Premature Rate Research Articles

Racial and Ethnic Differences in Outcomes of Neonates Born at Less Than 30 Weeks' Gestation, 2018-2022.

Previous research has examined outcomes among very preterm newborns by the birthing parent's race and ethnicity, but knowledge about these trends during the COVID-19 pandemic is limited. To examine trends in outcomes among Black, Hispanic, and Asian preterm newborns compared with White preterm newborns. This cohort study (2018-2022) took place at 774 neonatal intensive care units in the Vermont Oxford Network. Participants were newborns born at 22 to 29 weeks' gestation. Race and ethnicity. The primary outcomes were mortality and complications, including respiratory distress syndrome, necrotizing enterocolitis (NEC), early-onset sepsis, late-onset sepsis (LOS), severe intraventricular hemorrhage (sIVH), severe retinopathy of prematurity, chronic lung disease, pneumothorax, and complication-free survival. Among 90 336 newborns (47 215 male [52.3%]; 43 121 female [47.7%]; mean [SD] gestational age, 26.4 [2.1] weeks), 4734 (5.2%) were born to Asian, 20 345 (22.3%) to Hispanic, 31 264 (34.3%) to non-Hispanic Black, and 33 993 (37.3%) to non-Hispanic White birthing individuals. Rates of in-hospital mortality (4831 Black newborns [15.6%]; 3009 Hispanic newborns [14.9%]; and 4886 White newborns [14.4%]), NEC (2374 Black newborns [7.8%]; 1359 Hispanic newborns [6.9%]; and 2137 White newborns [6.5%]), LOS (3846 Black newborns [13.5%]; 2258 Hispanic newborns [12.3%]; and 3575 White newborns [11.5%]), and sIVH (2919 Black newborns [10.3%]; 1673 Hispanic newborns [9.2%]; and 2800 White newborns [9.1%]) were highest among Black and lowest among White newborns. Chronic lung disease and pneumothorax rates were lowest among Black and highest among White newborns. Over the study period, mortality rate differences were slightly higher for Black than White newborns, with no differences by 2022. NEC and LOS rates were consistently higher among Black than White newborns. By 2022, Black newborns had higher rates of NEC (rate difference, 1.3 percentage points; 95% CI, 0.46-2.2 percentage points) and LOS (rate difference, 2.7 percentage points; 95% CI, 1.4-4.0 percentage points). sIVH rates were higher for Black newborns in some years, whereas severe retinopathy of prematurity rates were lower. Hispanic newborns had mortality and complication rates similar to those of White newborns. Black and Hispanic newborns had lower respiratory complication rates and higher complication-free survival than White newborns. In this cohort study, there were no differences in mortality rates between Black and White newborns, but Black newborns had higher rates of NEC and LOS. Continued quality improvement and addressing social determinants of health are critical for promoting health equity in hospital outcomes and beyond.

Tongue-tie in the Neonatal Intensive Care Unit Compared to Healthy Newborns.

We sought to characterize the prevalence of ankyloglossia in our neonatal intensive care unit (NICU) population and to determine characteristics of this cohort compared to infants in the birth center (BC). Prospective data were collected using a standardized flow sheet. Breastfeeding infants undergoing evaluation for tongue-tie in the BC and NICU were included. Coryllos type, tip to frenulum length, tongue function, frequency of frenotomy, and breastfeeding outcomes were compared. Of 20,879 infants birthed at or admitted to the institution during the study period, there were fewer patients diagnosed with ankyloglossia in the BC compared to the NICU (3.3% BC vs. 5.4% NICU, p < 0.01). Of these, 163 underwent frenotomy: 86 in the BC and 77 in the NICU. For those undergoing frenotomy, gestational age (39.1 ± 1.3 BC, 34.4 ± 4.4 NICU, p < 0.01) and age at time of procedure (3.2 days BC, 29.2 NICU, p < 0.01) were the only demographic factors significantly different between the groups. There was no difference in Coryllos type or function score. In a subset of NICU infants with multiple assessments over time, function scores after frenotomy were significantly improved compared to pre-frenotomy (p < 0.01). Standard assessment tools appear to be appropriate for use in infants in the NICU, despite the higher rates of prematurity, low birth weights, and increased comorbidities. Assessment and intervention for tongue-tie can be one critical intervention to move these patients closer to oral feeding and discharge to home. 3 Laryngoscope, 134:5152-5159, 2024.

Do timing and severity of gestational COVID-19 impact perinatal and neonatal outcomes?

