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Determinants of Physical Activity Among Black Women During Pregnancy. J Obstet Gynecol Neonatal Nurs 2024; 53:172-184. [PMID: 38072009 DOI: 10.1016/j.jogn.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE To describe associations among background determinants of physical activity, modifiable theoretical determinants of physical activity, and measures of physical activity during the second and third trimesters of pregnancy among Black women. DESIGN Longitudinal cohort. SETTING Medical center obstetric clinic. PARTICIPANTS Pregnant Black women (n = 40 in second trimester, n = 38 in third trimester) METHODS: We measured background determinants (demographic and pregnancy characteristics, discrimination, and neighborhood walkability) during the second trimester. We measured modifiable theoretical determinants (self-efficacy and social support) and physical activity using self-report and device measures during the second and third trimesters. We used paired t tests to determine differences in the modifiable theoretical determinants from the second trimester to third trimester and used Pearson correlations among background and modifiable determinants and physical activity measures during the second trimester. RESULTS Participants' physical activity levels were low during the second and third trimesters (32% and 22% met recommendation, respectively). We found no changes in self-efficacy or social support between trimesters and found no associations between these modifiable determinants and actual physical activity. We found a positive correlation between previous pregnancies and physical activity measured by devices, r(36) = .33, p = .048. Pregnancy-specific stress, r(38) = -.40, p = .013, was negatively correlated, and age, r(38) = .38, p = .017, was positively correlated with self-reported physical activity. CONCLUSIONS Low levels of physical activity during pregnancy coupled with the absence of an association with modifiable factors affecting pregnancy physical activity indicate a need to further examine the social, cultural, and environmental determinants of physical activity.
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Impact of COVID-19 on Perinatal Outcomes and Birth Locations in a Large US Metropolitan Area. Healthcare (Basel) 2024; 12:340. [PMID: 38338226 PMCID: PMC10855483 DOI: 10.3390/healthcare12030340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/15/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
This was a population-based study to determine the impact of COVID-19 on birth outcomes in the Chicago metropolitan area, comparing pre-pandemic (April-September 2019) versus pandemic (April-September 2020) births. Multivariable regression models that adjusted for demographic and neighborhood characteristics were used to estimate the marginal effects of COVID-19 on intrauterine fetal demise (IUFD)/stillbirth, preterm birth, birth hospital designation, and maternal and infant hospital length of stay (LOS). There were no differences in IUFD/stillbirths or preterm births between eras. Commercially insured preterm and term infants were 4.8 percentage points (2.3, 7.4) and 3.4 percentage points (2.5, 4.2) more likely to be born in an academic medical center during the pandemic, while Medicaid-insured preterm and term infants were 3.6 percentage points less likely (-6.5, -0.7) and 1.8 percentage points less likely (-2.8, -0.9) to be born in an academic medical center compared to the pre-pandemic era. Infant LOS decreased from 2.4 to 2.2 days (-0.35, -0.20), maternal LOS for indicated PTBs decreased from 5.6 to 5.0 days (-0.94, -0.19), and term births decreased from 2.5 to 2.3 days (-0.21, -0.17). The pandemic had a significant effect on the location of births that may have exacerbated health inequities that continue into childhood.
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MRSA screening: incidence and maternal postpartum outcomes in an obstetric population at a tertiary care center. Arch Gynecol Obstet 2023; 307:1203-1208. [PMID: 35396975 DOI: 10.1007/s00404-022-06552-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/23/2022] [Indexed: 11/02/2022]
Abstract
PURPOSE To assess the incidence of MRSA positive patients in pregnancy, as well as the postpartum outcomes in MRSA positive patients. METHODS This is a retrospective cohort study of women who underwent universal MRSA universal at a tertiary medical center. A MRSA swab was routinely collected as part of the patient's prenatal care at 35-37 weeks gestation or on admission to labor and delivery. Demographic information and decolonization antibiotics were collected by electronic medical record review, using ICD-9 codes. Outcome data were collected, including mode of delivery, hospital length of stay, endometritis, wound cellulitis, and wound infection. p < 0.05 was considered significant. A univariate logistic regression and a multivariable binary logistic regression model were used to analyze the strength of association between outcomes and MRSA status. Statistical analysis was performed with SAS, version 9.4. RESULTS The incidence of MRSA during the 4 year study period was 1.9% (82 MRSA positive out of 4369 total patients). 90.2% (74/82) of MRSA positive patients received decolonization antibiotics. No difference was noted in mode of delivery. Logistic regression failed to identify any significant differences in other relevant outcomes for MRSA positive women including endometritis 1.1 (0.1-17.5) [positive 0, versus negative 0.6% (n = 24)], wound cellulitis 5.9 (0.4-82.1) positive 0, versus negative 0.1% (Gorwitz et al. in J Infect Dis 197:1226-1234, 2008) and wound infection 3.3 (0.6-16.9) [positive 1.2%, versus negative 0.5% ( in Am J Infect Control 32:470-85, 2004)] when compared to MRSA negative women. CONCLUSION When universal MRSA screening was performed at an academic tertiary care center, the overall incidence of MRSA was low. MRSA positive and subsequently decolinzed patients did not have any identified increase in postpartum infectious morbidity, as compared to MRSA negative patients.
