Vulnerable Period Research Articles

COVID-19 and Its Potential Impact on Children Born to Mothers Infected During Pregnancy: A Comprehensive Review

Pregnancy is a vulnerable period of time during which pregnant people are prone to infections like COVID-19, which can increase risks for both the mother and fetus. These infections may lead to complications such as preterm birth, developmental delays, and congenital abnormalities. While COVID-19 poses additional risks like placental dysfunction and neonatal infections, studies on long-term effects remain limited. Ongoing research and monitoring are essential to understand and mitigate potential cognitive and developmental challenges in children born to mothers infected with COVID-19. This review aims to guide clinicians in managing these risks throughout childhood. Maternal COVID-19 infection during pregnancy can have significant implications for fetal development, even if the newborn is not infected at birth. The release of inflammatory cytokines may cross the placental barrier, potentially disrupting fetal brain development and increasing the risk of long-term cognitive and behavioral issues, such as ADHD or autism. Placental dysfunction, caused by inflammation or thrombosis, can lead to intrauterine growth restriction (IUGR), preterm birth, or hypoxia, affecting both neurological and respiratory health in newborns. Furthermore, a compromised fetal immune system can increase susceptibility to autoimmune conditions and infections. The early diagnosis and management of infections during pregnancy are crucial in mitigating risks to both the mother and fetus. Swift intervention can prevent complications like preterm birth and long-term developmental challenges, ensuring better health outcomes for both the mother and child. Long-term monitoring of children born to mothers infected with COVID-19 is necessary to understand the full extent of the virus’s impact. This review evaluates the long-term systemic effects of maternal COVID-19 infection during pregnancy on fetuses, newborns, and children, focusing beyond vertical transmission. It highlights the broader impacts on fetal development, offering insights to help clinicians manage potential issues that may arise later in life.

Effects of Limosilactobacillus reuteri DSM 17938 in neonates exposed to antibiotics: a randomised controlled trial.

Perinatal antibiotic exposure potentially leads to gut microbiota dysbiosis, which is associated with functional gastrointestinal disorders (FGIDs). We aimed to investigate the effects of Limosilactobacillus reuteri DSM 17938 supplementation on the development of FGIDs, crying and sleep duration, and the gut microbial composition in infants exposed to antibiotics during the neonatal period. In this randomised, double-blind, placebo-controlled study, we included 89 term neonates treated with antibiotics. Neonates received the study product for six weeks. FGIDs, assessed by the Infant Gastrointestinal Symptom Questionnaire, crying and sleep duration were assessed at four and eight weeks, and six months after enrolment. Faecal samples were collected six weeks and twelve months after enrolment. The gut microbial community composition was analysed using 16S amplicon sequencing and qPCR. The proportion of infants with FGIDs was greater in the control group, although the difference between the groups was significant only six months after enrolment. At all time points, the probiotic group presented a longer sleep duration and shorter crying time than the control group, but the difference was not statistically significant. Probiotic consumption had no significant effect on the gut microbiota composition except for increased L. reuteri DSM 17938 abundance in the probiotic group at six weeks after enrolment. At specific time points after supplementation with L. reuteri DSM 17938, a reduction in the prevalence of FGIDs was observed in the probiotic group. However, no observable effect on the gut microbiota was detected during the intervention. We believe that probiotic supplementation in neonates during and after antibiotic treatment to minimise the negative effects of antibiotics on gut function during this vulnerable period of human development warrants further investigation. The trial is registered at ClinicalTrials.gov (NCT02865564).

Impact on healthcare costs of adding telemedicine to a multidisciplinary disease management program for heart failure: a sub-analysis of the iCOR trial