To examine the relationship between gestational COVID-19 and perinatal-neonatal outcomes. Prospective cohort study. Neonates born at Hospital del Mar (Barcelona) between 2020 and 2022 were classified into two cohorts according to their mother's COVID-19 status during pregnancy. Prenatal and postnatal variables were compared between the COVID-19 and the control cohort, and depending on timing and severity of maternal infection. We included 2701 neonates and observed higher rates of respiratory distress (5.7% vs 3.3%, p = 0.044) and pathological jaundice (7.7% vs 4.1%, p = 0.007) in the COVID-19 cohort, without differences between trimesters. We did not find statistically significant differences in other perinatal outcomes. The logistic regression analyses showed that maternal COVID-19 was not a risk factor for prematurity (OR:1.23;CI:0.75-2.03; p = 0.407). Infants born to mothers with COVID-19 during pregnancy in our hospital showed higher rates of respiratory distress and pathological jaundice, without increased rates of prematurity or other morbidities.

A multidisciplinary weight management intervention for adults with severe mental illness in forensic psychiatric inpatient services (Motiv8): a single blind cluster-randomised wait-list controlled feasibility trial.

People with severe mental illness experience physical health inequalities and a 15-20-year premature mortality rate. Forensic inpatients are particularly affected by restrictions on movement, long admissions, and obesogenic/sedative psychotropic medication. We aimed to establish the feasibility and acceptability of Motiv8, a multidisciplinary weight management intervention co-produced with service users for forensic inpatients. A randomised waitlist-controlled trial of Motiv8(+Treatment-As-Usual) vs.TAU was conducted in medium-secure forensic services in Greater Manchester. Motiv8 is a 9-week programme of exercise sessions, diet/cooking classes, psychology, physical health/sleep education, and peer support. Physical and mental health assessments were conducted at baseline/10-weeks/3-months. A nested qualitative study captured participant experiences. A staff sub-study explored ward environment. We aimed to recruit 32 participants (four cohorts). The trial met recruitment targets (n=29, 90.9%; 4 cohorts, 100%), participants were randomised to Motiv8+TAU (n=12) or waitlist (control) (n=17). Acceptable retention rates were observed (93.1%, 10-weeks; 72.4%, 3-months), and participants engaged well with the intervention. The blind was maintained, and no safety concerns raised. Assessment completion was high suggesting acceptability (>90% for people retained and engaged in the study). Participants reported high levels of satisfaction. The trial was not powered to detect group differences. However, data suggests it is feasible to conduct a rigorous, methodologically robust study of Motiv8 vs.TAU for adults on forensic inpatient units. Motiv8 was acceptable with potential promise providing evidence to proceed to a definitive trial for males. A larger trial is needed to explore potential effectiveness and reduce physical health inequalities for people with SMI. https://doi.org/10.1186/ISRCTN13539285, identifier ISRCTN13539285.

Efficacy and safety of different noninvasive ventilation strategies for postextubation respiratory support in Neonatal Respiratory Distress Syndrome: a systematic review and network meta-analysis.

The study aimed to compare the efficacy and safety of different noninvasive ventilation (NIV) modalities as primary respiratory support following extubation in Neonatal Respiratory Distress Syndrome (NRDS). A search was conducted in PubMed, Embase, Cochrane, Web of Science, China National Knowledge Network (CNKI), Wanfang database, VIP, and Chinese Biomedical Literature databases with a search time limit of April 2024 for the year of construction, and included randomized controlled clinical trials of different modes of noninvasive respiratory support after extubation in NRDS. The primary outcome indicators were the need for re-tracheal intubation within 72 h of extubation on noninvasive ventilatory support and carbon dioxide retention (PCO2) 24 h after extubation. Secondary outcome indicators included the incidence of bronchopulmonary dysplasia (BPD), nasal injury, pneumothorax, intraventricular hemorrhage (IVH) or periventricular white matter softening (PVL), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), and mortality rate. A systematic review and network meta-analysis of the literature was performed by two investigators who screened, extracted, and evaluated the quality of the data. A systematic review and network meta-analysis were then performed using R software. A total of 23 studies involving 2,331 neonates were analyzed. These studies examined four noninvasive respiratory modalities: continuous positive airway pressure ventilation (NCPAP), noninvasive intermittent positive pressure ventilation (NIPPV), bi-level positive airway pressure ventilation (N-BiPAP), and noninvasive high-frequency oscillatory ventilation (NHFOV). Results indicated that NHFOV, NIPPV, and N-BiPAP were significantly more effective than NCPAP in reducing the risk of reintubation (all P < 0.05), with NHFOV being the most effective. For carbon dioxide clearance, NHFOV outperformed both NIPPV and NCPAP (P < 0.05). Regarding the reduction of bronchopulmonary dysplasia (BPD) incidence, NHFOV and NIPPV showed a significant advantage over NCPAP. This network meta-analysis (NMA) suggested that NHFOV is the most effective mode of noninvasive respiratory support post-extubation, while NCPAP is the least effective. However, these findings should be interpreted with caution due to the limited number and quality of the studies included. https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier (CRD42024544886).

