Mode Of Delivery Research Articles

DISP-13. TELEHEALTH UTILIZATION IN NEURO-ONCOLOGY: EXPERIENCE AFTER THE COVID-19 PANDEMIC

Abstract BACKGROUND Central nervous system (CNS) tumors are frequently characterized by physical disabilities, and treatment is often associated with side effects, as well as financial toxicity and loss of income owing to disease-related neurological deficits. Treatment at centers with specialized neuro-oncology care is associated with an overall survival benefit. However, access to such centers can be limited for many patients. Telehealth services represent an option for improving access to specialized care. During the COVID-19 pandemic public health emergency (PHE), regulatory and reimbursement changes provided patients improved access to neuro-oncology by telehealth. METHODS We retrospectively analyzed our institutional utilization of telehealth visits in the neuro-oncology vs solid tumor oncology practice after the COVID-19 pandemic. RESULTS Between July 2020 and April 2021, telehealth represented 24.1% of all neuro-oncology visits compared to 13.3% for all solid tumor groups. Between May 2021 and April 2023, telehealth visits remained frequent in neuro-oncology compared to solid tumor groups (34.6% vs 15.2%). Utilization rates declined across the practice in the year following expiration of the COVID-19 PHE in May 2023, though remained high for neuro-oncology at 34.1% vs 15.2% for solid tumor groups. Overall, telehealth visit utilization for neuro-oncology has remained more than double that of the oncology practice as a whole. CONCLUSIONS The striking difference between telehealth visit utilization in neuro-oncology compared with general medical oncology indicates that patients with CNS tumors, and those that provide care for these patients, have come to depend on this mode of care delivery. Even after expiration of the COVID-19 PHE, telehealth use remains high in neuro-oncology at our institution. Prospective evaluation to determine the safety of and clinical outcomes associated with telehealth visits for individuals with CNS tumors are critically needed. Such data may promote regulatory and reimbursement reform enabling broader adoption, service sustainability, and improved access to specialized care.

Towards a ‘Newer Normal’? A Bibliometric Analysis Examining Organisational Culture in the Post-COVID-19 Higher Education Landscape in the United Kingdom

Concern continues to grow over the changing nature of work that initially formed a ‘new normal’ within higher education institutions resulting from the COVID-19 pandemic. This situation is now being further impacted by subsequent economic and political challenges in the sector, which in turn shifts the workplace towards an even ‘newer normal’. The purpose of this article is to: (1) methodically and logically review the extant literature and research linking the influence of the COVID-19 pandemic to the organisational culture of higher education institutions in the United Kingdom; and (2) based on a bibliometric analysis, to offer a road map for further empirical research in the future. Researchers have found that changing workplace norms, such as remote and hybrid working and other forms of flexibility in approaches to learning and the availability of delivery modes, have become increasingly common, which has changed the nature of working practices and underpinning aspects of organisational culture. Therefore, it now appears opportune to update existing knowledge on organisational culture theory within the United Kingdom higher education context to support policy development and enhance workplace practices in the post-COVID-19 period. From a theoretical perspective, this article contributes to organisational culture literature by assimilating a dataset of nascent studies generated through keyword search on Clarivate Analytics Web of Science that have examined the impact of COVID-19 on organisational culture in United Kingdom higher education institutions. This emergent dataset was analysed using VOS Viewer, with the results of subsequent quantitative bibliometric analysis identifying the main existing research fronts as well as potential research directions for the empirical development of organisational culture. Based on this bibliometric analysis, the main suggested future research agendas that need to be addressed linked to organisational culture in the UK higher education sector in the post-COVID period are: (a) to further examine changing cultural norms and expectations; (b) hybrid approaches to working; (c) academic identity; and (d) organisational culture and the changing psychological contract. Such research is important as the UK Higher Education sector now progresses towards an even ‘newer normal’.

