Women's Hours Research Articles

Twenty-four versus 48 hours of expectant management in the setting of premature rupture of membranes at term among women with a prior cesarean delivery.

Compare two approaches of expectant management in the setting of term premature rupture of membranes (PROM) among women with prior cesarean delivery. A retrospective study conducted in a tertiary care center during 2006 to 2017, including primiparous women with singleton pregnancy and a prior low-transverse cesarean delivery who presented with term PROM and requested trial of labor after cesarean (TOLAC). Outcomes were compared between the two campuses at our center: campus A enabled expectant management up to 48 hours following PROM and campus B enabled up to 24 hours after PROM. A total of 158 women met the inclusion criteria and were divided into two groups. Maternal characteristics of the two groups were similar. In campus B, the rate of oxytocin administration was significantly higher as compared with campus A (46.6% versus 26.0%, P= 0.01). The rate of successful TOLAC was similar between the groups (84.0% versus 84.5%, P= 0.96). Rates of chorioamnionitis, uterine rupture, postpartum hemorrhage, recurrent hospitalization, and Apg scores did not differ between the groups. Expectant management up to 48 hours in women with TOLAC presenting with term PROM was associated with a lower rate of induction of labor and similar maternal and neonatal outcomes.

ANALISIS PRODUKTIVITAS KELOMPOK WANITA TANI (KWT) DI KABUPATEN KLUNGKUNG

Currently, a number of Women Farmers Groups (KWT) in Klungkung Regency have long developed the Sustainable Food Garden (P2L) program. The P2L program was initiated by the central government. Since its launch, Klungkung Regency now has 6 KWTs developing the program. The objectives to be achieved in this study are: 1) to analyze the direct influence of the variables of education, age, and number of dependent children on the working hours of the Women Farmers Group in Klungkung Regency; 2) analyze the direct effect of education, age, number of dependent children and working hours on the productivity of the Women Farmers Group in Klungkung Regency; and 3) analyzing the indirect effect of education, age, number of dependent children on productivity through the working hours of the Women Farmers Group in Klungkung Regency. The sampling technique used is proportional random sampling. The analytical technique used in this research is Path Analysis. The results of this study are: 1) education, age, and number of dependent children have a positive effect on the outpouring of working hours for women farmers groups in Klungkung Regency; 2) age and number of dependents have no effect, while education and working hours have a positive effect on the productivity of women's farmer groups in Klungkung Regency; and 3) working hours as an intervening variable the effect of education, age and number of dependent children on the productivity of women farmers groups in Klungkung Regency. The implication of this research is that increasing education, age, and number of dependents will increase working hours, and increasing education and hours will increase productivity, while age and number of dependents have no significant effect on KWT productivity in Klungkung Regency. Working hours as an intervening variable. Keywords: Women Farmers Group, education, age, number of dependent children, working hours, productivity

Workin' moms ain't doing so bad: Evidence on the gender gap in working hours at the outset of the COVID-19 pandemic

Objective: In this project, we study changes in the working hours of men and women with and without children in the early phase of the COVID-19 crisis in Germany until August 2020.
 Background: The COVID-19 outbreak in Europe led to a sharp decrease in economic activity, along with temporary closures of childcare facilities and schools. Subsequent changes in working hours in the early phase of the pandemic and during summer 2020 may have contributed to inequalities between men and women or parents and non-parents respectively.
 Method: We use a unique panel dataset containing monthly survey data of the Institute for Employment Research (the IAB-HOPP) combined with administrative data of the German Federal Employment Agency. We run regression models with the change in working hours (before the crisis vs. working time at each panel wave) as the dependent variable and gender, parental status, and childcare arrangement as the main independent variables.
 Results: We observe a comparable reduction in working hours for both men and women during the spring lockdown. However, only the working hours of women recover and return to their pre-crisis level in summer 2020. Most surprisingly, having children has an accelerating effect on recovery for mothers but not for fathers. At the end of the observation period, fathers do not recover as fully as mothers do.
 Conclusion: These results challenge concerns about a temporary or possibly persistent 're-traditionalisation' of gender roles during the COVID-19 crisis.

