13,926 results on '"Paediatrics and Reproductive Medicine"'
Search Results
2. Family conflict and less parental monitoring were associated with greater screen time in early adolescence
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Al‐shoaibi, Abubakr AA, Zamora, Gabriel, Chu, Jonathan, Patel, Khushi P, Ganson, Kyle T, Testa, Alexander, Jackson, Dylan B, Tapert, Susan F, Baker, Fiona C, and Nagata, Jason M
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Paediatrics ,Biomedical and Clinical Sciences ,Women's Health ,Pediatric ,Behavioral and Social Science ,adolescent ,digital technology ,family conflict ,parenting ,social media ,Paediatrics and Reproductive Medicine ,Pediatrics - Abstract
AimThe current study investigated the prospective relationships between parental monitoring, family conflict, and screen time across six screen time modalities in early adolescents in the USA.MethodsWe utilised prospective cohort data of children (ages 10-14 years) from the Adolescent Brain Cognitive Development (ABCD) Study (years baseline to Year 2 of follow-up; 2016-2020; N = 10 757). Adjusted coefficients (B) and 95% confidence intervals (CIs) were estimated using mixed-effect models with robust standard errors.ResultsA higher parental monitoring score was associated with less total screen time (B = -0.37, 95% CI -0.58, -0.16), with the strongest associations being with video games and YouTube videos. Conversely, a higher family conflict score was associated with more total screen time (B = 0.08, 95% CI 0.03, 0.12), with the strongest associations being with YouTube videos, video games, and watching television shows/movies in Years 1 and 2.ConclusionThe current study found that greater parental monitoring was associated with less screen time, while greater family conflict was linked to more screen time. These results may inform strategies to reduce screen time in adolescence, such as improving communication between parents and their children to strengthen family relationships.
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- 2024
3. An emerging link between lncRNAs and cancer sex dimorphism
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Naciri, Ikrame, Andrade-Ludena, Maria D, Yang, Ying, Kong, Mei, and Sun, Sha
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Genetics ,Cancer ,Women's Health ,Estrogen ,2.1 Biological and endogenous factors ,Reproductive health and childbirth ,Humans ,RNA ,Long Noncoding ,Sex Characteristics ,Neoplasms ,Female ,Male ,Epigenesis ,Genetic ,Animals ,Gene Expression Regulation ,Neoplastic ,Sex Chromosomes ,Complementary and Alternative Medicine ,Paediatrics and Reproductive Medicine ,Genetics & Heredity ,Reproductive medicine - Abstract
The prevalence and progression of cancer differ in males and females, and thus, sexual dimorphism in tumor development directly impacts clinical research and medicine. Long non-coding RNAs (lncRNAs) are increasingly recognized as important players in gene expression and various cellular processes, including cancer development and progression. In recent years, lncRNAs have been implicated in the differences observed in cancer incidence, progression, and treatment responses between men and women. Here, we present a brief overview of the current knowledge regarding the role of lncRNAs in cancer sex dimorphism, focusing on how they affect epigenetic processes in male and female mammalian cells. We discuss the potential mechanisms by which lncRNAs may contribute to sex differences in cancer, including transcriptional control of sex chromosomes, hormonal signaling pathways, and immune responses. We also propose strategies for studying lncRNA functions in cancer sex dimorphism. Furthermore, we emphasize the importance of considering sex as a biological variable in cancer research and the need to investigate the role lncRNAs play in mediating these sex differences. In summary, we highlight the emerging link between lncRNAs and cancer sex dimorphism and their potential as therapeutic targets.
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- 2024
4. Comparative efficacy of combined oral contraceptives and the levonorgestrel 52 mg IUD
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Creinin, Mitchell D, Brown, Jewel A, Rankin, Holly A, and Yazdani, Sheeva
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Prevention ,Contraception/Reproduction ,Reproductive health and childbirth ,Good Health and Well Being ,Adherence ,Combined oral contraceptives ,Contraception ,Efficacy ,Intrauterine device ,Levonorgestrel ,Paediatrics and Reproductive Medicine ,Obstetrics & Reproductive Medicine ,Reproductive medicine - Abstract
The relative risk of pregnancy with the levonorgestrel 52 mg IUD is 3 times lower than with optimal combined oral contraceptive use.
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- 2024
5. Concentrations of remdesivir and GS-441524 in human milk from lactating individuals diagnosed with COVID-19
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Bertrand, Kerri, Sepulveda, Yadira, Spiegel, Benjamin J, Best, Brookie M, Suhandynata, Raymond, Rossi, Steven, Chambers, Christina D, and Momper, Jeremiah D
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Paediatrics ,Biomedical and Clinical Sciences ,Pediatric ,Coronaviruses ,Infectious Diseases ,Nutrition ,Breastfeeding ,Lactation and Breast Milk ,Coronaviruses Therapeutics and Interventions ,Clinical Research ,Humans ,Milk ,Human ,Alanine ,Adenosine Monophosphate ,Female ,Lactation ,Antiviral Agents ,COVID-19 Drug Treatment ,SARS-CoV-2 ,COVID-19 ,Adult ,Infant ,Infant ,Newborn ,Adenosine ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Pediatrics - Abstract
ImpactFindings from this study provide further reassuring evidence that infant exposure through human milk received from lactating individuals who require treatment with remdesivir is negligible.
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- 2024
6. Social epidemiology of the Mediterranean-dietary approaches to stop hypertension intervention for neurodegenerative delay (MIND) diet among early adolescents: the Adolescent Brain Cognitive Development Study
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Nagata, Jason M, Bashir, Ammal, Weinstein, Shayna, Al-Shoaibi, Abubakr AA, Shao, Iris Yuefan, Ganson, Kyle T, Testa, Alexander, and Garber, Andrea K
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Paediatrics ,Biomedical and Clinical Sciences ,Behavioral and Social Science ,Women's Health ,Prevention ,Hypertension ,Minority Health ,Social Determinants of Health ,Pediatric ,Health Disparities ,Nutrition ,Humans ,Male ,Female ,Dietary Approaches To Stop Hypertension ,Child ,Diet ,Mediterranean ,Adolescent ,Cognition ,United States ,Socioeconomic Factors ,Hispanic or Latino ,Neurodegenerative Diseases ,Patient Compliance ,Black or African American ,Asian ,White ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Pediatrics - Abstract
BackgroundThe purpose of our study was to understand the relationship between sociodemographic factors and adherence to the MIND (Mediterranean-DASH [Dietary Approaches to Stop Hypertension] Intervention for Neurodegenerative Delay) diet in a demographically diverse national population-based sample of 9-12-year-olds in the US.MethodsWe analyzed data from the Adolescent Brain and Cognitive Development (ABCD) Study (Year 1, N = 8333). Multivariable linear regression analysis was used to identify associations between MIND diet score and sociodemographic factors, including race/ethnicity, household income, parent education level, age, sex, and sexual minority status.ResultsCompared to White adolescents, Latino adolescents showed the greatest adherence to the MIND diet. Boys had lower adherence to the MIND diet than girls. Lower household income was associated with lower adherence to the MIND diet. Older age was associated with lower adherence to the MIND diet. Sexual minorities had a lower adherence to the MIND diet when compared to their heterosexual counterparts.DiscussionFemale sex, Latino ethnicity, Asian and Black race, high household income, heterosexual sexual orientation, and younger age were associated with higher adherence to the MIND diet. These sociodemographic differences can inform targeted screening and counseling for clinicians and public health organizations among diverse adolescent populations.Impact statementSociodemographic disparities in diet quality have been documented, but none have explored adherence to the MIND (Mediterranean-DASH [Dietary Approaches to Stop Hypertension] Intervention for Neurodegenerative Delay) diet in early adolescence. In this demographically diverse sample of 9-12-year-old early adolescents in the U.S., we found notable and nuanced sociodemographic disparities in adherence to the MIND diet. Sociodemographic factors associated with higher adherence to the MIND diet included female sex, Latino ethnicity, high household income, heterosexual sexual orientation, and younger age.
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- 2024
7. Advancing Research on Mobile Screen Media and Young Children’s Cognitive Skills
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Choe, Daniel Ewon, Golden, Aubrey B, and Olwert, Madeline R
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Paediatrics ,Biomedical and Clinical Sciences ,child ,child development ,cognition ,language ,mobile applications ,preschool ,screen time ,self-control ,smartphone ,Paediatrics and Reproductive Medicine ,Pediatrics - Published
- 2024
8. Risk Prediction for Clonal Cytopenia: Multicenter Real-World Evidence.
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Xie, Zhuoer, Komrokji, Rami S, Al-Ali, Najla, Regelson, Alexandra, Geyer, Susan, Patel, Anand A, Saygin, Caner, Zeidan, Amer M, Bewersdorf, Jan Philipp, Mendez, Lourdes M, Kishtagari, Ashwin, Zeidner, Joshua F, Coombs, Catherine C, Madanat, Yazan F, Chung, Stephen S, Badar, Talha, Foran, James M, Desai, Pinkal, Tsai, Charlton, Griffiths, Elizabeth A, Al Malki, Monzr M, Amanam, Idoroenyi, Lai, Catherine, Deeg, H Joachim, Ades, Lionel, Arana-Yi, Cecilia, Osman, Afaf Eg, Dinner, Shira Naomi, Abaza, Yasmin, Taylor, Justin, Chandhok, Namrata S, Soong, Deborah, Brunner, Andrew M, Carraway, Hetty E, Singh, Abhay, Elena, Chiara, Ferrari, Jacqueline, Galli, Anna, Pozzi, Sara, Padron, Eric, Patnaik, Mrinal M, Malcovati, Luca, Savona, Michael R, and Al-Kali, Aref
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Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Paediatrics and Reproductive Medicine ,Immunology ,Biochemistry and cell biology ,Cardiovascular medicine and haematology ,Paediatrics - Abstract
Clonal cytopenia of undetermined significance (CCUS) represents a distinct disease entity characterized by myeloid-related somatic mutations with a variant allele fraction of ≥2% in individuals with unexplained cytopenia(s) but without a myeloid neoplasm (MN). Notably, CCUS carries a risk of progressing to MN, particularly in cases featuring high-risk mutations. Understanding CCUS requires dedicated studies to elucidate its risk factors and natural history. Our analysis of 357 CCUS patients investigated the interplay between clonality, cytopenia, and prognosis. Multivariate analysis identified 3 key adverse prognostic factors: the presence of splicing mutation(s) (score = 2 points), platelet count
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- 2024
9. Patient‐Provider Trust as a Key Component of Prenatal Screening for Adverse Childhood Experiences (ACES): A Concept Analysis
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Gilliland, Paige D, Phipps, Jennifer E, Derret, Breän, D'Souza, Indira, Ha, Stephanie, Patil, Shwetha, and Simmons, Leigh Ann
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Health Services and Systems ,Health Sciences ,Health Disparities ,Health Services ,Clinical Research ,Pediatric ,Health and social care services research ,8.1 Organisation and delivery of services ,Generic health relevance ,Good Health and Well Being ,adverse childhood experiences ,birth outcomes ,holistic midwifery practice ,patient-provider relationships ,prenatal care ,screening ,trust ,patient‐provider relationships ,Nursing ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Obstetrics & Reproductive Medicine ,Reproductive medicine ,Midwifery - Abstract
IntroductionThe concept of patient-provider trust in prenatal adverse childhood experiences (ACEs) screening remains unexplored. This concept analysis illuminates the role of trust in prenatal ACE screening to improve patient-provider relationships, increase patient uptake of ACE screening, and ensure that ACE screening is implemented in a strengths-based, trauma-informed way.MethodsA concept analysis was conducted using the Rodgers' evolutionary method to define the antecedents, attributes, and consequences of this construct. The databases searched were PubMed, PsychInfo, and Scopus between 2010 and 2021. A total of 389 articles were retrieved using the search terms prenatal, adverse childhood experiences screening, adverse childhood experiences, and adverse childhood experiences questionnaire. Included articles for detailed review contained prenatal screening, trauma screening (ACE or other), trust or building trust between patient and health care provider, patient engagement, and shared decision making. Excluded articles were those not in the context of prenatal care and that were exclusively about screening with no discussion about the patient-provider relationship or patient perspectives. A total of 32 articles were reviewed for this concept analysis.ResultsWe define trust in prenatal ACE screening as a network of evidence-based attributes that include the timing of the screening, patient familiarity with the health care provider, cultural competence, demystifying trauma, open dialogue between the patient and health care provider, and patient comfort and respect.DiscussionThis concept analysis elucidates the importance of ACE screening and provides suggestions for establishing trust in the context of prenatal ACE screening. Results give insight and general guidance for health care providers looking to implement ACE screening in a trauma-informed way. Further research is needed to evaluate pregnant patients' attitudes toward ACE screening and how a health care provider's trauma history might influence their care. More inquiry is needed to understand the racial, ethnic, and cultural barriers to ACE screening.