Clinical audit on postpartum hemoglobin levels: A study on postpartum anemia

Objectives: The present study was carried out to assess the prevalence of anemia with reference to the Hb levels during postpartum period. The study also investigates the influence of age and mode of delivery on postpartum Hb levels. Material and Methods: It is a hospital-based retrospective descriptive study. The postpartum patients’ data were obtained from the medical records department of a tertiary care hospital. Data of the patients registered for routine blood investigation in the period of December 2023 to January 2024 were collected from the records. Based on patient’s hospital ID, other details including age, Hb level, and mode of delivery data were obtained. Statistical analysis was performed to check the effect of age and mode of delivery on postpartum Hb level by Pearson correlation using IBM Statistical Package for the Social Sciences Statistics version 24.0. Results: About 64.3% of the patients belonged to the age group of 20–30 years and remaining 35.7% within 30–40 years. The percentage of postpartum patients who underwent lower segment cesarean section (LSCS) and normal vaginal delivery (NVD) were 85.7% and 14.3%, respectively. However, cumulative percentage of NVD was higher (100%) than LSCS (85.7%). The postpartum Hb level ranged from 7.9 to 15.2 g/dL. About 54% of patients showed moderate anemia (8–10.9 g/dL), followed by 24% mild (11.9–11 g/dL) and 2% with severe anemic (<8 g/dL) condition. Conclusion: The study highlights the prevalence of PPA associated with both LSCS and NVD modes of delivery. Although the number of anemic patients was higher in LSCS (48) compared to NVD (8), the percentage remains the same at 80% each considering the total number of patients in each category. These observations point out the risk of high-volume blood loss associated with both modes of delivery and emphasize the need for adopting precautionary measures.

Improvements in Insulin Resistance and Glucose Metabolism Related to Breastfeeding Are Not Mediated by Subclinical Inflammation

Background: Lactation is known to improve insulin resistance, but this phenomenon remains poorly understood. Our goal was to evaluate whether subclinical inflammation could mediate the association between breastfeeding (BF) and improvement in glucose metabolism and markers of insulin resistance (MIRs) in the postpartum. Methods: A total of 95 adult women (≥18 years) with a BMI ≥ 25 kg/m2 from the outpatient clinic of the Federal University of São Paulo were followed from early pregnancy until 60 to 180 days postpartum. The patients were divided based on their BF status: BF and non-BF groups. A latent variable termed SubInf was created incorporating inflammation-related biomarkers: adiponectin, E-selectin, branched-chain amino acids, zonulin, copeptin, and lipopolysaccharides. The association of BR with MIRs in the postpartum was evaluated through linear regression analysis, and mediation analysis was performed to evaluate the role of SubInf in this association. Results: The groups were similar regarding gestational diabetes mellitus (GDM) prevalence, pre-gestational BMI, caloric intake, physical activity, and postpartum weight loss. The BF group presented lower levels of triglycerides (TGs), fasting glucose, fasting insulin, TG/HDLcholesterol ratio (TG/HDL), TyG index, and HOMA-IR compared to the non-BF group. A linear regression analysis adjusted for scholarity, parity, pre-gestational BMI, GDM, weight gain during pregnancy, and mode of delivery revealed an inverse association between BF and fasting glucose [−6.30 (−10.71 to −1.89), p = 0.005), HOMA-IR [−0.28 (−0.50 to −0.05), p = 0.017], TyG index [−0.04 (−0.06 to −0.01), p = 0.002], and TG/HDL ratio [−0.23 (−0.46 to −0.01), p = 0.001]. In the mediation analysis, SubInf did not mediate the indirect effect of BF on MIRs. Conclusions: In overweight and obese women, an association between BF and improvement in MIRs in the postpartum was seen, corroborating that BF should be stimulated, especially in these cardiometabolic high-risk women. Subclinical inflammation did not seem to mediate this association.