Abstract Background Impact of telemedicine on heart failure outcomes has shown conflicting results. Little is known about the effect of these programs on mid-term healthcare costs. Purpose To evaluate the cost-efficacy of a comprehensive telemonitoring program within the vulnerable post-discharge period after an acute heart failure admission. Methods The insuficiència cardiaca Optimizació Remota (iCOR) trial was a single-centre, randomized, open-label study designed to evaluate the efficacy of the addition of telemonitoring and teleintervention to a specialized multidisciplinary nurse-led heart failure (HF) program. Adult patients with a recent hospital admission for acute HF and an acceptable social support and cognitive ability were recruited. This sub-analysis evaluates the effect of telemedicine on mid-term healthcare costs, including clinical events, drugs and devices, technology purchase and maintenance, outpatient care, days of hospitalization, procedures and complementary tests. t-test via bootstrap estimation is used to compare differences between the telemedicine (TM) and the usual care (UC) groups. Results 81 patients were assigned to the TM group and 97 patients to the UC group. Mean age was 74 years, more than 50% had HF with preserved ejection fraction and 25% were frail. Baseline characteristics were well-balanced between groups. Among the TM subgroup, adherence was very high (< 1% of missed biometric daily transmissions). During 6 months of follow-up, mean total healthcare cost per patient was 7949 euros (€) in the UC cohort and 4383 € in the TM cohort (relative risk reduction [RRR] of 45%; between-group differences 3546 €, 95% confidence interval 627-6464 €, bootstrap achieved significance level 0.022). This result was consistent across several subgroups (age, sex, frailty, left ventricular ejection fraction, educational level) and mainly driven by a 63% RRR in costs of hospitalization (which accounted for two-thirds of the total costs) in the TM cohort. 20 patients required HF admissions in the TM group, compared to 51 patients in the TM group (p < 0.001). This was associated with a 59% RRR in the need for diagnostic procedures. Total number of days of hospitalization per patient decreased from 12.2 in the UC group to 4.2 days in the TM group (p = 0.003), impelled by a reduction in HF and cardiovascular days of hospital stay. On the contrary, ambulatory care costs increase two-fold in the TM group compared to UC group. Nevertheless, these costs only accounted for a 19% of the total costs. Cost of devices needed to implement TM supposed 698 € per patient. Use of TM was associated with a 355 € increase in the cost of ambulatory neurohormonal treatment for HF. Conclusions TM implementation during the vulnerable phase after an acute HF admission was associated to a 45% RR reduction in mean total healthcare cost per patient. This result was driven by an almost two-thirds decrease in costs of hospitalization.UC and TM total healthcare costs

Risks of high temperature exposure on infectious diseases in Portuguese hospitals

Abstract Background The convergence of climate change and infectious diseases presents a growing public health challenge. As global temperatures continue to climb, the geographical spread of climate-sensitive diseases is shifting, underscoring the necessity for comprehensive early warning systems grounded in a One Health framework. Methods This retrospective observational study analyzed daily maximum temperature from May to September, between 2000 and 2018, in mainland Portugal, at a county level, obtained from a European-level gridded observations dataset. Hospital admissions with a primary diagnosis of infectious and parasitic diseases were sourced from the Hospital Morbidity Database. A distributed lag non-linear model was developed to estimate the immediate and lagged relative risks (RR) of temperature exposure on admissions, focused on a lag of 10 days. Results Our research reveals a 16% (95% CI: 9% - 23%) rise in the RR of hospital admissions due to infectious and parasitic diseases after exposure to extremely high temperatures (39 °C). This elevated risk persists for up to 2 days following exposure, with the second day exhibiting the largest increase at 53% (31% - 80%). Furthermore, our findings indicate a subsequent resurgence in RR, reaching 6% (2% - 11%) 9 days after exposure. Conclusions Our results highlight a short-term effect of extreme temperature exposure on infectious and parasitic disease admissions. This data provides valuable insights to guide policymakers in identifying critical periods of vulnerability and implementing this knowledge into heat early warning systems, contributing to developing effective public health strategies against climate change. Acknowledgments The authors thank Fundação para a Ciência e a Tecnologia (FCT, Portugal) for research grant UIDP/04923/2020 and NOVA National School of Public Health for access to the Hospital Morbidity Database made available for research purposes by Administração Central do Sistema de Saúde, IP (ACSS). Key messages • Exposure to extremely high temperatures increases the risk of admission due to infectious and parasitic diseases by 16%, with a peak occurring two days after exposure. • This data is essential for policymakers to identify and integrate vulnerable periods into early heat warning systems, enhancing effective public health strategies against climate change.

Increased risk of cardiovascular events in the weeks following hospitalised COPD exacerbations: the EXACOS-CV French nationwide case-crossover study