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- 2024
10. Screening and characterization of 133 physiologically-relevant environmental chemicals for reproductive toxicity
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Ulaganathan, Gurugowtham, Jiang, Hui, Canio, Noah, Oke, Ashwini, Armstrong, Sujit Silas, Abrahamsson, Dimitri, Varshavsky, Julia R, Lam, Juleen, Cooper, Courtney, Robinson, Joshua F, Fung, Jennifer C, Woodruff, Tracey J, and Allard, Patrick
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Pharmacology and Pharmaceutical Sciences ,Reproductive Medicine ,Biomedical and Clinical Sciences ,Genetics ,Contraception/Reproduction ,Caenorhabditis elegans ,Animals ,Reproduction ,Environmental Pollutants ,Toxicity Tests ,High-Throughput Screening Assays ,C. elegans ,Reproductive toxicity ,NAMs ,Alternative testing ,QACs ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Toxicology ,Pharmacology and pharmaceutical sciences ,Reproductive medicine - Abstract
Reproduction is a functional outcome that relies on complex cellular, tissue, and organ interactions that span the developmental period to adulthood. Thus, the assessment of its disruption by environmental chemicals would benefit significantly from scalable and innovative approaches to testing using functionally comparable reproductive models such as the nematode C. elegans. We adapted a previously described low-throughput in vivo chromosome segregation assay using C. elegans predictive of reproductive toxicity and leveraged available public data sources (ToxCast, ICE) to screen and characterize 133 physiologically-relevant chemicals in a high-throughput manner. The screening outcome was further validated in a second, independent in vivo assay assessing embryonic viability. In total, 13 chemicals were classified as reproductive toxicants with the two most active chemicals belonging to the large family of Quaternary Ammonium Compounds (QACs) commonly used as disinfectants but with limited available reproductive toxicity data. We compared the results from the C. elegans assay with ToxCast in vitro data compiled from 700+ cell response assays and 300+ signaling pathways-based assays. We did not observe a difference in the bioactivity or in the average potency (AC50) between the top and bottom chemicals. However, the intended target categories were significantly different between the classified chemicals with, in particular, an over-representation of steroid hormone targets for the high Z-score chemicals. Taken together, these results point to the value of in vivo models that scale to high-throughput level for reproductive toxicity assessment and to the need to prioritize the assessment of QACs impacts on reproduction.
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- 2024
11. Menstrual cup use and intrauterine device expulsion in a copper intrauterine device randomized trial
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Brown, Jill E, Creinin, Mitchell D, Wu, Hongsheng, Hubacher, David, Schreiber, Courtney A, Kaneshiro, Bliss, Nanda, Kavita, and Blithe, Diana L
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Contraception/Reproduction ,Prevention ,Clinical Trials and Supportive Activities ,Clinical Research ,Good Health and Well Being ,Humans ,Female ,Intrauterine Devices ,Copper ,Adult ,Intrauterine Device Expulsion ,Menstrual Hygiene Products ,Young Adult ,Logistic Models ,Copper IUD ,Expulsion ,Menstrual cup ,Nulliparas ,Randomized trial ,Clinical Sciences ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Obstetrics & Reproductive Medicine ,Clinical sciences ,Reproductive medicine ,Health services and systems - Abstract
ObjectiveTo evaluate menstrual cup use and intrauterine device (IUD) expulsion.Study designWe performed a secondary analysis of a 3-year contraceptive efficacy trial comparing two copper 380 mm2 IUDs. Investigators randomized participants approximately 1:4 to the TCu380A or NTCu380-Mini IUD. Approximately 12 months after enrollment began, we advised participants against menstrual cup use due to observed IUD expulsions in cup users. We evaluated IUD expulsion (including spontaneous partial and complete expulsion and accidental self-removal) at 12 and 36 months. We used multivariable logistic regression to evaluate IUD expulsion by age, baseline menstrual volume, body mass index, IUD type, menstrual cup use, parity, and uterine length.ResultsThis analysis included 1046 participants (203 TCu380A and 843 NTCu380-Mini), with 879 (84.0%) nulliparas. Through 12 and 36 months, expulsion occurred in 74 (7.1%, 95% CI 5.5-8.6%) and 133 (12.7%, 95% CI 10.7-14.7%) participants, respectively. Overall, 250 (23.9%) reported menstrual cup use. More menstrual cup users than non-users experienced expulsion through 12 months (32/203 [15.8%] vs. 42/843 [5.0%]) and 36 months (58/250 [23.2%] vs. 75/796 [9.4%]). Through 36 months, NTCu380-Mini menstrual cup users had higher expulsion odds, while TCu380A cup users did not. Menstrual cup users more frequently experienced accidental self-removal than non-users in participants using the TCu380A (3/53 [5.7%] vs. 0/150 [0.0%]) and the NTCu380-Mini (20/197 [10.2%] vs. 7/646 [1.1%]). In multivariable regression, we found increased odds of expulsion through 36 months in participants using menstrual cups with the NTCu380-Mini (aOR 3.13, 95% CI 1.16-8.46) and
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- 2024
12. Abortion Education for Medical Students in an Era of Increased Abortion Restrictions.
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French, Valerie A and Hou, Melody Y
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Quality Education ,Paediatrics and Reproductive Medicine ,Obstetrics & Reproductive Medicine ,Reproductive medicine - Abstract
Following the Supreme Court's decision in Dobbs v Jackson Women's Health in June 2022, many states restricted or banned abortion. Medical educators have focused on how this change impacts abortion training for residents, but schools must also adapt undergraduate medical education. Medical schools provide the foundation for future physicians' knowledge and attitudes on abortion. Comprehensive, high-quality abortion education for all medical students is essential for the future of abortion care. Here, we present how education champions can lead curricular improvements in abortion education in the preclinical, clerkship, and postclerkship phases of undergraduate medical education.
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- 2024
13. Survival disparities in non-Hispanic Black and White cervical cancer patients vary by histology and are largely explained by modifiable factors
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Kucera, Calen W, Chappell, Nicole P, Tian, Chunqiao, Richardson, Michael T, Tarney, Christopher M, Hamilton, Chad A, Chan, John K, Kapp, Daniel S, Leath, Charles A, Casablanca, Yovanni, Rojas, Christine, Sitler, Collin A, Wenzel, Lari, Klopp, Ann, Jones, Nathaniel L, Rocconi, Rodney P, Farley, John H, O'Connor, Timothy D, Shriver, Craig D, Bateman, Nicholas W, Conrads, Thomas P, Phippen, Neil T, Maxwell, G Larry, and Darcy, Kathleen M
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Biomedical and Clinical Sciences ,Oncology and Carcinogenesis ,Cancer ,Health Disparities ,Social Determinants of Health ,Clinical Research ,Cervical Cancer ,Minority Health ,Women's Health ,Humans ,Female ,Uterine Cervical Neoplasms ,White People ,Middle Aged ,Black or African American ,Aged ,Carcinoma ,Squamous Cell ,Adult ,Adenocarcinoma ,United States ,Healthcare Disparities ,Health Status Disparities ,Socioeconomic Factors ,Proportional Hazards Models ,Neoplasm Staging ,Cervical cancer ,Racial disparities ,Propensity score analysis ,Squamous cell carcinoma ,NCDB ,Paediatrics and Reproductive Medicine ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis ,Reproductive medicine - Abstract
PurposeWe investigated racial disparities in survival by histology in cervical cancer and examined the factors contributing to these disparities.MethodsNon-Hispanic Black and non-Hispanic White (hereafter known as Black and White) patients with stage I-IV cervical carcinoma diagnosed between 2004 and 2017 in the National Cancer Database were studied. Survival differences were compared using Cox modeling to estimate hazard ratio (HR) or adjusted HR (AHR) and 95% confidence interval (CI). The contribution of demographic, socioeconomic and clinical factors to the Black vs White differences in survival was estimated after applying propensity score weighting in patients with squamous cell carcinoma (SCC) or adenocarcinoma (AC).ResultsThis study included 10,111 Black and 43,252 White patients with cervical cancer. Black patients had worse survival than White cervical cancer patients (HR = 1.40, 95% CI = 1.35-1.45). Survival disparities between Black and White patients varied significantly by histology (HR = 1.20, 95% CI = 1.15-1.24 for SCC; HR = 2.32, 95% CI = 2.12-2.54 for AC, interaction p
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- 2024
14. Perinatal Outcomes during versus Prior to the COVID-19 Pandemic and the Role of Maternal Depression and Perceived Stress: A Report from the ECHO Program
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McKee, Kimberly S, Tang, Xiaodan, Tung, Irene, Wu, Guojing, Alshawabkeh, Akram N, Arizaga, Jessica A, Bastain, Theresa M, Brennan, Patricia A, Breton, Carrie V, Camargo, Carlos A, Cioffi, Camille C, Cordero, Jose F, Dabelea, Dana, Deutsch, Arielle R, Duarte, Cristiane S, Dunlop, Anne L, Elliott, Amy J, Ferrara, Assiamira, Karagas, Margaret R, Lester, Barry, McEvoy, Cindy T, Meeker, John, Neiderhiser, Jenae M, Herbstman, Julie, Trasande, Leonardo, O'Connor, Thomas G, Hipwell, Alison E, and Comstock, Sarah S
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Reproductive Medicine ,Midwifery ,Biomedical and Clinical Sciences ,Health Sciences ,Depression ,Perinatal Period - Conditions Originating in Perinatal Period ,Social Determinants of Health ,Conditions Affecting the Embryonic and Fetal Periods ,Infectious Diseases ,Minority Health ,Coronaviruses Disparities and At-Risk Populations ,Women's Health ,Health Disparities ,Maternal Health ,Coronaviruses ,Pediatric ,Brain Disorders ,Mental Illness ,Emerging Infectious Diseases ,Behavioral and Social Science ,Mental Health ,Clinical Research ,Pregnancy ,Maternal Morbidity and Mortality ,Reproductive health and childbirth ,Good Health and Well Being ,Humans ,Female ,COVID-19 ,Stress ,Psychological ,Adult ,Prenatal Care ,Pregnancy Outcome ,SARS-CoV-2 ,Pregnancy Complications ,Infant ,Newborn ,United States ,Gestational Age ,stress ,pregnancy ,perinatal ,birth weight ,gestational age ,program collaborators for Environmental influences on Child Health Outcomes ,Clinical Sciences ,Paediatrics and Reproductive Medicine ,Obstetrics & Reproductive Medicine ,Paediatrics ,Reproductive medicine - Abstract
ObjectiveWe sought to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on perinatal outcomes while accounting for maternal depression or perceived stress and to describe COVID-specific stressors, including changes in prenatal care, across specific time periods of the pandemic.Study designData of dyads from 41 cohorts from the National Institutes of Health Environmental influences on Child Health Outcomes Program (N = 2,983) were used to compare birth outcomes before and during the pandemic (n = 2,355), and a partially overlapping sample (n = 1,490) responded to a COVID-19 questionnaire. Psychosocial stress was defined using prenatal screening for depression and perceived stress. Propensity-score matching and general estimating equations with robust variance estimation were used to estimate the pandemic's effect on birth outcomes.ResultsSymptoms of depression and perceived stress during pregnancy were similar prior to and during the pandemic, with nearly 40% of participants reporting mild to severe stress, and 24% reporting mild depression to severe depression. Gestations were shorter during the pandemic (B = - 0.33 weeks, p = 0.025), and depression was significantly associated with shortened gestation (B = - 0.02 weeks, p = 0.015) after adjustment. Birth weights were similar (B = - 28.14 g, p = 0.568), but infants born during the pandemic had slightly larger birth weights for gestational age at delivery than those born before the pandemic (B = 0.15 z-score units, p = 0.041). More women who gave birth early in the pandemic reported being moderately or extremely distressed about changes to their prenatal care and delivery (45%) compared with those who delivered later in the pandemic. A majority (72%) reported somewhat to extremely negative views of the impact of COVID-19 on their life.ConclusionIn this national cohort, we detected no effect of COVID-19 on prenatal depression or perceived stress. However, experiencing the COVID-19 pandemic in pregnancy was associated with decreases in gestational age at birth, as well as distress about changes in prenatal care early in the pandemic.Key points· COVID-19 was associated with shortened gestations.. · Depression was associated with shortened gestations.. · However, stress during the pandemic remained unchanged.. · Most women reported negative impacts of the pandemic..
