1
|
Abstract
As the world clamored to respond to the rapidly evolving coronavirus 2019 (COVID-19) pandemic, health care systems reacted swiftly to provide uninterrupted care for patients. Within obstetrics and gynecology, nearly every facet of care was influenced. Rescheduling of office visits, safety of labor and delivery and in the operating room, and implementation of telemedicine are examples. Social distancing has impacted academic centers in the education of trainees. COVID-19 vaccine trials have increased awareness of including pregnant and lactating women. Last, the pandemic has reminded us of issues related to ethics, diversity and inclusiveness, marginalized communities, and the women's health workforce.
Collapse
Affiliation(s)
- Denisse S Holcomb
- Department of Obstetrics and Gynecology, University of Texas Southwestern Center, Dallas, TX, USA.
| | - William F Rayburn
- Department of Obstetrics and Gynecology, University of New Mexico School of Medicine, Albuquerque, NM, USA
| |
Collapse
|
2
|
Jolivet RR, Gausman J, Kapoor N, Langer A, Sharma J, Semrau KEA. Operationalizing respectful maternity care at the healthcare provider level: a systematic scoping review. Reprod Health 2021; 18:194. [PMID: 34598705 PMCID: PMC8485458 DOI: 10.1186/s12978-021-01241-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ensuring the right to respectful care for maternal and newborn health, a critical dimension of quality and acceptability, requires meeting standards for Respectful Maternity Care (RMC). Absence of mistreatment does not constitute RMC. Evidence generation to inform definitional standards for RMC is in an early stage. The aim of this systematic review is clear provider-level operationalization of key RMC principles, to facilitate their consistent implementation. METHODS Two rights-based frameworks define the underlying principles of RMC. A qualitative synthesis of both frameworks resulted in seven fundamental rights during childbirth that form the foundation of RMC. To codify operational definitions for these key elements of RMC at the healthcare provider level, we systematically reviewed peer-reviewed literature, grey literature, white papers, and seminal documents on RMC. We focused on literature describing RMC in the affirmative rather than mistreatment experienced by women during childbirth, and operationalized RMC by describing objective provider-level behaviors. RESULTS Through a systematic review, 514 records (peer-reviewed articles, reports, and guidelines) were assessed to identify operational definitions of RMC grounded in those rights. After screening and review, 54 records were included in the qualitative synthesis and mapped to the seven RMC rights. The majority of articles provided guidance on operationalization of rights to freedom from harm and ill treatment; dignity and respect; information and informed consent; privacy and confidentiality; and timely healthcare. Only a quarter of articles mentioned concrete or affirmative actions to operationalize the right to non-discrimination, equality and equitable care; less than 15%, the right to liberty and freedom from coercion. Provider behaviors mentioned in the literature aligned overall with seven RMC principles; yet the smaller number of available research studies that included operationalized definitions for some key elements of RMC illustrates the nascent stage of evidence-generation in this area. CONCLUSIONS Lack of systematic codification, grounded in empirical evidence, of operational definitions for RMC at the provider level has limited the study, design, implementation, and comparative assessment of respectful care. This qualitative systematic review provides a foundation for maternity healthcare professional policy, training, programming, research, and program evaluation aimed at studying and improving RMC at the provider level.