Assessment of PM2.5 pollution features and health advantages in Northwest China.

The elevated concentration of suspended particulate matter in the atmosphere is closely associated with the morbidity and mortality of human diseases. In northwest China, fine particulate matter pollution has persistently affected local health, production, and daily life due to climatic factors and economic development. This paper first examines the distribution and variation of PM2.5 concentrations in northwest China from 2013 to 2022 to understand changes in PM2.5 exposure levels, as well as their associated health and economic benefits since the implementation of the "Air Pollution Prevention and Control Action Plan." Second, we estimated the number of premature deaths in the research region under various control scenarios based on PM2.5 concentrations recorded in 2013 and 2021, utilizing existing epidemiological studies for reference. Finally, we calculated the financial benefits resulting from variations in PM2.5 concentrations within this region. Results indicated that (1) from 2013 to 2022, the Tarim Basin exhibited the highest PM2.5 concentration among all studied areas, while northern Xinjiang and Qinghai Province had notably lower levels. Additionally, wintertime concentrations were consistently higher than those observed during summer months; however, there has been a general trend toward reduced PM2.5 content over the past decade. (2) A significant inverse relationship was found between premature mortality rates and PM2.5 concentrations; specifically, fluctuations in PM2.5 levels exerted a more pronounced impact on premature deaths attributable to cardiovascular diseases compared to respiratory conditions within this northwest region. (3) Males were disproportionately affected by increases in PM2.5 concentration relative to females-experiencing two to three times more early fatalities than their female counterparts did. (4) Over a 9-year period within this research area, fiscal benefits derived from interventions targeting PM2.5 treatment increased by approximately 891 million yuan.

Halving premature death and improving quality of life at all ages: cross-country analyses of past trends and future directions.

Although death in old age is unavoidable, premature death-defined here as death before age 70 years-is not. To assess whether halving premature mortality by 2050 is feasible, we examined the large variation in premature death rates before age 70 years and trends over the past 50 years (1970-2019), covering ten world regions and the 30 most-populous nations. This analysis was undertaken in conjunction with the third report of The Lancet Commission on Investing in Health: Global Health 2050: the path to halving premature death by mid-century. In this cross-country analysis of past mortality trends and future directions, all analyses on the probability of premature death (PPD) were conducted using life tables from the UN World Population Prospects 2024. For each sex, country, and year, probability of death was calculated from these life tables with 1-year age-specific mortality rates. Globally, PPD decreased from 56% in 1970 to 31% in 2019, although some countries saw reversals because of conflict, social instability, or HIV and AIDS. Child mortality has decreased faster than adult mortality. Among all countries, 34 halved their PPD over three decades between 1970 and 2019. Among the 30 most-populous countries, seven countries, with varying levels of baseline PPD and income, halved their PPD in the past half century. Seven of the most-populous countries had average annual rates of improvement in the period 2010-19 that, if sustained, could lead to a halving of PPD by 2050, including Korea (3·9%), Bangladesh (2·8%), Russia (2·7%), Ethiopia (2·4%), Iran (2·4%), South Africa (2·4%), and Türkiye (2·3%). Halving premature death by 2050 is feasible, although substantial investments in child and adult health are needed to sustain or accelerate the rate of improvement for high-performing and medium-performing countries. Particular attention must be paid to countries with very low or a worsening rate of improvement in PPD. By reducing premature mortality, more people will live longer and more healthy lives. However, as people live longer, the absolute number of years lived with chronic disease will increase and investments in services reducing chronic disease morbidity are needed. The Norwegian Agency for Development Cooperation, the Bill & Melinda Gates Foundation, and a Norwegian Research Council Centre of Excellence grant.

Risk factors for abusive head trauma in the pediatric population.

Abusive head trauma (AHT) is the leading cause of death from physical child abuse in children younger than 5 years of age in the United States. The mortality rate among patients with AHT is 25%, and the recurrence rate of child abuse rises to 35% when there is a lack of intervention. Thus, identifying child abuse is crucial yet especially challenging for infants and toddlers as they are preverbal. Current guidelines for child abuse do not sufficiently address the specific needs of a younger population. This study aimed to evaluate clinical factors associated with abuse among such populations. The National Trauma Data Bank was queried from 2017 to 2019 for patients younger than 3 years with acute head trauma. Patients who were suspected of having experienced child abuse (suspected child abuse [SCA] group) were propensity score matched with patients who were not suspected of having experienced child abuse (non-SCA group) based on demographics, comorbidities, and Glasgow Coma Scale (GCS) scores. Paired Student t-test and chi-square tests were used to compare differences in hospital outcomes between the two groups. Multivariable regression analysis was used to determine factors associated with SCA (p < 0.05). The authors identified 10,844 patients in the SCA group and 27,912 in the non-SCA group. Regression analysis results showed that patients in the SCA group had higher rates of prematurity (OR 2.30, p < 0.001), GCS scores < 13 (OR 1.79, p < 0.001), congenital disorders (OR 1.56, p < 0.001), and public insurance use (68.38% vs 52.88% p < 0.001). Black and Hispanic patients were more likely to be in the SCA group (OR 1.56, p < 0.001 and OR 1.35, p < 0.001, respectively). Following propensity score matching, SCA patients had a longer length of hospital stay (3.17 vs 1.34 days, p < 0.001) and higher mortality rate (4.89% vs 3.58%, p < 0.001). Acute head injuries in the SCA group were associated with prematurity, congenital disorder, low GCS score, and public insurance use. As such, the current guidelines should implement clinical history and insurance type to better reflect the at-risk patient population when evaluating infants and toddlers for potential abuse. There could be overidentification of child abuse among Black and Hispanic patients, and further research is warranted.

