported difficulty in filling those positions. We were unable to link the vacancies to the pandemic and burnout because hospitalizations and transports in the pediatric facilities decreased during the pandemic; however, we do report that coronavirus disease 2019 exposure before the vaccine was a source of stress for team members. There are opportunities to improve the identification of burnout and to foster resilience and boost retention of this highly skilled niche workforce.


Asunto(s)
COVID-19 , Transporte de Pacientes , Recién Nacido , Niño , Humanos , Estados Unidos/epidemiología , COVID-19/epidemiología , Pandemias , Estudios Transversales , Encuestas y Cuestionarios , Recursos Humanos
7.
Reumatismo ; 75(1)2023 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-37154256

RESUMEN

The COVID-19 pandemic represents a global health problem, which has been mitigated by the opportune introduction of vaccination programs. Although we already know the benefit that vaccines provide, these are not exempt from adverse events which can be mild to deadly, such as idiopathic inflammatory myopathies, in which a temporal association has not been defined. It is for this reason that we carried out a systematic review of all reported cases of vaccination against COVID-19 and myositis. To identify previously reported cases of idiopathic inflammatory myopathies associated with vaccination against SARS-CoV-2 we registered this protocol on the website of PROSPERO with identification number CRD42022355551. Of the 63 publications identified in MEDLINE and 117 in Scopus, 21 studies were included, reporting 31 cases of patients with vaccination-associated myositis. Most of these cases were women (61.3%); mean age was 52.3 years (range 19-76 years) and mean time of symptom onset post-vaccination was 6.8 days. More than half of the cases were associated with Comirnaty, 11 cases (35.5%) were classified as dermatomyositis, and 9 (29%) as amyopathic dermatomyositis. In 6 (19.3%) patients another probable trigger was identified. Case reports of inflammatory myopathies associated with vaccination have heterogeneous presentations without any specific characteristics: as a consequence, it is not possible to ensure a temporal association between vaccination and the development of inflammatory myopathies. Large epidemiological studies are required to determine the existence of a causal association.


Asunto(s)
COVID-19 , Miositis , Humanos , Femenino , Recién Nacido , Lactante , Masculino , SARS-CoV-2 , Pandemias , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/etiología , Miositis/inducido químicamente , Miositis/epidemiología , Vacunación/efectos adversos
8.
Ig Sanita Pubbl ; 80(2): 27-48, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37154807

RESUMEN

Background Healthcare systems are complex systems. Achieving financial, social, and environmental sustainability of these systems requires a high degree of integration and coordination at all levels, especially between acute-care settings and primary/community care services. Some authors have, therefore, suggest redirecting integrated healthcare research towards the network theory and network concepts as a useful lens. Objective The current paper proposes to investigate the existence, the institutional level of formalization and the degree of development of hospital/primary-community care Networks currently present in the main types of healthcare systems worldwide by studying an appropriate selection of representative countries for each system typology. Materials and Methods A narrative review of the scientific and gray literature following the methodology by Green et al. was, therefore, conducted to describe hospital and primary/community care networks and their integration/coordination in the main international models. To select these models, one country with the current highest life expectancy at birth for each of the B öhm's five healthcare system categories was chosen. The grade of integration of the Networks retrieved for each State was therefore qualitatively appraised (high, medium or low degree), following Valentijn's framework. Results The networks retrieved show: in Norway, Australia and Japan both at the government/ national and at the regional/lower level/other a high degree of systemic, organizational, normative and functional integration; in Switzerland both at the government/national and at the regional/lower level/other a medium degree of systemic, organizational, normative and functional integration; in the USA at the governmental/institution level a low degree of systemic, organizational and normative integration, with a medium degree of functional integration and at the regional/lower level/other integration a low degree of systemic and normative integration with medium degree of organization integration and high degree of functional integration. Discussion The high levels and degree of hospital/primary - community care integration of Norway, Australia and Japan are in line with what could be expected from the universalistic healthcare system in place. The medium levels of integration of Switzerland are also in line with what the Social health insurance system and, especially, the cantonal system. The low levels of integration of the USA are in line with the privatistic healthcare systems. However, a medium degree was found for functional integration probably due to its unparalleled technological advancement. Conclusions The study shows how the levels of hospital/primary-community care integration are connected to the specific healthcare system in place in each country. COVID-19 showed how complex systems like healthcare systems had to reconfigure themselves to reach high levels of integration in small time to be able to save lives and contain the spread of the virus. These results will prove useful for policymakers, healthcare and public health professionals in the task of establishing effective Networks to achieve high levels of integration in their institutions.