Collapse
Affiliation(s)
- R Rima Jolivet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Jewel Gausman
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Neena Kapoor
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Ana Langer
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Jigyasa Sharma
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Katherine E A Semrau
- BetterBirth Program, Ariadne Labs
- Brigham and Women's Hospital and Harvard TH Chan School of Public Health, Boston, MA, USA.,Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
| |
Collapse
|
3
|
Lee J, Galli J, Siemon J, Huang M, Schlumbrecht M. Assessment of Cancer Survivorship Training and Knowledge Among Resident Physicians in Obstetrics and Gynecology. J Cancer Educ 2021; 36:491-496. [PMID: 31734870 DOI: 10.1007/s13187-019-01652-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The number of gynecologic cancer survivors in the USA is expected to grow to nearly 2 million by 2029. Gynecologic oncologists alone will not be able to care for all of these women. Thus, preparation of general obstetrician/gynecologists (OBGYNs) to deliver this care is crucial. Our objective was to assess cancer survivorship training (CST) among OB/GYN residents and to evaluate knowledge in basic gynecologic cancer survivorship. OB/GYN residents were recruited nationally to complete a de novo questionnaire, querying demographics, hours of CST received, teaching methods used, and efficacy of those methods. Survivorship knowledge was assessed by ten questions based on the 2017 Society of Gynecologic Oncology recommendations on post-treatment surveillance, which includes topics appropriate for generalists. Analyses were done using t tests and ANOVA, with significance set at p = 0.05. In total, 128 residents responded to the survey. Observation was the most common method of CST (53%), with patient contact reported as the most effective method (42.6%). The mean score of correct responses (MSCRs) among all respondents was 61.5%. MSCR significantly improved with increasing post-graduate year (PGY) (p = 0.003). Survivorship training method was not associated with improved MSCR. Improvements in MSCR were observed with an increasing number of CST hours (p = 0.011). A total of 13.9% of residents reported feeling "very comfortable" with survivorship care, yet 88.5% of respondents indicated they did not want additional CST. More hours of CST are associated with improved resident in knowledge in cancer survivorship care, though deficits still remain. Further investigation into optimizing CST is warranted.
Collapse
Affiliation(s)
- Jared Lee
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Johnny Galli
- Department of Obstetrics, Gynecology, and Reproductive Science, University of Miami Miller School of Medicine, Miami, FL, USA
| | - John Siemon
- Department of Obstetrics, Gynecology, and Reproductive Science, University of Miami Miller School of Medicine, Miami, FL, USA
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, The University of Miami Miller School of Medicine, 1121 NW 14th St, Suite 345C, Miami, FL, 33136, USA
| | - Marilyn Huang
- Department of Obstetrics, Gynecology, and Reproductive Science, University of Miami Miller School of Medicine, Miami, FL, USA
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, The University of Miami Miller School of Medicine, 1121 NW 14th St, Suite 345C, Miami, FL, 33136, USA
| | - Matthew Schlumbrecht
- Department of Obstetrics, Gynecology, and Reproductive Science, University of Miami Miller School of Medicine, Miami, FL, USA.
- Division of Gynecologic Oncology, Sylvester Comprehensive Cancer Center, The University of Miami Miller School of Medicine, 1121 NW 14th St, Suite 345C, Miami, FL, 33136, USA.
| |
Collapse
|
4
|
Melese KG, Weji BG, Berheto TM, Bekru ET. Utilization of partograph during labour: A case of Wolaita Zone, Southern Ethiopia. Heliyon 2020; 6:e05633. [PMID: 33364475 PMCID: PMC7754518 DOI: 10.1016/j.heliyon.2020.e05633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/03/2020] [Accepted: 11/25/2020] [Indexed: 12/02/2022] Open
Abstract
The World Health Organization recommends the utilization of partograph for all laboring mothers. Partograph is a cost-effective, single sheet of paper that is used to follow maternal and fetal condition and progress of labour. Obstructed and prolonged labours are major causes of maternal deaths. These causes can be minimized by routine utilization of partograph. However, several maternal and fetal deaths occur in health facilities due to poor quality of labour follow-up. Therefore, this study aims to assess the utilization of partograph and associated factors among obstetric care providers working in Wolaita zone health facilities, Southern Ethiopia. An institution-based cross-sectional survey was conducted from April to May 2016. A pretested and structured self-administered questionnaire was used to collect the data. Data entry and analysis was conducted using SPSS Version 21.0. Logistic regression was used to identify associations. A P value <0.2 in binary logistic regression were transferred to multiple logistic regressions. Odds ratio with 95% CI, P-value <0.05 were considered as statistically significant. Of a total of 442 participants, 73.6% utilize partograph routinely. From the total variables in the study, a midwifery profession showed a significant association with the dependent variable (AOR = 4.7,95% CI:1.8–12). The utilization of partograph in the study area was low as per the World Health Organization recommendation. This study recommends that assigning midwives in the obstetric ward other than other health professionals will increase the routine utilization of partograph.