Abstract Introduction Previous studies indicate that in people living with chronic obstructive pulmonary disease (COPD), the risk of myocardial infarction (MI), heart failure (HF) decompensation, arrhythmias and ischemic stroke increases following a COPD exacerbation. This association has not been explored for detailed types of cardiovascular events (CVE), namely for different types of myocardial infarction. Objective To quantify the risk of CVE following a COPD exacerbation overall, and by detailed type of CVE. Methods A case-crossover study was conducted using the French national hospital discharge database (Programme de Médicalisation des Systèmes d'Information, PMSI). Case-patients: (i) were aged≥40 years with a COPD diagnosis; (ii) hospitalised in 2018-2019 for CVE; (iii) experienced the CVE within 24 weeks of a hospitalised exacerbation of COPD. Hospitalisation date for CVE was index date. Conditional logistic regression models estimated the association between a hospitalised exacerbation and CVE (overall and by type of CVE) – expressed as odds ratios (OR) – comparing the odds of a hospitalised COPD exacerbation during the risk period (4 weeks prior to index date) versus control periods (9-24 weeks prior to index date). Results Among 122,172 patients with COPD hospitalised for a severe CVE in 2018-2019, 9,840 (8%) had a hospitalised exacerbation of COPD in the prior 24 weeks and qualified as case-patients. Mean age was 76.8 years (SD 10.7); 6,496 (66%) were male. The most frequent CVE were decompensated heart failure (n=5,888, 60%) and acute coronary syndrome (n=1,070, 11%); in-hospital death in the 24 weeks following an exacerbation of COPD occurred in 950 (10%) patients. Median time elapsed between hospitalised exacerbation and CVE (any type) was 43 days (Figure 1); the shortest delays were observed for non-STEMI (24 days) and resuscitated cardiac arrest (28 days). Risk of CVE in the 4 weeks following a hospitalised COPD exacerbation was 3-times the risk in the 9-24 weeks post-exacerbation (OR 3.0; 95%CI 2.9-3.2 – Figure 2). This increase in risk was observed for each individual type of CVE. The highest effect size was observed for non-STEMI (OR 5.3; 95%CI 4.5-6.3). Conclusion The risk of CVE substantially increases following a hospitalised exacerbation of COPD overall and for all types of CVE (acute ischemic events, arrhythmias, and heart failure decompensation). The first month following a hospitalised exacerbation is a period of vulnerability for people living with COPD, with some variability in the magnitude and temporality of risk increase according to the type of CVE. These results stress the need for immediate and sustained monitoring of exacerbating COPD patients to prevent a subsequent severe cardiac event. In addition, exacerbations prevention is an essential target of COPD treatment.

National Patterns of Remote Patient Monitoring Service Availability at US Hospitals and their Readmission Performance for Cardiovascular Conditions.

Digital remote patient monitoring (RPM) enables longitudinal care outside traditional healthcare settings, especially in the vulnerable period after hospitalizations, with broad coverage of the service by payers. We sought to evaluate patterns of RPM service availability at US hospitals and the association of these services with 30-day readmissions for two key cardiovascular conditions, heart failure (HF) and acute myocardial infarction (AMI). We used contemporary national data from the American Hospital Association (AHA) Annual Survey to ascertain US hospitals offering RPM services for post-discharge or chronic care and used census-based county-level data to define the characteristics of the communities they serve. We linked these with hospitals' benchmarked risk-standardized relative performance on readmissions (excess readmission ratio [ERR]) from CMS Hospital Quality Reports (2018-2022). We used mixed-effects multivariable regression to examine the association between RPM services at hospitals and hospital characteristics-adjusted ERR for HF and AMI. There were 2,754 hospitals with CMS quality report data. Over five years of the study, there was a 38.3% increase in the number of hospitals offering RPM services, rising from 952 (42.0%) hospitals in 2018 to 1,237 (58.1%) in 2022. However, the availability of RPM services varied across different hospital groups with smaller, non-teaching hospitals, particularly those serving rural, low-income communities, and those located in the South, were less likely to offer RPM services. There was a consistent association between the availability of RPM services and better risk-standardized readmission performance for HF, with lower ERR for hospitals offering RPM compared with those not offering RPM (absolute difference, -0.016 [-0.023, -0.009], standardized difference, 24.6%, p<0.001). However, no such association was observed for AMI (-0.007 [-0.016, 0.002], standardized difference, 10.3%, p=0.19). In this national study of US hospitals, there has been a large increase in the availability of RPM services but with large variation among hospitals, with lower availability in hospitals serving low-income and rural communities. RPM services were associated with lower hospital readmission rates for HF but not AMI.

Experiences with healthcare navigation and bias among adult women with sickle cell disease: a qualitative study.