Risk Factors for Prematurity and Congenital Malformations in Assisted Reproductive Technology Pregnancies-A Retrospective Study.

Background: Assisted reproductive technology (ART) nowadays plays a major role in the treatment of infertility, with the most frequently used techniques being in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). The objective of this study is to analyze pregnancies achieved using these ART techniques and their correlations with the prematurity and congenital malformations rates. Methods: This is an observational retrospective longitudinal study that includes 814 newborns conceived through an ART, namely IVF or ICSI. Results: Using a multivariate logistic regression analysis mode, there is a higher prematurity rate in twin pregnancies OR 16 (95% CI 10.7, 23.8), donor conception OR 1.8 (95% CI 1.1, 3.3) and PIH pregnancy OR 2.6 (95% CI 1.5, 4.5). The odds of malformations in these ART pregnancies are increased by the stage of the embryo (day 3) OR 2.6 (95% CI 1.3, 5.2), fresh embryo transfer OR 2 (95% CI 1.2, 3.4) and donor conception OR 2.3 (95% CI 1.2, 4.4). The ART used (IVF/ICSI) does not influence the prematurity or birth defects rate. Conclusions: Donor conception is found to increase the odds of both prematurity and congenital malformations. The ART used (IVF/ICSI) does not influence the prematurity or birth defects rate.

A profile approach to physical activity levels: what’s intensity got to do with reasons and motives for exercise?

BackgroundDespite the well-known benefits of physical activity (PA), non-communicable disease and premature mortality rates among adults continue to rise. The relationship between adults’ goals and exercise-specific motivation on the type of PA intensity one engages remains unclear. The purpose of this study was to identify physical activity (PA) profiles based on frequency and intensity (i.e., levels of PA) in an adult sample. A secondary purpose was to examine how the PA profiles differ on the reasons people have for exercising and behavioral regulation.MethodsA Cross-sectional survey was conducted with 1,169 (46.8 ± 16.7 years) participants solicited from a hospital-affiliated wellness center, social media promotions, and a research volunteer registry. The International PA Questionnaire (IPAQ) was used to determine frequency, intensity, and time spent engaging in PA. Additionally, the Reasons to Exercise (REX-2) scale, the Behavioral Regulation in Exercise Questionnaire-3 (BREQ-3), and demographics were assessed. K-cluster analyses were performed to identify profiles based on PA levels using the IPAQ guidelines. Multivariate analysis of variance (MANOVA) was used to assess profile differences.ResultsFive distinct PA clusters were derived, and defined as: a Low, Walking, Moderate Intensity, High Intensity, and Sitting cluster (p < .001). These clusters differed significantly (p < .001) from each other with respect to motivation, the reasons adults have for exercise, and PA levels.ConclusionThe results from this study support the important role of psychological factors such as motivation and reasons for exercise on behavioral outcomes (i.e., physical activity). For future research investigating adults PA- related behaviors, whether it be on adults starting a new exercise program or for PA maintenance, it may be beneficial to develop programs that encourage participants to reflect on the reasons they identify as important for exercising, and how such reasons contribute to their overall PA engagement behaviors.

