Full Weeks Research Articles

The relation between preterm birth and self-reported spinal pain in pre-adolescence—a study of 47,063 subjects from the Danish National Birth Cohort

Repeated exposure to pain and stress in early life may cause alterations in pain sensitivity later in life. Children born preterm are often exposed to painful invasive procedures. This study aimed to explore the relationship between being born preterm and self-report of spinal pain in pre-adolescence. This prospective study was based on the Danish National Birth Cohort and consisted of 47,063 11–14-year-olds. Data from the Danish National Birth Cohort were linked with national registers through Statistics Denmark. Analyses were performed as multiple logistic regression models estimating odds ratios and 95% confidence intervals. Spinal pain (neck, mid back, and/or low back pain) was assessed using a subdivision of the Young Spine Questionnaire. Severe spinal pain was defined as having pain often or once in a while with an intensity of four to six on the Revised Faces Pain Scale. Inverse probability weighting was used to account for potential selection bias. Girls born very preterm (< 34 full weeks of gestation) were less likely to report spinal pain (OR: 0.60; 95% CI: 0.40–0.93) compared with those term-born. The associations were weaker when examining moderate to severe spinal pain and when examining the three spinal regions separately. None of these was statistically significant.Conclusion: We found no associations for boys. In conclusion, this study indicates that girls born very preterm are seemingly less likely to have severe spinal pain in pre-adolescence than girls born at term.What is Known:• Spinal pain is one of the largest disease burdens globally, and the evidence regarding the etiology of spinal pain in children and adolescents is limited.• Repeated exposure to pain and stress in early life (i.e., being preterm) may cause alterations in pain sensitivity later in life.What is New:• Girls born very preterm (< 34 full weeks of gestation) seem less likely to report severe spinal pain in pre-adolescence compared with girls born at full term.• There is no association between gestational age and later experience of spinal pain in pre-adolescent boys.

Use of progestagens to preserve pregnancy: modern approaches

Review objectives: to summarize current and clinical data on the role of progesterone support in women at risk of miscarriage and premature pregnancy according to the standards of evidence-based medicine. Control of plasma progesterone levels is a fundamental tool for managing the effectiveness of assisted reproductive technologies. The association of a low level of serum progesterone with lower rates of current pregnancy and live birth in cycles of assisted reproductive technologies was revealed. Patients with low serum progesterone on the day of embryo transfer need individualized support of the luteal phase, which involves adding additional doses of progesterone to standard regimens.&#x0D; Vaginal micronized progesterone is currently believed to be the only progestogen that increases the likelihood of a live birth in women with bleeding in early pregnancy which has one or more miscarriages.&#x0D; Vaginal progesterone can be considered for patients with a high risk of miscarriage in the following modes: with vaginal bleeding and a history of one or more miscarriages (threatened miscarriage) – 400 mg twice a day, starting with the detection of vaginal bleeding up to 16 full weeks of pregnancy; with a history of three or more pregnancy losses of unknown etiology (habitual miscarriage) – asymptomatic patients — 200 mg twice a day up to 12 full weeks of pregnancy; patients with vaginal bleeding – 400 mg 2 times a day up to 16 weeks of pregnancy. Currently, there is no evidence of the effectiveness other forms of progesterone and other doses.&#x0D; Conclusions. Vaginal micronized progesterone demonstrated: high efficiency as a standard of luteal phase support; increasing the chance of a live birth in women with a double risk factor for miscarriage (vaginal bleeding in the 1st trimester and ≥1 previous miscarriage); the absence of safety problems for the fetus and the health of newborns when used in the early and late stages of pregnancy.

A topic models analysis of the news coverage of the Omicron variant in the United Kingdom press

BackgroundThe COVID-19 pandemic has caused numerous casualties, overloaded hospitals, reduced the wellbeing of many and had a substantial negative economic impact globally. As the population of the United Kingdom was preparing for recovery, the uncertainty relating to the discovery of the new Omicron variant on November 24 2021 threatened those plans. There was thus an important need for sensemaking, which could be provided, partly, through diffusion of information in the press, which we here examine.MethodWe used topic modeling, to extract 50 topics from close to 1,500 UK press articles published during a period of approximately one month from the appearance of Omicron. We performed ANOVAs in order to compare topics between full weeks, starting on week 48 of 2021.ResultsThe three topics documenting the new variant (Omicron origins, Virus mutations, News of a new variant) as well as mentions of vaccination excluding booster, Scotlands First minister statement (Communications) travel bans and mask wearing (Restrictions) and the impact of market and investing (Domains and events) decreased through time (all ps < .01). Some topics featured lower representation at week two or three with higher values before and after: Government’s Scientific Advisory Group for Emergencies recommendations (Communications), Situation in the US, Situation in Europe (Other countries and regions), all ps < .01. Several topics referring to symptoms and cases—e.g., rises of infections, hospitalisations, the pandemic the holidays, mild symptoms and care; restrictions and measures—e.g., financial help, Christmas and Plan B, restrictions and New Year; and domains of consequences and events—e.g., such as politics, NHS and patients, retail sales and airlines, featured increasing representation, (all ps < .01). Other topics featured less regular or non-significant patterns. Conclusion. Changes in sensemaking in the press closely matched the changes in the official discourse relating to Omicron and reflects the trajectory of the infection and its local consequences.