The purpose of this study was to use qualitative interviews to understand the experiences of adult women with sickle cell disease (SCD) through daily life and navigating the healthcare system. We conducted semi-structured interviews with reproductive-aged women with SCD and performed thematic analysis. We analyzed interviews from 20 participants. Our data demonstrated three overarching themes: perceptions of disease, transitions of care, and stigma and bias. Participants identified feelings of both empowerment and powerlessness from SCD that evolved over time and globally impacted their lives. The transition from pediatric to adult care was a vulnerable period, both surrounding changes in disease character and challenges transitioning healthcare systems. Finally, participants faced discrimination and prejudice within SCD care, which manifested as disvaluing of their own disease expertise or perpetuation of a "drug-seeking" stereotype. In the context of this bias, some participants prioritized seeking same-race providers. Experiences with SCD contribute significantly to daily quality of life in women with SCD, and ongoing care gaps exist in relation to their disease. Within our population, SCD as a physical and mental stressor requiring interdisciplinary support should not be underestimated. More robust systems to support the transition from pediatric to adult care are also necessary, both on a healthcare institution level and to support patients' engagement in their care. Finally, provider education and training on anti-racist practice and both recognizing and eliminating bias are essential to improving care of SCD patients. Possible interactions between sex, gender, and race in the experience of SCD warrant further exploration.

Effect of glycemic gap on prognosis and complications in vulnerable period of acute heart failure

Background: To investigate the effect of glycemic gap on the prognosis and complications of heart failure in patients with acute heart failure. Methods: 100 patients with acute heart failure treated in our hospital from January 2022 to August 2023 were divided into two groups according to the prognosis: good prognosis group (n = 58) and poor prognosis group (n = 42). Univariate analysis of the prognostic factors of acute heart failure patients in vulnerable period, multivariate Logistics regression analysis of the prognostic factors of acute heart failure patients. ROC analysis of the value of glycemic gap in predicting the prognosis of patients with acute heart failure in the vulnerable period of heart failure, and compare the occurrence of complications between the two groups. Including: arrhythmia, angina pectoris, cardiogenic shock, thrombosis. Results: There was no significant difference in age, sex, history of hypertension, BMI, TG, history of diabetes and serum potassium between the two groups. The glycemic gap, BNP, Ang II, cTnI and SCR in the good prognosis group were lower than those in the poor prognosis group, while LVEF and hemoglobin were higher than those in the poor prognosis group. Binary Logistics regression analysis showed that. Glycemic gap, BNP, Ang II, cTnI, SCR, LVEF and hemoglobin were independent prognostic factors in patients with acute heart failure. The area under the glycemic gap value curve was determined to be 0.8071. The sensitivity of the assessment was 72.8, while the specificity was 70.5, . The incidence of complications in the good prognosis group (1.72%) was significantly lower than that in the poor prognosis group (16.67%). Conclusions: Glycemic gap is related to the prognosis and complications of heart failure in patients with acute heart failure. Hyperglycemia gap will affect the prognosis of heart failure in patients with acute heart failure, resulting in poor prognosis and increasing the incidence of complications.

The Effect of Tele-Continuous Care on Maternal Functioning and Neonatal Perception among Iranian Primiparous Mothers: A Randomized Field Trial Study

Background/Objectives: New mothers face significant challenges during the postpartum period, which can impact their maternal performance. This study aimed to assess the effect of tele-continuous midwifery care on maternal functioning and neonatal perception in first-time Iranian mothers. Methods: A randomized controlled field trial was conducted from January to May 2023 on 48 first-time mothers in the postpartum ward at Arash Women’s Hospital, Tehran. Participants were randomly assigned to either an intervention or control group. The intervention group received tele-continuous care for six weeks postpartum, while the control group received standard care. The Barkin Index of Maternal Functioning (BIMF) and the Neonatal Perception Inventory (NPI) were used to collect data in the second and sixth weeks after delivery. Data were analyzed using SPSS 26. Results: The mean age was 26.2 ± 4.8 years in the intervention group and 28.0 ± 6.1 years in the control group. An independent t-test revealed a significant difference in maternal functioning (BIMF score) between the intervention and control groups by the sixth week postpartum (p &lt; 0.0001). A significant improvement in BIMF scores was observed within the intervention group from the second to the sixth week (p = 0.007). However, the Mann–Whitney test showed no significant difference in neonatal perception (NPI scores) within the intervention group (p = 0.219), while a significant difference was found in the control group (p = 0.007). Conclusions: Tele-continuous midwifery care effectively enhances maternal functioning during the vulnerable postpartum period, highlighting the necessity of ongoing support for new mothers.

Addressing barriers to implementing and scaling PrEP in carceral settings: Applying insights from implementation science.