Asunto(s)
COVID-19 , Recién Nacido , Humanos , Atención a la Salud , Hospitales , Australia , Instituciones de Salud
9.
Int J Health Geogr ; 22(1): 10, 2023 05 04.
Artículo en Inglés | MEDLINE | ID: mdl-37143110

RESUMEN

BACKGROUND: COVID-19 has been characterised by its global and rapid spread, with high infection, hospitalisation, and mortality rates worldwide. However, the course of the pandemic showed differences in chronology and intensity in different geographical areas and countries, probably due to a multitude of factors. Among these, socio-economic deprivation has been supposed to play a substantial role, although available evidence is not fully in agreement. Our study aimed to assess incidence and fatality rates of COVID-19 across the levels of socio-economic deprivation during the first epidemic wave (March-May 2020) in the Italian Province of Foggia, Apulia Region. METHODS: Based on the data of the regional active surveillance platform, we performed a retrospective epidemiological study among all COVID-19 confirmed cases that occurred in the Apulian District of Foggia, Italy, from March 1st to May 5th, 2020. Geocoded addresses were linked to the individual Census Tract (CT) of residence. Effects of socio-economic condition were calculated by means of the Socio-Economic and Health-related Deprivation Index (SEHDI) on COVID-19 incidence and fatality. RESULTS: Of the 1054 confirmed COVID-19 cases, 537 (50.9%) were men, 682 (64.7%) were 0-64 years old, and 338 (32.1%) had pre-existing comorbidities. COVID-19 incidence was higher in the less deprived areas (p < 0.05), independently on age. The level of socio-economic deprivation did not show a significant impact on the vital status, while a higher fatality was observed in male cases (p < 0.001), cases > 65 years (p < 0.001), cases having a connection with a nursing home (p < 0.05) or having at least 1 comorbidity (p < 0.001). On the other hand, a significant protection for healthcare workers was apparent (p < 0.001). CONCLUSIONS: Our findings show that deprivation alone does not affect COVID-19 incidence and fatality burden, suggesting that the burden of disease is driven by a complexity of factors not yet fully understood. Better knowledge is needed to identify subgroups at higher risk and implement effective preventive strategies.


Asunto(s)
COVID-19 , Inequidades en Salud , Pobreza , Adolescente , Adulto , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Adulto Joven , COVID-19/epidemiología , Incidencia , Italia/epidemiología , Pandemias , Estudios Retrospectivos , Factores Socioeconómicos , Mortalidad , Clase Social
10.
Artículo en Inglés | MEDLINE | ID: mdl-37174254

RESUMEN

The 24-Hour Movement Guidelines provide specific recommendations on movement behaviors for children and adolescents. The objective of this study was to verify the adequacy of children and adolescents to the guidelines for moderate to vigorous physical activity, recreational screen time, and sleep duration, and the overall adequacy to the guidelines, before and during the COVID-19 pandemic. A cross-sectional study was conducted with parents or guardians of children or adolescents from different regions of Brazil using a digital interview form including sociodemographic characteristics of families, moderate to vigorous physical activity, recreational screen time, and sleep duration before and during the pandemic. Statistically significant variation was observed in both groups in relation to moderate to vigorous physical activity and recreational screen time between the two periods evaluated. Overall adequacy to the guidelines before the pandemic was 19.28% for children from Group 1 (0-5 years old) and 39.50% for those from Group 2 (6 to 17 years old). During the pandemic, it corresponded to 3.58% in Group 1 and 4.94% in Group 2 (p-value between periods ≤0.001). This study showed the significant impact of pandemic restrictions on reducing overall compliance and physical activity, and increasing screen time among Brazilian children and adolescents.