First-in-human phase 1/2 study of ubamatamab, a MUC16xCD3 bispecific antibody, administered alone or in combination with cemiplimab in patients with recurrent ovarian cancer.

TPS5624 Background: Mucin-16 is a cell surface glycoprotein that is overexpressed in epithelial ovarian cancer (OC). Ubamatamab (REGN4018) is a mucin-16 x cluster of differentiation 3 (MUC16xCD3) bispecific antibody that promotes T cell–mediated cytotoxicity by facilitating contact between cancer cells and T cells. In mouse model studies, ubamatamab demonstrated dose-dependent antitumor activity against MUC16-expressing OC tumor cells.1 Cemiplimab is an anti–programmed cell death-1 monoclonal antibody. In a Phase 1 study (NCT03564340) in patients with recurrent OC, ubamatamab monotherapy demonstrated an acceptable safety profile, durable clinical activity across a range of doses between 20 mg and 800 mg intravenous (IV) weekly (as measured by RECIST and cancer antigen 125 [CA-125] response rates), and linear pharmacokinetics up to 800 mg IV weekly.2 These clinical data support further evaluation of a once every 3-week (Q3W) regimen of ubamatamab alone and in combination with cemiplimab. The study is currently recruiting patients to combination dose escalation, monotherapy dose expansion, and the randomized Phase 2 cohort. Methods: In Phase 2, up to 150 patients with advanced platinum-resistant OC and elevated serum cancer antigen-125 will be randomized to three arms (1:1:1) to receive ubamatamab 250 mg IV Q3W or 800 mg IV Q3W as monotherapy, or ubamatamab 250 mg IV Q3W in combination with cemiplimab 350 mg Q3W. All arms will include weekly step-up dosing of ubamatamab (1 mg week 1, 20 mg week 2, and full dose weeks 3 and 4) to limit risk of cytokine release syndrome prior to proceeding to Q3W dosing. Expansion cohorts will use a Simon 2-stage study design, with an interim analysis after the first 20 patients. Any arm with ≥3 objective responses will be expanded to 50 patients. The primary objective of the dose expansion phase is to assess the preliminary efficacy of ubamatamab as monotherapy or in combination with cemiplimab, separately by cohort. Secondary objectives include characterization of the safety profile by cohort, and the pharmacokinetics of ubamatamab alone or in combination with cemiplimab, as well as patient-reported outcomes for all cohorts. In this dose expansion phase the primary endpoint will be the objective response rate for each arm as defined by RECIST 1.1 criteria. Secondary endpoints include evaluation of duration of response and progression-free survival as well as further evaluation of safety and pharmacokinetics. Exploratory endpoints include evaluation of baseline tumor MUC16 immunohistochemistry expression and other biomarkers as predictors of response. The impact of ubamatamab on quality of life and physical functioning will also be assessed.

School absenteeism among students in Germany, Japan, Sweden, and the United Kingdom:

School absenteeism is a challenge in many countries. Still, there are few comparisons between countries, which is partly due to a lack of shared definitions of concepts. This article makes use of PISA data to compare self-reported student absenteeism in Germany, Japan, Sweden, and the United Kingdom (UK). Three data sets are used, from 2012, 2015, and 2018. The self-reported absenteeism, which is referred to as truancy in the PISA studies, was measured as having skipped a whole school day at least once in the two full weeks before students completed the PISA student questionnaire. The results show great variation between the studied countries, from 24.4% in the UK in 2015 to 1.5% in Japan in 2012. The percentage of students who reported having skipped school is much higher in the UK than in the other three countries. The differences between the countries concerning the percentage of students reporting having been absent from school are significant for all years, except between Sweden and Germany in 2015. Germany and the UK have a similar pattern in development, with the highest percentages in 2015, while Sweden and Japan have small (albeit not significant) increases from 2012 to 2018. The UK is the only country where the changes between 2012 and 2015 as well as between 2015 and 2018 were significant. It is not possible to see any obvious patterns between the countries that might be linked to differences related to their welfare regimes, education systems, or values. To find such patterns, it may be necessary either to include more countries in a study or to conduct more in-depth studies on each country.