Exploring Online Teaching's Impact on Instructors in Core Engineering Courses: Insights, Challenges, and Future Directions

ABSTRACTThis study examines the impact of online teaching on instructors of fundamental engineering courses, focusing on insights, challenges, and future pathways. By analyzing the instructors' perspectives, the research examines various aspects of online teaching, including mode of delivery, student engagement strategies, assessment preferences, and future directions. Insights are drawn from a comprehensive survey of instructors, shedding light on their experiences, challenges, and preferences in the online teaching landscape. The findings highlight a preference for synchronous sessions, the utilization of diverse engagement techniques, and the significance of maintaining academic integrity in assessments. Instructors' preference for face‐to‐face interaction for improved academic performance and openness to hybrid teaching modes are evident. This study not only provides valuable insights into the dynamics of online teaching but also paves the way for future advancements in pedagogical strategies and educational technology integration. The research identifies potential areas for future work, ranging from refining hybrid teaching models to exploring emerging technologies and fostering instructor training.

Intraosseous Delivery of Mesenchymal Stem Cells for the Treatment of Bone and Hematological Diseases

Mesenchymal stem cells are used most in regenerative medicine due to their capacities in differentiation and immune modulation. The intraosseous injection of MSC into the bone has been recommended because of expected outcomes for retention, bioavailability, and enhanced therapeutic efficacy, particularly in conditions involving the bone, such as osteoporosis and osteonecrosis. A review of the intraosseous delivery of mesenchymal stem cells in comparison with intravenous and intra-arterial delivery methods will be subjected to critical examination. This delivery mode fares better regarding paracrine signaling and immunomodulation attributes, which are the cornerstone of tissue regeneration and inflammation reduction. The local complications and technical challenges still apply with this method. This study was more focused on further research soon to be conducted to further elucidate long-term safety and efficacy of intraosseous mesenchymal stem cell therapy. Though much has been achieved with very impressive progress in this field, it is worth noting that more studies need to be put into place so that this technique can be established as a routine approach, especially with further research in biomaterials, gene therapy, and personalized medicine.

Current practice, barriers and drivers to embedding environmental sustainability in undergraduate dental schools in the UK and Ireland

Aims This study aimed to: i) identify current teaching practice and approaches to embedding environmental sustainability (ES) in the undergraduate dental curriculum in the UK and Republic of Ireland (ROI); and ii) uncover existing barriers and drivers to incorporating ES in dental education.Methods A questionnaire was developed and distributed to all dental schools in the UK and ROI in the form of an online survey. The intended respondents were deans, heads of schools, directors of education, or senior academics of all dental schools in the UK and ROI that deliver undergraduate dentistry/dental surgery programmes.Results In total, 18 dental schools responded to the survey, representing a response rate of 100% from the intended respondents. Note 56% of dental schools do not currently teach ES. Time constraints and a lack of knowledge and learning resources were the most reported barriers.Conclusion Currently, ES is not taught in most dental schools in the UK and ROI. Many schools face challenges in finalising the delivery modalities of ES teaching, particularly in clinical environments. Numerous barriers have been identified that complicate embedding this topic in the curriculum. Positively, universities, staff, students and the recently published learning outcomes are driving impactful change across the sector.

Transvaginal ultrasonography-measured cervical length versus the modified Bishop score for preinduction cervical assessment at term: A randomised controlled trial