Asunto(s)
COVID-19 , Pandemias , Humanos , Niño , Adolescente , Recién Nacido , Lactante , Preescolar , Brasil/epidemiología , COVID-19/epidemiología , Estudios Transversales , Sueño , Conducta Sedentaria
11.
J Med Virol ; 95(4): e28735, 2023 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-37185855

RESUMEN

Data on the safety of inactivated COVID-19 vaccines in pregnant women is limited and monitoring pregnancy outcomes is required. We aimed to examine whether vaccination with inactivated COVID-19 vaccines before conception was associated with pregnancy complications or adverse birth outcomes. We conducted a birth cohort study in Shanghai, China. A total of 7000 healthy pregnant women were enrolled, of whom 5848 were followed up through delivery. Vaccine administration information was obtained from electronic vaccination records. Relative risks (RRs) of gestational diabetes mellitus (GDM), hypertensive disorders in pregnancy (HDP), intrahepatic cholestasis of pregnancy (ICP), preterm birth (PTB), low birth weight (LBW), and macrosomia associated with COVID-19 vaccination were estimated by multivariable-adjusted log-binomial analysis. After exclusion, 5457 participants were included in the final analysis, of whom 2668 (48.9%) received at least two doses of an inactivated vaccine before conception. Compared with unvaccinated women, there was no significant increase in the risks of GDM (RR = 0.80, 95% confidence interval [CI], 0.69, 0.93), HDP (RR = 0.88, 95% CI, 0.70, 1.11), or ICP (RR = 1.61, 95% CI, 0.95, 2.72) in vaccinated women. Similarly, vaccination was not significantly associated with any increased risks of PTB (RR = 0.84, 95% CI, 0.67, 1.04), LBW (RR = 0.85, 95% CI, 0.66, 1.11), or macrosomia (RR = 1.10, 95% CI, 0.86, 1.42). The observed associations remained in all sensitivity analyses. Our findings suggested that vaccination with inactivated COVID-19 vaccines was not significantly associated with an increased risk of pregnancy complications or adverse birth outcomes.


Asunto(s)
COVID-19 , Complicaciones del Embarazo , Nacimiento Prematuro , Embarazo , Recién Nacido , Femenino , Humanos , Estudios de Cohortes , Vacunas contra la COVID-19/efectos adversos , Mujeres Embarazadas , Macrosomía Fetal , Nacimiento Prematuro/epidemiología , Pueblos del Este de Asia , China/epidemiología , COVID-19/prevención & control , Resultado del Embarazo
12.
J Matern Fetal Neonatal Med ; 36(1): 2204391, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37127549