Regional inequalities in years of life lost within the European Economic Area: Using the Gini coefficient and slope index of inequality to assess spatial disparities

Abstract Background Health inequalities have been linked to reduced life expectations. This study aimed to investigate regional variations in all-cause years of life lost (YLLs) in European Economic Area (EEA) countries prior to the COVID-19 pandemic. Methods Demographic data were extracted from Eurostat for 1390 small regions 32 EEA countries. Age-standardised sex specific YLL rates per 100,000 population in 2019 were estimated for EEA regions (Eurostat NUTS level 3) using methodologies derived from the Global Burden of Disease study. Relative spatial disparities were evaluated using the Gini coefficient (GC) and absolute spatial disparities assessed using the slope index of inequality (SII). Results Between EEA countries, relative geographical inequality in age-standardized YLL rates was higher than within them, slightly more so for males (GC = 16.96% [95% CI = 16.26-17.65]) than females (14.22% [13.62-14.82]). Among females, the UK (11.21% [95% CI 10.11-12.30]), Greece, and Croatia had the highest relative spatial inequality, while Ireland (3.37% [2.26-4.48]), Slovakia, and the Netherlands had the lowest. For males, Belgium (10.76% [9.34-12.17]), the UK, and Croatia exhibited the highest relative spatial inequality, while Ireland (1.99% [1.18-2.81]), Lithuania, and Slovakia had the lowest. Germany had the largest absolute geographical inequality in YLLs among females (SII=16.86% [16.28 to 17.44]), followed by Estonia and the UK. Among males, Estonia had the largest absolute spatial inequality (36.60% [-10.88 to 84.07]), followed by Latvia and Hungary. Ireland had the lowest absolute spatial inequality for both females and males. Conclusions Relative and absolute disparities in premature mortality rates are evident across regions of the EEA, both within countries and across the entire region. These findings offer insights for national and local stakeholders, aiding them in customising public health interventions to target spatial health disparities.

Discontinuation of long-acting reversible contraception: a retrospective Dutch study in general practice

Background In the Netherlands, the use of long-acting reversible contraception (LARC) methods increases. Studies show high premature discontinuation rates of LARCs, but comprehensive insights into the Dutch situation remain limited. Aim The aim of this study is to determine (1) the rate and reasons of discontinuation of different types of LARC in the first 2.5 years of use and (2) what patient characteristics are associated with premature discontinuation. Design and setting Retrospective cohort study utilising data from a Dutch primary care research network. Methods We included all women who received a LARC between 2017 and 2019 with a 2.5-year follow-up period. We performed a descriptive analysis, Kaplan Meier and logistic regression analysis to answer the research questions. Results We included 642 women. In total, 166 women (25.9%) discontinued their LARC within 2.5 years. Discontinuation rates were 22% for levonorgestrel intra-uterine systems (LNG-IUS) 52 mg, 25% for LNG-IUS 19.5 mg, 39% for copper IUDs and 47% for subdermal implants. Common reasons for discontinuation were: alterations in bleeding pattern (68%), abdominal pain (32%), headache or mood fluctuation (24%) and a preference for natural contraceptive methods (23%). Factors associated with discontinuation for reasons other than pregnancy wish were: age between 30 and 34 years old (OR 5.1, 95% CI [1.26–20.48]) and a history of sexual, physical and/or psychological abuse (OR 3.16, 95% CI [1.60–6.23]). A high educational level (OR 0.33, 95% CI [0.12–0.89]) was associated with a lower risk of discontinuation. Conclusion The discontinuation rates of LARCs are high. Better counselling might prevent premature discontinuation.

Cervical cerclage vs cervical pessary in women with cervical insufficiency: A multicentric, open-label, randomised, controlled pilot trial [the CEPEIC trial]

ObjectiveCervical insufficiency accounts for 8 % of preterm births. Pessary and cerclage are considered preventive approaches for preterm birth. These interventions were compared in terms of reducing the prematurity rate in women with previous preterm birth, due to cervical insufficiency or due to having a short cervix in their current pregnancy. MethodsThis was a prospective, multicentric, open-label, randomised, pilot, controlled trial. Participants were women with singleton pregnancies who had previous preterm birth caused by cervical insufficiency or previous preterm birth and a short cervix [≤ 25 mm] in their current pregnancy. Women were randomised [1:1] to either cerclage or pessary. The primary outcome was to assess the feasibility of a trial on cervical pessary vs. cerclage to prevent preterm birth before 34 weeks in women with cervical insufficiency. As a secondary outcome, we studied the morbidity rate of the pessary versus the cerclage in women with cervical insufficiency and assessed the financial impact of using both devices in these women. The sample size was calculated based on the estimated population that we could potentially recruit: 60 women, 30 for each group, to ascertain whether the rate of preterm birth < 34 weeks of gestation may be reduced from 34 % to at least 27 % in the pessary group, as in the results obtained with the cerclage. ResultsNo significant differences in preterm birth < 34 weeks of gestation were observed in our study, although it was underpowered to detect these differences [the relative risk [RR] of PB < 34 weeks of gestation was 0.8 [95 % CI: 0.31–2.09, p = 0.888]. The rates of obstetric and perinatal complications were similar for both devices [15 cases in both groups, 50 % of cases [RR; 0.6–1.68; p = 1]. Cervical pessary had fewer secondary effects than the cerclage [less bleeding at insertion in the pessary group compared with cerclage, 1 case vs 14 cases, p < 0.001; less pain at removal in the pessary group compared with cerclage, 14 vs 22 cases. p = 0.042 and less bleeding, 2 cases vs. 10 cases, p = 0.027]. ConclusionsPessary does not seem less effective than cerclage, although these findings need to be confirmed in a larger randomised controlled trial. Pessary had fewer secondary effects than cerclage both at insertion and removal. SinopsisCervical pessary does not seem to be less effective than cerclage. Cervical pessary had fewer secondary effects than cerclage.