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- 2024
15. Associations of empirically derived dietary patterns and cognitive performance in older men: Results of the Osteoporotic Fractures in Men (MrOS) study
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Rogers-Soeder, Tara S, Patel, Sheena, Shikany, James M, Langsetmo, Lisa, Judd, Suzanne E, Ensrud, Kristine E, LeBlanc, Erin, Cauley, Jane A, Redline, Susan, Fink, Howard A, Lane, Nancy E, and Group, Osteoporotic Fractures in Men Study Research
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Public Health ,Biomedical and Clinical Sciences ,Nutrition and Dietetics ,Health Sciences ,Nutrition ,Brain Disorders ,Behavioral and Social Science ,Aging ,Dietary Supplements ,Prevention ,Osteoporotic Fractures in Men (MrOS) Study Research Group ,Cognition ,Dementia ,Dietary pattern ,Factor analysis ,Older men ,Clinical Sciences ,Paediatrics and Reproductive Medicine ,Obstetrics & Reproductive Medicine ,Biomedical and clinical sciences ,Health sciences - Abstract
ObjectiveThe aim of this study was to examine associations between empirically derived dietary pattern scores and cognition, as well as risk of cognitive decline, over an average of 4.6 (± 0.3) years in older men.Materials and methodsThis analysis was conducted as part of the Osteoporotic Fractures in Men (MrOS) prospective cohort study. Diet was assessed at Visit 1 (3/2000-4/2002) by food frequency questionnaire, and dietary patterns (Western and Prudent) were derived by factor analysis. The analytic cohort comprised 4231 community-dwelling American men who were aged 65 years or more. Cognitive function was assessed with the Modified Mini-Mental State exam (3MS) and the Trails B test at Visit 1 and at Visit 2 (3/2005-5/2006). Associations between dietary pattern score and cognition and risk of cognitive decline were estimated using mixed effects regression models. Model 1 was adjusted for age, clinic site and total energy intake (TEI). Model 2 was further adjusted for calcium and vitamin D supplement use, body mass index (BMI), physical activity, smoking, diabetes and hypertension (Western diet group) and education, calcium and vitamin D supplement use, depression, BMI, physical activity, smoking and stroke (Prudent diet group).ResultsAdherence to the Western dietary pattern was associated with higher 3MS scores and shorter Trails B test time at Visit 1 in Model 2. Adherence to the Prudent dietary pattern was associated with higher 3MS scores in Model 1 but not Model 2. There were no independent associations between dietary pattern scores and risk of cognitive decline 4.6 (± 0.3) years later at Visit 2.ConclusionThe results do not support a robust protective effect of the Prudent dietary pattern on cognition in the MrOS cohort. Associations between the Western dietary pattern and better cognitive scores should be interpreted with caution. Further research is needed to understand the complex interactions between dietary patterns and cognition in older men.
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- 2024
16. Associations Between Adverse Childhood Experiences and Early Adolescent Physical Activity in the United States
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Al-Shoaibi, Abubakr AA, Iyra, Puja, Raney, Julia H, Ganson, Kyle T, Dooley, Erin E, Testa, Alexander, Jackson, Dylan B, Gabriel, Kelley P, Baker, Fiona C, and Nagata, Jason M
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Paediatrics ,Biomedical and Clinical Sciences ,Prevention ,Clinical Research ,Pediatric ,Good Health and Well Being ,Humans ,Female ,Male ,Adverse Childhood Experiences ,Child ,Adolescent ,Exercise ,United States ,Child Abuse ,Linear Models ,Physical Abuse ,Divorce ,Cohort Studies ,Fitbit ,adolescents ,adverse childhood experiences ,physical activity ,Paediatrics and Reproductive Medicine ,Pediatrics - Abstract
ObjectiveTo determine the associations between the number of adverse childhood experiences (ACEs) and objectively-measured physical activity (PA) in a population-based, demographically diverse cohort of 9-14-year-olds and to determine which subtypes of ACEs were associated with physical activity levels.MethodsWe analyzed data (n = 7046) from the Adolescent Brain Cognitive Development (ABCD) Study 4.0 release at baseline and year 2 follow-up. ACE (cumulative score and subtypes) and physical activity (average Fitbit daily steps assessed at Year 2) were analyzed using linear regression analyses. Covariates included race and ethnicity, sex, household income, parent education, body mass index, study site, twins/siblings, and data collection period.ResultsAdjusted models suggest an inverse association between number of ACEs and Fitbit daily steps, with ≥4 (compared to 0) ACEs associated with 567 fewer daily steps (95% CI -902.2, -232.2). Of the ACEs subtypes, emotional abuse (B = -719.3, 95% CI -1430.8, -7.9), physical neglect (B = -423.7, 95% CI -752.8, -94.6), household mental illness (B = -317.1, 95% CI -488.3, -145.9), and household divorce or separation (B = -275.4, 95% CI -521.5, -29.2) were inversely and statistically significant associated with Fitbit daily steps after adjusting for confounders.ConclusionsOur results suggest that there is an inverse, dose-dependent relationship between cumulative number of ACEs and physical activity as measured by daily steps. This work highlights the importance of screening for ACEs among young people at an early age to help identify those who could benefit from interventions or community programs that support increased physical activity.
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- 2024
17. Co-Use of Tobacco Products and Cannabis Is Associated with Absenteeism and Lower Grades in California High School Students
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Dove, Melanie S, Tong, Elisa K, and Gee, Kevin A
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Paediatrics ,Biomedical and Clinical Sciences ,Drug Abuse (NIDA only) ,Tobacco ,Substance Misuse ,Cannabinoid Research ,Pediatric ,Good Health and Well Being ,Humans ,Absenteeism ,Adolescent ,California ,Male ,Female ,Students ,Marijuana Smoking ,Cross-Sectional Studies ,Schools ,Health Surveys ,Tobacco Products ,Human Movement and Sports Sciences ,Paediatrics and Reproductive Medicine ,Pediatrics - Abstract
ObjectiveTo examine the association between co-use of commercial tobacco product (hereafter referred to as tobacco) and cannabis with educational outcomes among high school students.Study designWe analyzed high school student data from the 2021-2022 California Healthy Kids Survey (n = 287 653). Current (past-month) or ever tobacco and cannabis use was categorized as co-use, only tobacco or cannabis, or neither. Two self-reported educational outcomes were examined: absenteeism and grades. Adjusted logistic and linear regression models were used to examine the association between tobacco/cannabis use and absenteeism or grades, respectively. Estimates were adjusted for individual, peer, and school covariates, and clustering within schools.ResultsCurrent co-use of tobacco and cannabis was more than double the use of only tobacco (3.7% vs 1.7%) and similar to only cannabis (3.7%). Almost 18% of students reported absenteeism. Compared with students who used neither substance, students with current co-use had greater odds of absenteeism (aOR 1.41, 95% CI 1.33-1.49) and lower grades (β = -0.87, 95% CI -0.92 to -0.82). Compared with students using tobacco alone, students with co-use also had a significant elevated odds of absenteeism (aOR 1.19, 95% CI 1.10-1.29) and lower grades (β = -0.39, 95% CI -0.46 to -0.32). Similar results were found for students who ever used tobacco and cannabis.ConclusionsCalifornia youth who co-use tobacco and cannabis were most likely to have absenteeism and lower grades. Comprehensive efforts to prevent or reduce youth substance use may improve educational outcomes.
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- 2024
18. Understanding the mechanical behavior of intrauterine devices during simulated removal
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La Saponara, Valeria, Wan, Shuhao, Nagarkar, Bhagyashree, Zwain, Faress, and Creinin, Mitchell D
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Female ,Humans ,Intrauterine Devices ,Copper ,Intrauterine Devices ,Levonorgestrel ,Uterus ,Device Removal ,Force ,Fracture ,Intrauterine device ,Strain ,Stress ,Clinical Sciences ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Obstetrics & Reproductive Medicine ,Clinical sciences ,Reproductive medicine ,Health services and systems - Abstract
ObjectiveTo evaluate differences based on intrauterine device (IUD) frame geometry in force, and stress, and strain at the stem/arms junction during simulated IUD removal.Study designWe manufactured injection-molded frame models for three Nova-T IUDs (Mirena [model M]; Liletta [model L]; Kyleena [model K]) and a Tatum-T IUD (Paragard [model P]) at two-times scaling. We created a custom fixture to simulate the uterus and used a screw-driven machine to pull models at various displacement rates through the 10 cm fixture cavity to measure force and strain and calculate stress at the IUD stem/arms junction. We tested models at 30 mm/min and higher displacement rates for exploratory analyses. We used Mann-Whitney U test for statistical testing.ResultsWe completed testing at 30 mm/min using five of each Nova-T model and nine model P samples. Resistance against the cavity walls created significantly more force on model P (11.83, interquartile range [IQR] 11.61-12.31) than any Nova-T model samples (p
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- 2024
19. Maternal Epidemiology of Brachial Plexus Birth Injuries in California: 1996 to 2012
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Manske, Mary Claire B, Wilson, Machelle D, Wise, Barton L, Melnikow, Joy, Hedriana, Herman L, James, Michelle A, and Tancredi, Daniel J
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Biomedical and Clinical Sciences ,Midwifery ,Public Health ,Health Sciences ,Reproductive Medicine ,Health Disparities ,Pediatric ,Minority Health ,2.4 Surveillance and distribution ,Good Health and Well Being ,Adult ,Female ,Humans ,Infant ,Newborn ,Male ,Pregnancy ,Young Adult ,Birth Injuries ,Brachial Plexus ,California ,Hispanic or Latino ,Incidence ,Logistic Models ,Maternal Age ,Multivariate Analysis ,Retrospective Studies ,Risk Factors ,Black or African American ,brachial plexus birth injury ,epidemiology ,maternal demographic characteristics ,perinatal outcomes ,health disparities ,Clinical Sciences ,Paediatrics and Reproductive Medicine ,Obstetrics & Reproductive Medicine ,Paediatrics ,Reproductive medicine - Abstract
ObjectiveThis study aimed to evaluate the incidence of brachial plexus birth injury (BPBI) and its associations with maternal demographic factors. Additionally, we sought to determine whether longitudinal changes in BPBI incidence differed by maternal demographics.Study designWe conducted a retrospective cohort study of over 8 million maternal-infant pairs using California's Office of Statewide Health Planning and Development Linked Birth Files from 1991 to 2012. Descriptive statistics were used to determine BPBI incidence and the prevalence of maternal demographic factors (race, ethnicity, age). Multivariable logistic regression was used to determine associations of year, maternal race, ethnicity, and age with BPBI. Excess population-level risk associated with these characteristics was determined by calculating population attributable fractions.ResultsThe incidence of BPBI between 1991 and 2012 was 1.28 per 1,000 live births, with peak incidence of 1.84 per 1,000 in 1998 and low of 0.9 per 1,000 in 2008. Incidence varied by demographic group, with infants of Black (1.78 per 1,000) and Hispanic (1.34 per 1,000) mothers having higher incidences compared with White (1.25 per 1,000), Asian (0.8 per 1,000), Native American (1.29 per 1,000), other race (1.35 per 1,000), and non-Hispanic (1.15 per 1,000) mothers. After controlling for delivery method, macrosomia, shoulder dystocia, and year, infants of Black (adjusted odds ratio [AOR] = 1.88, 95% confidence interval [CI] = 1.70, 2.08), Hispanic (AOR = 1.25, 95% CI = 1.18, 1.32), and advanced-age mothers (AOR = 1.16, 95% CI = 1.09, 1.25) were at increased risk. Disparities in risk experienced by Black, Hispanic, and advanced-age mothers contributed to a 5, 10, and 2% excess risk at the population level, respectively. Longitudinal trends in incidence did not vary among demographic groups. Population-level changes in maternal demographics did not explain changes in incidence over time.ConclusionAlthough BPBI incidence has decreased in California, demographic disparities exist. Infants of Black, Hispanic, and advanced-age mothers are at increased BPBI risk compared with White, non-Hispanic, and younger mothers.Key points· The incidence of BPBI has decreased over time.. · Demographic disparities in BPBI incidence and risk exist.. · Infants of Black, Hispanic, and advanced age mothers are at greatest risk of BPBI..