Intrapartum nipple stimulation therapy for labor induction: a randomized controlled external pilot study of acceptability and feasibility

BACKGROUNDNipple stimulation is purported as a natural and inexpensive method for inducing labor, but its use is understudied. OBJECTIVEWe aimed to assess whether conducting a large randomized controlled trial comparing intrapartum nipple stimulation therapy with oxytocin infusion is feasible and acceptable to patients and obstetrical care providers. STUDY DESIGNThis single-center parallel-group randomized controlled external pilot study (ClinicalTrials.gov Identifier NCT04756089) included women at ≥36 weeks of gestation who were planned to receive exogenous oxytocin for their labor induction. Women who were <18 years old, non-English speaking, or with fetuses at increased risk of neonatal intensive care were excluded. Stratified by parity, women were randomized 3:1 to intrapartum nipple stimulation therapy or immediate receipt of oxytocin. Women assigned to nipple stimulation therapy were asked to stimulate with an electric breast pump or by hand for periods of at least 30 minutes, with breaks as needed for up to 15 minutes at a time, for at least a cumulative 2 hours before considering initiation of oxytocin, and to complete intrapartum diaries. Labor characteristics and outcomes were examined. Validated questionnaires were used to assess the participants’ pain level during the intervention, their sense of control during childbirth, and their breastfeeding success. Primary outcome measures were recruitment, adherence to study protocol and follow-up, and crossover rates. RESULTSA total of 620 women underwent labor induction from March 13, 2021 to June 23, 2021. Of 557 potentially eligible women, 53 were approached by available research staff. Of the 53 women, 24 (45%) consented and enrolled: 18 randomized to nipple stimulation and 6 randomized to oxytocin. Moreover, 1 woman assigned to nipple stimulation withdrew because of delay of clinical care and received oxytocin (crossover rate of 1/24 [4%]), and 1 woman assigned to oxytocin did not receive it because of spontaneous labor progress. All other participants followed their assigned intervention. The 17 women who performed nipple stimulation stimulated for a median duration of 198 (interquartile range, 125–291) minutes and required a median of 69 (interquartile range, 21–80) minutes of stimulation before achieving at least 3 contractions in a 10-minute window, averaged >30 minutes (also known as “adequate” contractions). Among those assigned to nipple stimulation therapy, 15 of 17 women (88%) later received oxytocin infusion before delivery. The median times from intervention start to delivery were 16.4 (interquartile range, 0.6–28.2) hours for women assigned to nipple stimulation and 20.6 (interquartile range, 14.2–23.4) hours for women assigned to oxytocin infusion. Of note, 12 women (50%) completed their postpartum study questionnaires. CONCLUSIONRandom assignment to either intrapartum nipple stimulation therapy or oxytocin infusion for labor induction was feasible and acceptable to patients and obstetrical care providers.

CHALLENGES OF PALESTINIAN WOMEN’S PARTICIPATION IN HIGHER LEADERSHIP POSITIONS IN EDUCATIONAL INSTITUTIONS AND WAY TO OVERCOME THEM

The purpose of this study to identify the challenges facing the participation of Palestinian women in assuming higher educational leadership positions in the various Palestinian educational institutions and higher education institutions. The study shed light on possible ways to overcome these challenges. The sample of the study consisted of twelve Palestinian women working in different institutions with different job titles, and they were chosen in an intentional and accessible way. To achieve the objectives of the study, a qualitative approach was used to answer the study questions. The semi-closed interview tool was used, and the responses of the respondents were organized into patterns and answers. The results of the study showed a great similarity between the challenges that Palestinian women face locally and the challenges that face women in different countries globally. Such as the lack of awareness of women themselves about their rights, unprofessional jealousy among women themselves at work, lack of societal support for women and underestimating the importance of their roles, the stereotype of women resulting from a defect in the value system and upbringing among members of society, the spread of violence towards women in conservative cities, and other defects in administrative organization within some educational institutions. But what distinguished the reality of the challenges was the current political situation under the Israeli occupation, which constituted an additional obstacle. Such as the difficulty of moving and traveling freely is the long hours that women spend in the racist Israeli security check stations that are scattered between cities and governorates. In light of the results of the study, the researcher concluded a set of recommendations, the most important of which are: Work to empower Palestinian women in their work by holding courses and workshops that seek to increase Palestinian women's knowledge of their rights, raise their confidence in themselves and their work, and hold community courses within various higher education institutions that will clarify the importance of the role of women in society and work to change the negative stereotype they have towards women, And work on issuing regulations and legislation that would allocate free hours for women to be able to write and produce scientifically. Challenges of Palestinian Women's Participation, Educational Leadership Centers.