Within the United States, individuals experiencing incarceration are at higher risk for HIV acquisition compared to the general population, yet may face additional difficulty engaging in HIV prevention clinical services. HIV pre-exposure prophylaxis (PrEP) is an effective approach to preventing HIV transmission, and the Centers for Disease Control (CDC) recommends that PrEP be offered in carceral settings, particularly during the vulnerable community re-entry period. However, there have been few efforts to scale PrEP in this setting. Based on our experience implementing PrEP in Rhode Island's state carceral system, we have identified potential approaches to overcoming barriers to PrEP use in this unique practice environment by utilizing the implementation research logic model (IRLM). We then evaluated specific implementation determinants and barriers as well as strategies used to overcome those barriers to effectively scale PrEP in this setting. We developed a "toolkit," or 14-step guide, for others in the field to use for implementing PrEP in carceral settings including the development and use of clinical protocols as well as community linkage strategies. Our experiences with barriers in the carceral setting, identifying and leveraging implementation strategies, allowed us to develop a "toolkit" to guide other PrEP implementation projects in carceral settings. We encourage others to scale-out our work to other carceral settings to better reach and engage a group of individuals both at elevated risk for HIV and currently underserved by HIV prevention strategies, including PrEP.

Critical Vulnerability in Leadership as a Key Factor in Successful Change Management Communication

This research explores the relationship between the discovered phenomenon of critical vulnerability in leadership during organizational change and its successful outcome. The phenomenon under study is fundamentally distinguished from vulnerable leadership, which is covered in literature as a deliberate tactic leaders use to improve interpersonal relationships and performance. This study concentrates on challenging and uncontrollable leader vulnerability manifested as a decline in the authority and influence of the leader among stakeholders. The main reason for the observed critical leader vulnerability is hypothesized to be the gap in leadership mindset levels between the leader and stakeholders at the onset of the organizational change. It is also hypothesized that the change communication of an authentic leader, predetermined by a high level of leadership mindset, triggers the leader's vulnerability and, at the same time, paradoxically contributes to the evolution of stakeholders' leadership mindset. This, in turn, is a prerequisite for achieving remarkable prosocial results. Relying on the described assumptions, we executed preliminary research, aiming to identify the change communication patterns of leaders in the state of vulnerability (hereinafter referred to as "vulnerable change communication") and to explore how they catalyze the stakeholder mindset evolution. The final sample group involved 9 top managers who faced vulnerability while leading the change process and made significant contributions to the development of their organizations. The research methodology relied on qualitative methods—in-depth interviews on which narrative and thematic analysis was based. Leaders were asked questions to discover goals of change, the presence of periods of vulnerability, the causes and consequences of its occurrence, their communication patterns, and results achieved. The obtained data were analyzed by applying recognized frameworks such as the Michigan Model of Leadership with its Competing Values Framework (CVF), the Approach of Management of Organizational Change Paradoxes, Programmed and Adaptive Approaches to Change, and Stakeholder Communication Model of Change. The present study has taken the first steps towards confirming the existence of an unambiguous connection between certain patterns of leadership change communication, embracing vulnerability by leaders, and remarkable prosocial outcomes. We found that change communication strategy based on embracing personal vulnerability and a high level of leadership mindset characterized by a value-based position, commitment to outstanding prosocial results, and synthetic decision-making ensures the leader the following: 1) Construction of Shared Leadership. The leader creates an organizational culture that transforms stakeholder resistance based on self and group interests into the evolution of a stakeholder leadership mindset and consolidation of the company. The formula for combining the best of both programmed and adaptive approaches to change includes preserving the integrity of the vision and managing meaning and outcome on the one hand, and supporting the strategy by the deployment of communication and bottom-up initiative on the other. 2) Managing Organizational Change Paradoxes. The leader addresses institutional contradictions and stakeholder divergent interests that naturally arise during the change process and creates the basis for subsequent institutionalization on a much stronger and healthier foundation. The paradoxical effect of a leader's personal vulnerability on organizational vulnerability is that the leader helps to reduce the organization's risks by taking them on themselves. Further exploration of the phenomenon of vulnerability will allow us to consider the inclusion of this component in the framework of change management models, to identify vulnerable leaders, specify the vulnerable communication model of change, and develop a list of recommendations for leaders to more consciously navigate the difficult stage of vulnerability as a systemic and inevitable attribute of achieving remarkable prosocial results.