RESUMEN

BACKGROUND: In an effort to prevent the spread of coronavirus disease 2019 (COVID-19), governments restricted outdoor activities and imposed lockdown quarantine. This change in lifestyle probably affected individuals' eating habits and physical activity. OBJECTIVE: To examine the effect of lockdown due to the COVID-19 pandemic on maternal antenatal weight gain, neonatal macrosomia, and other maternal and neonatal outcomes of women delivering at an academic medical center in Israel. METHOD: A retrospective, two-period cohort study conducted at a university teaching medical center in Afula, Israel. The study period was between April and September 2020. This period signifies worsening in pandemic situations, during which citizens experienced strict prolonged lockdown measures. The parallel unexposed period (control period) was between April and September 2019. Singleton pregnancies delivered at >24 weeks were eligible. Primary outcome was incidence of macrosomia. Secondary outcomes included gestational weight gain, body mass index (BMI) at delivery, rates of gestational diabetes mellitus (GDM), mode of delivery, postpartum hemorrhage (PPH), and neonatal outcomes reflecting neonatal birth weight and condition at delivery. RESULTS: A total of 4,765 women were included, 2,442 in the study group and 2,323 in the control group. The incidence of macrosomia was significantly higher in 2020 (6.2%) than in 2019 (4.9%), (p = .048; OR: 1.29; 95% CI: 1.002- 1.65). Women gained significantly more weight (median 1 kg more), weighed more at delivery (median 1 kg), and had higher BMI at delivery in 2020 compared with those in 2019 (p < .01). The incidence of GDM was 9.5% and 8.5% in the study and control groups respectively (p = .26; OR: 1.12; 95% CI: 0.92-1.37). Greater percentage of women did not perform the glucose challenge test in 2020 (9.9%) compared with those in 2019 (7.5%) (p = .003, OR: 1.36; 95% CI: 1.11-1.67). The incidence of any hypertension related to pregnancy was significantly higher in 2020 compared to 2019 (5.8% vs 4.4% respectively, (p = .042; OR: 1.32; 95% CI: 1.02-1.71). The proportion of women who smoked during pregnancy was also significantly higher in 2020 than in 2019 (5.1% vs 3.7%, respectively, p = .02; OR: 1.40; 95% CI: 1.06-1.86). Delivery mode did not differ, while the incidence of PPH was significantly higher in 2020 than in 2019 (5.6% vs 3.4%, respectively, p = .001; OR: 1.65; 95% CI: 1.25-2.19). Neonatal condition at delivery was comparable. CONCLUSION: COVID-19-related lockdown was associated with the increased rate of macrosomic infants. This indirect effect of the pandemic is probably related to poorer maternal antenatal metabolic health status. Long-term consequences should be further examined.


Asunto(s)
COVID-19 , Diabetes Gestacional , Ganancia de Peso Gestacional , Enfermedades del Recién Nacido , Recién Nacido , Embarazo , Femenino , Humanos , Macrosomía Fetal/epidemiología , Estudios Retrospectivos , Estudios de Cohortes , Israel , Pandemias , COVID-19/epidemiología , Control de Enfermedades Transmisibles , Diabetes Gestacional/epidemiología , Aumento de Peso , Peso al Nacer , Enfermedades del Recién Nacido/epidemiología , Índice de Masa Corporal , Resultado del Embarazo
13.
BMC Pregnancy Childbirth ; 23(1): 304, 2023 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-37127586

RESUMEN

BACKGROUND: The interrelationship of psychological and social factors in the current COVID-19 pandemic has been highlighted in research mainly focused on the global north. The impact of lockdowns can exacerbate psychological distress and affect access to services. Less is known about the psychosocial impact on women in the context of lower-middle income countries (LMICs); the aim of this study was to capture the impact of COVID-19 on women's experiences of pregnancy, birth and postpartum in Indonesia. METHODS: We conducted a rapid cross-sectional online survey of women across all 34 provinces in Indonesia to capture participants' experiences. Data were collected between 10th July to 9th August 2020 including demographics, effects on general and mental health and impact on service use. Descriptive statistics and thematic analysis were used to analyse responses, including those women who self-identified with a pre-existing mental health problem. RESULTS: Responses were obtained from 1137 women, this included pregnant women (n = 842) and postpartum women (n = 295). The majority of women (97%) had accessed antenatal care during their pregnancy, but 84% of women reporting feeling fearful and anxious about attending visits, resulting in some women not attending or changing provider. A small number (13%) were denied the presence of a birth companion, with 28% of women reporting that their babies had been removed at birth due to protocols or baby's health. Feeling anxious was a common experience among women (62%) during their pregnancy, birth or postnatal period, with a small number (9%) feeling depressed. Lockdown measures led to tensions within personal and family relationships. CONCLUSIONS: Women in Indonesia reported that the pandemic added an increased burden in pregnancy, birth and post-partum period: physically, psychologically, spiritually and financially. Maternity services were disrupted and health insurance cover lacked responsiveness, which either directly or indirectly impacted on women's choices, and equal access to care. Given the longevity of the current pandemic there is a need to develop tailored supportive interventions for women and their families and develop bespoke training for midwives and other relevant health professionals.