Collapse
Affiliation(s)
- Kidest Getu Melese
- School of Midwifery, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Bedilu Girma Weji
- Department of Anesthesia, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tezera Moshago Berheto
- School of Public Health, College of Health Sciences and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Eyasu Tamru Bekru
- Department of Nursing, College of Health Science, Institute of Medicine and Health Sciences, Debrebrehan University, Debrebrehan, Ethiopia
| |
Collapse
|
5
|
Zaidi H, Lamalmi N, Lahlou L, Slaoui M, Barkat A, Alamrani S, Alhamany Z. Clinical predictive factors of histological chorioamnionitis: case-control study. Heliyon 2020; 6:e05698. [PMID: 33364485 PMCID: PMC7750559 DOI: 10.1016/j.heliyon.2020.e05698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/17/2020] [Accepted: 12/07/2020] [Indexed: 10/30/2022] Open
Abstract
Introduction Histological chorioamnionitis or "intrauterine inflammation or infection" (Triple I) it is an acute inflammation of amniotic membrane, chorionic plate and umbilical cord. Subject To assess in the event of the clinical predictive factors associated to histological chorioamnionitis. Methods Prospective examination of 50 placentas from aberrant pregnancies, and 50 placentas from 'normal' deliveries. The Placentas analyzed by the conventional histopathology method, and the severity of chorioamnionitis was classified histologically according to the intensity and the topography of placental inflammation.The clinical and histopathological features of the study groups were introduced into the SPSS 13 database (License University Mohammed V-Rabat). Results 36/50 placentas of aberrant pregnancies showed a histological chorioamnionitis often associated to a funisitis, and 11/50 normal placentas have shown some lesions of histological chorioamnionitis mainly grade one without funisitis.On the other hand we noted a statistically significant association between histological chorioamnionitis and premature rupture of the membranes (PROM) over than 12h (p < 0.001). Conclusions Our study confirmed the predominance of histological chorioamnionitis lesions in clinically suspected cases of chorioamnionitis with 72% versus 22% in the controls group.Among the clinical parameters studied, only the premature rupture of the Membranes was shown a statistically significant association with the appearance of histological signs of chorioamnionitis.In conclusion, chorioamnionitis is sometimes clinically silent. Morphological placental study could be a confirmation of this pathology, which is predominantly associated to PROM over than 12 h.
Collapse
Affiliation(s)
- H Zaidi
- Mohammed V University, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco.,Laboratory of Pathological Anatomy and Cytology, Children's Hospital, CHU Ibn Sina, 10170, Rabat, Morocco
| | - N Lamalmi
- Mohammed V University, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco.,Laboratory of Pathological Anatomy and Cytology, Children's Hospital, CHU Ibn Sina, 10170, Rabat, Morocco
| | - L Lahlou
- Mohammed V University, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco.,Laboratory of Biostatistics and Clinical Research, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco
| | - M Slaoui
- Mohammed V University, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco
| | - A Barkat
- Mohammed V University, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco.,Neonatology Department P5, Children's Hospital, CHU Ibn Sina, 10170, Rabat, Morocco
| | - S Alamrani
- Mohammed V University, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco.,Maternity Souissi, CHU Ibn Sina, 10170, Rabat, Morocco
| | - Z Alhamany
- Mohammed V University, Faculty of Medicine and Pharmacy, 10170, Rabat, Morocco.,Laboratory of Pathological Anatomy and Cytology, Children's Hospital, CHU Ibn Sina, 10170, Rabat, Morocco
| |
Collapse
|
6
|
Boeckstaens S, Dewalheyns S, Heremans R, Vikram R, Timmerman D, Van den Bosch T, Verbakel JY. Signs and symptoms associated with uterine cancer in pre- and postmenopausal women. Heliyon 2020; 6:e05372. [PMID: 33204876 PMCID: PMC7649270 DOI: 10.1016/j.heliyon.2020.e05372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/09/2020] [Accepted: 10/26/2020] [Indexed: 10/31/2022] Open
Abstract