Клинико-анамнестические факторы риска антенатальной смерти доношенного плода

Introduction. Current clinical and laboratory methods for assessing the intrauterine growth of a fetus are indirect and often have a low prognostic significance. Meanwhile, the determination of risk factors of antenatal death of a full-term fetus with the assessment of their prognostic significance and the possible preventability of adverse perinatal outcome will identify ways to reduce the stillbirth rate. Aim. Determine the clinical and anamnestic risk factors for antenatal death of a full-term fetus in the Chelyabinsk region. Materials and methods. A retrospective analysis of the medical records of all cases with antenatal fetal death at 37 weeks 0 days – 41 weeks 6 days of pregnancy, registered in the territory of the Chelyabinsk region from 2019 to 2021, was carried out. Two groups were assigned: group 1 – women with antenatal death of the full-term fetus (158 patients), group 2 – women with live full-term births (50 patients). Results. Women with antenatal death of the full-term fetus statistically significantly more often lived in the city of Chelyabinsk and big cities of the Chelyabinsk region, had secondary vocational education and used to smoke tobacco; they had first or second pregnancy and first delivery. Among these women, female pelvic inflammatory diseases, hypertension, endocrine system diseases and specific infectious diseases (HIV infection, hepatitis C and tuberculosis) were statistically more common. These women had statistically more pregnancy-related complications such as hypertension without significant proteinuria; diabetes mellitus arising in pregnancy; gestational edema; false labour up to 37 full weeks of pregnancy; placental disorders; maternal care for poor fetal growth; acute respiratory infections. The following factors have a direct impact on antenatal death at full-term pregnancy: a history of hypertension, moderate pre-eclampsia, placental disorders, and fetal growth retardation. Conclusion. In the presence of risk factors directly affecting the occurrence of antenatal death of a full-term fetus, we consider it appropriate to deliver at 37 weeks 0 days – 38 weeks 0 days of pregnancy in order to reduce the risk of an adverse outcome of pregnancy.

Reproductive, obstetric, and long-term health outcome after uterus transplantation: results of the first clinical trial

To evaluate reproductive, obstetric, and long-term health of the first completed study of uterus transplantation (UTx). Prospective. University hospital. Nine live donor UTx procedures were conducted and seven were successful. Donors, recipients, and children born were observed. Invitro fertilization was performed with embryo transfer (ET) of day 2 or day 5 embryos in natural cycles. Pregnancies and growth trajectory of the children born were observed. Health-related quality of life, psychosocial outcome, and medical health of donors and recipients were evaluated by questionnaires. The results of invitro fertilization, pregnancies, growth of children, and long-term health of patients were reported. Six women delivered nine infants, with three women giving birth twice (cumulative birth rates of 86% and 67% in surgically successful and performed transplants, respectively). The overall clinical pregnancy rate (CPR) and live birth rate (LBR) per ET were 32.6% and 19.6%, respectively. For day 2 embryos, the CPR and LBR per ET were 12.5% and 8.6%, respectively. For day 5 embryos, the CPR and LBR per ET were 81.8% and 45.4%, respectively. Fetal growth and blood flow were normal in all pregnancies. Time of delivery (median in full pregnancy weeks + days [ranges]) by cesarean section and weight deviations was 35 + 3 (31 + 6 to 38 + 0) and -1% (-13% to 23%), respectively. Three women developed preeclampsia and four neonates acquired respiratory distress syndrome. All children were healthy and followed a normal growth trajectory. Measures of long-term health in both donors and recipients were noted to be favorable. When UTx resulted in a birth, scores for anxiety, depression, and relationship satisfaction were reassuring for both the donors and recipients. The results of this first complete UTx trial show that this is an effective infertility treatment, resulting in births of healthy children and associated with only minor psychological and medical long-term effects for donors and recipients. NCT02987023.

From a child who IS a problem to a child who HAS a problem: fixed period school exclusions and mental health outcomes from routine outcome monitoring among children and young people attending school counselling.