Does Age Affect Desmopressin Responsiveness in Patients with Von Willebrand Disease?

Background: Patients with von Willebrand Disease (VWD) typically undergo a desmopressin acetate (DDAVP) responsiveness challenge at diagnosis to assess whether their coagulation deficits are sufficiently reversed following DDAVP administration. If responsive, patients can be treated with DDAVP in future when at increased risk of bleeding. Current practice assumes that DDAVP responsiveness remains constant over the adult lifetime, and therefore many adult patients are not re-tested. In the normal population, VWF plasma levels (VWF:Ag),VWF ristocetin activity (VWF:RCO) and coagulation factor VIII (FVIII:C) increase with age. This relationship has also been observed in patients with type 1 VWD. We hypothesized that DDAVP responsiveness also increased with age, and set out to investigate this relationship in patients with type 1 VWD.Methods: We conducted a retrospective chart review of 106 patients enrolled at our center since 1990 who met diagnostic criteria for VWD and had undergone at least 1 DDAVP challenge. We recorded baseline, 1 hour, 2 hour and 4 hour post-DDAVP VWF related parameters for every patient when available. Baseline values were taken prior to DDAVP challenge, but may not reflect nadir levels required to diagnose VWD. We excluded patients on medications known to impact VWF and FVIII levels, and patients with types 2B, 2M and 3 VWD due to contraindication or lack of benefit with DDAVP. We stratified analyses by gender to control for the impact of estrogen on VWF and FVIII:C levels. Our primary outcome was DDAVP responsiveness in type 1 VWD, measured as changes in VWF:Ag, VWF:RCo, and FVIII:C levels one hour after DDAVP. As a secondary outcome, we determined these changes in type 2A VWD patients. Analyses were conducted using descriptive statistics, and Pearson and Spearman correlations were used to evaluate for the presence of linear and monotonic relationships, respectively.Results: We had 90 patients (66 female) at our center with type 1 and 16 with type 2A (10 female) VWD who had undergone at least 1 DDAVP challenge. Blood type was available for 66 patients with type 1 VWD; 47 were type O (33 female) and 19 were non-type O (18 female). Mean age at DDAVP challenge for women with type 1 VWD was 23.2 years (SD 15.6) and 27.4 years (SD 19.8) for men. Mean DDAVP dose was approximately 0.3 mcg/kg, with no dose cap. Mean baseline VWF:RCo for type 1 VWD women was 0.39 IU/ml (SD 0.16) and 0.25 IU/ml (SD 0.14) for men, with concordant VWF:Ag mean levels. Mean baseline FVIII:C was 0.74 IU/ml (SD 0.33) and 0.49 IU/ml (SD 0.32) for the women and men, respectively. Blood type was available for 11 patients with type 2A VWD; 6 were type O (5 female) and 5 were non-type O (4 female). In the type 2A group, mean age at DDAVP challenge was 23.7 years (SD 19.0) in women and 50.7 years (SD 18.9) in men. Mean baseline VWF related parameters in type 2A VWD patients were, for women and men, respectively: VWF:Ag 0.48 IU/ml (SD 0.33), VWF:RCo 0.20 IU/ml (SD 0.09), FVIII:C 0.56 IU/ml (SD 0.14) and VWF:Ag 0.50 IU/ml (SD 0.30), VWF:RCo 0.18 IU/ml (SD 0.09), FVIII:C 0.57 IU/ml (SD 0.33).We excluded eleven type 1 VWD patients and one type 2A VWD patient due to medication use. The correlation between age and VWF-related responsiveness to DDAVP at 1 hour in women with type 1 VWD did not reveal a meaningful linear (VWF:Ag, Pearson -0.08, p = 0.62; FVIII:C Pearson 0.04, p=0.77) or monotonic (VWF:Ag, Spearman -0.03, p = 0.86; FVIII:C Spearman 0.12, p=0.40) relationship. However, when we explored the relationship graphically there was an indication of an age-related effect in women of child-bearing years for VWF:Ag, VWF:RCo and FVIII:C (see Figure 1). This finding was not observed in men with type 1 VWD, or in type 2A patients. Regression models including non-linear age terms may assist in explaining this trend.Conclusion: In women with type 1 VWD, we found that responsiveness to DDAVP appears to be amplified around child-bearing years. This trend is reminiscent of the well-established relationship between serum estrogen levels and coaguability. To our knowledge, we have shown for the first time that post-pubertal women with type 1 VWD may have an enhanced ability to respond dynamically to DDAVP but only around this time period. We will confirm our findings with advanced statistical modeling. Future studies should assess whether these age-related changes of coagulation studies translate into meaningful lifecycle-related changes in the bleeding phenotype of type 1 VWD. [Display omitted] DisclosuresJames:Bayer: Research Funding; Shire: Research Funding; CSL Behring: Research Funding. Sholzberg:Shire: Honoraria, Research Funding; CSL Behring: Honoraria, Research Funding; NovoNordisk: Honoraria; Octapharma: Honoraria, Research Funding.