Uterine cancer is the most and second most common gynecological malignancy in developed and developing countries, respectively. The majority of endometrial cancers are diagnosed early due to the presence of abnormal uterine bleeding. The existing literature however contains only little data regarding the prevalence of such symptoms compared to patients with no or benign pathology. Therefore, a systematic review was conducted in order to determine the significance of various clinical signs and symptoms predicting uterine cancer. Embase, Web of Science and Medline databases were searched from inception until 18 June 2019. Studies eligible for selection inclusion assessed the diagnostic accuracy of clinical signs and symptoms in pre- and postmenopausal women aged 18-99 years old with uterine malignancy. Case reports, case series and studies of which full text was not available, were excluded. The risk of bias was assessed using the QUADAS-2 tool by two independent reviewers. Results were visualized by forest plots using RevMan(5.3). Forty-one studies were eventually included in this systematic review. Abnormal uterine bleeding occurring in pre-, post- and perimenopausal women was proven to be the most widely investigated symptom in relation to cancer of the uterus. Thirty-two articles examined patients with postmenopausal bleeding of which sensitivity and specificity varied between 0.28 to 0.86 and 0.63 to 0.84, respectively. Abnormal bleeding in pre- and perimenopausal women on the other hand showed a sensitivity ranging from 0.63 to 0.81. Its specificity could not be calculated due to missing data. Other symptoms appeared not sufficiently examined to assess their diagnostic accuracy range. This review highlights the current lack of knowledge regarding the diagnostic accuracy of several signs and symptoms for uterine cancer. After a thorough in-depth review of the literature, meta-analysis could not be performed due to the absence of control populations in the majority of articles. Further research is needed to establish the rule-in or rule-out value of specific clinical signs to identify patients at risk for uterine malignancy prompting further clinical assessment.
Collapse
Affiliation(s)
- Shari Boeckstaens
- Department of Obstetrics and Gynaecology, KU Leuven, Belgium
- Department of Obstetric Ultrasound and Fetal Medicine, University College London Hospital, United Kingdom
| | | | - Ruben Heremans
- Department of Obstetrics and Gynaecology, KU Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Belgium
| | - Radhika Vikram
- Department of Obstetrics and Gynaecology, West Hertfordshire Hospitals, Watford, United Kingdom
| | - Dirk Timmerman
- Department of Obstetrics and Gynaecology, KU Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Belgium
| | - Thierry Van den Bosch
- Department of Obstetrics and Gynaecology, KU Leuven, Belgium
- Laboratory for Tumor Immunology and Immunotherapy, KU Leuven, Belgium
| | - Jan Y. Verbakel
- Department of Public Health and Primary Care, KU Leuven, Belgium
- Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom
| |
Collapse
|
7
|
Siakwa M, Nyarko-Sampson M, Bruce SD. Obstetric outcomes: A comparison of teenagers and adults in the Cape Coast metropolis, Ghana. Heliyon 2020; 6:e05466. [PMID: 33241147 PMCID: PMC7672273 DOI: 10.1016/j.heliyon.2020.e05466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 09/16/2020] [Accepted: 11/05/2020] [Indexed: 11/27/2022] Open
Abstract
Prevalence of teenage pregnancy is very high in the Central Region of Ghana. Although, pregnant teenagers are perceived to be high-risk mothers, very little has been documented about obstetric outcomes among these mothers in Ghana. This case-control observational study compared maternal and perinatal outcomes between teen and adult mothers in the Cape Coast metropolis. Data on maternal and perinatal outcome variables were collected with a data extraction form from maternal history record and delivery record books of 505 teens and 501 adults. Maternal and perinatal outcomes for the two groups were compared using chi-square or Fisher's exact test and odds ratios at 95% confidence interval. Prenatal services utilization was high among the participants. Prevalence of adverse maternal and perinatal outcomes were low, which is comparable between the two groups. Spontaneous vaginal delivery was higher in the teens with the adults having higher predisposition for caesarean section. The adult mothers were more likely to have preterm delivery and babies with low minute 1 APGAR score, the teens on the other hand had babies with significantly lower birth weight. The favourable and comparable pregnancy outcomes among the participants could be attributed to the high prenatal service utilization. Improved access to prenatal service utilization would produce better pregnancy outcomes.