Asunto(s)
COVID-19 , Pandemias , Recién Nacido , Femenino , Embarazo , Humanos , Indonesia , Estudios Transversales , Control de Enfermedades Transmisibles , Parto/psicología , Periodo Posparto/psicología
14.
PLoS One ; 18(5): e0285612, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37196049

RESUMEN

The ongoing COVID-19 pandemic has killed at least 1.1 million people in the United States and over 6.7 million globally. Accurately estimating the age-specific infection fatality rate (IFR) of SARS-CoV-2 for different populations is crucial for assessing and understanding the impact of COVID-19 and for appropriately allocating vaccines and treatments to at-risk groups. We estimated age-specific IFRs of wild-type SARS-CoV-2 using published seroprevalence, case, and death data from New York City (NYC) from March to May 2020, using a Bayesian framework that accounted for delays between key epidemiological events. IFRs increased 3-4-fold with every 20 years of age, from 0.06% in individuals between 18-45 years old to 4.7% in individuals over 75. We then compared IFRs in NYC to several city- and country-wide estimates including England, Switzerland (Geneva), Sweden (Stockholm), Belgium, Mexico, and Brazil, as well as a global estimate. IFRs in NYC were higher for individuals younger than 65 years old than most other populations, but similar for older individuals. IFRs for age groups less than 65 decreased with income and increased with income inequality measured using the Gini index. These results demonstrate that the age-specific fatality of COVID-19 differs among developed countries and raises questions about factors underlying these differences, including underlying health conditions and healthcare access.


Asunto(s)
COVID-19 , SARS-CoV-2 , Humanos , Recién Nacido , Anciano , COVID-19/epidemiología , Pandemias , Estudios Seroepidemiológicos , Teorema de Bayes , Factores de Edad
15.
PLoS One ; 18(5): e0285847, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37220134

RESUMEN

BACKGROUND: There is a dearth of studies assessing the effects of SARS-CoV-2 on the healthcare system and access to care, especially in lower- and middle-income countries such as Malawi. We aimed to assess the impacts of COVID-19 on reported maternal and neonatal complications as well as potential changes in maternal care access to care among five primary care health facilities in Blantyre, Malawi. METHODS: This retrospective cohort study assessed maternal and neonatal register data from five participating health centers in Blantyre, Malawi using the Malawi District Health Information Software 2 (DHIS2) to compare outcomes from 15 months before COVID-19 emerged, defined as the pre-Covid period (January 2019 -March 2020) with nine months after COVID-19 (April 2020 -December 2020). RESULTS: There was a significant decrease in reported use of vacuum extraction, which went from <0.01%in the pre-COVID period to 0% in the COVID period (p = 0.01). The proportion of births reporting fetal distress almost tripled from 0.46% to 1.36% (p = 0.001) during the COVID-19 period. Additionally, reported anticonvulsant use significantly increased from 0.01% to 1.2% (p<0.01), and antibiotic use significantly increased from 0.45% to 1.6% (p = 0.01). Asphyxia was the only significant neonatal complication variable reported, increasing from 2.80% to 3.45% (p = 0.01). CONCLUSION: Our findings suggest that significant outcomes were mainly due to the indirect effects of COVID-19 rather than the virus itself. Based on our findings and the contextual qualitative interviews with two Malawian expert midwives, we concluded that mothers may have been affected more due to understaffing and shortage of skilled personnel in the study health facilities. Therefore, the development of highly skilled health workers may contribute to better outcomes, along with adequate staffing and a streamlined referral process.