Introduction: The inducibility of the cervix for labour induction is usually determined by cervical status evaluation. The Bishop score is historically used to forecast the success of induction of labour, although it is subjective, and not reproducible. However, transvaginal ultrasound measurements of cervical length are rarely used for preinduction cervical assessment. The study compared cervical length measured via transvaginal ultrasound and the modified Bishop score for preinduction cervical assessment at term. Methods: The study involved 72 pregnant, nulliparous women for induction of labour at term. They were randomised into the transvaginal ultrasound group and the modified Bishop score group. The cervix was said to be ‘ripe’ when the transvaginal ultrasound cervical length (CL) was < 28 mm or the modified Bishop score was ⩾ 6. The cervix was considered ‘unripe’ when the Bishop score was < 6 or the transvaginal ultrasound was ⩾ 28 mm. Participants with ripe cervices had induction of labour with an oxytocin infusion, while those with unripe cervices had preinduction cervical ripening with misoprostol. The primary outcome measures were the mode of delivery and the total amount of prostaglandins administered for preinduction cervical ripening. Results: There was no significant difference between the two groups with regard to the mode of delivery ( p = 0.795), the total amount of prostaglandins administered for preinduction cervical ripening (105.0 ± 51.04 µg vs 111.90 ± 52.2 µg; p = 0.0671), the proportion of women who were administered prostaglandins due to an unfavourable cervix (41.7% vs 55.6%; p = 0.812), induction-to-the-active phase of the labour interval (11.00 ± 4.2 hours vs 11.82 ± 4.12 hours; p = 0.407) or the induction-delivery interval (20.15 ± 5.7 hours vs 22.66 ± 4.33 hours; p = 0.06) in both groups, respectively. Compared with those in the Bishop score group (Bishop score ⩾ 6), the induction-to-active phase of labour intervals (6.47 ± 0.77 hours vs 7.33 ± 1.21 hours, p = 0.024) and the induction-to-delivery intervals (14.97 ± 1.0 hours vs 18.39 ± 0.85 hours; p = 0.0001) in the transvaginal ultrasound group (cervical length < 28 mm) were significantly shorter, respectively. Conclusion: Preinduction cervical assessment using transvaginal ultrasound (cervical length < 28 mm) or the modified Bishop score is a successful predictor of the outcome of labour induction A larger multicentre studies are needed to identify optimal cervical length cutoffs and to determine if this could decrease unnecessary prostaglandin use or decrease caesarean section rate.

Routine HPV vaccination: Reflection on delivery strategies based on countries’ experiences

Despite the introduction of the human papillomavirus (HPV) vaccine in many low- and middle-income countries (LMICs), countries are still struggling to maintain HPV vaccination coverage and manage sustainable delivery strategies. This article explores the challenges and effective strategies for HPV vaccine delivery in LMICs, with a focus on reflecting upon current HPV vaccine delivery strategies in the World Health Organization (WHO) HPV vaccine introduction guidelines to align with practical implementation experiences. The article utilizes presentations and discussions from Coalition to Strengthen the HPV Immunization Community (CHIC) symposia, field experiences of program implementers who participated in the meeting and immunization expert opinions, to inform its findings. Several countries are spotlighted for their delivery strategies. These include routinized campaign mode vaccinations at schools in The Gambia, Zambia, and Ethiopia; routine health facility services in Tanzania, Kenya, and Maldives; and outreach strategies targeting out-of-school girls. By evaluating these diverse strategies, the article suggests a need to delve deeper and build an understanding of the routinized campaign mode of HPV vaccine delivery, and advocates for expanding the scope of delivery strategies and consequently updating the WHO HPV vaccine delivery guidelines in line with the evolving landscape of HPV vaccination delivery to ensure comprehensive, cost-effective, and sustainable programs in LMICs.

Outcomes of peripartum cardiomyopathy in North Africa: insights from a single-center observational study in Tunisia

BackgroundPeripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening condition. Due to the scarcity of epidemiological data in North Africa, we conducted this study to assess the outcomes of PPCM in our region.Materials and methodsThis monocentric retrospective cohort study involving all patients diagnosed with PPCM was conducted between January 2010 and December 2022.ResultsTwenty-seven PPCM patients, with a median age of 33 years (Interquartile range (IQR) = 9), were included. 52% of patients were diagnosed during the postpartum period. Dyspnea New York Heart Association III/IV(NYHA III/IV) was the most common functional symptom (85%). The median left ventricle ejection fraction (LVEF) was 30% (IQR = 11%). Atrial fibrillation occurred in 11.1% of patients, thromboembolic complications occurred in 18.5%, Pulmonary edema occurred in 85% of patients and cardiogenic shock occurred in 14.8% of patients, with two patients requiring Extracorporeal Membrane Oxygenation (ECMO) support. The predominant mode of delivery was a cesarean Sect. (82% of patients), and the indication for a cesarean delivery was obstetrical in 59% of patients. Prematurity occurred in 36% of newborns, and intrauterine fetal death occurred in one pregnancy. The median follow-up was 24 months [6–144 months]. LVEF recovery was noted in 67% of patients. Bromocriptine was administered to six patients (22%), and none of these patients died and out of them, five patients recovered their LVEF (83%). The overall mortality rate during the follow-up period was 15%, comprising three in-hospital cardiac deaths and one occurring two years later due to refractory advanced heart failure. No significant differences were observed between LVEF recovery and LVEF non-recovery groups. Factors significantly associated with mortality were multiparity, poor antenatal care (ANC) attendance, thromboembolic events, cardiogenic shock, and Pulmonary edema. Five patients with LV recovery subsequently became pregnant, none experienced a relapse of PPCM. However, one of the descendants of a patient was diagnosed with dilated cardiomyopathy.ConclusionThis study revealed that the diagnosis of PPCM in our hospital is often delayed until symptoms become more advanced, resulting in high morbi-mortality.

Development and validation of a risk prediction model for postpartum urinary incontinence in primiparas with singleton pregnancies: a multicenter clinical investigation

BackgroundPostpartum urinary incontinence (UI) is a serious condition that significantly affects the quality of life. Several studies have demonstrated that it is associated with pelvic floor dysfunction. This study aimed to develop and validate a UI risk prediction model to identify primiparas with singleton pregnancies at high risk.MethodsA multistage stratified random sampling process was used. UI was measured using the International Standard Consultation on Incontinence Questionnaire Form (a modified Bristol questionnaire, ICIQ-FLUTS). Records of 1,340 primiparas with singleton pregnancies were reviewed, and data were collected from January 2014 to December 2014 in multiple centers. A univariate logistic regression analysis was performed, followed by a multivariable logistic regression analysis of the data. Using bootstrap resampling, we constructed a nomogram to assess postpartum UI risk.ResultsA total of 1,340 patients were enrolled, including 345 with postpartum UI and 995 with non-postpartum UI. The occurrence of postpartum UI was significantly related to the mode of delivery, family history of UI, coffee or tea consumption, antenatal UI, and frequent cough. The nomogram exhibited good discriminatory ability with a C-index of 0.718 (95% confidence interval: 0.684–0.752) and a bootstrap-corrected C-index of 0.716. Additionally, the calibration curve demonstrated that the predicted outcomes aligned well with the actual observations. Ultimately, the decision curve analysis indicated that the nomogram exhibited favorable clinical applicability.ConclusionThe decision curve analysis suggests that the nomogram could provide clinical value. The clinician will then feel more confident about making clinical recommendations regarding postpartum UI screening for primiparous women with singleton pregnancies.

Learning in motion! Design of an evidence-based professional development programme to empower teacher educators to adopt play-based, gender-responsive pedagogies

ABSTRACT The 2030 Agenda for Sustainable Development calls for action to achieve global goals relating to quality education and gender equality. Teacher education is a setting where novel pedagogical practices can be introduced and mainstreamed, ultimately influencing the educational experience at the school level. This study aimed to design a professional development programme to support teacher educators at Palestinian universities to adopt gender-responsive and play-based learning practices. The researchers used the Behaviour Change Wheel (BCW) to develop an evidence-based intervention, resulting in the selection of six intervention functions (education, persuasion, training, environmental restructuring, modelling, and enablement) and 16 behaviour change techniques from the following taxonomy categories: natural consequences, feedback and monitoring, comparison of outcomes, comparison of behaviour, shaping knowledge, repetition and substitution, antecedents, social support, and goals and planning. Mode of delivery primarily involved face-to-face group-based facilitation. Using the BCW to guide the intervention development process allowed for a comprehensive review of teacher educators existing perspectives and the design of programme content to support them to change their teaching practices. The resulting novel professional development programme for teacher educators will be further researched to confirm relevance and impact.

