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Funeral workers (FWs) work within increasingly medicalized and commodified death-management systems. This study explored Worker Health and Safety (WHS) impacts in contemporary death management on Australian and Irish FWs. Mixed methods combined a survey and interviews. Survey data were descriptively summarized, interviews thematically analyzed, and a schematic systems model developed of the combined results. Survey participants (n = 45) reported psychosocial hazards from work pressures, competition, and fatigue. Psychosocial hazards were more frequently reported than physical hazards by Australian FWs. Physical hazards were of greater concern to Irish FWs. Themes from 11 interviews were: Personal Attributes, Work Demands, and Socio-Cultural Context. All FWs reported conflicts between individual capacities, work demands, and resources, resulting in hazardous personal states including difficulty sleeping and stress. Respectfully manually handling human remains and "event management" demands for increasingly elaborate funerals created negative WHS impacts. This research informs risk management for FWs and other workers in the increasingly complex death-care industry. [ABSTRACT FROM AUTHOR]

Purpose: Short umbilical cords are associated with adverse perinatal outcomes. Clinicians may rely on measurements made by pathologists, which do not include portions of the cord remaining n the child or sent for blood gasses. Methods: This was a retrospective chart review of term placentas. Sequential cases from January through August 2017 were reviewed from the Pathology archive. Results: 198 placentas were recorded as either third trimester of mature, of which 146 were 37 or greater weeks of gestation. Of these 146, 142 had cords measuring less than 35 cm, the definition of short. Mean cord length was 19.6 cm. Of the 146 placentas, 50(34%) had had blood gases submitted. Conclusions: 34% of short cords by Pathology measurement had had blood gases sent. The fact that 142 out of 146 sequential placentas were recorded as "short" suggests an additional unmeasured loss of length due to cord attached to the infant. Pathology laboratory measurements should not be interpreted as truly short without clinical correlation. [ABSTRACT FROM AUTHOR]

Workers employed in clinical healthcare settings often encounter dying and death of patients as a part of their role. This scoping review aimed to explore the physical and psychosocial OHS impacts on health workers exposed to death within their occupational role and their inherent coping strategies. Six electronic databases PsycINFO (Ovid), Medline (Ovid), AMED (EBSCO), CINAHL (EBSCO), and Proquest Social Sciences were searched for peer reviewed research articles published between March 1971 and April 2022. PRISMA-ScR guidelines were followed. Three authors independently assessed articles for inclusion. Fifty-three studies with focus settings in hospitals, hospice, general practice and residential care were identified. Five main themes were developed and organized using and ergonomic systems approach: Cultural Environment, Workplace, Job Demands, Impacts and Coping. The findings demonstrate that caring for dying patients, the dead and their families in clinical settings impacts workers emotionally, physically, behaviorally and spiritually. [ABSTRACT FROM AUTHOR]

Abstract: Background: The study was conducted to evaluate the effect of perioperative ketorolac on pain associated with first-trimester aspiration abortion. Study Design: A double-blind, randomized, placebo-controlled trial was performed involving pregnant women up to 14 weeks'' gestation who desired pregnancy termination. Subjects were randomized to receive ketorolac 30 mg intravenously (n=31) or placebo (n=45) at the time of induction of anesthesia. Postoperative pain was assessed using a visual analog scale (VAS). The primary outcome was pain control as determined by VAS score. Secondary measures of patient use of supplemental postoperative pain medications and patient satisfaction were assessed. Results: Subjects in the ketorolac group had lower postoperative pain scores on the VAS at all time points compared to the placebo group, but the difference was not statistically significant. The ketorolac group used less postoperative acetaminophen compared to the placebo group (6.5% versus 35.6%), respectively. Subjects in the placebo group and the ketorolac group had similar requirements for postoperative narcotics in the recovery room (22.2% versus 19.4%). Patient satisfaction with pain level was equivalent between the groups at all postoperative end points. There was no observed difference in perioperative blood loss observed between the two groups. Conclusion: Perioperative ketorolac has the same effect on postoperative pain as determined by VAS as placebo. The use of ketorolac at the 30-mg dose cannot be recommended for better pain control for patients undergoing first-trimester pregnancy termination by suction curettage. The only positive effect of the use of ketorolac compared to placebo was a reduction in the use of acetaminophen. Ketorolac use does not appear to change blood loss in the operating room or through postoperative day 1 compared to placebo. [Copyright &y& Elsevier]