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- 2024
20. Current Postlaunch Implementation of State Mandates of Newborn Screening for Critical Congenital Heart Disease by Pulse Oximetry in U.S. States and Hospitals
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Sakai-Bizmark, Rie, Chang, Ruey-Kang R, Martin, Gerard R, Hom, Lisa A, Marr, Emily H, Ko, Jamie, Goff, Donna A, Mena, Laurie A, von Kohler, Connie, Bedel, Lauren EM, Murillo, Mary, Estevez, Dennys, and Hays, Ron D
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Health Services and Systems ,Biomedical and Clinical Sciences ,Health Sciences ,Congenital Structural Anomalies ,Clinical Research ,Rare Diseases ,Pediatric ,Health Services ,Cardiovascular ,Heart Disease ,Humans ,Oximetry ,Heart Defects ,Congenital ,Neonatal Screening ,Infant ,Newborn ,United States ,Guideline Adherence ,Surveys and Questionnaires ,Hospitals ,Mandatory Programs ,RUSP ,pulse oximetry screening ,CFIR ,implementation ,newborn screening ,CCHD ,congenital heart disease ,nurses ,Clinical Sciences ,Paediatrics and Reproductive Medicine ,Obstetrics & Reproductive Medicine ,Paediatrics ,Reproductive medicine ,Midwifery - Abstract
ObjectiveOur objective was to gauge adherence to nationally endorsed protocols in implementation of pulse oximetry (POx) screening for critical congenital heart disease (CCHD) in infants after mandate by all states and to assess associated characteristics.Study designBetween March and October 2019, an online questionnaire was administered to nurse supervisors who oversee personnel conducting POx screening. The questionnaire used eight questions regarding performance and interpretation of screening protocols to measure policy consistency, which is adherence to nationally endorsed protocols for POx screening developed by professional medical societies. Multilevel linear regression models evaluated associations between policy consistency and characteristics of hospitals and individuals, state of hospital location, early versus late mandate adopters, and state reporting requirements.ResultsResponses from 189 nurse supervisors spanning 38 states were analyzed. Only 17% received maximum points indicating full policy consistency, and 24% selected all four options for potential hypoxia that require a repeat screen. Notably, 33% did not recognize ≤90% SpO2 as an immediate failed screen and 31% responded that an infant with SpO2 of 89% in one extremity will be rescreened by nurses in an hour rather than receiving an immediate physician referral. Lower policy consistency was associated with lack of state reporting mandates (beta = -1.23 p = 0.01) and early adoption by states (beta = -1.01, p
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- 2024
21. The National Academies of Sciences, Engineering, and Medicine recommendations on Medicaid parity and future of pediatric subspecialty workforce
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Lakshminrusimha, Satyan, Lubarsky, David A, Gamber, Rhae Ana, and Devaskar, Sherin U
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Paediatrics ,Biomedical and Clinical Sciences ,Perinatal Period - Conditions Originating in Perinatal Period ,Pediatric ,Clinical Research ,Health and social care services research ,8.1 Organisation and delivery of services ,Good Health and Well Being ,Clinical Sciences ,Paediatrics and Reproductive Medicine ,Pediatrics - Abstract
Medicaid supports 41% of all births in the US and nearly 347,580 admissions to neonatal intensive care units in 2022. Medicaid reimbursement is critical to child health inclusive of departments of Pediatrics and children's hospitals. Low Medicaid reimbursement is one of the causes for low pediatric subspecialist salaries and has led to workforce challenges. The National Academies of Science, Engineering, and Medicine (NASEM) recently suggested increased Medicaid reimbursement as a strategy to sustain pediatric subspecialist workforce. This review article briefly outlines the importance of Medicaid reimbursement to Neonatal-Perinatal Medicine and its role in providing coverage for preterm births. We also highlight the recommendations of NASEM pertaining to reimbursement that are relevant to neonatal care and its impact on providers, patients, and families. It is imperative that neonatologists join the rest of pediatric subspecialists in lending their support to demonstrate unity in ensuring success in the implementation of the NASEM recommendations.
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- 2024
22. Comparison of a Person-Centered Pregnancy Prevention Question and One Key Question® to Assess Postpartum Contraceptive Needs
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Congdon, Jayme L, Vittinghoff, Eric, and Dehlendorf, Christine
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Adolescent Sexual Activity ,Prevention ,Teenage Pregnancy ,Contraception/Reproduction ,Clinical Research ,Pediatric ,Reproductive health and childbirth ,Good Health and Well Being ,Contraception ,Family planning ,Health services research ,Patient-centered care ,Postpartum ,Clinical Sciences ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Obstetrics & Reproductive Medicine ,Clinical sciences ,Reproductive medicine ,Health services and systems - Abstract
ObjectivesTo explore the relevance of pregnancy intention as a screen for contraceptive needs among postpartum individuals.Study designWe surveyed 234 postpartum individuals to assess the alignment between pregnancy intentions in the next year and current desire to prevent pregnancy.ResultsMost individuals (87%) desired pregnancy prevention now, including 73% of individuals who desired or were ambivalent about pregnancy in the next year.ConclusionA majority of individuals considering pregnancy in the next year desired pregnancy prevention now. Directly assessing current desire to prevent pregnancy may be more specific for contraceptive needs in postpartum individuals.ImplicationsOur ability to ensure that all individuals who want to prevent pregnancy have access to contraception depends on the use of effective screening questions. These findings prompt consideration of broader clinical implementation of screening for desire to prevent pregnancy in lieu of questions about pregnancy intention in the next year.
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- 2024
23. Successful postcoital testing of Ovaprene: An investigational non-hormonal monthly vaginal contraceptive
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Mauck, Christine, Thurman, Andrea, Jensen, Jeffrey T, Schreiber, Courtney A, Baker, Jeff, Hou, Melody Y, Chavoustie, Steven, Dart, Clint, Wu, Hongsheng, Zack, Nadene, Hatheway, Jessica, and Friend, David
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Contraception/Reproduction ,Clinical Research ,Clinical Trials and Supportive Activities ,Prevention ,Reproductive health and childbirth ,Good Health and Well Being ,Male ,Pregnancy ,Humans ,Female ,Semen ,Contraceptive Devices ,Female ,Vagina ,Body Mass Index ,Contraceptive Agents ,Contraception ,Contraceptive ,Ovaprene ,Postcoital test ,Vaginal ,Clinical Sciences ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Obstetrics & Reproductive Medicine ,Clinical sciences ,Reproductive medicine ,Health services and systems - Abstract
ObjectiveEvaluate reduction in progressively motile sperm per high power field (HPF) in midcycle cervical mucus after intercourse with Ovaprene: an investigational monthly non-hormonal vaginal contraceptive consisting of a vaginal ring and mechanical barrier, releasing spermiostatic ferrous gluconate.Study designOpen-label, multicenter study enrolling heterosexually-active women with previous permanent contraception. Participants underwent a baseline postcoital test cycle with no device to confirm the presence of sperm, followed by one diaphragm postcoital test cycle, one Ovaprene safety cycle, and two Ovaprene postcoital test cycles. In each postcoital test cycle, participants underwent a midcycle cervical mucus evaluation to confirm an Insler score ≥10 and absence of sperm, and then returned two to four hours after vaginal intercourse for repeat cervical mucus evaluation. We considered
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- 2024
24. Scabies Infection While Expressing Human Milk for Critically Ill Infants: Is It Safe?
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Chan, Rachel and Hoyt-Austin, Adrienne E
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Medical Microbiology ,Biomedical and Clinical Sciences ,Pediatric ,Infectious Diseases ,Perinatal Period - Conditions Originating in Perinatal Period ,Clinical Research ,Infant Mortality ,Aetiology ,2.2 Factors relating to the physical environment ,Reproductive health and childbirth ,Infection ,Good Health and Well Being ,scabies ,breastfeeding ,infant ,human milk ,NICU ,Nutrition and Dietetics ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Pediatrics ,Nutrition and dietetics ,Paediatrics - Abstract
Background: Scabies infections of the breast in lactating individuals are not well described, especially how maternal infection can impact human milk feeding of hospitalized infants in the intensive care setting. Methods: This case report presents a critically ill female infant with a complex surgical history whose mother had an active scabies infection around the breast postpartum and wished to provide expressed human milk. Results: In this case report, human milk was recommended despite maternal scabies infection. Conclusion: Given the limited information that is known about the risk of scabies transmission in human milk for critically ill infants, this case adds to the knowledge base and supports the call for further research.
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- 2024
25. Presentation, Management, and Child Protective Service Reporting of Children Who Test Positive for Cannabis in an Emergency Room Setting.
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Dubinin, Alexandra, Bialostozky, Mario, Richardson, Andrew, and Laub, Natalie
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Biomedical and Clinical Sciences ,Clinical Sciences ,Substance Misuse ,Drug Abuse (NIDA only) ,Clinical Research ,Health Services ,Pediatric ,Good Health and Well Being ,Paediatrics and Reproductive Medicine ,Emergency & Critical Care Medicine ,Paediatrics - Abstract
ObjectivesRates of cannabis ingestion among young children are increasing. Small studies have evaluated symptomatology of these children. The literature lacks research regarding factors influencing medical management. Our goal was to 1) understand circumstances leading to exposure over time and 2) gain insight into factors that may influence emergency room management and Child Protective Services reporting over time.MethodsRetrospective cross-sectional study on children younger than 10 years with cannabis-positive urine drug screens in the emergency room setting. Single-factor analysis of variance and Fisher exact tests were used to assess for trends. Two-tailed t tests and Fisher exact tests were used to compare management of children presenting to the emergency room with chief complaint (CC) "ingestion" versus those without.ResultsOf the 179 children, the mean age was 3.7 years and 48% were boys. We observed a significant increase over time in cannabis-positive children. The most common location of exposure was the primary residence (54%), with parents as the most frequent users (46%). In the emergency department, the most common CC was ingestion followed by altered mental status and fatigue. Children with an "ingestion" CC were managed with less testing than those with other CCs. They received fewer needle sticks (43% vs 91%), less imaging (5% vs 56% computed tomography heads), and fewer procedures (0% vs 8% lumbar punctures). Children with "ingestion" CC were less likely to be reported to Child Protective Services.ConclusionsPediatric cannabis exposures are increasing and have a wide array of clinical presentations that complicate emergency room management. Parental report of cannabis ingestion seems to impact and reduce potentially unnecessary testing.
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- 2024
26. Incidence of central precocious puberty declines to pre-pandemic levels post COVID-19 pandemic increase: single-center retrospective review in the United States
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Trujillo, Marcela Vargas, Rungvivatjarus, Tiranun, and Klein, Karen O
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Biomedical and Clinical Sciences ,Clinical Sciences ,Pediatric ,Clinical Research ,Paediatrics and Reproductive Medicine ,Other Medical and Health Sciences ,Paediatrics - Abstract
Background and aim of the study: We previously published the increased frequency of new CPP cases during the Covid-19 pandemic in our pediatric endocrinology clinic at Rady Children's Hospital in San Diego, CA, US. We conducted this follow-up study to examine the incidence of new CPP cases requiring treatment with GnRH agonist (GnRHa) in our clinic during 2 years post-pandemic. Methods: We performed a retrospective comparison of the number of visits of children newly diagnosed with CPP treated with GnRHa during the 2 years following the first year of Covid-19 pandemic (5/2021–7/2023). We evaluated clinical and bone maturation data as well as differences in timing from diagnosis to onset of treatment. Results: We previously reported in the pre-Covid year, 28 children (1 boy, 27 girls) treated with GnRHa for CPP out of 2,340 new endocrinology visits (1.2% of patients seen). During Covid-19 year, 64 children (7 boys, 57 girls) were treated out of 2,261 new visits (2.8%). The incidence of new CPP cases requiring GnRHa during the pandemic more than doubled compared to pre-pandemic. In the first year post-year 1 of the pandemic (5/2021–4/2022), 46 children (3 boys, 40 girls) started treatment with GnRHa for CPP out of 2,595 new endocrinology visits (1.6% of patients seen). During the second follow-up year (5/2022–4/2023), 22 children (4 boys, 18 girls) started treatment with GnRHa for CPP out of 2,676 new endocrinology visits (0.8% of patients seen). Age at onset of treatment, degree of bone age (BA) advancement, time from diagnosis to onset of treatment, and changes in BMI during the pandemic were not different from pre-pandemic or post-pandemic. Conclusions: CPP cases requiring GnRHa treatment significantly increased during the first year of the Covid-19 pandemic and then decreased each year post-pandemic. This was not related to BMI, age at diagnosis, degree of bone age advancement, or time from diagnosis to onset of treatment as all these factors have been similar during pre-pandemic, pandemic, and post-pandemic years. It is reasonable that the postulated hypotheses published regarding the increase during the pandemic would resolve post-pandemic.