Asunto(s)
COVID-19 , Recién Nacido , Femenino , Embarazo , Humanos , SARS-CoV-2 , Malaui , Salud Materna , Estudios Retrospectivos , Instituciones de Salud , Gobierno , Madres
16.
J Pregnancy ; 2023: 3015072, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37215313

RESUMEN

Background: COVID-19 is a new pandemic, which was declared by the World Health Organization in 2019 as a threat to public health. According to numerous reports, it can have negative consequences for pregnant women, labour, and neonates born to infected mothers. The aim of this paper was to gather the evidence and to present a summary of the results of studies concerning COVID-19 in pregnant women and their neonates. Methods: Articles from prestigious journals covering the period from 2020 to February 2023, relevant review papers, and original research articles from PubMed were analysed. In order to analyse the available research literature, the Web of Science, Scopus, and PubMed databases were used, in which the search for articles was conducted using terms ("pregnancy," "coronavirus," "SARS-CoV-2," and "newborn") and using PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analysis) guidelines for clinical trials. Meta-analyses and systematic reviews (2022-2023) on symptoms, neonatal course, and risk of COVID-19 infection have been summarized. Summary of meta-analyses and systematic reviews (2022-2023) on the effect and adverse reaction of the COVID-19 vaccination is presented. Results: As a result of the research conducted, it was confirmed that in most pregnant women, no serious signs of the infection were observed, although isolated cases of death related to COVID-19 in pregnant women were reported. Several authors called attention to the more severe course of the infection in pregnant women with obesity. It seemed that no vertical transmission from mother to child was occurring. Nevertheless, the information was not clinching. The condition of the neonates born to mothers with COVID-19 was in most cases described as normal; however, some papers reported deaths of infected neonates. Conclusions: Due to insufficient data, further research is necessary. Further studies and follow-up are recommended, which would make possible an assessment of remote effects of COVID-19 on pregnancy and vital parameters of the newborn.


Asunto(s)
COVID-19 , Complicaciones Infecciosas del Embarazo , Niño , Femenino , Humanos , Recién Nacido , Embarazo , Vacunas contra la COVID-19 , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Parto , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/diagnóstico , SARS-CoV-2
17.
Rev Med Inst Mex Seguro Soc ; 61(3): 314-320, 2023 May 02.
Artículo en Español | MEDLINE | ID: mdl-37216499

RESUMEN

Background: COVID-19 in pregnancy can increase the risk of complications due to the cardiorespiratory and immunological changes typical of pregnancy. Objective: To report the epidemiological characterization of COVID-19 in Mexican pregnant women. Material and methods: Cohort study on pregnant women with a positive COVID-19 test, which were followed until delivery and one month later. Results: 758 pregnant women were included in the analysis. Mothers' mean age was 28.8 ± 6.1 years; the majority were workers 497 (65.6%) and with an urban origin (482, 63.6%); the most common blood group was O with 458 (63.0%); 478 (63.0%) were nulliparous women and more than 25% had some comorbidities; the average gestation weeks at infection were 34.4 ± 5.1 weeks; only 170 pregnant women (22.4%) received vaccination; the most frequent vaccine was BioNTech Pfizer (96, 60%); there were no serious adverse events attributed to vaccination. The mean gestational age at delivery was 35.4 ± 5.2 weeks; 85% of pregnancies were cesarean section; the most frequent complication was prematurity (406, 53.5%), followed by preeclampsia (199, 26.2%); there were 5 cases of maternal death and 39 cases of perinatal death. Conclusions: COVID-19 in pregnancy increases the risk of preterm birth, preeclampsia, and maternal death. Vaccination against COVID-19 in this series showed no risk for pregnant women and their newborns.


Introducción: la COVID-19 en el embarazo puede incrementar el riesgo de complicaciones debido a los cambios cardiorrespiratorios e inmunológicos propios de la gestación. Objetivo: reportar la caracterización epidemiológica de la COVID-19 en población obstétrica mexicana. Material y métodos: estudio de cohorte en embarazadas con prueba positiva para COVID-19 que fueron seguidas hasta la resolución del embarazo y un mes después. Resultados: 758 mujeres embarazadas fueron incluidas en el análisis. La media de edad en las madres fue 28.8 ± 6.1 años; la mayoría trabajadoras 497 (65.6%) y de origen urbano (482, 63.6%); el grupo sanguíneo más común fue O 458 (63.0%); 478 (63.0%) fueron primigestas, y más del 25% padecía comorbilidades; las semanas de gestación promedio al contagio fueron 34.4 ± 5.1 semanas; solo 170 gestantes (22.4%) recibieron vacunación; la vacuna más frecuente fue BioNTech Pfizer (96, 60%); no hubo eventos adversos graves atribuibles a la vacunación. La edad gestacional media al nacer fue de 35.4 ± 5.2 semanas; el 85% de los embarazos se interrumpieron por cesárea; la complicación más frecuente fue la prematurez con 406 (53.5%), seguida de preeclampsia con 199 (26.2%); hubo 5 casos de muerte materna y 39 casos de muerte perinatal. Conclusiones: la COVID-19 en el embarazo aumenta el riesgo de parto prematuro, preeclampsia y muerte materna. Al menos en esta serie la vacunación contra COVID-19 no mostró riesgo para las mujeres embarazadas y sus recién nacidos.