Purpose . To determine what advice general practitioners (GPs) are giving on the health benefits of over‐the‐counter probiotics. Design . A web‐based questionnaire. Materials and methods . The questionnaire was posted on the website for the Southwest Thames Faculty of the Royal College of General Practitioners and letters were sent to all Surrey GPs, inviting them to take part. The questionnaire included a variety of clinical scenarios in which probiotic advice might be appropriate. Results . There was a 16.6% response rate. The value of taking probiotics with and after antibiotics was featured in one question and 72% of GPs were aware that this reduces the incidence of diarrhoea. Thirteen clinical scenarios were included in the questionnaire. Six scenarios involved patients taking antibiotics for various types of infection and seven scenarios described other conditions in which probiotic benefits have been claimed. GPs varied in their experience and opinion as to whether advice to take a probiotic would be appropriate in these scenarios, with the choice of the option ‘frequently advise’ varying from 63% (recurrent vaginal candidiasis) to 1% (to reduce the risk of bowel and bladder cancer). The first four questions were tested on a sample of 40 non‐responders who gave similar responses but a smaller bias in favour of probiotic advice. Conclusions . Although this survey was probably biased in favour of giving probiotic advice, the >50% response to the idea of giving probiotics with at least some clinical scenarios suggests that the idea of advising probiotics, when appropriate, has reached the tipping point in general practice. [ABSTRACT FROM AUTHOR]

Background: Women with enlarged leiomyomatous uteri often have limited options for termination of pregnancy (TOP) and are referred to tertiary-care centers for management. This article presents a unique surgical approach to TOP in such women that has not been previously described in the literature. Case: A 35-year-old gravida 6, para 2032, at 9 weeks and 3 days of pregnancy, presented with a 30-week-sized leiomyomatous uterus displacing the pregnancy to the fundus with distortion of the cervix and endometrial cavity. This patient desired future fertility and declined medical management of her condition. She underwent a transfundal suction curettage via laparotomy at 13 weeks and 2 days of her pregnancy. Results: The patient's estimated blood loss was 300 cc. She had an uncomplicated postoperative course and underwent a myomectomy 12 weeks after a surgical abortion. Conclusions: A literature review revealed several case reports of medical management, and 1 reported use of an endotracheal tube for surgical termination. However, no other reports were found to guide surgical management in women with enlarged leiomyomatous uteri. When conventional suction curettage or dilation and extraction are not technically feasible in pregnant women, due to distortion of the cervix and endometrial cavity secondary to the leiomyomas, transfundal suction curettage via laparotomy may be considered. This approach is an alternative to medical management in women with enlarged leiomyomatous uteri who desire termination of their pregnancies. [ABSTRACT FROM AUTHOR]

The article describes the case of a 37-year-old woman who was diagnosed with pulmonary alveolar proteinosis (PAP) in March 2013. Topics covered include the symptoms experienced by the patient including worsening dyspnoea, fatigue, insomnia and generalized body pains, the classifications of PAP, and the medical examinations performed including transbronchial biopsy and chest radiograph.