Nitrofurantoin 100 mg versus 50 mg prophylaxis for urinary tract infections, a cohort study

ObjectivesGuidelines do not distinguish between 50 mg or 100 mg nitrofurantoin as daily prophylaxis for recurrent urinary tract infection (UTI), although 50 mg might have a better safety profile. Our objective was to compare the effectiveness and safety of both regimens. MethodsData were retrospectively collected from 84 Dutch GP practices between 2013 and 2020. Nitrofurantoin prescriptions of 100 mg and 50 mg every 24 hours in women were included. Cox proportional hazard regression analysis was used to calculate hazard ratios on first episode of UTI, pyelonephritis and (adverse) events. Patients were followed for the duration of consecutive repeated prescriptions, assuming non-informative right censoring, up to 1 year. ResultsNitrofurantoin prophylaxis was prescribed in 1893 patients. Median lengths of follow up were 90 days (interquartile range (IQR) 37–179 days) for 100 mg (n = 551) and 90 days (IQR 30–146 days) for 50 mg (n = 1342) with few differences in baseline characteristics between populations. Under 100 mg and 50 mg, 82/551 (14.9%) and 199/1342 (14.8%) developed UTI and 46/551 (8.3%) and 81/1342 (6.0%) developed pyelonephritis, respectively. Adjusted HRs of 100 mg versus 50 mg were 1.01 (95% CI 0.78–1.30) on first UTI, 1.37 (95% CI 0.95–1.98) on first pyelonephritis episode, 1.82 (95% CI 1.20–2.74) on first consultation for cough, 2.68 for dyspnoea (95% CI 1.11–6.45) and 2.43 for nausea (95% CI 1.03–5.74). ConclusionDaily prophylaxis for recurrent UTI with 100 mg instead of 50 mg nitrofurantoin was associated with an equivalent hazard on UTI or pyelonephritis, and a higher hazard on cough, dyspnoea and nausea. We recommend 50 mg nitrofurantoin as daily prophylaxis.

Lowering Standards to Wed? Spouse Quality, Marriage, and Labor Market Responses to the Gender Wage Gap

Abstract This paper examines the effect of the female-to-male wage ratio, “relative wage,” on women's spouse quality, marriage, and labor supply over three decades. Exploiting task-based demand shifts as a shock to relative pay, I find that a higher relative wage (a) increases the quality of women's mates, as measured by higher spousal education; (b) reduces marriage without substitution to cohabitation; and (c) raises women's hours of work. These effects are consistent with a model in which a higher relative wage increases the minimum nonpecuniary benefits (“quality”) women require from a spouse and therefore reduce marriage among low-quality husbands.

The opportunity costs of birth in Australia: Hospital resource savings for a post-COVID-19 era.