Collapse
Affiliation(s)
- Mate Siakwa
- School of Nursing and Midwifery, University of Cape Coast, Ghana
| | | | - Sylvia D Bruce
- School of Nursing and Midwifery, University of Cape Coast, Ghana
| |
Collapse
|
8
|
Naja S, Al Kubaisi N, Singh R, Bougmiza I. Generalized and pregnancy-related anxiety prevalence and predictors among pregnant women attending primary health care in Qatar, 2018-2019. Heliyon 2020; 6:e05264. [PMID: 33134579 PMCID: PMC7586091 DOI: 10.1016/j.heliyon.2020.e05264] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/14/2020] [Accepted: 10/12/2020] [Indexed: 12/28/2022] Open
Abstract
Background Cumulative evidence suggests that early identification of anxiety in pregnancy is important, given that antenatal anxiety has been linked to morbid outcomes in expecting mothers and their offspring. However, the burden of antenatal anxiety is not yet known in Qatar. This research aims to measure the prevalence and determinants of generalized and pregnancy-related anxiety among pregnant women. Methods Eight hundred pregnant women completed a structured interview and self-administrated questionnaires after being selected through probability sampling from nine primary healthcare centers distributed across Qatar. We subjected the data to Binary and Multiple Logistic Regression Analysis. Furthermore, we conducted a Confirmatory Factor Analysis for the utilized scales. Results Out of eight hundred participants, 26.5% reported high pregnancy-related anxiety, while 16.4% had a generalized anxiety disorder. A high level of perceived social support and resilience was shown to mitigate generalized and pregnancy-related anxiety. However, we revealed that different determinants influence the two types of anxiety. Limitations There is no recognized optimal cut-off point to distinguish ‘high risk’ in pregnancy-related anxiety scales. Conclusions Pregnancy-related anxiety is more prevalent than generalized anxiety among pregnant women in Qatar, indicating that stakeholders must include screening for pregnancy-related anxiety in Qatar's clinical guidelines. Tailored interventional studies could focus on increasing resilience and social support to decrease the burden of antenatal anxiety.
Collapse
Affiliation(s)
| | | | - Rajvir Singh
- Biostatistics, Hamad Medical Corporation, Doha, Qatar
| | | |
Collapse
|
9
|
Ratan BM, Greely JT, Jensen MD, Kilpatrick CC. A Conceptual Model for Residents as Teachers in Obstetrics and Gynecology. Med Sci Educ 2020; 30:1169-1176. [PMID: 34457779 PMCID: PMC8368430 DOI: 10.1007/s40670-020-00985-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND The learning environment in obstetrics and gynecology (OB/GYN) may have intrinsic differences that require modifying existing resident as teacher models for high-quality teaching. OBJECTIVE To explore medical students' views of resident teaching on the OB/GYN clerkship in order to develop more effective educators. METHODS Between October 2017 and June 2018, we performed medical student focus groups at the end of the 2-month OB/GYN clerkship. Topics discussed included positive and negative teaching interactions with residents, barriers specific to the OB/GYN clerkship, and best methods for resident teaching. Qualitative analysis utilizing 3 reviewers and N-Vivo software were used to identify themes. RESULTS A total of 37 students participated in five focus groups. The most common barriers were a learning environment that was less predictable than on other rotations and lack of autonomy due to patient advocacy concerns. The three main contributors to positive learning experiences were team inclusion, clear expectations, and feedback. Negative interactions were passive learning experiences and inconsistent expectations. The best methods for resident teaching were verbalization of cognitive processes, preparation to use common patient encounters as teaching moments, and modeling skills needed for proficient patient care. DISCUSSION The learning environment on OB/GYN is unpredictable and influenced by four Ps: patient autonomy, passive experiences, procedures, and preconceived notions. The strategy of a resident teacher should focus on medical student inclusion and preparation for teaching role. We thus suggest a TEAM (Thinking Aloud, Expectations, Advanced Preparation, Modeling) approach to improve resident teaching on the OB/GYN clerkship.