Paleobiology and paleoecology of the woolly rhinoceros (Coelodonta antiquitatis) in Northern and Central Europe: New insights from multi-proxy data

The woolly rhinoceros, Coelodonta antiquitatis, was an emblematic component of Pleistocene faunas in Eurasia, which went extinct around ca. 12.5 ky BP. The loss of its tundra-steppe habitat due to climatic changes is considered the main cause for its extinction, whereas human impact was limited. In this study, we investigated the paleobiology and paleoecology of C. antiquitatis during the last glacial interval (Würm/Weichselian; 130 to 11.7 kya). We explored evolutionary trends for diet, physiology, and habitat via dental wear, enamel hypoplasia, body mass, age structure, mortality curves and stable isotopes (carbon and oxygen). Our results confirmed that C. antiquitatis was a large-sized species, with body mass around 2000–2500 kg, and with C3 grazing or mixed-feeding habits. Age structure and mortality curves revealed potential sampling and/or taphonomical biases at a few localities (e.g., Brixham cave, Ofnethöhle, North Sea), and indicated several vulnerability periods (birth, weaning, cow-calf separation/maturity) also retrieved by hypoplasia analyses. We observed some spatio-temporal fluctuations of body mass (1850–2955 kg), dietary preferences (strict to variable grazing) and hypoplasia prevalence (7.41–47.06 %) of C. antiquitatis depending on the locality, but correlation to specific climatic events (stadials-interstadials) is difficult without exact datation. These variations were however limited, highlighting a rather strict climatic niche and suggesting a high vulnerability to climatic and vegetation changes.

The RNA receptor RIG-I binding synthetic oligodeoxynucleotide promotes pneumonia survival.

Pneumonia is a worldwide threat to public health, demanding novel preventative and therapeutic strategies. The lung epithelium is a critical environmental interface that functions as a physical barrier to pathogen invasion while also actively sensing and responding to pathogens. We have reported that stimulating lung epithelial cells with a combination therapeutic consisting of a diacylated lipopeptide and a synthetic CpG oligodeoxynucleotide (ODN) induces synergistic pneumonia protection against a wide range of pathogens. We report here that mice deficient in Toll-like receptor 9 (TLR9), the previously described receptor for ODN, still displayed partial ODN-induced protection. This prompted us to seek an alternate ODN receptor, and we discovered by mass spectroscopy that the RNA sensor RIG-I could also bind DNA-like ODN. ODN binding by RIG-I resulted in MAVS-dependent pneumonia-protective signaling events. While RIG-I is essential to native defenses against viral infections, we report that therapeutic RIG-I activation with ODN promoted pathogen killing and host survival following both viral and bacterial challenges. These data indicate that maximal ODN-induced pneumonia protection requires activation of both TLR9/MyD88 and RIG-I/MAVS signaling pathways. These findings not only identify what we believe to be a novel pattern recognition receptor for DNA-like molecules, but reveal a potential therapeutic strategy to protect susceptible individuals against lethal pneumonias during periods of peak vulnerability.

Peripartal COVID-19-Related Restrictions and Psychological Burden - A Quantitative Survey in Austria

The period from pregnancy to postpartum is a vulnerable time with an increased risk of mental illness. The COVID-19 pandemic led to restrictions in peripartum care, such as infection control measures, or restrictions regarding accompanying persons. Effects of COVID-19-related restrictions on the psyche and well-being during the peripartum period in Austria were retrospectively assessed using a partially standardized online questionnaire. In addition to closed questions on restrictions and psychological stress, this also contained the Edinburgh Postnatal Depression Scale (EPDS). Data from 850 women who had given birth during the pandemic were included in the analysis. In 8.5% of cases, appointments were canceled during prenatal care, 10.7% had to wear a face mask during the birth. One in 10 women had to cope with the birth and one in 5 with the puerperium without a companion. Unaccompanied women were significantly less likely to feel well cared for during the birth, more likely to feel alone in the puerperium and, according to the EPDS score, were more likely (39% vs. 20%; p<0.001) to have a high probability of postpartum depression. The pandemic-related restrictions led to anxiety, worry, loneliness and an increased risk of depression during the peripartum period. The balance of mental health was negatively affected by measures and restrictions. Even in times of pandemic, more attention needs to be paid to the vulnerable peripartum period.

When Do Tumours Develop? Neoplastic Processes Across Different Timescales: Age, Season and Round the Circadian Clock.