New approaches and performance analysis of on-demand delivery systems using buses

With the rapid growth of on-demand delivery, traditional third-party delivery services using electric bicycles face increasing challenges, including increased labor costs and safety issues. To address these issues, we propose two modes for on-demand delivery systems using buses. One is the “bus terminal + professional crowd shippers” (B&P) mode, which involves consolidating parcels from various origins at the bus transfer hub. From there, they are grouped and delivered by buses. The other is the “bus stop + crowdsourced passenger” (B&C) mode, which transports parcels directly from the origin to the destination by passengers without the need for consolidation and sorting at bus transfer hubs. Both modes fully utilize the surplus capacity of buses and employ resources from retail stores and third-party shippers. We evaluated these modes using key performance indicators (KPIs) such as labor costs, cost increases from en-route destination changes, and average delivery time per kilometer. This analysis was based on 18,349 delivery cases in downtown Ningbo, China. Through this evaluation, we identified the strengths, weaknesses, opportunities, and threats associated with each mode. Our findings reveal that both the B&P and B&C modes effectively reduce delivery costs and external impacts while maintaining a user experience and efficiency level comparable to traditional third-party delivery services for mid-to-long-distance (3–10 km) deliveries. However, the use of public transportation may limit the flexibility of the delivery mode. Based on these insights, we provide strategic recommendations for the further development and implementation of B&P and B&C modes.

Nudge theories and strategies influencing adult health behaviors and outcomes in COPD management: a systematic review

ObjectiveChronic obstructive pulmonary disease (COPD) is a chronic respiratory disease with high prevalence and mortality, and self-management is a key component for better outcomes of COPD. Recently, nudging has shown promising potential in COPD management. In the present study, we conducted a systematic review to collate the list of nudges and identified the variables that influence nudging.MethodsWe undertook a systematic review. We employed database searches and snowballing. Data from selected studies were extracted. The risk of bias was assessed using the Cochrane Effective Practice and Organization of Care risk of bias tool. The study is registered with PROSPERO, CRD42023427051.ResultsWe retrieved 4,022 studies from database searches and 38 studies were included. By snowballing, 5 additional studies were obtained. Nudges were classified into four types: social influence, gamification, reminder, and feedback. Medication adherence, inhalation technique, physical activity, smoking cessation, vaccination administration, exercise capacity, self-efficacy, pulmonary function, clinical symptoms, and quality of life were analyzed as targeted health behaviors and outcomes. We found medication adherence was significantly improved by reminders via mobile applications or text materials, as well as feedback based on devices. Additionally, reminders through text materials greatly enhance inhalation techniques and vaccination in patients.ConclusionThis review demonstrates nudging can improve the health behaviors of patients with COPD and shows great potential for certain outcomes, particularly medication adherence, inhalation techniques, and vaccination. Additionally, the delivery modes, the patient characteristics, and the durations and seasons of interventions may influence the successful nudge-based intervention.Clinical trial registrationThis review has been registered in the international Prospective Registry of Systematic Evaluation (PROSPERO) database (identifier number CRD42023427051).

Fecal tryptophan metabolite profiling in newborns in relation to microbiota and antibiotic treatment