BackgroundCOVID‐19 caused significant disruptions to health systems globally; however, restricting the family presence during birth saw an increase in women considering community birth options. This study aimed to quantify the hospital resource savings that could occur if all low‐risk women in Australia gave birth at home or in birth centers.MethodsA whole‐of‐population linked administrative data set containing all women (n = 44 498) who gave birth in Queensland, Australia, between 01/07/2012 and 30/06/2015 was reweighted to represent all Australian women giving birth in 2017. A static microsimulation model of woman and infant health service resource use was created based on 2017 data. The model was comprised of a base model, representing "current" care, and a counterfactual model, representing hypothetical scenarios where all low‐risk Australian women gave birth at home or in birth centers.ResultsIf all low‐risk women gave birth at home in 2017, cesarean rates would have reduced from 13.4% to 2.7%. Similarly, there would have been 860 fewer inpatient bed days and 10.1 fewer hours of women's intensive care unit time per 1000 births. If all women gave birth in birth centers, cesarean rates would have reduced to 6.7%. In addition, over 760 inpatient bed days would have been saved along with 5.6 hours of women's intensive care unit time per 1000 births.ConclusionsSignificant health resource savings could occur by shifting low‐risk births from hospitals to home birth and birth center services. Greater examination of Australian women's preferences for home birth and birth center birth models of care is needed.

Outcomes of Expectant Management of Term Prelabor Rupture of Membranes

ObjectiveTo assess rates of induction/augmentation of labor, maternal infection, neonatal outcomes, and time to birth when women were expectantly managed after term prelabor rupture of membranes (PROM) at home or in the hospital. DesignRetrospective, descriptive study based on a review of data from a hospital midwifery service database and chart review. SettingA large Midwest hospital with 4,700 births annually. ParticipantsWe used the cases of women who received midwifery care, experienced term PROM, and had singleton fetuses in the vertex position. MethodsWe conducted an analysis of maternal and neonatal outcomes with term PROM using data from a midwifery service quality improvement database. We compared characteristics and outcomes between management plans (immediate induction, expectant hospital, and expectant home) using chi-square, analysis of variance, and independent t-tests. ResultsPROM occurred in 281 (12%) of the 2,357 women cared for by the midwifery service between January 2016 and December 2018. One hundred fifty women (53.3%) opted to wait for labor onset at home, 102 (36.3%) were expectantly managed in the hospital, 21 (7.5%) were admitted for immediate induction of labor, and 8 (2.8%) were admitted for immediate cesarean birth. The rate of spontaneous labor onset was not significantly different between the two expectant management groups or between nulliparous and multiparous women. A total of 88 (34.9%) women who were expectantly managed ultimately had their labors induced. Rates of chorioamnionitis and endometritis were not significantly different between the expectant management groups in this study or compared with national averages. There was no difference in NICU admissions or Apgar scores below 7. The mean time from PROM to birth was significantly shorter in the expectant management in hospital group (27.3 hours) than in the expectant management at home group (33.5 hours). ConclusionExpectant management at home or in the hospital is appropriate for low-risk pregnant women with term PROM. Women for whom this option is appropriate include those with term singleton fetuses in vertex presentation with reassuring fetal heart rates and confirmed clear amniotic fluid. Acceptable time frames for home management include up to 24 hours for women with negative group B streptococcus cultures and up to 12 hours for those with positive cultures.

Determinants of Women’s Participation in Strategic Decision Making in 5-star Hotels in Nairobi City, Nairobi County, Kenya

Hotel, Catering and Tourism industry are among the leading sectors globally. Figures from World Tourism Organization show that the global hotel industry revenue is increasing every year. The research was conducted to explore the determinants of women’s contribution in strategic decision-making in 5-star Hotels in Nairobi City, Kenya. Precisely, the study investigated the influence of organizational factors in the hotel industry. The literature is pegged on the theories that relate to women’s involvement in strategic decision-making in hospitality and review other relevant studies. These theories are Upper Echelon Theory and Role Congruity Theory. Existing literature was reviewed and three hypotheses were tested. Descriptive survey design was used. The study targeted managers of 5-star Hotels in Nairobi City which comprised of 340 employees in managerial positions. A sample of 78 was chosen out of the population of 340 with a 95% confidence level. The research employed stratified random sampling technique to 340 respondents in 5-star Hotels. Respondents were selected using simple random sampling method. The research administered questionnaires to collect data and further analysis done. The study applied Karl Pearson’s product moment correlation analysis to determine the correlation of variables. Cronbach’s alpha was used to test for reliability, or internal consistency. Validity test was also done. Validity happens when the measures of a unit have high correlation. Data collection was done through open-ended questionnaires. Data presentation was done through tables. Study findings indicate organizational factors play key influence in this study. There was close relationship between women’s inclusion in leadership and all factors used in the study. This study enhanced the existing literature and the recommendations of the research will be useful to hospitality industry management as well as the government, hotel owners, management and hospitality training institutions. The study recommends policy makers in the hotel industry to make adjustments in the organizational structure to accommodate more women in leadership and make women-friendly corporate policies. The study recommends embracing of new strategies that aim at coming up with progressive ideas to address working hours for women in management positions, raise aspirations and confidence of women. The study recommends further research to be conducted on government’s efforts and challenges it faces to achieve gender equity in hospitality industry management.