While it is recognised that most, if not all, multicellular organisms harbour neoplastic processes within their bodies, the timing of when these undesirable cell proliferations are most likely to occur and progress throughout the organism's lifetime remains only partially documented. Due to the different mechanisms implicated in tumourigenesis, it is highly unlikely that this probability remains constant at all times and stages of life. In this article, we summarise what is known about this variation, considering the roles of age, season and circadian rhythm. While most studies requiring that level of detail be done on humans, we also review available evidence in other animal species. For each of these timescales, we identify mechanisms or biological functions shaping the variation. When possible, we show that evolutionary processes likely played a role, either directly to regulate the cancer risk or indirectly through trade-offs. We find that neoplastic risk varies with age in a more complex way than predicted by early epidemiological models: rather than resulting from mutations alone, tumour development is dictated by tissue- and age-specific processes. Similarly, the seasonal cycle can be associated with risk variation in some species with life-history events such as sexual competition or mating being timed according to the season. Lastly, we show that the circadian cycle influences tumourigenesis in physiological, pathological and therapeutic contexts. We also highlight two biological functions at the core of these variations across our three timescales: immunity and metabolism. Finally, we show that our understanding of the entanglement between tumourigenic processes and biological cycles is constrained by the limited number of species for which we have extensive data. Improving our knowledge of the periods of vulnerability to the onset and/or progression of (malignant) tumours is a key issue that deserves further investigation, as it is key to successful cancer prevention strategies.

Seasonal variation in mood among individuals with and without bipolar disorder

IntroductionBipolar disorder is a disorder characterized by cyclic changes in mood, yet limited research has explored longitudinal patterns of seasonality on mood symptoms in this population. This study aimed to examine longitudinal mood symptoms in individuals with bipolar type I and II, and healthy controls to determine if seasonal patterns were present and to validate the Global Seasonality Score as a measure of seasonality. MethodsParticipants from the Prechter Longitudinal Study of Bipolar Disorder were included. Seasonal variations in mood were determined from the Patient Health Questionnaire, Altman Self-Rating Mania scale, and the Seasonal Pattern Assessment Questionnaire. Mixed effects models were utilized to examine the effects of season and diagnostic group on patterns of mood over time. ResultsAll groups exhibited significant seasonal effects on mood symptoms, with evidence of decreased depressive symptoms and increased mania symptoms in longer daylight months. The Global Seasonality Score showed significant differences between diagnostic groups, with bipolar I and II groups demonstrating higher seasonality than healthy controls. High seasonality was associated with greater variance in mood symptoms. ConclusionThe present study found evidence of seasonal patterns in mood symptoms in individuals with bipolar type I and II. These results highlight the need for consideration of seasonality in assessment and treatment in bipolar disorder and suggest that interventions such as light therapy during seasons of heightened risk could be beneficial. The validation of the Global Seasonality Score as a reliable measure further underscores the benefit of utilizing self-report measures to identify periods of vulnerability.

Vulnerable periods for the mouse mammary gland: Comparison of the effects of ethinyl estradiol exposures during two early stages of development

The mammary gland is responsive to endogenous hormones and environmental chemicals that are estrogen receptor (ER) agonists. The mouse mammary gland offers the opportunity to dissect the most sensitive windows of exposure. 17α-ethinyl estradiol (EE2) is a pharmaceutical ER agonist that often serves as a positive control for estrogen-active chemicals. Here, adult female mice were exposed to EE2 starting either at pregnancy day 7, or on lactational day 1, and exposures continued until the litters were weaned. The pups were therefore exposed during gestation + the juvenile period, or during the juvenile period alone. The morphology of the mammary gland was evaluated in both male and female offspring at two life stages: weaning (postnatal day [PND]21) and at puberty (PND32). Other hormone-sensitive outcomes evaluated included body weight, anogenital index, frequency of open vagina, and weight of the uterus. We found age- and sex-dependent effects of EE2 on these estrogen-responsive endpoints including the morphology of the mammary gland. Importantly, EE2 altered mammary gland morphology even when exposures were limited to the juvenile period. However, the number of endpoints that were affected in animals from the EE2-Juvenile-Only period were fewer, and typically of a lower magnitude, compared to those observed in the EE2-Gest-Juvenile group. Understanding the effects of environmental estrogen exposures during the juvenile period is critical because humans are exposed to estrogenic pollutants throughout life, including in early childhood.