Depot medroxyprogesterone acetate (Depo-Provera) has been associated with an increased risk of HIV acquisition. In a longitudinal study, we investigated the impact of Depo-Provera use by healthy women on expression of immune markers for HIV preference and on HIV infection ex vivo at baseline (visit 1), one month (visit 2) and three months (visit 3) after Depo-Provera treatment. We found a significant increase in the frequency and expression of integrin α4β7 on CD4+ T cells at visit 2. Interestingly, Hispanic but not black women exhibited a significant increase in integrin α4β7 cell numbers and expression levels at visit 2, whereas, black but not Hispanic women exhibited a significant change in CCR5 and CD38 expression levels between visit 2 and visit 3. The frequency of terminal effector memory CD4 + T cells decreased significantly in black women from visit 1 to visit 3. Virus production following ex vivo HIV infection of PBMCs was increased at visit 3 compared to visit 1. In black women, the frequency of HIV p24 + CD4 + T cells was higher at visit 3 than at visit 1. Expression of integrin α4β7 on HIV p24 + CD4 + T cells following ex vivo infection at visit 2 was significantly less than at visit 1. These results demonstrate that Depo-Provera alters the immune profile of peripheral CD4 + T cells and increases susceptibility to HIV infection ex vivo. The observation that these effects differed between women of different ethnicities has implications for developing effective and targeted strategies for HIV prevention., Competing Interests: The authors have declared that no conflict of interest exists.

Review: This research had institutional review board approval from the University of Medicine and Dentistry of New Jersey and the State of New Jersey Department of Health and Senior Services. IRB #0120110286 BACKGROUND: The death rate during the first year of life, or infant mortality rate (IMR), is a key indicator of a nation's health. Many factors affect IMR in the United States, including race and ethnicity. The 2020 U.S. Healthy People IMR target goal has been revised to 6.0 deaths per 1,000 births. In 2006, the IMR in New Jersey was 5.5 deaths per 1,000 births, ranging from 4.4 for Caucasians, to 11.5 for African Americans., Objective: This study is designed to determine whether IMRs vary by zip code in the greater Newark region and identify maternal/infant characteristics associated with elevated IMRs., Methods: A descriptive study was conducted using New Jersey Department of Health (NJDOH) birth certificate data and U.S. Census data by zip code in the greater Newark area. IMRs were analyzed by zip code and by characteristics of mothers and infants., Results: IMRs vary by zip code of residence. The lowest and highest IMRs were in zip codes 07105 and 07102, respectively, both located within the city of Newark. Maternal characteristics associated with high IMR, in multivariable analysis, include: lack of prenatal care, single marital status, and non-Hispanic black race. Demographic characteristics associated with high IMRs were: low mean household income and a large percentage of the population living below poverty level., Conclusions: Race/ethnicity, marital status, and zip code of residence show significant impact upon infant mortality. Poverty and race/ethnicity are associated with increased IMRs and track to ZIP code., (Copyright © 2016. Published by Elsevier Inc.)

Trichoepithelioma is a rare benign skin lesion arising from hair follicles. It most commonly arises on the face and scalp. It is exceptionally rare on the vulva. We present a case and review the literature.

Objective: To evaluate whether stillbirths with no explanation found at autopsy have thinner cords than live, gestational-age-matched controls., Study Design: Stillbirth autopsies performed at University Hospital, Newark, New Jersey, from January 1995 to October 2002 were reviewed. Cases with no explanation for the death at autopsy had their umbilical cord diameters compared to those in 3 groups of age-matched controls: stillbirths with an identifiable cause of death, liveborns with placentas submitted for pathology evaluation and liveborns from which the placentas were not submitted to pathology. Age-adjusted ANOVAs were performed for comparisons., Results: Of 181 autopsies performed during the review period, 21 cases (11.6%) provided no information at autopsy that would explain or contribute to an understanding of the death. There was no significant difference in cord diameters between either group ofstillbirths or the pathology-submitted controls. Third-trimester placentas from liveborns without placental submission to pathology had significantly greater cord diameters (p = 0.001)., Conclusion: This study does not support the theory that a cord accident or decreased umbilical blood flow resulting from a leaner umbilical cord can explain a significant number of stillbirths with no other findings at autopsy. However, it supports the literature in that leaner cords appear to be associated with a wide variety of adverse perinatal conditions.