Collapse
Affiliation(s)
- Bani M. Ratan
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX USA
| | - Jocelyn T. Greely
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX USA
| | - M. Diane Jensen
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX USA
| | - Charlie C. Kilpatrick
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX USA
| |
Collapse
|
10
|
Mokkala K, Juhila J, Houttu N, Sorsa T, Laitinen K. Early pregnancy serum IGFBP-1 relates to lipid profile in overweight and obese women. Heliyon 2020; 6:e04788. [PMID: 32923723 DOI: 10.1016/j.heliyon.2020.e04788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 06/30/2020] [Accepted: 08/21/2020] [Indexed: 12/22/2022] Open
Abstract
Lower level of insulin-like growth factor-binding protein (IGFBP-1) has been observed in insulin resistance, while higher level of matrix metalloproteinase-8 (MMP-8) has been linked to obesity. The aim here was to study in overweight and obese women, typically manifesting with insulin resistance, whether IGFBP-1 and MMP-8 are related to and reflect systemic low-grade inflammation, metabolism and diet. Fasting serum from overweight and obese pregnant women (n = 100) in early pregnancy were analysed for IGFBP-1, phosphorylated IGFBP-1 (phIGFBP-1) and MMP-8. High-sensitivity CRP and GlycA were used as markers for low grade inflammation. GlycA and lipids were quantified using NMR. IGFBP-1 associated negatively with GlycA, evidenced by higher concentrations in the lowest quartile (median 1.53 (IQR 1.45–1.72)) compared to the highest (1.46 (1.39–1.55)) (P = 0.03). Several lipid metabolites, particularly HDL-cholesterol, correlated inversely with phIGFBP-1 (FDR<0.1). Nutritional status and diet contributed to the levels of IGFBP-1, demonstrated as an inverse correlation with maternal weight (Spearman r = -0.205, P = 0.04) and dietary intake of vitamin A (r = -0.253, P = 0.014) and a direct correlation with dietary intake of polyunsaturated fatty acids (Spearman r = 0.222, P = 0.03). MMP-8 correlated inversely with pyridoxine (r = -0.321, P = 0.002) and potassium (r = -0.220, P = 0.033). Maternal serum IGFBP-1 may contribute to maternal lipid metabolism in overweight and obese women during early pregnancy. These findings may be of importance in identification of metabolic disturbances preceding the adverse metabolic outcomes in pregnancy.
Collapse
|
11
|
Hussein H, Shamsipour M, Yunesian M, Hasanvand MS, Fotouhi A. Association of adverse birth outcomes with exposure to fuel type use: A prospective cohort study in the northern region of Ghana. Heliyon 2020; 6:e04169. [PMID: 32551393 PMCID: PMC7287244 DOI: 10.1016/j.heliyon.2020.e04169] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/30/2020] [Accepted: 06/05/2020] [Indexed: 11/28/2022] Open
Abstract
We aimed to investigate the potential associations between exposure to fuel types for cooking and birth outcomes in Northern Region of Ghana. Third trimester pregnant women were recruited during antenatal visit to the hospital and followed-up till delivery. Three questionnaires were administered covering baseline information, exposure to fuel types, and birth outcomes. Adjusting for potential confounding factors, log binomial regression model was applied to investigate the association between low birth weights (LBW), preterm birth and perinatal deaths in mothers and fuel types. Of the 1626 participants recruited at baseline, about 1323 women in the delivery period completed the study. At delivery period, maternal mean (SD) age was 27.3 (5.2) years. Mothers who used charcoal and firewood for cooking had 1.47 times (95% CI 1.04–2.05) and 1.18 times (95% CI 0.83–1.69) increased in risk of preterm birth respectively after controlling for potential confounding variables. Although, non-significant, mothers who used charcoal had 1.34 times (95% CI 0.45–3.97) increased risk in LBW, while those who used firewood had 1.23 times (95% CI 0.41–3.71) risk in LBW. Similarly, babies of mothers who used charcoal and those who used firewood respectively had 1.72 times (95% CI 0.52–5.65) and 1.70 times (95% CI 0.49–5.92) risk in small for gestational age after controlling for maternal BMI at first visit and anemia. Lastly, mothers who used charcoal and those who used firewood respectively had 1.87 times (95% CI 0.29–11.64) and 2.02 times (95% CI 0.31–13.04) increased risk in perinatal mortality after controlling for potential confounding variables. We observed a significant association between charcoal and preterm birth. Also, we observed a non-significant association between charcoal and firewood users and LBW, SGA and perinatal mortality respectively, compared to those using gas or electricity. This suggests cooking with charcoal and firewood could have health consequences on the outcome of pregnancy.