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- 2024
27. The Search for the Causes of Common Hyperandrogenism, 1965 to circa 2015
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Rosenfield, Robert L
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Clinical Sciences ,Genetics ,Infertility ,Obesity ,Contraception/Reproduction ,Pediatric ,Aetiology ,2.1 Biological and endogenous factors ,Reproductive health and childbirth ,Metabolic and endocrine ,Endocrine history ,Hyperandrogenism ,Insulin resistance ,Polycystic ovary syndrome ,Premature adrenarche ,Biochemistry and Cell Biology ,Paediatrics and Reproductive Medicine ,Endocrinology & Metabolism ,Clinical sciences ,Reproductive medicine - Abstract
From 1965-2015, immense strides were made into understanding the mechanisms underlying the common androgen excess disorders, premature adrenarche and polycystic ovary syndrome (PCOS). The author reviews the critical discoveries of this era from his perspective investigating these disorders, commencing with his early discoveries of the unique pattern of plasma androgens in premature adrenarche and the elevation of an index of the plasma free testosterone concentration in most hirsute women. The molecular genetic basis, though not the developmental biologic basis, for adrenarche is now known and 11-oxytestosterones shown to be major bioactive adrenal androgens. The evolution of the lines of research into the pathogenesis of PCOS is historically traced: research milestones are cited in the areas of neuroendocrinology; insulin resistance, hyperinsulinism, type 2 diabetes mellitus; folliculogenesis; androgen secretion; obesity; phenotyping, prenatal androgenization, epigenetics, and complex genetics. Large scale genome-wide association studies led to the 2014 discovery of an unsuspected steroidogenic regulator DENND1A (differentially expressed in normal and neoplastic development). The splice variant DENND1A.V2 is constitutively overexpressed in PCOS theca cells in long-term culture and accounts for their PCOS-like phenotype. The genetics are complex, however: DENND1A intronic variant copy number is related to phenotype severity, and recent data indicates that rare variants in a DENND1A regulatory network and other genes are related to PCOS. Obesity exacerbates PCOS manifestations via insulin resistance and pro-inflammatory cytokine excess; excess adipose tissue also forms testosterone. Polycystic ovaries in one-quarter of apparently normal women lie on the PCOS functional spectrum. Much remains to be learned.
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- 2024
28. Association between diagnosed perinatal mood and anxiety disorders and adverse perinatal outcomes
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Accortt, Eynav, Mirocha, James, Jackman, Susan, Coussons-Read, Mary, Schetter, Christine Dunkel, and Hobel, Calvin
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Biomedical and Clinical Sciences ,Midwifery ,Health Sciences ,Paediatrics ,Reproductive Medicine ,Brain Disorders ,Mental Health ,Prevention ,Perinatal Period - Conditions Originating in Perinatal Period ,Clinical Research ,Preterm ,Low Birth Weight and Health of the Newborn ,Pediatric ,Infant Mortality ,Reproductive health and childbirth ,Mental health ,Good Health and Well Being ,Humans ,Infant ,Newborn ,Pregnancy ,Female ,Adult ,Young Adult ,Middle Aged ,Premature Birth ,Anxiety Disorders ,Fetal Death ,Chorioamnionitis ,Diabetes ,Gestational ,Pregnancy Outcome ,Perinatal mood and anxiety disorders ,prenatal depression ,postpartum depression ,adverse perinatal outcomes ,Paediatrics and Reproductive Medicine ,Obstetrics & Reproductive Medicine ,Reproductive medicine - Abstract
PurposeTo determine whether a diagnosis of a perinatal mood and anxiety disorder (PMAD) is associated with adverse perinatal outcomes.MethodsMental health symptom screening and diagnostic data from 82 women with single gestation in the Healthy Babies Before Birth study conducted from 2013 to 2018 were obtained by clinic interview. If a woman scored over 10 on the Patient Health Questionnaire (PHQ-9) or endorsed the suicidality item; or scored over 7 on the Overall Anxiety Severity and Impairment Scale (OASIS), a Structured Clinical Interview for DSM-IV (SCID) Axis I Disorders was administered. An adverse perinatal outcome was operationalized as a diagnosis of gestational diabetes mellitus, intrauterine growth restriction, preeclampsia, chorioamnionitis, hemorrhage, fetal death, preterm birth, or a low birthweight baby, and abstracted from the medical records.ResultsWomen were between 22.0 and 45.0 years old (Mean age = 33.1 ± 4.3). Mean BMI was 24.7 ± 5.6 (Range 16.8 to 47.1). Nineteen percent (16) of the 82 women had a SCID diagnosis of a PMAD. Thirty-seven percent (30) had a diagnosed adverse perinatal outcome. Multiple logistic regression was conducted with these predictors: SCID diagnosis of a PMAD, maternal age, BMI. All predictors were significant with respective odds ratios as follows: OR = 3.58, 95% CI 1.03-12.44, p = .045; OR = 2.30, 95% CI 1.21-4.38, p = .011; OR = 1.69, 95% CI 1.06-2.69, p = .027.ConclusionsA PMAD diagnosis was associated with 3.5 times higher odds of having an adverse perinatal outcome. For every 5 years a woman aged or every five units her BMI increased her odds of having an adverse perinatal outcome increased. Older age and increased BMI are well established adverse perinatal outcome risk factors. These results suggest that mental illness risk should also be consistently assessed in obstetric settings.
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- 2024
29. Health facility assessment of small and sick newborn care in low- and middle-income countries: systematic tool development and operationalisation with NEST360 and UNICEF
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Penzias, Rebecca E, Bohne, Christine, Ngwala, Samuel K, Zimba, Evelyn, Lufesi, Norman, Rashid, Ekran, Gicheha, Edith, Odedere, Opeyemi, Dosunmu, Olabisi, Tillya, Robert, Shabani, Josephine, Cross, James H, Liaghati-Mobarhan, Sara, Chiume, Msandeni, Banda, George, Chalira, Alfred, Wainaina, John, Gathara, David, Irimu, Grace, Adudans, Steve, James, Femi, Tongo, Olukemi, Ezeaka, Veronica Chinyere, Msemo, Georgina, Salim, Nahya, Day, Louise T, Powell-Jackson, Timothy, Chandna, Jaya, Majamanda, Maureen, Molyneux, Elizabeth M, Oden, Maria, Richards-Kortum, Rebecca, Ohuma, Eric O, Paton, Chris, Hailegabriel, Tedbabe, Gupta, Gagan, and Lawn, Joy E
- Subjects
Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Health Services ,Prevention ,Clinical Research ,8.1 Organisation and delivery of services ,8.3 Policy ,ethics ,and research governance ,Generic health relevance ,Good Health and Well Being ,Infant ,Newborn ,Humans ,Developing Countries ,Quality of Health Care ,United Nations ,Tanzania ,Health Facilities ,with the Health Facility Assessment Technical Content Reviewers ,Co-design Group ,Health Facility Assessment Data Collection Learning Group ,ENAP coverage targets ,Health facility assessment ,Inpatient Care ,Level-2 small and sick newborn care ,Low- and Middle-Income Countries ,Newborn ,Service readiness ,Paediatrics and Reproductive Medicine ,Pediatrics ,Paediatrics ,Midwifery - Abstract
BackgroundEach year an estimated 2.3 million newborns die in the first 28 days of life. Most of these deaths are preventable, and high-quality neonatal care is fundamental for surviving and thriving. Service readiness is used to assess the capacity of hospitals to provide care, but current health facility assessment (HFA) tools do not fully evaluate inpatient small and sick newborn care (SSNC).MethodsHealth systems ingredients for SSNC were identified from international guidelines, notably World Health Organization (WHO), and other standards for SSNC. Existing global and national service readiness tools were identified and mapped against this ingredients list. A novel HFA tool was co-designed according to a priori considerations determined by policymakers from four African governments, including that the HFA be completed in one day and assess readiness across the health system. The tool was reviewed by > 150 global experts, and refined and operationalised in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania between September 2019 and March 2021.ResultsEight hundred and sixty-six key health systems ingredients for service readiness for inpatient SSNC were identified and mapped against four global and eight national tools measuring SSNC service readiness. Tools revealed major content gaps particularly for devices and consumables, care guidelines, and facility infrastructure, with a mean of 13.2% (n = 866, range 2.2-34.4%) of ingredients included. Two tools covered 32.7% and 34.4% (n = 866) of ingredients and were used as inputs for the new HFA tool, which included ten modules organised by adapted WHO health system building blocks, including: infrastructure, pharmacy and laboratory, medical devices and supplies, biomedical technician workshop, human resources, information systems, leadership and governance, family-centred care, and infection prevention and control. This HFA tool can be conducted at a hospital by seven assessors in one day and has been used in 64 hospitals in Kenya, Malawi, Nigeria, and Tanzania.ConclusionThis HFA tool is available open-access to adapt for use to comprehensively measure service readiness for level-2 SSNC, including respiratory support. The resulting facility-level data enable comparable tracking for Every Newborn Action Plan coverage target four within and between countries, identifying facility and national-level health systems gaps for action.
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- 2024
30. Pathophysiological roles of thrombospondin-4 in disease development
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Genaro, Karina and Luo, Z David
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Biochemistry and Cell Biology ,Biological Sciences ,Osteoporosis ,Aetiology ,2.1 Biological and endogenous factors ,Musculoskeletal ,Humans ,Thrombospondins ,Extracellular Matrix ,Cell Movement ,Morphogenesis ,Cardiovascular Diseases ,Thrombospondin-4 ,Calcium-binding ,Extracellular matrix glycoprotein ,Angiogenesis ,Inflammation ,Synaptogenesis ,Cardiovascular diseases ,Cancer growth ,Metastasis ,Nociception ,Paediatrics and Reproductive Medicine ,Developmental Biology ,Biochemistry and cell biology - Abstract
Thrombospondin-4 (TSP-4) belongs to the extracellular matrix glycoprotein family of thrombospondins (TSPs). The multidomain, pentameric structure of TSP-4 allows its interactions with numerous extracellular matrix components, proteins and signaling molecules that enable its modulation to various physiological and pathological processes. Characterization of TSP-4 expression under development and pathogenesis of disorders has yielded important insights into mechanisms underlying the unique role of TSP-4 in mediating various processes including cell-cell, cell-extracellular matrix interactions, cell migration, proliferation, tissue remodeling, angiogenesis, and synaptogenesis. Maladaptation of these processes in response to pathological insults and stress can accelerate the development of disorders including skeletal dysplasia, osteoporosis, degenerative joint disease, cardiovascular diseases, tumor progression/metastasis and neurological disorders. Overall, the diverse functions of TSP-4 suggest that it may be a potential marker or therapeutic target for prognosis, diagnosis, and treatment of various pathological conditions upon further investigations. This review article highlights recent findings on the role of TSP-4 in both physiological and pathological conditions with a focus on what sets it apart from other TSPs.
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- 2024
31. Child mask mandates for COVID-19: a systematic review
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Sandlund, Johanna, Duriseti, Ram, Ladhani, Shamez N, Stuart, Kelly, Noble, Jeanne, and Høeg, Tracy Beth
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Biomedical and Clinical Sciences ,Clinical Sciences ,Pediatric ,Prevention ,Clinical Research ,Infectious Diseases ,Good Health and Well Being ,Child ,Humans ,COVID-19 ,SARS-CoV-2 ,Pandemics ,Bias ,Antibodies ,Covid-19 ,Infectious Disease Medicine ,Child Health ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Pediatrics ,Clinical sciences ,Paediatrics - Abstract
BackgroundMask mandates for children during the COVID-19 pandemic varied in different locations. A risk-benefit analysis of this intervention has not yet been performed. In this study, we performed a systematic review to assess research on the effectiveness of mask wearing in children.MethodsWe performed database searches up to February 2023. The studies were screened by title and abstract, and included studies were further screened as full-text references. A risk-of-bias analysis was performed by two independent reviewers and adjudicated by a third reviewer.ResultsWe screened 597 studies and included 22 in the final analysis. There were no randomised controlled trials in children assessing the benefits of mask wearing to reduce SARS-CoV-2 infection or transmission. The six observational studies reporting an association between child masking and lower infection rate or antibody seropositivity had critical (n=5) or serious (n=1) risk of bias; all six were potentially confounded by important differences between masked and unmasked groups and two were shown to have non-significant results when reanalysed. Sixteen other observational studies found no association between mask wearing and infection or transmission.ConclusionsReal-world effectiveness of child mask mandates against SARS-CoV-2 transmission or infection has not been demonstrated with high-quality evidence. The current body of scientific data does not support masking children for protection against COVID-19.