Asunto(s)
COVID-19 , Muerte Materna , Preeclampsia , Nacimiento Prematuro , Embarazo , Recién Nacido , Femenino , Humanos , Adulto Joven , Adulto , Lactante , Resultado del Embarazo , Estudios de Cohortes , Mujeres Embarazadas , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etiología , COVID-19/epidemiología , COVID-19/prevención & control , Cesárea
18.
J Matern Fetal Neonatal Med ; 36(1): 2199343, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37217448

RESUMEN

OBJECTIVE: COVID-19 has been reported to increase the risk of prematurity, however, due to the frequent absence of unaffected controls as well as inadequate accounting for confounders in many studies, the question requires further investigation. We sought to determine the impact of COVID-19 disease on preterm birth (PTB) overall, as well as related subcategories such as early prematurity, spontaneous, medically indicated preterm birth, and preterm labor (PTL). We assessed the impact of confounders such as COVID-19 risk factors, a-priori risk factors for PTB, symptomatology, and disease severity on rates of prematurity. METHODS: This was a retrospective cohort study of pregnant women from March 2020 till October 1st, 2020. The study included patients from 14 obstetric centers in Michigan, USA. Cases were defined as women diagnosed with COVID-19 at any point during their pregnancy. Cases were matched with uninfected women who delivered in the same unit, within 30 d of the delivery of the index case. Outcomes of interest were frequencies of prematurity overall and subcategories of preterm birth (early, spontaneous/medically indicated, preterm labor, and premature preterm rupture of membranes) in cases compared to controls. The impact of modifiers of these outcomes was documented with extensive control for potential confounders. A p value <.05 was used to infer significance. RESULTS: The rate of prematurity was 8.9% in controls, 9.4% in asymptomatic cases, 26.5% in symptomatic COVID-19 cases, and 58.8% among cases admitted to the ICU. Gestational age at delivery was noted to decrease with disease severity. Cases were at an increased risk of prematurity overall [adjusted relative risk (aRR) = 1.62 (1.2-2.18)] and of early prematurity (<34 weeks) [aRR = 1.8 (1.02-3.16)] when compared to controls. Medically indicated prematurity related to preeclampsia [aRR = 2.46 (1.47-4.12)] or other indications [aRR = 2.32 (1.12-4.79)], were the primary drivers of overall prematurity risk. Symptomatic cases were at an increased risk of preterm labor [aRR = 1.74 (1.04-2.8)] and spontaneous preterm birth due to premature preterm rupture of membranes [aRR = 2.2(1.05-4.55)] when compared to controls and asymptomatic cases combined. The gestational age at delivery followed a dose-response relation with disease severity, as more severe cases tended to deliver earlier (Wilcoxon p < .05). CONCLUSIONS: COVID-19 is an independent risk factor for preterm birth. The increased preterm birth rate in COVID-19 was primarily driven by medically indicated delivery, with preeclampsia as the principal risk factor. Symptomatic status and disease severity were significant drivers of preterm birth.