Collapse
Affiliation(s)
- Hawawu Hussein
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,African Union Scientific Technical and Research Commission, Abuja, Nigeria.,Tamale Teaching Hospital, Research Department, Tamale, Ghana
| | - Mansour Shamsipour
- Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Masud Yunesian
- Department of Research Methodology and Data Analysis, Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran.,Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sadegh Hasanvand
- Centre for Air Pollution Research (CAPR), Institute for Environmental Research (IER), Tehran University of Medical Sciences, Tehran, Iran
| | - Akbar Fotouhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
12
|
Piras GN, Bozzola M, Bianchin L, Bernasconi S, Bona G, Lorenzoni G, Buzi F, Rigon F, Tonini G, De Sanctis V, Perissinotto E. The levelling-off of the secular trend of age at menarche among Italian girls. Heliyon 2020; 6:e04222. [PMID: 32613111 PMCID: PMC7322252 DOI: 10.1016/j.heliyon.2020.e04222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 04/24/2020] [Accepted: 06/11/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The main aim of this study was to verify whether the secular trend stopped in Italy by comparing the results of a 1990-2000 birth cohort versus a 1980-1990 birth cohort of Italian young women. The results were used to speculate about age at menarche as adaptive response to non-genetic factors. METHODS In 2016, a study was set on 413, 18-to-26 year-old women (1990-2000 birth cohort) attending two Italian Universities by web-based, self-reported questionnaires. Previously in 2000, a research including 3,783 high school female students (1980-1990 birth cohort) was led. The age at menarche distribution was performed by Kaplan-Meier analysis. The comparison between the findings of the two birth cohorts was performed by Wilcoxon sum-rank test. Mixed models analysis was applied to evaluate the effect of cohort and socio-economic status on age at menarche. RESULTS 1990-2000 cohort's age at menarche median was 12.44y (95%CI 12.37; 12.59y). There was no significant difference with age at menarche of the previous cohort (p = 0.56). Consistently, the advance of age at menarche in comparison to the mothers' one was not significantly different between the two cohorts (-0.27y±0.10y vs -0.25y±0.03y, p = 0.33). The socio-economic level was not significantly associated with menarcheal age. CONCLUSIONS The findings of this study confirm that, like in other developed countries, the advance of age at menarche has stopped in Italy, consistently with the stop of the improvement of socio-economic conditions. Further studies are needed to explore the differential effect of each non-genetic factor to outline future scenarios of human sexual maturation. TRIAL REGISTRATION the Comitato Etico per la Sperimentazione Clinica (CESC) della Provincia di Padova of the Veneto Region (Italy), n°3993/U16/16.