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- 2024
32. Need for Time and Training: Pediatric Program Directors’ Perceptions About Mentorship of Residents
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Gustafson, Sarah, Shope, Margaret, Fromme, H Barrett, and Orlov, Nicola
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Paediatrics ,Biomedical and Clinical Sciences ,Humans ,Child ,United States ,Mentors ,Cross-Sectional Studies ,Mentoring ,Education ,Medical ,Graduate ,Faculty ,Surveys and Questionnaires ,advising ,graduate medical education ,mentorship ,Paediatrics and Reproductive Medicine ,Pediatrics - Abstract
ObjectiveWe aimed to describe pediatric program directors' perceptions of existing mentorship programs in pediatric residencies, to assess whether characteristics used for mentor-mentee assignments impact mentoring outcomes, and to identify barriers to success in mentorship programs.MethodsWith the support of the Association of Pediatric Program Directors (APPD) Research Task Force, we conducted a cross-sectional survey study of all associate pediatric program directors in the United States in March 2022.ResultsNearly half (82 of 197, 41.6%) of programs responded. Most (87.8%) report having a formal mentoring program. Half of programs (51.4%) do not provide training to residents on how to be a mentee, and only slightly more than half (62.5%) provide training to faculty mentors. Most programs (80.6%) do not provide protected time for faculty mentors. There were no meaningful associations with characteristics used for mentorship matches and perceived successful mentorship. Top barriers from the program leadership perspective included faculty and residents lacking time, residents lacking skills to be proactive mentees, and inadequate funding.ConclusionsWhile a majority of programs have formal mentorship programs, many do not provide training to mentors or mentees. Barriers to mentorship include a lack of funding and time. National organizations, such as APPD and the Accreditation Council for Graduate Medical Education, have an opportunity to provide guidance and support for protected time, funding, and training for mentors and mentees.
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- 2024
33. Long-range optical coherence tomography of pediatric airway during drug induced sleep endoscopy: A preliminary report
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Goshtasbi, Khodayar, Su, Erica, Jing, Joseph C, Nguyen, Theodore V, Hong, Ellen M, Dilley, Katelyn D, Ahuja, Gurpreet S, Chen, Zhongping, and Wong, Brian JF
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Sciences ,Biomedical Imaging ,Sleep Research ,Pediatric ,Lung ,Bioengineering ,Clinical Research ,Humans ,Child ,Tomography ,Optical Coherence ,Polysomnography ,Endoscopy ,Sleep Apnea ,Obstructive ,Sleep ,Airway Obstruction ,Paediatrics and Reproductive Medicine ,Clinical sciences ,Paediatrics - Abstract
ObjectiveDrug induced sleep endoscopy (DISE) is often performed for pediatric obstructive sleep apnea (OSA) when initial diagnostic studies do not provide adequate information for therapy. However, DISE scoring is subjective and with limitations. This proof-of-concept study demonstrates the use of a novel long-range optical coherence tomography (LR-OCT) system during DISE of two pediatric patients.MethodsLR-OCT was used to visualize the airway of pediatric patients during DISE. At the conclusion of DISE, the OCT probe was guided in the airway under endoscopic visual guidance, and cross-sectional images were acquired at the four VOTE locations. Data processing involved image resizing and alignment, followed by rendering of three-dimensional (3D) volumetric models of the airways.ResultsTwo patients were included in this study. Patient one had 18.4%, 20.9%, 72.3%, and 97.3% maximal obstruction at velum, oropharynx, tongue base, and epiglottis, while patient two had 40.2%, 41.4%, 8.0%, and 17.5% maximal obstruction at these regions, respectively. Three-dimensional reconstructions of patients' airways were also constructed from the OCT images.ConclusionThis proof-of-concept study demonstrates the successful evaluation of pediatric airway during DISE using LR-OCT, which accurately identified sites and degrees of obstruction with respective 3D airway reconstruction.
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- 2024
34. Use of telemedicine to obtain contraception among young adults: Inequities by health insurance
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Yarger, Jennifer, Hopkins, Kristine, Elmes, Sarah, Rossetto, Irene, Van Liefde, Danielle, De La Melena, Stephanie, and Harper, Cynthia C
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Clinical Research ,Prevention ,Contraception/Reproduction ,Rural Health ,Good Health and Well Being ,Contraception ,Health insurance ,Telehealth ,Telemedicine ,Young adult ,Clinical Sciences ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Obstetrics & Reproductive Medicine ,Clinical sciences ,Reproductive medicine ,Health services and systems - Abstract
ObjectivesThe objective of this study was to describe the use of telemedicine for contraception in a sample of young adults and examine differences by health insurance coverage.Study designWe analyzed survey data collected from May 2020 to July 2022 from individuals at risk of pregnancy aged 18 to 29 recruited at 29 community colleges in California and Texas. We used multivariable mixed-effects logistic regression models with random effects for site and individual to compare the use of telemedicine to obtain contraception by insurance status, sociodemographic characteristics, and state.ResultsOur analytic sample included 6465 observations from 1630 individuals. Participants reported using a contraceptive method obtained through telemedicine in just 6% of observations. Uninsured participants were significantly less likely than those privately insured to use contraception obtained through telemedicine (adjusted odds ratio [aOR], 0.54; 95% confidence interval [CI], 0.31-0.97), as were participants who did not know their insurance status (aOR, 0.54; 95% CI, 0.29-0.99). Texas participants were less likely to use contraception obtained via telemedicine than those in California (aOR, 0.42; CI: 0.25-0.69).ConclusionsFew young people in this study obtained contraception through telemedicine, and insurance was crucial for access in both states.ImplicationsAlthough telemedicine holds promise for increasing contraceptive access, we found that few young adults were using it, particularly among the uninsured. Efforts are needed to improve young adults' access to telemedicine for contraception and address insurance disparities.
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- 2024
35. Safety Testing of Ovaprene: an Investigational Non-Hormonal Monthly Vaginal Contraceptive
- Author
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Mauck, Christine, Thurman, Andrea, Jensen, Jeffrey T, Schreiber, Courtney A, Baker, Jeff, Hou, Melody Y, Chavoustie, Steven, Dart, Clint, Wu, Hongsheng, Ravel, Jacques, Gajer, Pawel, Herold, Betsy C, Jacot, Terry, Zack, Nadene, Hatheway, Jessica, and Friend, Dave
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Clinical Sciences ,Prevention ,Infectious Diseases ,Patient Safety ,Clinical Research ,Contraception/Reproduction ,Good Health and Well Being ,Contraception ,Ovaprene ,contraceptive ,vaginal ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Obstetrics & Reproductive Medicine ,Clinical sciences ,Reproductive medicine ,Health services and systems - Abstract
ObjectiveEvaluate safety of Ovaprene, an investigational non-hormonal vaginal contraceptive designed for monthly use.Study designOpen-label, multicenter study enrolling heterosexually-active women with previous permanent contraception who underwent assessments during five menstrual cycles: baseline postcoital test cycle, diaphragm postcoital test cycle, Ovaprene safety cycle, and two Ovaprene postcoital test cycles. Safety outcomes included treatment emergent adverse events (TEAEs), systemic laboratory findings, pelvic examinations, colposcopies, Nugent scores, determination of community state types of vaginal microbiota, and anti-Escherichia coli activity and inflammatory markers in cervicovaginal fluids.ResultsWe enrolled 38 participants. Of these, 33 used Ovaprene and completed 77 Ovaprene cycles. The most common product-related urogenital TEAEs were bacterial vaginosis (BV) and vaginal odor. The frequency of transitioning from Lactobacillus-dominated community state type to community state type IV (not Lactobacillus-dominated) was similar before Ovaprene use and afterwards. Mean Nugent scores were
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- 2024
36. Neighborhood Income Is Associated with Health Care Use in Pediatric Short Bowel Syndrome
- Author
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Gutierrez, Susan A, Pathak, Sagar, Raghu, Vikram, Shui, Amy, Huang, Chiung-Yu, Rhee, Sue, McKenzie-Sampson, Safyer, Lai, Jennifer C, and Wadhwani, Sharad I
- Subjects
Paediatrics ,Biomedical and Clinical Sciences ,Patient Safety ,Pediatric ,Good Health and Well Being ,Child ,Humans ,Male ,Female ,Short Bowel Syndrome ,Income ,Hospitalization ,Length of Stay ,Delivery of Health Care ,central-line associated bloodstream infections ,disparities ,intestinal failure ,socioeconomic ,Human Movement and Sports Sciences ,Paediatrics and Reproductive Medicine ,Pediatrics - Abstract
ObjectiveTo evaluate associations between neighborhood income and burden of hospitalizations for children with short bowel syndrome (SBS).Study designWe used the Pediatric Health Information System (PHIS) database to evaluate associations between neighborhood income and hospital readmissions, readmissions for central line-associated bloodstream infections (CLABSI), and hospital length of stay (LOS) for patients
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- 2024
37. Underrepresentation of racial and ethnic minority groups in gynecologic oncology: An analysis of over 250 trials
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Richardson, Michael T, Barry, Danika, Steinberg, Jecca R, Thirunavu, Vineeth, Strom, Danielle E, Holder, Kai, Zhang, Naixin, Turner, Brandon E, Magnani, Christopher J, Weeks, Brannon T, Young, Anna Marie P, Lu, Connie F, Wolgemuth, Tierney R, Laasiri, Nora, Squires, Natalie A, Anderson, Jill N, Karlan, Beth Y, Chan, John K, Kapp, Daniel S, Roque, Dario R, and Salani, Ritu
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Oncology and Carcinogenesis ,Clinical Research ,American Indian or Alaska Native ,Ovarian Cancer ,Cancer ,Rare Diseases ,Clinical Trials and Supportive Activities ,Prevention ,Good Health and Well Being ,Humans ,Female ,United States ,Genital Neoplasms ,Female ,Ethnicity ,Ethnic and Racial Minorities ,Minority Groups ,Ovarian Neoplasms ,Uterine Neoplasms ,Gynecologic cancers ,Race and ethnicity ,Underrepresentation ,Trial enrollment ,Time trends ,Paediatrics and Reproductive Medicine ,Oncology & Carcinogenesis ,Clinical sciences ,Oncology and carcinogenesis ,Reproductive medicine - Abstract
ObjectiveTo describe the participation of racial and ethnic minority groups (REMGs) in gynecologic oncology trials.MethodsGynecologic oncology studies registered on ClinicalTrials.gov between 2007 and 2020 were identified. Trials with published results were analyzed based on reporting of race/ethnicity in relation to disease site and trial characteristics. Expected enrollment by race/ethnicity was calculated and compared to actual enrollment, adjusted for 2010 US Census population data.Results2146 gynecologic oncology trials were identified. Of published trials (n = 252), 99 (39.3%) reported race/ethnicity data. Recent trials were more likely to report these data (36% from 2007 to 2009; 51% 2013-2015; and 53% from 2016 to 2018, p = 0.01). Of all trials, ovarian cancer trials were least likely to report race/ethnicity data (32.1% vs 39.3%, p = 0.011). Population-adjusted under-enrollment for Blacks was 7-fold in ovarian cancer, Latinx 10-fold for ovarian and 6-fold in uterine cancer trials, Asians 2.5-fold in uterine cancer trials, and American Indian and Alaska Native individuals 6-fold in ovarian trials. Trials for most disease sites have enrolled more REMGs in recent years - REMGs made up 19.6% of trial participants in 2007-2009 compared to 38.1% in 2016-2018 (p
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- 2024
38. Machine Learning-Based Prediction of Pediatric Ulcerative Colitis Treatment Response using Diagnostic Histopathology
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Liu, Xiaoxuan, Prasath, Surya, Siddiqui, Iram, Walters, Thomas D, Denson, Lee A, consortium, PROTECT, Hyams, Jeffrey S, Kugathasan, Subra, Griffiths, Anne M, Collins, Margaret H, Baldassano, Robert N, Boyle, Brendan M, Heyman, Melvin B, Leleiko, Neal S, Mack, David, Markowitz, James, Noe, Joshua D, Oliva-Hemker, Maria, Otley, Anthony, Patel, Ashish S, Pfefferkorn, Marian, Rufo, Paul A, Sauer, Cary G, Strople, Jennifer, Sudel, Boris, Wali, Prateek, Ziring, David, and Dhaliwal, Jasbir
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Biomedical and Clinical Sciences ,Clinical Sciences ,PROTECT Consortium ,Neurosciences ,Paediatrics and Reproductive Medicine ,Gastroenterology & Hepatology ,Clinical sciences ,Nutrition and dietetics - Published
- 2024
39. Miscarriage risk assessment: a bioinformatic approach to identifying candidate lethal genes and variants
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Aminbeidokhti, Mona, Qu, Jia-Hua, Belur, Shweta, Cakmak, Hakan, Jaswa, Eleni, Lathi, Ruth B, Sirota, Marina, Snyder, Michael P, Yatsenko, Svetlana A, and Rajkovic, Aleksandar
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Genetics ,Biological Sciences ,Human Genome ,Prevention ,Genetic Testing ,Clinical Research ,Aetiology ,2.1 Biological and endogenous factors ,Reproductive health and childbirth ,Female ,Infant ,Newborn ,Humans ,Pregnancy ,Animals ,Mice ,Abortion ,Spontaneous ,Genes ,Lethal ,Genetic Carrier Screening ,Ethnicity ,Computational Biology ,Complementary and Alternative Medicine ,Paediatrics and Reproductive Medicine ,Genetics & Heredity ,Reproductive medicine - Abstract
PurposeMiscarriage, often resulting from a variety of genetic factors, is a common pregnancy outcome. Preconception genetic carrier screening (PGCS) identifies at-risk partners for newborn genetic disorders; however, PGCS panels currently lack miscarriage-related genes. In this study, we evaluated the potential impact of both known and candidate genes on prenatal lethality and the effectiveness of PGCS in diverse populations.MethodsWe analyzed 125,748 human exome sequences and mouse and human gene function databases. Our goals were to identify genes crucial for human fetal survival (lethal genes), to find variants not present in a homozygous state in healthy humans, and to estimate carrier rates of known and candidate lethal genes in various populations and ethnic groups.ResultsThis study identified 138 genes in which heterozygous lethal variants are present in the general population with a frequency of 0.5% or greater. Screening for these 138 genes could identify 4.6% (in the Finnish population) to 39.8% (in the East Asian population) of couples at risk of miscarriage. This explains the cause of pregnancy loss in approximately 1.1-10% of cases affected by biallelic lethal variants.ConclusionThis study has identified a set of genes and variants potentially associated with lethality across different ethnic backgrounds. The variation of these genes across ethnic groups underscores the need for a comprehensive, pan-ethnic PGCS panel that includes genes related to miscarriage.