How likely are Eastern European and central Asian countries to achieve global NCD targets: multi-country analysis

BackgroundIn Europe, mortality rates from noncommunicable diseases (NCDs) among persons 30–69 years of age (“NCD premature mortality rates”) have declined significantly, except in twelve countries of Eastern Europe and Central Asia, namely Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine and Uzbekistan. Data on long-term trends in NCD mortality in these countries are limited. We analyzed NCD premature mortality rates, identified change points in NCD mortality trends and forecasted how likely countries are to achieve the global NCD targets, stratified by gender and NCD type.MethodsWe used the 1990–2019 Global Burden of Disease database to analyze NCD trends and identified country-specific change points by using piecewise linear regression. We assessed the likelihood of achieving the global targets for reducing NCD premature mortality rates among persons 30–69 years of age from four NCDs: cancers, diabetes, cardiovascular and chronic respiratory diseases. The global NCD targets are 25% reduction in mortality from 2010 to 2025 (WHO 25X25 target) and 33%—from 2015 to 2030 (SDG 3.4.1). We applied the analysis to both genders and four NCDs.ResultsOnly Kazakhstan and Russia are likely to achieve the global NCD targets. For Kazakhstan, WHO 25X25 and SDG 3.4.1 global targets for mortality rates were 494.3 and 374.8 per 100,000 population respectively; the corresponding predicted values (PVs) were 360.6 [CI 260.1–461.1] and 245.1 [CI 113.4–376.8]. For Russia, WHO 25X25 and SDG 3.4.1 global targets were 560.5 and 442.8 per 100,000 population respectively; the corresponding PVs were 427.7 [CI 270.3–585.1] and 311.0 [CI 102.8–519.1]. Achieving NCD global targets is less likely for Kyrgyzstan, while it is unlikely for the rest of countries. Most countries had higher mortality rates and slower progress among men compared with women. The likelihood of achieving overall global NCD targets was mainly explained by reduction in cardiovascular mortality.ConclusionsIn most Eastern Europe and Central Asia countries, progress towards achieving NCD global targets is slow, or there’s a reverse trend. Further quantitative and qualitative research is needed to understand the underlying reasons. Separate indicators are needed to monitor trends for cancers, diabetes and chronic respiratory diseases.

Impact of SARS-CoV-2 infection on neonates born to mothers with positive COVID-19 tests. Retrospective cohort study

Background and objectives. COVID-19 infection in pregnant women has an important impact on perinatal and neonatal outcomes. In the small group with critically ill mothers, the complications in the neonates are influenced more by the mother’s state of health than by the disease caused by the SARS-CoV-2 infection. The authors aimed to evaluate the impact of neonatal positive results on SARS-CoV-2 testing. Materials and methods. The retrospective cohort study included all newborns with positive results on SARS-CoV-2 PRC testing admitted to IMSP Mother and Child Institute Kishinev, Republic of Moldova, between 2020 and 2021. Analyzed data were extracted from the maternal and neonatal medical charts, focusing on gestational age, gender, birthweight, Apgar score, type of delivery, respiratory support, radiography findings, and the number of days spent in the NICU. Results. In the present study, of the total number of patients (47), only 7 neonates had a positive COVID-19 test. Two premature infants with a positive test did not suffer from respiratory distress, while the other five needed nasal CPAP (one term infant and four premature infants of 32, 33, and 34 weeks gestational age). There was a high prematurity rate (89.36%) and a high C-section delivery rate (74.4%). Conclusions. In conclusion, the results of our study have shown the direct impact of maternal COVID-19 infection on neonates, irrespective of whether the SARS-CoV-2 test was positive or negative.