Exclusion from school is a disciplinary tool with an increasingly recognised relationship to poor mental health among children and young people. We explored the relationship between mental health and school exclusion for a cohort of children and young people receiving one to one counselling. We analysed routinely collected data from a diverse UK sample of children and young people aged between four and 16 years old and receiving school-based counselling (n = 6712 students from 308 primary and 61 secondary schools). Fixed period school exclusion rates (number of sessions) were compared between the academic year before and the academic year in which the child attended counselling. Mental health (Strengths and Difficulties Questionnaire) was compared at baseline and at the end of the intervention (after between 16-22 counselling sessions depending on the phase of education). Despite more complex and severe initial difficulties, and facing greater adversity, children and young people who experienced school exclusion prior to counselling demonstrated a significant reduction in subsequent sessions of school exclusion in the academic year that the counselling took place (from two full school weeks to half a school week). Moreover, over 74% of the students had fewer reported exclusions and more than half (56.14%) did not have any further subsequent exclusions. They also had better mental health measured by the teacher reported SDQ (pre-intervention M = 18.94, SD = 6.83 vs. postintervention M = 15.67, SD = 7.56, t(310) = 8.23, p < .001) or by the parents (pre-intervention M = 18.09, SD = 6.42 vs. postintervention M = 14.0, SD = 6.99, t(171) = 7.71, p < .001). School-based mental health interventions may positively influence educational engagement as well as mental health. Providers should, therefore, monitor both to explore the impact of their interventions. The identification of poor mental health may alter staff perceptions and management of challenging pupils, which future studies should explore.

High Levels of Prevention-Effective Adherence to HIV PrEP: An Analysis of Substudy Data From the EPIC-NSW Trial.

Preexposure prophylaxis (PrEP) prevents HIV infection but relies on good adherence at times of risk, termed "prevention-effective adherence." Most studies assess adherence without reference to sexual behaviur, making it challenging to determine if poor adherence coincides with HIV risk. We examined data from a behavioral substudy of a large-scale PrEP implementation trial in New South Wales, Australia. Trial participants completed optional brief quarterly surveys, reporting the number of pills taken and sexual behavior with male partners for each day of the "last full week" before each survey. Condomless sex (CLS) was defined as "higher risk" for HIV when with HIV-positive men with detectable/unknown viral loads or unknown HIV status men. Adequate PrEP protection was defined as ≥4 pills for participants assigned male sex at birth and ≥6 pills for participants assigned female sex at birth (including transgender men). Of 9596 participants dispensed PrEP, 4401 completed baseline and ≥1 follow-up survey. Participants reported on 12,399 "last full weeks": 7485 weeks (60.4%) involved CLS and 2521 weeks (33.7% of CLS-weeks) involved higher risk CLS. There were 103 weeks in which participants did not have adequate PrEP protection and had higher risk CLS: 4.1% of higher-risk CLS weeks (n = 103/2521), 1.4% of all CLS weeks (n = 103/7485), and 0.8% of all observed weeks (n = 103/12,399). In a large PrEP trial, prevention-effective adherence to PrEP was very high at 99%. Our findings illustrate the importance of measuring pill-taking and sexual behavior in the same period so that prevention-effective adherence can be better estimated.

Particle and metal exposure in Parisian subway: Relationship between exposure biomarkers in air, exhaled breath condensate, and urine.

Subway particulate toxicity results from in vitro and in vivo studies diverge and call for applied human research on outcomes from chronic exposures and potential exposure biomarkers. We aimed to (1) quantify airborne particulate matter (PM) concentrations (mass and number) and metal concentrations in exhaled breath condensate (EBC), urine, and PM; (2) investigate their associations (EBC vs. PM vs. urine); and (3) assess the relevance of EBC in biomonitoring. Nine subway workers in three jobs: station agents, locomotive operators and security guards were monitored during their 6-h shifts over two consecutive weeks. Six-hour weighed average mass concentrations expressed as PM10, PM2.5 and their metal concentrations were determined. Urine and EBC samples were collected pre- and post-shift. Ultrafine particle (UFP) number concentrations were quantified in PM and EBC samples. Metal concentrations in urine and EBC were standardized by creatinine and EBC volume, respectively, and log-transformed. Associations were investigated using Pearson correlation and linear mixed regression models, with participant's ID as random effect. PM concentrations were below occupational exposure limits (OEL) and varied significantly between jobs. Locomotive operators had the highest exposure (189 and 137μg/m3 for PM10 and PM2.5, respectively), while station agents had the highest UFP exposure (1.97×104 particles/cm3). Five metals (Al, Fe, Zn, Cu, and Mn) in PM2.5 and three (Al, Fe, and Zn) in PM10 were above the limit of quantification (LOQ). Fe, Cu, Al and Zn were the most abundant by mass fraction in PM. In EBC, the metal concentrations in decreasing order were: Zn>Cu>Ni>Ba>Mn. Security guards had the highest EBC metal concentrations, and in particular Zn and Cu. Urinary metal concentrations in decreasing order were: Si>Zn>Mo>Ti>Cu>Ba≈Ni>Co. All urinary metal concentrations from the subway workers were similar to concentrations found in the general population. A statistically significant relationship was found for ultrafine particle number concentrations in PM and in EBC. Zn and Cu concentrations in post-shift EBC were associated with Zn and Cu concentrations in PM10 and with post-shift urinary Zn and Cu concentrations. Therefore, EBC appears a relevant matrix for assessing exposure to UFP in human biomonitoring when inhalation is a primary route of exposure. We found different temporal variation patterns between particle and metal exposures in three matrices (PM, urine, EBC) quantified daily over two full weeks in subway workers. These patterns might be related to metal oxidation, particulates' solubility and size as well as their lung absorption capabilities, which need to be further explored in toxicological research. Further research should also focus on understanding possible influences of low chronic exposures to subway particulates on health in larger cohorts.