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- 2024
40. Financial assistance and other financial coping strategies after a pediatric cancer diagnosis
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Lin, Jackie J, Evans, Erica M, Praxedes, Kathleen, Agrawal, Anurag K, and Winestone, Lena E
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Paediatrics ,Biomedical and Clinical Sciences ,Oncology and Carcinogenesis ,Behavioral and Social Science ,Basic Behavioral and Social Science ,Pediatric ,Clinical Research ,Cancer ,Nutrition ,Zero Hunger ,financial toxicity ,material hardship ,pediatric oncology ,psychosocial ,Clinical Sciences ,Paediatrics and Reproductive Medicine ,Oncology & Carcinogenesis ,Oncology and carcinogenesis - Abstract
BackgroundFamilies experience financial burden and household material hardship (HMH) after a pediatric cancer diagnosis. This study investigates types of financial assistance and other financial coping strategies (FCS) adopted by families during the first year after diagnosis.MethodsRetrospective survey of caregivers of pediatric patients diagnosed with cancer from 2015 to 2019. The survey collected data on demographics, diagnosis, income, HMH, and private, hospital, and government assistance received and other FCS adopted after diagnosis. Bivariate and multivariable logistic regressions were used to analyze FCS by income. Subgroup analysis of families experiencing HMH was used to identify predictors of receiving government assistance.ResultsOf 156 respondents, 52% were low-to-middle income, 29% had public insurance, and 22% had non-English language preference. Low-to-middle-income families were more likely to incur debt (odds ratio [OR] 6.24, p
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- 2024
41. Assessing sleep behaviors in Latino children and adolescents: what is known, what are we missing, and how do we move forward?
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Blanco, Estela, Hyde, Eric T, and Martinez, Suzanna M
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Paediatrics ,Biomedical and Clinical Sciences ,Prevention ,Behavioral and Social Science ,Pediatric Research Initiative ,Lung ,Pediatric ,Clinical Research ,Sleep Research ,Generic health relevance ,Good Health and Well Being ,Humans ,Child ,Preschool ,Child ,United States ,Adolescent ,Cross-Sectional Studies ,Health Behavior ,Sleep ,Health Education ,Hispanic or Latino ,Paediatrics and Reproductive Medicine ,Pediatrics - Abstract
Purpose of reviewSleep health is a commonly overlooked component of pediatric cardiometabolic risk. Disparities in sleep duration and meeting of pediatric sleep guidelines have been well documented among at-risk populations in the United States, including Latinos. However, sleep research often fails to describe or account for contextual and cultural factors impacting the ability for Latino families to meet guidelines. The current review focuses on recent findings related to measurement of sleep duration, understanding of contextual factors that impact sleep hygiene, and interventions designed to increase sleep duration and quality among U.S. Latino families with infants, young children, and adolescents.Recent findingsTen studies focusing on sleep health in U.S. Latino children, using different study designs were identified. Overall, cross-sectional studies confirmed inadequate sleep among Latino children, intervention studies demonstrated promise of culturally-sensitive health behavior education for improving sleep in early childhood, and qualitative studies highlighted neighborhood and cultural factors that impact sleep quality.Implications for clinical practice and researchRather than new prevalence studies on adherence to sleep recommendations among Latino families, research focusing on adapting clinical guidelines to accommodate the realities of many Latino families (e.g., co-sleeping and bedsharing) will advance our knowledge. A shift towards objective measurement of the 24-h period as well as evaluating specific contextual barriers that make It challenging to meet sleep guidelines for Latino children is needed.
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- 2024
42. Awareness of the Maternal Health Benefits of Lactation Among U.S. Pregnant Individuals
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Iwuagwu, Caidon, Chen, Melissa J, Hoyt-Austin, Adrienne E, Kair, Laura, Fix, Margaret, and Schwarz, Eleanor Bimla
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Health Services and Systems ,Health Sciences ,Behavioral and Social Science ,Reproductive health and childbirth ,Good Health and Well Being ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Public Health ,Midwifery ,Public health ,Policy and administration - Abstract
IntroductionWe assessed awareness of the maternal health benefits of lactation among a sample of nulliparous pregnant individuals in the United States, identified variables associated with awareness of these benefits, and examined whether awareness of these benefits impacts breastfeeding attitudes or intentions.MethodsWe administered a web-based survey to nulliparous U.S.-born individuals carrying a singleton gestation of at least 28 weeks. We assessed awareness of the maternal health benefits of lactation using 10 items to create a summative score. We examined variation in awareness of these benefits by demographic characteristics, health insurance, and personal or family health history and used multivariable models to estimate associations between awareness of the maternal health benefits of lactation and breastfeeding intentions.ResultsOf the 675 individuals invited to complete surveys, 451 (67%) responded. Only 50% were aware that breastfeeding lowers maternal risk of breast cancer; fewer were aware that breastfeeding lowers the risk of ovarian cancer (35%), diabetes (27%), and hypertension and heart disease (26%). Awareness of the maternal benefits of lactation did not vary by age or race/ethnicity. However, significant regional variation was noted. In multivariable models, scores of awareness of the maternal health benefits of breastfeeding were significantly associated with intentions to breastfeed for at least 12 months (adjusted odds ratio, 1.23; 95% confidence interval, 1.11, 1.37).ConclusionsEfforts to increase awareness of the maternal health benefits of lactation are still needed. Increasing awareness of the maternal health benefits of lactation may strengthen intentions to breastfeed as recommended.
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- 2024
43. A prediction model for classifying maternal pregnancy smoking using California state birth certificate information
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He, Di, Huang, Xiwen, Arah, Onyebuchi A, Walker, Douglas I, Jones, Dean P, Ritz, Beate, and Heck, Julia E
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Medical Biochemistry and Metabolomics ,Reproductive Medicine ,Biomedical and Clinical Sciences ,Health Sciences ,Clinical Research ,Pediatric ,Tobacco ,Perinatal Period - Conditions Originating in Perinatal Period ,Cancer ,Tobacco Smoke and Health ,Prevention ,Good Health and Well Being ,Child ,Female ,Humans ,Infant ,Newborn ,Pregnancy ,Birth Certificates ,California ,Case-Control Studies ,Neoplasms ,Smoking ,Tobacco Smoking ,Models ,Statistical ,birth certificates ,maternal pregnancy smoking ,neonatal blood spots ,prediction model ,tobacco biomarkers ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Epidemiology ,Paediatrics ,Reproductive medicine - Abstract
BackgroundSystematically recorded smoking data are not always available in vital statistics records, and even when available it can underestimate true smoking rates.ObjectiveTo develop a prediction model for maternal tobacco smoking in late pregnancy based on birth certificate information using a combination of self- or provider-reported smoking and biomarkers (smoking metabolites) in neonatal blood spots as the alloyed gold standard.MethodsWe designed a case-control study where childhood cancer cases were identified from the California Cancer Registry and controls were from the California birth rolls between 1983 and 2011 who were cancer-free by the age of six. In this analysis, we included 894 control participants and performed high-resolution metabolomics analyses in their neonatal dried blood spots, where we extracted cotinine [mass-to-charge ratio (m/z) = 177.1023] and hydroxycotinine (m/z = 193.0973). Potential predictors of smoking were selected from California birth certificates. Logistic regression with stepwise backward selection was used to build a prediction model. Model performance was evaluated in a training sample, a bootstrapped sample, and an external validation sample.ResultsOut of seven predictor variables entered into the logistic model, five were selected by the stepwise procedure: maternal race/ethnicity, maternal education, child's birth year, parity, and child's birth weight. We calculated an overall discrimination accuracy of 0.72 and an area under the receiver operating characteristic curve (AUC) of 0.81 (95% confidence interval [CI] 0.77, 0.84) in the training set. Similar accuracies were achieved in the internal (AUC 0.81, 95% CI 0.77, 0.84) and external (AUC 0.69, 95% CI 0.64, 0.74) validation sets.ConclusionsThis easy-to-apply model may benefit future birth registry-based studies when there is missing maternal smoking information; however, some smoking status misclassification remains a concern when only variables from the birth certificate are used to predict maternal smoking.
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- 2024
44. Intravenous immunoglobulin resistance in Kawasaki disease patients: prediction using clinical data
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Lam, Jonathan Y, Song, Min-Seob, Kim, Gi-Beom, Shimizu, Chisato, Bainto, Emelia, Tremoulet, Adriana H, Nemati, Shamim, and Burns, Jane C
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Biomedical and Clinical Sciences ,Clinical Sciences ,Clinical Research ,Humans ,Infant ,Biomarkers ,Drug Resistance ,Immunoglobulins ,Intravenous ,Mucocutaneous Lymph Node Syndrome ,Retrospective Studies ,East Asian People ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Pediatrics ,Paediatrics - Abstract
BackgroundAbout 10-20% of Kawasaki disease (KD) patients are resistant to the initial infusion of intravenous immunoglobin (IVIG). The aim of this study was to assess whether IVIG resistance in KD patients could be predicted using standard clinical and laboratory features.MethodsData were from two cohorts: a Korean cohort of 7101 KD patients from 2015 to 2017 and a cohort of 649 KD patients from San Diego enrolled from 1998 to 2021. Features included laboratory values, the worst Z-score from the initial echocardiogram or during hospitalization, and the five clinical KD signs at presentation.ResultsFive machine learning models achieved a maximum median AUC of 0.711 [IQR: 0.706-0.72] in the Korean cohort and 0.696 [IQR: 0.609-0.722] in the San Diego cohort during stratified 10-fold cross-validation using significant laboratory features identified from univariate analysis. Adding the Z-score, KD clinical signs, or both did not considerably improve the median AUC in either cohort.ConclusionsUsing commonly measured clinical laboratory data alone or in conjunction with echocardiographic findings and clinical features is not sufficient to predict IVIG resistance. Further attempts to predict IVIG resistance will need to incorporate additional data such as transcriptomics, proteomics, and genetics to achieve meaningful predictive utility.ImpactWe demonstrated that laboratory, echocardiographic, and clinical findings cannot predict intravenous immunoglobin (IVIG) resistance to a clinically meaningful extent using machine learning in a homogenous Asian or ethnically diverse population of patients with Kawasaki disease (KD). Visualizing these features using uniform manifold approximation and projection (UMAP) is an important step to evaluate predictive utility in a qualitative manner. Further attempts to predict IVIG resistance in KD patients will need to incorporate novel biomarkers or other specialized features such as genetic differences or transcriptomics to be clinically useful.