Prenatal diagnosis in fetal right aortic arch using chromosomal microarray analysis and whole exome sequencing: a Chinese single-center retrospective study

BackgroundRight aortic arch (RAA) is a common congenital aortic arch abnormality. Fetuses with RAA frequently have good outcomes after birth. However, chromosomal abnormalities and genetic syndromes suggest poor prognosis for these patients. So far the underlying genetic etiology is still not identified in most RAA patients based on traditional genetic techniques and a problem is still debated whether fetuses with isolated RAA should be referred for CMA. Our study aims to investigate the genetic etiology of fetuses with right aortic arch (RAA) by chromosomal microarray analysis (CMA) and whole exome sequencing (WES) and evaluate the efficacy of CMA in fetal isolated RAA.ResultsAmong these 153 fetuses, 99 (64.7%) with isolated RAA and 54 (35.3%) with non-isolated RAA; 25.5% (39/153) with additional intracardiac anomalies (ICA), and 19.0% (29/153) with extracardiac anomalies (ECA). Tetralogy of Fallot (n = 10) and persistent left superior vena cava (n = 11) are the most common ICA and ECA, respectively. CMA detected 15 clinically significant copy number variations (CNVs) in 14 cases (9.2%); microdeletion of 22q11.21 was the most common pathogenic CNVs (7.8%). The chromosomal abnormalities rate was higher in non-isolated RAA and RAA with ICA groups than in isolated RAA group (16.7% vs. 5.1%; 20% vs. 5.1%, both p < 0.05). From five cases further undergoing WES, a diagnostic variant in MTOR gene (c.7255G > A, de novo) was first reported in prenatal, extending the prenatal manifestation of Smith–Kingsmore syndrome (OMIM: 616638); a clinically relevant variant c.3407A > T in STAG2 was identified, being inherited from the healthy mother. Moreover, the premature birth and termination rates were higher in non-isolated RAA group than in isolated RAA group (11.1% vs. 1.0%; 37.0% vs. 2.0%, both p < 0.01).ConclusionsWe demonstrate that CMA and WES are useful diagnostic tools for fetal RAA, particularly non-isolated RAA, and all fetuses with RAA should be referred for CMA. The data probably aids in prenatal diagnosis and prenatal counseling of fetal RAA.

The Negative Impact of Maternal HIV Infection on Birth Outcomes-Myth or Reality?

Human Immunodeficiency Virus (HIV) infection during pregnancy poses significant risks to both maternal and child health, with potential adverse effects on perinatal outcomes. This study aimed to compare perinatal outcomes, including birth weight, length, Apgar scores, and prematurity rates, between HIV-exposed, uninfected (HEU) children and HIV-unexposed, uninfected (HUU) children. A total of 204 neonates were included in the study, comprising 102 born to HIV-positive mothers and 102 born to uninfected mothers. Our findings revealed significant differences in birth weight (p < 0.001), length (p < 0.001), and Apgar scores at both 1 min (p = 0.003) and 5 min (p < 0.001) between HIV-exposed and -unexposed children. The HIV-exposed group exhibited lower birth weights and lengths, along with lower Apgar scores, indicating potential neonatal health challenges. No significant disparities were observed in the prematurity risk between the two groups (OR = 2.58, p = 0.126), but the risk of being born small for gestational age (SGA) in the case of HEU newborns was significantly high (OR = 17.41, p < 0.001). The significant differences in birth weight, length, and Apgar scores underscore the need for tailored healthcare interventions and support for neonates born to HIV-positive mothers. These findings contribute to our understanding of the complex interplay between maternal HIV infection and perinatal outcomes, guiding healthcare professionals in delivering targeted care for this vulnerable population.

Adverse health effects of exposure to plastic, microplastics and their additives: environmental, legal and policy implications for Israel

BackgroundIsrael is a regional "hotspot" of plastic pollution, with little discussion of potential adverse health effects from exposure to plastic. This review aims to stimulate discussion and drive policy by focusing on these adverse health effects.Main bodyPlastics are synthetic polymers containing additives which can leach from food- and beverage-contact plastic into our food and beverages, and from plastic textiles onto our skin. Plastics persist in the environment for generations, fragmenting into MNPs: Micro (1 micron–5 mm)-Nano (1 nm–1 micron)-Plastic, which contaminate our atmosphere, water, and food chain. MNP can enter the human body through ingestion, inhalation and touch. MNP < 10 microns can cross epithelial barriers in the respiratory and gastrointestinal systems, and fragments < 100 nm can cross intact skin, enabling entry into body tissues. MNP have been found in multiple organs of the human body. Patients with MNP in atheromas of carotid arteries have increased risk of a combined measure of stroke, cardiovascular disease, and death. Toxic additives to plastics include bisphenols, phthalates, and PFAS, endocrine-disrupting chemicals (EDCs) which cause dysregulation of thyroid function, reproduction, and metabolism, including increased risk of obesity, diabetes, endometriosis, cancer, and decreased fertility, sperm count and quality. Fetal exposure to EDCs is associated with increased rates of miscarriages, prematurity and low birth weight. There is likely no safe level of exposure to EDCs, with increasing evidence of trans-generational and epigenetic effects. There are several existing Israeli laws to reduce plastic use and waste. Taxes on single-use plastic (SUP) were recently cancelled. There are many gaps in regulatory standards for food-, beverage- and child- safe plastic. Existing standards are poorly enforced.ConclusionReduction in production and use of plastic, promotion of recycling and reduction of leaching of toxic additives into our food and beverages are essential policy goals. Specific recommendations: Periodic monitoring of MNP in bottled beverages, food, indoor air; Strengthen enforcement of standards for food-, beverage-, and child-safe plastic; Renew tax on SUPs; National ban on SUP at public beaches, nature reserves and parks; Ban products manufactured with MNP; Increase research on sources and health outcomes of exposure to MNP and EDCs.