Collapse
Affiliation(s)
- Gianluca Niccolò Piras
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | | | - Luigi Bianchin
- UOC Infanzia, Adolescenza, Famiglia, AULSS 3, Serenissima Venezia, Italy
| | | | - Gianni Bona
- Department of Mother and Child Health, Division of Pediatrics, Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| | - Fabio Buzi
- Department of Pediatrics, “Carlo Poma” Hospital, Mantova, Italy
| | - Franco Rigon
- Department of Pediatrics, University of Padua, Padova, Italy
| | - Giorgio Tonini
- Centre of Pediatric Diabetology, Burlo Garofolo Hospital, Trieste, Italy
| | - Vincenzo De Sanctis
- Private Accredited Hospital Quisisana, Paediatric and Adolescent Outpatients Clinic, Ferrara, Italy
| | - Egle Perissinotto
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Italy
| |
Collapse
|
13
|
Mansoor H, Salman M, Asif N, Mustafa ZU, Nawaz AS, Mohsin J, Arif B, Sheikh A, Noor-E-Hira, Shehzadi N, Hussain K, Masood A. Menstrual knowledge and practices of Pakistani girls: A multicenter, cross-sectional study. Heliyon 2020; 6:e03157. [PMID: 32042953 PMCID: PMC7002775 DOI: 10.1016/j.heliyon.2020.e03157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/20/2019] [Accepted: 12/31/2019] [Indexed: 11/29/2022] Open
Abstract
Information regarding the menstrual knowledge and practices of Pakistani girls is sparse. Therefore, we aimed to evaluate the knowledge and practices of Pakistani girls regarding menstruation. This cross-sectional study was conducted among four categories of university female students of medical, pharmacy, nursing, and arts & humanities during a period of 5 months (November 2016–March 2017). The data were acquired using a self-administered questionnaire from 3 medical institutes, 2 pharmacy institutes, 3 nursing institutes and 2 arts & humanities institutes at Lahore, Pakistan. The mean age of participants (N = 1777) was 20.38 ± 2.39 years. Overall 39.5%, 76.1% and 29.3% respondents’ provided correct answers to the questions concerning menstrual cycle length, duration of menstrual bleeding and source of bleeding, respectively. Regarding the understanding of menstruation, around 27% understood it as monthly bleeding happening with every woman, whereas 18% stated that it was a sign of adulthood. However, a small proportion believed that it was removal of dirt from the body. Regarding the practices-related to menstruation, there were some malpractices regarding diet and dietary intake (avoiding certain foods, eating less, and less fluid intake). However, the hygienic practices were found to be satisfactory. In conclusion, Pakistani university girls have some misconceptions, misperceptions and malpractices related to menstruation. Our findings draw attention to conduct awareness programs in order to eradicate these misconceptions, myths and malpractices.
Collapse
Affiliation(s)
- Hafsa Mansoor
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Muhammad Salman
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Noman Asif
- District Headquarter Hospital Pakpattan, Pakpattan, Pakistan
| | - Zia Ul Mustafa
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan.,District Headquarter Hospital Pakpattan, Pakpattan, Pakistan
| | | | - Jabeen Mohsin
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Bushra Arif
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Amna Sheikh
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Noor-E-Hira
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Naureen Shehzadi
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Khalid Hussain
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| | - Athar Masood
- Punjab University College of Pharmacy, University of the Punjab, Lahore, Pakistan
| |
Collapse
|
14
|
Decamps-Mini D, Pelofi J, Treisser A. [Off-label drug use of the misoprostol in gynecology & obstetrics: From a medico-economics benefit to a potential legal risk]. ACTA ACUST UNITED AC 2015; 43:453-8. [PMID: 26032707 DOI: 10.1016/j.gyobfe.2015.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 02/11/2015] [Indexed: 11/22/2022]
Abstract
The scandal of the Mediator® case led the legislature to take measures in order to regulate off-label drugs prescriptions. Indeed the law issued in December 29th, 2011 on strengthening the safety of drugs and all derivative health products came to pave the way for an "over-cautious" practice of medicine in line with the precautionary principle erected as a constitutional principle. The supervision of off-label prescribing has had a direct impact on the exercise of the medical profession and has resurrected the issues related to the freedom of prescription, the obligation to provide information to patients and in general their whole responsibility. It is important to mention that the prescribing act is part of the freedom and the strict prerogative of those skilled in the art: the physician in this case. The off-label prescription is commonly accepted in certain specialties, such as anesthesia and intensive care, oncology or pediatrics where it is even subject of a memorandum of use because of concerns regarding the availability of forms adapted to children. However, the physician must ensure that no appropriate therapeutic alternative is available and inform the patient, fundamental principle of the right to respect for the will of the person. Off-label use of the prostaglandin-E1 analogue misoprostol in obstetrics and gynecology is a good example. In fact, this drug obtained a marketing authorization for the treatment or prevention of peptic ulcers and other stomach disorders, is commonly used off-label when inducing labour or intrauterine device insertion. These are the issues that need to be clarify and carefully assessed in order to help physicians to understand the impact of the law and the state of the jurisprudence on the exercise of their profession.
Collapse
|