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- 2024
45. Associations between Social Adversity and Biomarkers of Inflammation, Stress, and Aging in Children
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Pantell, Matthew S, Silveira, Patricia P, de Mendonça Filho, Euclides José, Wing, Holly, Brown, Erika M, Keeton, Victoria F, Pokhvisneva, Irina, O’Donnell, Kieran J, Neuhaus, John, Hessler, Danielle, Meaney, Michael J, Adler, Nancy E, and Gottlieb, Laura M
- Subjects
Paediatrics ,Biomedical and Clinical Sciences ,Pediatric Research Initiative ,Prevention ,Behavioral and Social Science ,Brain Disorders ,Pediatric ,Aetiology ,2.3 Psychological ,social and economic factors ,Inflammatory and immune system ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Pediatrics - Abstract
BackgroundPrior work has found relationships between childhood social adversity and biomarkers of stress, but knowledge gaps remain. To help address these gaps, we explored associations between social adversity and biomarkers of inflammation (interleukin-1β [IL-1β], IL-6, IL-8, tumor necrosis factor-alpha [TNF-α], and salivary cytokine hierarchical "clusters" based on the three interleukins), neuroendocrine function (cortisol, cortisone, dehydroepiandrosterone, testosterone, and progesterone), neuromodulation (N-arachidonoylethanolamine, stearoylethanolamine, oleoylethanolamide, and palmitoylethanolamide), and epigenetic aging (Pediatric-Buccal-Epigenetic clock).MethodsWe collected biomarker samples of children ages 0-17 recruited from an acute care pediatrics clinic and examined their associations with caregiver-endorsed education, income, social risk factors, and cumulative adversity. We calculated regression-adjusted means for each biomarker and compared associations with social factors using Wald tests. We used logistic regression to predict being in the highest cytokine cluster based on social predictors.ResultsOur final sample included 537 children but varied based on each biomarker. Cumulative social adversity was significantly associated with having higher levels of all inflammatory markers and with cortisol, displaying a U-shaped distribution. There were no significant relationships between cumulative social adversity and cortisone, neuromodulation biomarkers or epigenetic aging.ConclusionOur findings support prior work suggesting that social stress exposures contribute to increased inflammation in children.ImpactOur study is one of the largest studies examining associations between childhood social adversity and biomarkers of inflammation, neuroendocrine function, neuromodulation, and epigenetic aging. It is one of the largest studies to link childhood social adversity to biomarkers of inflammation, and the first of which we are aware to link cumulative social adversity to cytokine clusters. It is also one of the largest studies to examine associations between steroids and epigenetic aging among children, and one of the only studies of which we are aware to examine associations between social adversity and endocannabinoids among children.Clinical trial registrationNCT02746393.
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- 2024
46. Primary care and abortion provider perspectives on mail-order medication abortion: a qualitative study
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Raifman, Sarah, Gurazada, Tanvi, Beaman, Jessica, Biggs, M Antonia, Schwarz, Eleanor Bimla, Gold, Marji, and Grossman, Daniel
- Subjects
Health Services and Systems ,Health Sciences ,Women's Health ,Health Services ,Clinical Research ,Management of diseases and conditions ,8.1 Organisation and delivery of services ,Health and social care services research ,7.1 Individual care needs ,Good Health and Well Being ,Humans ,Abortion ,Induced ,Female ,Qualitative Research ,Primary Health Care ,Postal Service ,Attitude of Health Personnel ,Pregnancy ,Prospective Studies ,Adult ,Male ,United States ,Middle Aged ,Abortifacient Agents ,Medication abortion ,Mail-order pharmacy ,Qualitative ,Primary care ,Nursing ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Obstetrics & Reproductive Medicine ,Reproductive medicine ,Midwifery ,Public health - Abstract
BackgroundThis qualitative study aims to assess perspectives of clinicians and clinic staff on mail-order pharmacy dispensing for medication abortion.MethodsParticipants included clinicians and staff involved in implementing a mail-order dispensing model for medication abortion at eleven clinics in seven states as part of a prospective cohort study, which began in January 2020 (before the FDA removed the in-person dispensing requirement for mifepristone). From June 2021 to July 2022, we invited participants at the participating clinics, including six primary care and five abortion clinics, to complete a semi-structured video interview about their experiences. We then conducted qualitative thematic analysis of interview data, summarizing themes related to perceived benefits and concerns about the mail-order model, perceived patient interest, and potential barriers to larger-scale implementation.ResultsWe conducted 24 interviews in total with clinicians (13 physicians and one nurse practitioner) and clinic staff (n = 10). Participants highlighted perceived benefits of the mail-order model, including its potential to expand abortion services into primary care, increase patient autonomy and privacy, and to normalize abortion services. They also highlighted key logistical, clinical, and feasibility concerns about the mail-order model, and specific challenges related to integrating abortion into primary care.ConclusionClinicians and clinic staff working in primary care and abortion clinics were optimistic that mail-order dispensing of medication abortion can improve the ability of some providers to provide abortion and enable more patients to access services. The feasibility of mail-order pharmacy dispensing of medication abortion following the Supreme Court Dobbs decision is to be determined.Trial registrationRegistry: Clinicaltrials.gov.Trial registration numberNCT03913104. Date of registration: first submitted on April 3, 2019 and first posted on April 12, 2019.
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- 2024
47. Patterns of peripartum depression and anxiety during the pre-vaccine COVID-19 pandemic
- Author
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Altendahl, Marie R, Xu, Liwen, Asiodu, Ifeyinwa, Boscardin, W John, Gaw, Stephanie L, Flaherman, Valerie J, Jacoby, Vanessa L, Richards, Misty C, Krakow, Deborah, and Afshar, Yalda
- Subjects
Reproductive Medicine ,Midwifery ,Biomedical and Clinical Sciences ,Health Sciences ,Mental Health ,Depression ,Major Depressive Disorder ,Behavioral and Social Science ,Brain Disorders ,Prevention ,Mental health ,Reproductive health and childbirth ,Good Health and Well Being ,Humans ,Female ,Pregnancy ,COVID-19 ,Adult ,Prospective Studies ,Anxiety ,Peripartum Period ,Prevalence ,SARS-CoV-2 ,Pregnancy Complications ,Psychiatric Status Rating Scales ,Depression ,Postpartum ,Maternal mental health ,Nursing ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Obstetrics & Reproductive Medicine ,Reproductive medicine - Abstract
BackgroundPregnant people are vulnerable to new or worsening mental health conditions. This study aims to describe prevalence and course of depression and anxiety symptoms in pregnancy during the pre-vaccine COVID-19 pandemic.MethodsThis is a prospective cohort study of pregnant individuals with known or suspected COVID-19. Participants completed Edinburgh Postnatal Depression Scale (EPDS) and Generalized-Anxiety Disorder-7 (GAD-7) questionnaires, screening tools for depression and anxiety, at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum. Prevalence of elevated depressive and anxiety symptoms at each visit was described. Univariable logistic regression analysis was used to determine the association between demographic and clinical factors and those with elevated depression or anxiety symptoms.Results317 participants were included. The prevalence of elevated antepartum depression symptoms was 14.6%, 10.3%, and 20.6% at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum, respectively. The rate of elevated anxiety symptoms was 15.1%, 10.0%, and 17.3% at 34weeks gestational age, 6-8weeks postpartum, and 6months postpartum, respectively. A prior history of depression and/or anxiety (p's
- Published
- 2024
48. Prenatal opioid use as a predictor of postpartum suicide attempts among reproductive-age women enrolled in Oregon Medicaid
- Author
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Yoon, Jangho, Masoumirad, Mandana, Bui, Linh N, Richard, Patrick, and Harvey, S Marie
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Reproductive Medicine ,Biomedical and Clinical Sciences ,Suicide ,Prevention ,Suicide Prevention ,Pediatric ,Behavioral and Social Science ,Brain Disorders ,Clinical Research ,Reproductive health and childbirth ,Good Health and Well Being ,Pregnancy ,United States ,Female ,Humans ,Analgesics ,Opioid ,Suicide ,Attempted ,Oregon ,Medicaid ,Postpartum Period ,Opioid-Related Disorders ,Suicide attempts ,Opioid use disorder ,Postpartum ,Depression ,Substance use ,Nursing ,Paediatrics and Reproductive Medicine ,Public Health and Health Services ,Obstetrics & Reproductive Medicine ,Reproductive medicine ,Midwifery ,Public health - Abstract
BackgroundThe rates of suicide and opioid use disorder (OUD) among pregnant and postpartum women continue to increase. This research characterized OUD and suicide attempts among Medicaid-enrolled perinatal women and examined prenatal OUD diagnosis as a marker for postpartum suicide attempts.MethodsData from Oregon birth certificates, Medicaid eligibility and claims files, and hospital discharge records were linked and analyzed. The sample included Oregon Medicaid women aged 15-44 who became pregnant and gave live births between January 2008 and January 2016 (N = 61,481). Key measures included indicators of suicide attempts (separately for any means and opioid poisoning) and OUD diagnosis, separately assessed during pregnancy and the one-year postpartum period. Probit regression was used to examine the overall relationship between prenatal OUD diagnosis and postpartum suicide attempts. A simultaneous equations model was employed to explore the link between prenatal OUD diagnosis and postpartum suicide attempts, mediated by postpartum OUD diagnosis.ResultsThirty-three prenatal suicide attempts by any means were identified. Postpartum suicide attempts were more frequent with 58 attempts, corresponding to a rate of 94.3 attempts per 100,000. Of these attempts, 79% (46 attempts) involved opioid poisoning. A total of 1,799 unique women (4.6% of the sample) were diagnosed with OUD either during pregnancy or one-year postpartum with 53% receiving the diagnosis postpartum. Postpartum suicide attempts by opioid poisoning increased from 55.5 per 100,000 in 2009 to 105.1 per 100,000 in 2016. The rate of prenatal OUD also almost doubled over the same period. Prenatal OUD diagnosis was associated with a 0.15%-point increase in the probability of suicide attempts by opioid poisoning within the first year postpartum. This increase reflects a three-fold increase compared to the rate for women without a prenatal OUD diagnosis. A prenatal OUD diagnosis was significantly associated with an elevated risk of postpartum suicide attempts by opioid poisoning via a postpartum OUD diagnosis.ConclusionsThe risk of suicide attempt by opioid poisoning is elevated for Medicaid-enrolled reproductive-age women during pregnancy and postpartum. Women diagnosed with prenatal OUD may face an increased risk of postpartum suicides attempts involving opioid poisoning.
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- 2024
49. Management and treatment of musculoskeletal problems in adults with cerebral palsy: Experience gained from two lifespan clinics
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Katsma, Mark, Liu, Haiqing, Pan, Xiaoyu, Ryan, Kyle J, Roye, David P, and Chambers, Henry G
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Paediatrics ,Biomedical and Clinical Sciences ,Cerebral palsy ,adults ,musculoskeletal ,orthopedic surgery ,Paediatrics and Reproductive Medicine - Published
- 2024
50. Unraveling reproductive and maternal health challenges of women living with HIV/AIDS in Vietnam: a qualitative study
- Author
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Nguyen, Lynn T, Minh Giang, Le, Nguyen, Diep B, Nguyen, Trang T, and Lin, Chunqing
- Subjects
Biomedical and Clinical Sciences ,Midwifery ,Public Health ,Health Sciences ,Reproductive Medicine ,Clinical Research ,Behavioral and Social Science ,HIV/AIDS ,Contraception/Reproduction ,Pediatric ,Health Services ,8.1 Organisation and delivery of services ,Health and social care services research ,Reproductive health and childbirth ,Infection ,Good Health and Well Being ,Pregnancy ,Humans ,Female ,Infant ,Newborn ,Acquired Immunodeficiency Syndrome ,HIV ,Maternal Health ,Vietnam ,HIV Infections ,Qualitative Research ,Women ,Stigma ,Maternal care ,Reproductive health ,Paediatrics and Reproductive Medicine ,Obstetrics & Reproductive Medicine ,Reproductive medicine ,Public health - Abstract
BackgroundHuman Immunodeficiency Virus (HIV) remains a significant public health concern worldwide. Women living with HIV/AIDS (WLHA) have the additional and unique need to seek sexual and reproductive health services. WLHA's maternal health journeys can be shaped by the cultural norms and resources that exist in their society. This study sought to understand if and how WLHA's family planning, pregnancy, and motherhood experiences could be influenced by the patriarchal culture, gender roles, and HIV stigma in Vietnam, specifically.MethodsBetween December 2021 and March 2022, 30 WLHA with diverse socioeconomic backgrounds and childbirth experiences were interviewed in Hanoi, Vietnam. These semi-structured interviews covered topics including HIV stigma, gender norms, pregnancy experiences, and child-rearing challenges. Interviews were audio recorded, transcribed, and analysed using ATLAS.ti.ResultsQualitative analyses of participant quotes revealed how limited information on one's health prospects and reproductive options posed a significant challenge to family planning. Societal and familial expectations as well as economic circumstances also influenced reproductive decision-making. WLHA often encountered substandard healthcare during pregnancy, labor, and delivery. Stigma and lack of provider attentiveness resulted in cases where women were denied pain relief and other medical services. Communication breakdowns resulted in failure to administer antiretroviral therapy for newborns. Motherhood for WLHA was shadowed by concerns for not only their own health, but also the wellbeing of their children, as HIV stigma affected their children at school and in society as well. Many WLHA highlighted the constructive or destructive role that family members could play in their childbirth decision-making and care-giving experiences.ConclusionsOverall, this study underscores the complex ways that cultural expectations, family support, and stigma in healthcare impact WLHA. Efforts to educate and engage families and healthcare providers are warranted to better understand and address the needs of WLHA, ultimately improving their reproductive and maternal health.
- Published
- 2024
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