Incidence of Acute Hamstring Injuries in Soccer: A Systematic Review of 13 Studies Involving More Than 3800 Athletes With 2 Million Sport Exposure Hours.

To estimate the incidence and recurrence rates of acute hamstring injuries in all levels of soccer. Epidemiology systematic review. We searched the PubMed (including MEDLINE), CINAHL, SPORTDiscus, Embase, and Cochrane Central Register of Controlled Trials electronic databases. We included prospective studies of all levels of adult soccer players that registered acute hamstring injuries and provided a description of incidence of acute hamstring injuries per 1000 playing hours (or available data to calculate this). Due to heterogeneity, we synthesized the data descriptively. Thirteen studies including 3868 players met the inclusion criteria. Two of 13 included studies reported on hamstring injuries in women, and all reported the same in men. The incidence of acute hamstring injury ranged from 0.3 to 0.5 per 1000 exposure hours in women and 0.3 to 1.9 per 1000 exposure hours in men. Hamstring injuries accounted for 5% to 15% of all soccer-related injuries. Hamstring injury recurrence rates ranged from 4% to 68%, depending on the injury definition. Certainty of evidence ranged from moderate to very low. The incidence of acute hamstring injury in soccer was 0.3 to 1.9 per 1000 exposure hours. The recurrence rate was 4% to 68%. The strength of the evidence was limited by a lack of methodological rigor, the use of varying definitions for acute hamstring injury, and heterogeneous methods of reporting on acute hamstring injuries. J Orthop Sports Phys Ther 2021;51(1):27-36. Epub 11 Dec 2020. doi:10.2519/jospt.2021.9305.

Do you have time to take a walk together? Private and joint time within the household

AbstractWe develop a theoretical model for the intra-household allocation of time and consumption that distinguishes between partners’ joint and private leisure. Estimating the model using time-use data leads to five findings. First, the intra-household expenditure distribution correlates with relative wages, consistent with the collective model. Second, men put relatively more weight on private expenditure and composite leisure. Third, joint and private leisure are imperfect substitutes. Fourth, joint and private leisure are independent of the wage distribution, suggesting that togetherness does not substitute for economic factors. Fifth, higher female wages imply higher childcare hours for women, but lower for men.

In Response.

We would like to thank Professor Steer1 for his letter in response to our editorial regarding epidural-related maternal fever (ERMF).2 He quite rightly points out that there is indeed an association between incidence of ERMF and duration of epidural local anesthetic infusion. The majority of studies have reported the development of ERMF within 6 hours of onset of labor epidural analgesia.3 This time appears to be consistent with the recently described immunomodulatory effects, which are likely to occur in relation to local anesthetic–mediated changes.4,5 However, we believe the association between duration of local anesthetic infusion is a relatively minor contributor to the incidence of ERMF, compared to the presence or absence of epidural analgesia itself. There is likely to be some difference in temperature (and therefore ERMF incidence) between patients experiencing exposure times of 8 vs 12 hours of labor epidural analgesia, for example. However, the greatest determinant of development of ERMF still remains the use or absence of labor epidural analgesia utilization. For example, using data from the original article describing ERMF by Fusi et al,6 the difference in temperature between 8 and 12 hours in women receiving labor epidural analgesia was 0.5°C (37.3°C vs 37.8°C).6 However, the greatest difference was still seen between the nonepidural and epidural groups at each time point (0.7°C at 8 hours and 1.1°C at 12 hours). Similarly, in a large randomized controlled trial of early versus late epidural initiation, Wang et al7 found no difference in temperature in the 2 groups, despite large differences in epidural exposure (4.8 vs 12.6 hours).7 Therefore, we would like to acknowledge the relationship between duration of labor epidural infusion and ERMF; however, the greatest determinant remains the presence or absence of labor epidural usage when used for durations in the clinical setting. Pervez Sultan, MBChB, FRCA, MD (Res)Department of Anesthesiology, Perioperative and Pain MedicineStanford University School of MedicineStanford, California Scott Segal, MDDepartment of AnesthesiologyWake Forest University School of MedicineWinston-Salem, North Carolina

Formal and informal care received by middle-aged and older adults with chronic conditions in Canada: CLSA data.