Asunto(s)
COVID-19 , Trabajo de Parto Prematuro , Preeclampsia , Nacimiento Prematuro , Recién Nacido , Femenino , Embarazo , Humanos , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etiología , Estudios Retrospectivos , Michigan/epidemiología , COVID-19/complicaciones , COVID-19/epidemiología , SARS-CoV-2 , Resultado del Embarazo
19.
Commun Biol ; 6(1): 511, 2023 05 12.
Artículo en Inglés | MEDLINE | ID: mdl-37173432

RESUMEN

Remdesivir is an antiviral drug used for COVID-19 treatment worldwide. Cardiovascular side effects have been associated with remdesivir; however, the underlying molecular mechanism remains unknown. Here, we performed a large-scale G-protein-coupled receptor screening in combination with structural modeling and found that remdesivir is a selective, partial agonist for urotensin-II receptor (UTS2R) through the Gαi/o-dependent AKT/ERK axis. Functionally, remdesivir treatment induced prolonged field potential and APD90 in human induced pluripotent stem cell (iPS)-derived cardiomyocytes and impaired contractility in both neonatal and adult cardiomyocytes, all of which mirror the clinical pathology. Importantly, remdesivir-mediated cardiac malfunctions were effectively attenuated by antagonizing UTS2R signaling. Finally, we characterized the effect of 110 single-nucleotide variants in UTS2R gene reported in genome database and found four missense variants that show gain-of-function effects in the receptor sensitivity to remdesivir. Collectively, our study illuminates a previously unknown mechanism underlying remdesivir-related cardiovascular events and that genetic variations of UTS2R gene can be a potential risk factor for cardiovascular events during remdesivir treatment, which collectively paves the way for a therapeutic opportunity to prevent such events in the future.


Asunto(s)
Antivirales , COVID-19 , Insuficiencia Cardíaca , Células Madre Pluripotentes Inducidas , Receptores Acoplados a Proteínas G , Humanos , Recién Nacido , COVID-19/patología , Tratamiento Farmacológico de COVID-19 , Insuficiencia Cardíaca/patología , Miocitos Cardíacos , Receptores Acoplados a Proteínas G/agonistas , Antivirales/farmacología
20.
Med Sci Monit ; 29: e939915, 2023 May 19.
Artículo en Inglés | MEDLINE | ID: mdl-37202922

RESUMEN

BACKGROUND Monitoring of mortality rate and causes of death in pediatric hospitals is required in Poland. This study is aimed to evaluate the causes of death in neonates, infants, children, and adolescents obtained from the medical records of the University Children's Clinical Hospital (UCCH) of Bialystok between 2018 and 2021. MATERIAL AND METHODS This was an observational, cross-sectional study. Medical records of 59 patients (12 neonates, 17 infants, 14 children, 16 adolescents) who died in the UCCH of Bialystok in 2018-2021 were analyzed. The records included personal data, medical history, and causes of death. RESULTS Between 2018 and 2021, the leading death causes were congenital malformations, deformations, and chromosomal abnormalities (25.42%, N=15) and conditions originating in the perinatal period (11.86%, N=7). The leading death causes in each age group were: in neonates - congenital malformations, deformations, and chromosomal abnormalities (50%, N=6), in infants -conditions originating in the perinatal period (29.41%, N=5), in children - diseases of the respiratory system (30.77%, N=4), and in teenagers - external causes of morbidity (31%, N=5). Before the COVID-19 pandemic (2018-2019), the leading death causes were congenital malformations, deformations, and chromosomal abnormalities (20.69%, N=6) and conditions originating in the perinatal period (20.69%, N=6). During the COVID-19 pandemic (2020-2021), congenital malformations, deformations, and chromosomal abnormalities (26.67%, N=8) and COVID-19 (10.00%, N=3) were the most common death causes. CONCLUSIONS Leading death causes varied among age groups. The COVID-19 pandemic had an impact on pediatric causes of death and changed their distribution. The results of this analysis should be discussed and conclusions should improve the quality of pediatric care.


Asunto(s)
COVID-19 , Hospitales Pediátricos , Recién Nacido , Embarazo , Femenino , Humanos , Niño , Lactante , Adolescente , Causas de Muerte , Pandemias , Universidades , Aberraciones Cromosómicas , Mortalidad Infantil
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