Reproductive, Obstetrical and Long-Term Health Outcome after Uterus Transplantation: Results of the First Clinical Trial

Background: Uterus transplantation (UTx) is the first available treatment for absolute uterine factor infertility, caused by absence of the uterus or presence of a non-functional uterus. The proof-of-concept of this new fertility treatment was by the world´s first live birth after UTx in 2014. The present study represents the first report on outcome of a complete study cohort undergoing UTx and provides unique data on efficiency and long-term safety of this novel infertility treatment. Methods: We conducted a prospective clinical trial of nine live-donor UTx procedures at Sahlgrenska University Hospital, Gothenburg, Sweden. Seven grafts achieved long-term survival, thereby allowing pregnancy attempts. Hysterectomies were performed within seven years of UTx. The results of in vitro fertilisation, pregnancies, births, growth trajectory of children born, and the long-term medical and psychological health of patients are reported. Findings: Six women delivered nine healthy babies, with three women giving birth twice (cumulative birth rates of 86% in surgically successful transplants and 67% in performed transplants). The clinical pregnancy rate per embryo transfer (ET) was 32.6%. The livebirth rate per ET was 19.6%. Fetal growth and blood flow were normal in all pregnancies. Times of delivery (median in full pregnancy weeks+days (ranges)) by caesarean section and weight deviations were 35+3 (31+6 - 38+0) and -1% (-13% - +23%), respectively. Three women developed preeclampsia during pregnancy and four children acquired respiratory distress syndrome. All children were healthy and followed a normal growth trajectory. The long-term medical health of uterus donors and recipients was generally good. When UTx resulted in a birth, scores for anxiety, depression and relationship satisfaction were reassuring for both donors and recipients. Interpretations: The results of this first clinical UTx trial show that this is an effective infertility treatment for women with absolute uterine factor infertility, resulting in births of healthy children and associated with only minor psychological and medical long-term effects for live donors and graft recipients. Trial Registration: The prospective, observational study “Uterus transplantation from live donors” was registered as a clinical trial (NCT 01844362) Funding: Jan and Dan Olsson Foundation for Science, Knut and Alice Wallenberg Foundation, Swedish Research Council. Declaration of Interest: None of the authors have any conflict of interest. Ethical Approval: This study was approved by the Regional Ethics Committee of Gothenburg, Sweden (#88-12).

Assessment of the hormonal levels in different management strategies for women with cervical insufficiency and a history of anovulatory infertility