Middle-aged and older adults are more likely to suffer from chronic conditions, which can increase their need for both formal and informal care. This study seeks to assess and compare the extent to which the use of formal and informal care is attributed to different chronic conditions among middle-aged and older women and men in Canada. We used baseline data from the Canadian Longitudinal Study on Aging (CLSA). Outcomes of interest were the number of hours of formal care and informal care received during the past 12 months. All chronic conditions were first classified according to existing classification frameworks. If total formal and informal care hours for a particular condition differed greatly from other conditions, we considered it as a stand-alone classification. We used a two-part model consisting of a logistic regression for the probability of receiving formal/informal care and a generalized linear model for the hours of formal/informal care for those who received care. Our final analytic sample was 23,206 women and 22,903 men who did not have missing data. Among the 16 chronic conditions considered, multiple sclerosis, memory problems, Parkinsonism, and stroke had the greatest average marginal effects on overall hours of formal care among women (53.07, 13.95, 9.13 and 8.14 incremental hours annually, respectively) and men (152.17, 8.13, 13.95 and 6.00 incremental hours). Similarly, the average marginal effects of these four conditions on informal care were the greatest (77.78, 29.52, 26.18 and 34.95 incremental hours for women and 133.94, 34.99, 104.86 and 17.85 incremental hours for men). Chronic conditions, especially multiple sclerosis, Parkinsonism, memory problems, and stroke, are associated with substantial time of formal and informal care in middle-aged and older women and men. Findings will help decision-makers assess the potential impact of chronic disease prevention and management programs in an aging population.

Short-Term Effect of COVID-19 on Self-Employed Workers in Canada.

Using the Canadian Labour Force Survey, we document the short-term impact of coronavirus disease 2019 (COVID-19) on self-employed individuals in Canada, whom we interpret as small business owners. We document an important decrease in business ownership between February 2020 and May 2020 (−14.8 percent for incorporated and −10.1 percent for unincorporated entities). We find a substantial decrease in ownership and aggregate hours for women, immigrants, and less educated people over the same period. The occupational categories with the largest decrease are in art, culture, and recreation (−14.8 percent); in education, law, and social, community, and government services (−13.6 percent); and in sales and service occupations (−12.8 percent).

The accommodation of Muslim body practices in German public swimming pools

ABSTRACT The renegotiation of secularity for Muslims has reached sports facilities such as swimming pools, where the human body is central and an element of cross-cultural contestation. The present study identifies factors that could explain intra-organizational variations in religious accommodation. Data from a survey of geo-located swimming pools in Germany (n = 339) shows that conflict among users becomes more likely if the variation in body practices, the share of right-wing populist votes and the population of immigrant background increases. On the organizational level, we find that 75 per cent of the pools in our sample allow the burqini while only 10 per cent provide separate swimming hours for women. Higher shares of right-wing populist (and to a lesser extent of conservative) votes in the organization’s environment correlate with a higher likelihood of burqini bans. Our findings suggest that the relationship between organizational change and citizens’ attitudes is loose at best.

Alcohol use in pregnancy and its impact on the mother and child.

To review the impact of prenatal alcohol exposure on the outcomes of the mother and child. Narrative review. Review of literature. Mothers and infants affected by prenatal alcohol use. Outcomes of mothers and children. Prenatal alcohol exposure is one of the most important causes of preventable cognitive impairment in the world. The developing neurological system is exquisitely sensitive to harm from alcohol and there is now also substantial evidence that alcohol-related harm can extend beyond the individual person, leading to epigenetic changes and intergenerational vulnerability and disadvantage. There is no known safe level or timing of drinking for pregnant or lactating women and binge drinking (> four drinks within 2 hours for women) is the most harmful. Alcohol-exposure increases the risk of congenital problems, including Fetal Alcohol Spectrum Disorder (FASD) and its most severe form, Fetal Alcohol Syndrome (FAS). The impact of FASD and FAS is enduring and life-long with no current treatment or cure. Emerging therapeutic options may mitigate the worst impact of alcohol exposure but significant knowledge gaps remain. This review discusses the history, epidemiology and clinical presentations of prenatal alcohol exposure, focusing on FASD and FAS, and the impact of evidence on future research, practice and policy directions.