In the first days of life, the newborns’ intestinal microbiota develops simultaneously with the intestinal gut barrier and follows intestinal immunity. The mode of delivery shows significant impact on microbial development and, thus, the initiation of the tryptophan catabolism pathway. Further antibiotics (ATB) treatment of mothers before or during delivery affects the microbial and tryptophan metabolite composition of stool of the caesarean- and vaginal-delivered newborns. The determination of microbiome and levels of tryptophan microbial metabolites in meconium and stool can characterize intestinal colonization of a newborn. From 134 samples from the Central European Longitudinal Studies of Parents and Children: The Next Generation (CELSPAC: TNG) cohort study, 16S rRNA gene sequencing was performed, and microbial tryptophan metabolites were quantified using ultra-high-performance liquid chromatography with triple-quadrupole mass spectrometry. Microbial diversity and concentrations of tryptophan metabolites were significantly higher in stool compared to meconium. Treatment of mothers with ATB before or during delivery affects metabolite composition and microbial diversity in stool of vaginal- and caesarean-delivered newborns. Correlation of microbial and metabolite composition shows significant positive correlations of indol-3-lactic acid, N-acetyl-tryptophan and indol-3-acetic acid with Bifidobacterium, Bacteroides and Peptoclostridium. The positive effect of vaginal delivery on newborns’ microbiome development is degraded when mother is treated with ATB before or during delivery.Key points• Antibiotic treatment diminishes the positive effects of vaginal delivery.• Antibiotic treatment affects metabolite and microbial composition in newborns.• Bifidobacterium and Peptoclostridium could be the producer of indole-lactic acid.

Does the timing of postprandial glucose monitoring affect the obstetric and neonatal outcomes in patients with gestational diabetes? A prospective study comparing 1 and 2-h postprandial monitoring.

The aim of this study was to examine the obstetrical and neonatal outcomes in patients with gestational diabetes mellitus (GDM) who had postprandial glucose monitoring 1 vs. 2 h following meals. In this prospective cohort study, we included patients with GDM who were referred to our medical center between July 2019 and June 2021. Patients chose the timing of postprandial glucose monitoring based on their own preferences. Obstetrical and neonatal outcomes, as well as patient satisfaction, were compared between patients who performed postprandial glucose monitoring 1 and 2 h after meals (PPG1 vs. PPG2). The primary outcome was birth weight. The study was powered to detect a 250 g increase in birth weight. Overall, 99 patients were included: 50 in the PPG1 group and 49 in the PPG2 group. Baseline characteristics were comparable between the groups. Neonates in the PPG1 and PPG2 groups had similar birth weights (3319 ± 355 vs. 3319 ± 520 g, respectively, p = 0.99). Glycemic control, mode of delivery, gestational age at delivery, and satisfaction rates were also similar between the study groups. In patients with GDM, performing1 vs. 2 h following meals resulted in similar obstetrical and neonatal outcomes and similar satisfaction rates. We therefore recommend counseling patients to choose either strategy based on their personal preference.

Impact of postpartum physical activity on maternal depression and anxiety: a systematic review and meta-analysis

ObjectiveTo examine the influence of postpartum exercise on maternal depression and anxiety.DesignSystematic review with random effects meta-analysis and meta-regression.Data sourcesOnline databases up to 12 January 2024, reference lists, recommended studies...

Dr Associate Professor

Background: Most women do not desire pregnancy immediately after delivery and are highly motivated to accept family planning methods. The post partum intrauterine device is one of the family planning methods that can address this need. According to prior reports intrauterine device use has been very low from the contraceptive method mix. Objective: To assess barriers to postpartum intra uterine device uptake among mothers who delivered at two public hospitals in Addis Ababa, Ethiopia. Method: It is an institution based cross-sectional study. Simple random sampling method was used to select study participants. Descriptive statistics and regression analysis were used to determine the presence and strength of association between uptake of post partum intrauterine device and independent variables. Result: In this study the uptake of postpartum intrauterine contraceptive device was 11% (95%CI=8.0, 14). The stated barriers for the none uptake of post partum intrauterine device were fear and concern (61.6%), religions value for family planning (16.9%), husband and relative opinion (7%), culture norm (5%) and health provider related factor (5% (17/367)). Parity and mode of delivery were significantly associated post partum intrauterine device uptake. The odds of intrauterine contraceptive device utilization for mothers with previous number of deliveries of ?3 and 1-2 were 35 (AOR=34.8, 95%CI=7.33, 165.4) and 4 (AOR=4.2, 95%CI=1.47, 12.07) times higher than those with no previous delivery. In addition, assisted vaginal delivery had 11 (AOR=11.06, 95%CI=3.26, 37.5) times increased odds of intrauterine contraceptive device uptake than SVD. Conclusion and recommendations: The uptake of post partum intrauterine device was low (11%). The main barriers identified for the low uptake were fear and concern to myth and misconceptions, religions value for family planning, husband and relative opinion, culture norm and health provider related factors. To identify and address reasons for gaps in knowledge and to clear public misconceptions and fears further large scale studies are recommended. Key-words: PPIUD, Contraception, post partum, Ethiopia.