RELATIONSHIP BETWEEN TOOTH BRUSHING BEHAVIOR AND DENTAL CARIES IN CHILDREN AT 27 SUNGAI SAPIH PUBLIC ELEMENTARY SCHOOL KURANJI, PADANG CITY

Caries is often experienced in mid-childhood 10-12 years which is referred to as a vulnerable period, because it is at that time that milk teeth begin to fall out and the first permanent teeth begin to grow. The 2018 West Sumatra Basic Health Research Results ( Rikesdas ) stated that 41.74% of children aged 10-14 years experience dental caries, while the prevalence of dental caries in Padang City is around 6,154 children, which is 36.71% . The behavior of maintaining community dental health in maintaining oral health is brushing teeth, while brushing teeth is the most important primary prevention action recommended . Research objectives to find out relationship between tooth brushing behavior and dental caries in children at 27 Sungai Sapih Public Elementary School Kuranji, Padang City . The type of research used is quantitative research, namely analytic with an observation approach . The population in this study were all students in grades 4 and 5 at State Elementary School 27 Sungai Sapih Kuranji Padang City, totaling 114 people with total sampling technique. This research was conducted at 27 Sungai Sapih Public Elementary School Kuranji, Padang City. When the research was conducted in November 2022 -February 2023 . Analysis data using Spearman test, data processing using computerized program SPSS IBM version 25.0 . The results of the study showed that the most tooth brushing behavior was moderate, namely 94 people (82.5%), the most dental caries was very low, namely 56 people (49.1%) and there were relationship between tooth brushing behavior and dental caries in children at 27 Sungai Sapih Public Elementary School Kuranji, Padang City. ( p = 0.001 ) . It is recommended for dental health workers to educate schools about the importance of dental and oral care and how to brush their teeth properly and correctly so that they can increase students' knowledge and behavior in brushing their teeth for the better.

10 year risk of death in adolescents with learning disability or autism in England: a national cohort study using linked health and education data from ECHILD

BackgroundTransition from adolescent to adult health and education services is a vulnerable period for young people with learning disability (LD) or autism spectrum disorders (ASD), yet there is a lack of information on their risk of death in that period. MethodsWe developed an English national cohort of 11-year-olds enrolled in state schools between 2009/10-20014/15, followed-up until their 22nd birthday, death or 31st August 2020 using linked health, mortality and education data from the ECHILD database. LD and ASD were indicated using diagnoses from hospital admissions or if LD or ASD were a reason for special educational needs provision in education records before age 11. We estimated crude mortality rates and compared with unaffected peers using rate ratios (RR). ResultsThe cohort comprised 3,080,516 young people (52% boys), of whom 4,589 (0.15%) died (crude mortality rate: 0.17/1000 person-years, 95% CI: 0.16-0.17/1000). 45,174 (1.5%) young people were autistic (85% boys; 15% with co-existing LD), of whom 113 died (mortality rate: 0.29/1000 person-years, 95%CI: 0.24-0.35/1000). Mortality was 1.7 times higher for autistic young people compared to their peers (RR: 1.7, 95% CI: 1.4-2.1). Among 40,264 (1.3% of all) young people with LD (63% boys; 17% with co-existing ASD) there were 812 deaths (mortality rate: 2.31/1000, 95%CI: 2.15-2.47/1000PY). They had 17 times higher risk of death (RR: 16.4, 95%CI: 15.2-17.7). ConclusionsYoung people with LD/ASD are more likely to die than their peers. Findings on disparities within these groups according to co-existing comorbidities, sex and socioeconomic factors will be reported.

Balancing constraints and requirements in an application process

ObjectiveAdolescence is a vulnerable period for onset of depression. Socioeconomic deprivation may elevate the risk of depression. We explored the risk of depression in early adulthood in relation to deprivation during adolescence. Approach97,561 individuals aged 10-14 years were grouped at baseline (2010) using small-area indicator of area-level deprivation (measured in quintiles) and linked with yearly antidepressant prescriptions (2010–2021). A logistic random-intercept multilevel model estimated the longitudinal trajectory of yearly antidepressant prescriptions (2010-2021) between deprivation quintiles in 2010, adjusting for sex and age at baseline. ResultsIn 2010, the marginal probability of receiving antidepressants for an average young person differed little between those living in the most (0.0028: 95%CI=0.0025,0.0032) and least (0.0027: 0.0023,0.0032) deprived areas (p=0.75). By 2021, the marginal probability had increased more for those who lived in the most deprived areas in 2010 (0.191: 0.187,0.195) compared to those who lived in the least deprived areas in 2010 (0.140: 0.135,0.145)(p&lt;0.001). Estimated antidepressant prescriptions were higher in females compared to males (Odds Ratio[OR]=3.15: 3.00,3.29) and increased per year of age at baseline (OR=1.26: 1.24,1.28). ConclusionsGrowing up in more socially deprived areas is associated with an increase in antidepressant prescription risk during early adulthood. Improvements in administrative data access and linkage are needed to further explore these findings. ImplicationsPolicy makers and data custodians should recognise the potential for administrative data in identifying social disadvantage and associated vulnerabilities in the general population, and take steps to make this data accessible to the research community.