Cervical insufficiency (CI) is one of the causes of preterm birth. The rate of CI is higher in women after in vitro fertilization treatment for infertility compared to the general population. The aim. To assess the hormonal level in women with CI and a history of anovulatory infertility in the second and third trimesters of pregnancy in different management strategies for CI. Materials and methods. 60 pregnant women with CI who conceived through in vitro fertilization treatment for anovulatory infertility were divided into two groups: in the I group (30 women), CI was corrected only with cervical cerclage / pessary in the II trimester of pregnancy, in the II group (30 persons), cervical cerclage / pessary was combined with vaginal progesterone 200 mg ones a day until 34 full weeks of gestation. 30 pregnant women without СІ or infertility with the physiological course of pregnancy were controls. The concentrations of estradiol, progesterone, placental lactogen, prolactin and cortisol were determined in the terms of 19–22 and 30–32 weeks of gestation in the maternal blood serum. Results. In the patients with CI at 19–22 gestational weeks, the estradiol and placental lactogen concentrations were slightly lower in the I and II groups than those in the control women, the level of progesterone was less in the I group by 13.44 %, in the II group – by 17.30 % (P &lt; 0.05) compared to the controls; the levels of prolactin and cortisol in the I and II groups were increased significantly (P &lt; 0.001). At 30–32 gestational weeks, the levels of estradiol (P &lt; 0.05), progesterone (a decrease of 23.10 %, P &lt; 0.001) and placental lactogen (a decrease of 10.74 %, P &lt; 0.05) were significantly less as compared to the physiological ranges, while these parameters in the II group patients were on the lower limit of normal. In the I group, the concentrations of prolactin and cortisol were higher by 41.70 % (P &lt; 0.001) and 27.36 % (P &lt; 0.001), respectively, than the controls, in the II group – only by 24.10 % (P &lt; 0.05) and 13.70 % (P &lt; 0.05), respectively. Conclusions. In the women with cervical insufficiency after in vitro fertilization treatment for anovulatory infertility, the levels of estradiol, progesterone and placental lactogen are not significantly different from physiological indices, but the prolactin and cortisol concentrations are much higher. Adjunctive vaginal progesterone treatment to cervical cerclage/pessary in the third trimester of pregnancy promotes the normalization of progesterone, estradiol and placental lactogen levels, the decrease in prolactin and cortisol indices at 30–32 gestational weeks compared to the women with cervical cerclage/pessary alone.

Prevalence and Temporal Characteristics of Housing Needs in an Urban Emergency Department.

IntroductionOur objective was to determine the proportion of patients in our emergency department (ED) who are unhoused or marginally housed and when they typically present to the ED.MethodsWe surveyed patients in an urban, safety-net ED from June–August 2018, using a sampling strategy that met them at all times of day, every day of the week. Patients used two social needs screening tools with additional questions on housing during sampling shifts representing two full weeks. Housing status was determined using items validated for housing stability, including PRAPARE, the Accountable Health Communities Survey, and items from the United States Department of Health and Human Services. Propensity scores estimated differences among respondents and non-respondents.ResultsOf those surveyed, 35% (95% confidence interval [CI], 31–38) identified as homeless and 28% (95% CI, 25–31) as unstably housed. Respondents and non-respondents were similar by propensity score. The average cumulative number of homeless and unstably housed patients arriving per daily 8-hour window peaks at 7 AM, with 46% (95% CI, 29–64) of the daily aggregate of those reporting homelessness and 44% (95% CI, 24–64) with unstable housing presenting over the next eight hours.ConclusionThe ED represents a low-barrier contact point for reaching individuals experiencing housing challenges, who may interact rarely with other institutions. The current prevalence of homelessness and housing instability among urban ED patients may be substantially higher than reported in historical and national-level statistics. Housing services offered within normal business hours would reach a meaningful number of those who are unhoused or marginally housed

Neonatal and child mortality data in retrospective population-based surveys compared with prospective demographic surveillance: EN-INDEPTH study

BackgroundGlobal mortality estimates remain heavily dependent on household surveys in low- and middle-income countries, where most under-five deaths occur. Few studies have assessed the accuracy of mortality data or determinants of capturing births in surveys.MethodsThe Every Newborn-INDEPTH study (EN-INDEPTH) included a large, multi-country survey of women aged 15–49 interviewed about livebirths and their survival status in five Health and Demographic Surveillance Systems (HDSSs). The HDSSs undertake regular household visits to register births and deaths for a given population. We analysed EN-INDEPTH survey data to assess background factors associated with not recalling a complete date-of-birth. We calculated Kaplan-Meier survival estimates for both survey and HDSS data and describe age-at-death distributions during the past 5 years for children born to the same women. We assessed the proportion of HDSS-births that could be matched on month-of-birth to survey-births and used regression models to identify factors associated with matching.Results69,176 women interviewed in the survey reported 109,817 births and 3064 deaths in children under 5 years in the 5 years prior to the survey. In the HDSS data, the same women had 83,768 registered births and 2335 under-five deaths in the same period. A complete date-of-birth was not reported for 1–7% of survey-births. Birthdates were less likely to be complete for dead children and children born to women of higher parity or with little/no education. Distributions of reported age-at-death indicated heaping at full weeks (neonatal period) and at 12 months. Heaping was more pronounced in the survey data. Survey estimates of under-five mortality rates were similar to HDSS estimates of under-five mortality in two of five sites, higher in the survey in two sites (15%, 41%) and lower (24%) in one site. The proportion of HDSS-births matched to survey-births ranged from 51 to 89% across HDSSs and births of children who had died were less likely to be matched.ConclusionsMortality estimates in the survey and HDSS were not markedly different for most sites. However, neither source is a “gold standard” and both sources miss some events. Research is required to improve capture and accuracy to better track newborn and child survival targets.