1H NMR-Based Metabolomic Profiling and Comparison of Human Milk Across Different Lactation Stages in Secretors and Non-Secretors: A Study of Chinese Lactating Women

BackgroundHuman milk oligosaccharides (HMOs) and other milk-derived metabolites are crucial for infant health, influencing gut microbiota and overall development. ObjectiveThis study aims to uncover insights into the variations of HMOs and non-HMO metabolites based on secretor (Se) status, lactation time, mode of delivery, and infant sex. MethodsAn exploratory cross-sectional study was designed to compare the levels of HMOs and non-HMOs metabolites in milk samples from 129 lactating Chinese women within 1 year postpartum. Nuclear magnetic resonance analysis was employed for the identification and quantification of the metabolites. The metabolites measured were grouped into sugars, free amino acids, fatty acids, and metabolites related to energy metabolism. The influence of delivery mode and infant sex on milk metabolite composition were explored. ResultsUniform Manifold Approximation and Projection (UMAP) analysis of HMOs profiles revealed distinct clustering based on Se status, with significant differences in 2'-FL and 3-FL levels observed between Se+ and Se- groups. A decreasing trend for 2'-FL and 6-’SL levels, along with an increase in 3-FL levels, was observed with increasing lactating period within 12 months postpartum. Non-HMOs metabolite analysis indicated that Se status only affected glutamate levels. An increase in glutamine levels was observed 3–9 months postpartum. A continuous increase in o-phosphocholine levels was noted in 12 months postpartum, along with reductions in citrate and sn-glycero-phosphocholine levels. Delivery mode and infant sex did not affect both HMOs and non-HMOs levels. ConclusionsMetabolomic analysis of human milk reveals significant variation of HMOs, but not in non-HMOs, based on Se status. Changes in certain HMOs and non-HMOs levels were also observed over the one year of lactation. Understanding how these metabolites change over time may influence recommendations for maternal diet, supplementation, and the timing of breastfeeding to ensure optimal nutrient delivery to the infant.

Long-term maternal outcomes 5 years after cesarean section in Sierra Leone: A prospective cohort study.

Cesarean section (CS) is a life-saving procedure when performed for the right indication but carries substantial risks, specifically during subsequent pregnancies. The aim of this study was to evaluate obstetric outcomes for women 5 years after a CS performed by medical doctors and associate clinicians. This was a prospective multi-center observational study of women who had a CS at any of nine hospitals in Sierra Leone. Women and their offspring were followed up with three home visits for 5 years after surgery. Outcomes of interest included long-term complications, mode and place of delivery, and maternal and pediatric outcomes of subsequent pregnancies. Of the 1274 women included in the study, 140 (11.0%) were lost to follow-up. Within 5 years after the index CS, 27.0% of the women became pregnant and 2.5% had a second pregnancy. Women with perinatal death at the index CS had 5.25 higher odds of becoming pregnant within 1 year. Of the 259 women who delivered, 31 (12.0%) had a planned CS and 228 (88.0%) attempted a trial of labor after CS, resulting in either a successful vaginal birth (n = 138; 60.5%) or an emergency CS (n = 90; 39.5%). Peripartum and long-term complications did not significantly differ between those that were operated on by medical doctors and associate clinicians. Within 5 years after CS, one in four women became pregnant again and more than half had a vaginal delivery. Significant differences in place and mode of birth between wealth quintiles illustrate inequities.