Abstract A116: Occupational disparities in women’s employment after cancer

Abstract Background: Due to advances in early diagnosis and treatment, the population of working-age cancer survivor population has grown. However, few studies have examined long-term (10+ years) employment outcomes after treatment. We evaluated the impact of cancer on employment outcomes among women enrolled in the Health and Retirement Study (HRS), a nationally representative panel of non-institutionalized adults aged 51 and older in the United States Methods: Data came from nine waves of the HRS (1998-2014) (n = 7,088; Observations = 26,355). We conducted two sets of analyses: The first set of analyses examined the impact of cancer on employment status and the second set of analyses examined the impact of cancer on the number of work hours for women who were working full time (≥ 35 hours per typical work week) at baseline. For the analysis of employment status, we used a random intercept logistic regression in a multi-level growth curve framework to analyze change over time in likelihood of employment. For the analysis of hours of work per week, we used a mixed-effects coefficient regression to assess work hours trajectories in relation to cancer. Results: There were 7,088 working-age (51-64 years) women in the study sample. Approximately 7% (n=483) of the sample were cancer survivors, with a mean number of years since diagnosis of 9 years. After controlling for sociodemographic and health factors, women who were 6-10 year cancer survivors had a 2.3 times greater likelihood of being employed over time than women without a history of cancer; however, if these women had professional jobs, they were less likely to work over time (OR = 0.4) than professional women without a history of cancer. Long-term (10+ year) cancer survivors in professional occupations tended to work less hours per week at baseline (-4.1 hours) and over time (-2.4 hours) than professional women who without a history of cancer. Conclusions: Professional women may be vulnerable to job loss after cancer treatment. Identifying factors associated with continued employment for women will be key to developing strategies to promoting quality survivorship in the growing cancer survivor population. Citation Format: Christine Ekenga, Eunsun Kwon, BoRin Kim, Sojung Park. Occupational disparities in women’s employment after cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A116.

Double-Balloon Device for 6 Compared With 12 Hours for Cervical Ripening: A Randomized Controlled Trial.

To evaluate whether removal of a double-balloon device for cervical ripening for 6 compared with 12 hours in women with an unfavorable cervix will result in a shorter time to delivery, similar cervical ripening, and without affecting cesarean delivery rate. In a prospective randomized trial, cervical ripening was performed using a double-balloon device. Women were randomized to removal of the device after 6 compared with 12 hours. Primary outcome was time to delivery. Secondary outcomes included mode of delivery, Bishop score, and maternal and neonatal adverse outcomes. A sample size of 100 nulliparous and 100 parous women was required assuming a 95% CI, power of 80%, and mean decrease of 6 hours to delivery between the groups. From March 2017 through February 2019, 688 women were screened, 243 were found eligible, and 197 were randomized as follows: nulliparous cohort (n=101): removal after 6 hours (n=48) compared with removal after 12 hours (n=53); parous cohort (n=96): removal after 6 hours (n=49) compared with removal after 12 hours (n=47). Insertion-to-delivery interval was significantly shorter in the 6-hour group for both nulliparous (25.6±12.8 hours vs 31.4±15.2 hours, P<.04; mean difference 5.8, 95% CI 0.2-11.3), and parous cohorts (18.0±6.8 hours vs 22.6±8.2 hours, P=.003; mean difference 4.7, 95% CI 1.6-7.7). Bishop score change and cesarean delivery rate were similar between groups regardless of parity. The 12-hour group in the combined cohort was associated with higher rates of maternal intrapartum fever (2% vs 10%, P=.02; odds ratio 5.3, 95% CI 1.1-24.8). Insertion-to-delivery interval is shorter after 6 compared with 12 hours for both nulliparous and parous women. Cervical ripening with a double-balloon device may be achieved in 6 hours. The longer time was associated with a higher rate of intrapartum fever. Six hours should be considered as standard placement time for double-balloon catheters. ClinicalTrials.gov, NCT03045939.