Seasonal prematurity, perinatal mortality and deficiency of serum folic acid in pregnant women

Aim : to assess the seasonality of prematurity, stillbirth, perinatal mortality and deficiency of serum folic acid in pregnant women at the Gyanja Perinatal Center (Gyanja, Azerbaijan). Materials and Methods . In 2016, 3,221 pregnant women were hospitalized at gestational age of at least 22 full weeks or more. A case of hospitalization for obstetric care of pregnant women at gestation age of 22 full weeks was used as a unit of statistical observation. All female patients were stratified in accordance of hospitalization date by calendar months and annual seasons. In each season (winter - January, spring - April, summer - July, autumn - October) in 50 pregnant women at trimester I and III (8 groups of pregnant women) serum folic acid, homocysteine, С-reactive protein, fibrinogen and alkaline phosphatase were measured. Results . The smallest and largest percentage of infants with very low birth weight (&lt; 1500 g) was among children born in January (2.28 ± 0.75 %; 95 % Cl = 0.78-3.78) and November (13.99 ± 2.49%; 95% Cl = 9.01-18.97), respectively (р &lt; 0.01). Comparatively assessed proportion of newborns with very low body weight in the summer and winter periods (4.55 ± 0.55 % and 4.90 ± 0.51 %, respectively) confirmed lack of significant intergroup difference (р &gt; 0.05). Stillbirth rate between infants born in the summer and winter periods differed (1.92 ± 0.36 % and 2.53 ± 0.37 %, respectively) insignificantly (р &gt; 0.05). Seasonal change in risk of prematurity, stillbirth and perinatal mortality was associated with seasonal changes in the level of serum folic acid, homocysteine, C-reactive protein, fibrinogen and alkaline phosphatase. Conclusion . Infants born with low and very low weight, stillbirth and perinatal losses are relatively common in autumn - from September 21 till December 20.

The Association between Having a Preterm Birth and Later Maternal Mental Health: An Analysis of U.S. Pregnancy Risk Assessment Monitoring System Data.

Although previous studies have found a relationship between having a preterm birth and maternal depression, methodologic issues may have limited the generalizability of results. Thus, the purpose of this study was to evaluate the relationship between having a preterm birth and postpartum depressive symptoms using a large, population-based sample of U.S. women. This secondary data analysis used 2012-2014 U.S. Pregnancy Risk Assessment Monitoring System data (N=89,366). Data on the exposure, preterm birth, were obtained from birth certificates. Infants born at 32 to less than 37weeks' gestation were considered moderate to late preterm, infants born at 28 to less than 32 full weeks' gestation were considered very preterm, and infant born at less than 28 full weeks' gestation were considered extremely preterm. To assess the outcome, two Pregnancy Risk Assessment Monitoring System questions measuring postpartum depressive symptoms were used. Logistic regression was used to calculate unadjusted and adjusted odds ratios (ORs) and 95% confidence interval (CIs). After adjustment for confounders, the relationship between having a preterm birth and maternal hopelessness was statistically significant for those who had very preterm and extremely preterm births (moderate to late preterm OR, 1.19; 95% CI, 1.00-1.42; very preterm OR, 1.28; 95% CI, 1.04-1.58; extremely preterm OR, 1.81; 95% CI, 1.31-2.49). In addition, after adjustment, findings indicated no association between preterm birth and maternal loss of interest (extremely preterm OR, 0.85 95% CI, 0.60-1.19; very preterm OR, 1.04; 95% CI, 0.86-1.26; preterm OR, 0.95; 95% CI, 0.82-1.10). Given the statistically significant increased association between having a preterm birth and postpartum depressive symptoms, health professionals may consider implementing comprehensive screening for depression and other mental illnesses among women who give birth prematurely. Findings may also inform future interventions to emphasize the importance of postpartum care among women who have experienced preterm birth.