The Strong Correlation Between Multiple Births and Preterm Birth Rates in Greece From 1991 to 2022.

Background This study aims to investigate the correlation between the rising preterm birth rate (PBR) in Greece from 1991 to 2022 and the incidence of multiple births. Methodology Official data on live births in Greece from 1991 to 2022 were sourced from the Hellenic Statistical Authority. The PBR, defined as the number of live births occurring at <37 gestational weeks, and the multiple birth rate (MBR), representing live births from multifetal gestations, were calculated per 100 total live births. The relationship between the PBR and the MBR was evaluated using the non-parametric Spearman's rank correlation coefficient (rho). This association was confirmed through linear regression models, with MBR as the independent variable and PBR as the dependent variable, calculating the beta coefficient (β) and the coefficient of determination (R-squared). Results A very strong direct positive correlation was identified between PBR and MBR throughout the study period, with a Spearman's rho of 0.950 (p < 0.001). This conclusion was further supported by the linear regression model, which yielded a β coefficient of 3.32 (95% confidence interval = 2.78 to 3.86, p < 0.001). The R-squared was 0.838, indicating that the change in MBR explained 83.8% of the rise in PBR. The strongest correlations were observed for moderate PBR (32-33 weeks) with a rho of 0.962 (p < 0.001) and late PBR (34-36 weeks) with a rho of 0.940 (p < 0.001). During the period of a steep increase in prematurity rates in the country (1991-2011), an almost perfect correlation between PBR and MBR (rho = 0.987, p < 0.001) was noted. However, in recent years (2011-2022), characterized by a marginal increase in PBR, this association diminished, with a rho of 0.655 (p = 0.021). Conclusions This analysis revealed a strong positive correlation between the PBR and MBR in Greece from 1991 to 2022, underscoring the significant impact of multiple pregnancies on the substantial increase in preterm births within the Greek population.

FC36: Advance care planning with older people living with psychosis- preliminary findings regarding the experiences and attitudes of mental health clinicians with a view to implementation strategy

Objectives: Older people living with mental illness, including schizophrenia and other psychotic disorders, experience increased physical morbidity and premature mortality rates compared to the general population. However, Advance Care Plans (ACP) are rarely documented in this group, despite ability to discuss end-of-life care and express wishes. The aim of this study is to explore mental health clinicians’ attitudes, experiences, and perceived barriers and facilitators to ACP with people living with psychotic illnesses, to better understand the reasons for this gap and develop a needs-responsive approach toimplementation.Methods: This qualitative study involves focus groups of multidisciplinary mental health clinicians who work with people aged 55+ with psychotic illnesses. It is being conducted in three public mental health services in Sydney, Australia. Focus groups are audio-recorded, transcribed and analysed using reflexive thematic analysis, grounded within an interpretive description framework.Results: Preliminary findings from an unsaturated sample of 12 multidisciplinary clinicians (psychiatrists, social workers, occupational therapists, psychologists) will be presented. Emerging themes regarding experiences of ACP include ‘no experience’, ‘not a priority’, ‘particular relevance for nursing home residents’ and ‘difficult to navigate consumer choices in the context of delusions’. Emerging themes in relation to attitudes about implementing ACP with people with psychotic illnesses include: ‘ACPs are needed’, ‘ambivalence’, ‘I don’t know how’, and ‘whose responsibility are ACPs?’. Barriers to ACP include: ‘misconceptions about ACP’, ‘misperceptions about psychotic illness’, ‘clinician uncertainty- capacity, emotional state, psychosis risk’, ‘systems issues’, ‘lack of knowledge and confidence’, and ‘interfering with therapeutic relationships’. Potential facilitators include: ‘get the timing right’, ‘make it multidisciplinary’, ‘opportunity to practice’, ‘embed in protocol’, ‘upskilling clinicians- modelling and training’, and ‘support from an external ACP role’.Conclusions: Mental health clinicians may be the only healthcare professional in contact with an older person living with psychosis, providing unique opportunities to explore ACP. Clinicians recognise the need for ACP, the complexity of such Discussions, and importance of nuanced capacity assessment and appropriate timing. Proposed solutions to implementing ACP include combining targeted education with practical training for clinicians, embedding ACP in practice using a team approach and system change, or -alternatively-through a dedicated external ACP role.