Association Between Post-concussion Intraindividual Variability In Sleep And Step Counts: An Exploratory Study

Evidence supports transient increases in intraindividual variability (IIV) in sleep post-concussion, a time when physical activity may be reduced. Acute and chronic physical activity impacts sleep, including reducing wake after sleep onset (WASO) and increasing total sleep time (TST). PURPOSE: To determine the association between IIV in sleep and physical activity in concussed individuals and matched controls one and two weeks post-injury. METHODS: Twenty college students were physician-diagnosed with a concussion. Eleven concussed individuals with symptom duration ≥14 days (23.6±8.6 days) were included in this analysis to examine sleep across two full weeks post-injury. Non-concussed controls (n=11) were well-matched on age, sex, physical activity, and subjective sleep quality. A wrist-worn ActiGraph monitor was provided during initial evaluation (within 72 hours post-injury for concussed) and worn continuously until symptom resolution (duration matched for non-concussed controls). Intraindividual coefficient of variations were calculated for the first week and second week post-injury for each sleep outcome: sleep onset latency (SOL), WASO, TST, sleep efficiency, and number of awakenings. Daily total step counts were also obtained from the ActiGraph monitor and averaged across each week (STEPS). Pearson correlations were conducted per group and separately during weeks 1 and 2 post-injury (α = 0.05) to examine associations between STEPS and IVV in sleep. RESULTS: Across week 1 post-injury, concussed individuals with a greater step count (week 1 average: 12,214±2000 steps) experienced greater IVV in WASO (r = 0.67, p = 0.023) and less IVV in TST (r = -0.68, p = 0.022). No significant associations existed in other sleep outcomes or in the matched control group across week 1. No associations were evident in either concussed or control groups for week 2. CONCLUSIONS: Concussed individuals who were more active across week 1 post-injury experienced greater night-to-night sleep fragmentation variation but experienced a more consistent nighttime sleep duration schedule. The findings from this exploratory study warrant examining associations between sleep IVV and physical activity in a larger study of concussed and non-concussed individuals.

Predicting first-trimester outcome of embryos with cardiac activity in women with recurrent spontaneous abortion.

ObjectiveThis study was performed to evaluate the capability of routine clinical indicators to predict the early outcome of embryos with cardiac activity in women with recurrent spontaneous abortion (RSA).MethodsA retrospective cohort study of pregnant women with a history of RSA in a Chinese tertiary hospital was performed using unadjusted and multivariable logistic regression.ResultsOf 789 pregnant women with RSA, 625 (79.21%) had ongoing pregnancy, whereas 164 (20.79%) developed abortion before 20 full weeks of gestational age even after embryonic heart motion was detected. The final model had an area under the curve of 0.81 (95% confidence interval, 0.78–0.84) with a sensitivity of 74.39%, a specificity of 76.00%, and a false-positive rate of 52.32% at a fixed detection rate of 90%.ConclusionsThe combination of multiple routine clinical indicators was valuable in predicting the early outcome of embryos with cardiac activity in viable pregnancies with RSA. However, this model might result in a high false-positive rate with a fixed detection rate of 90%; other markers must be investigated to identify first-trimester RSA once positive embryonic heart motion is established.

A Model of Pedometer Determined Physical Activity in Primary School Children

The purpose of this research is to create a model of interaction between steps/day counts regarding genders, seasons of a year, and days of week.&#x0D; Material and Methods. Totally 74 of 4-th grade pupils (38 boys and 36 girls) from three primary schools in the industrial city were involved into the pedometer investigation. All the students were good healthy, and they participated in the schools’ lessons of physical education according to the common program. Pedometer determined physical activity was measured during a day using fitness tracker band. The measurements were done during one academic year using three full weeks (a week in autumn, winter, and spring). ANOVA was used to determine differences between samples grouped according days of weeks.&#x0D; Results. A strong significant difference between counts of steps during days of week for boys (p = 0.006) and smaller for girls (p = 0.052) were discovered with corresponding parts in the total variation (62.5 and 46.0 %). The same significant differences were discovered between mean counts in seasons (p = 0.053, 0.037) with corresponding parts in the total variation (14.5, 22.8 %). Rather significant variations of interaction between days of week and mean season results took place for boys (23.0%) as well for girls (31.1 %).&#x0D; Conclusions. During evaluation of physical activity in children based on steps/day counts, interaction between gender, season, and day of week should be taken into consideration.

Taking Note: Justice Harry A. Blackmun's Observations from Oral Argument about Life, the Law, and the U.S. Supreme Court

Taking Note: Justice Harry A. Blackmun's Observations from Oral Argument about Life, the Law, and the U.S. Supreme Court