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Cytokine profiling: variation in immune modulation with preterm birth vs. uncomplicated term birth identifies pivotal signals in pathogenesis of preterm birth. J Perinat Med 2021; 49:299-309. [PMID: 33035192 PMCID: PMC9849608 DOI: 10.1515/jpm-2020-0025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To assess deviations in longitudinally measured cytokines with preterm birth (PTB). METHODS Prospective longitudinal study targeting 80 subjects. Phlebotomy specimens for broad panel of cytokine analysis were obtained at three time (T) intervals: first trimester (T1: 8-14 weeks' gestation), second trimester (T2: 18-22 weeks' gestation), and third trimester (T3: 28-32 weeks' gestation). Important demographics and outcomes were tracked. Data were stratified and the target groups were analyzed as follows: "Uncomplicated" (delivered ≥37 weeks) or "Preterm Birth" (<37 weeks). Generalized Linear Modeling determined rate of change T1-T3 by outcome. RESULTS Complete data replete with phlebotomy at all three visits were obtained on 80 women. Birth outcomes were as follows: 11 Uncomplicated Term Birth (UTB), 28 PTB, 4 low birth weight (LBW), 16 OB complications (OBC), 11 current infections (IFN), and 10 mixed complications (MC=2 or more of the above). 28 PTB were compared to 11 uncomplicated term deliveries. In both groups, T helper type 1 (TH1) cytokine (IL-1β), pleiotrophic pro-inflammatory cytokine (IL-6), and counter-regulatory cytokine (IL-10) responses decreased over gestation, but rates of change in IL-1β, IL-6, and IL-10 were significantly different. Stratification of women by smoking status additionally demonstrated significant variance in immune status over the course of pregnancy. CONCLUSIONS Women delivering PTB demonstrated significant differences in cytokine trajectory over pregnancy; these data further validate key role played by immune regulation in directing pregnancy outcome. Likewise, smoking impacts longitudinal trajectory of cytokines over pregnancy.
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Society for Maternal-Fetal Medicine Special Statement: Society for Maternal-Fetal Medicine's conflict of interest policy. Am J Obstet Gynecol 2020; 223:B47-B57.e3. [PMID: 32971012 DOI: 10.1016/j.ajog.2020.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A vital mission of the Society for Maternal-Fetal Medicine is to provide independent, objective, scientifically based information and recommendations for providers, patients, and payors of high-risk pregnancy care. To ensure that these recommendations are free from bias, special interest, or the perception of either, a publicly transparent process for disclosing relevant financial and nonfinancial interests (disclosures of interest) and management of potential conflicts of interest are essential. Educational and research presentations also require proper disclosure to allow attendees to properly assess information presented at the Society for Maternal-Fetal Medicine events. The Society for Maternal-Fetal Medicine established a task force to review the current Society for Maternal-Fetal Medicine policies and procedures as they pertain to disclosure of interest and conflict of interest. To establish current best practices in disclosure of interest and conflict of interest definitions, reporting, and conflict of interest mitigation, members of the task force reviewed external literature, including policies of other medical organizations. The Society for Maternal-Fetal Medicine is committed to a continuous process of improvement in the approach to these issues and will revise this policy as indicated.
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Deep Learning Utilizing Generative Adversarial Neural Networks Facilitates Maker and Pathway Analysis for Radiosensitivity in Rare Uterine Carcinosarcoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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0687 Comparative Changes Of Patient Reported Outcomes In Positive Airway Pressure And Upper Airway Stimulation For Obstructive Sleep Apnea. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Upper Airway Stimulation (UAS) is increasingly being used for obstructive sleep apnea (OSA) treatment, however, data comparing changes in patient reported outcomes (PROs) in response to positive airway pressure (PAP) versus UAS are limited. We hypothesize that there will be no difference in PROs between the two groups after treatment.
Methods
UAS and PAP groups were 1:3 matched on age, sex, Body Mass Index (BMI) and Apnea Hypopnea Index (AHI, category 15-30, >30). Linear mixed models assessed the difference of change in Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), Patient Health Questionnaire (PHQ9) and Insomnia Severity Index (ISI) measures on matched strata of UAS versus PAP groups with adjustment of baseline and matching factors. All analysis was performed in SAS software (version 9.4, Cary, NC).
Results
The analytic sample comprised 193 PAP patients and 69 UAS patients, with mean age=62.9+/-9.4 years, 27.5% female, mean BMI=29.1+/-3.2kg/m2, and median AHI 42.7, IQR: 31.5, 57.2. ESS in PAP (n=190) reduced by -2.63 (-3.38,-1.88) and in UAS (n=56) reduced by -2.22 (-3.34, -1.10), with a mean difference of 0.41 (-0.70, 1.52, p=.46). FOSQ in PAP (n=188) showed a change of 1.38 (0.99, 1.78) and in UAS (n=49) a change of 1.82 (1.17, 2.46), with a mean difference of 0.43 (-0.23, 1.09, p=.19). PHQ9 in PAP (n=185) showed a significant change of -2.24(-3.00, 1.47) and in UAS (n=45) a change of -3.75(-5.07,-2.42), with a mean difference of -1.51(-2.93,-0.088, p=.038). ISI in PAP (n=193) showed a significant change of -3.20(-4.39,-2.02) and in UAS (n=47) a change of -4.83(-6.77,-2.90), with a mean difference of -1.63(-3.62, 0.37, p=.11).
Conclusion
Similar improvements in PROs were observed in both UAS and PAP patient groups, however UAS appeared to confer greater benefit in depressive symptoms relative to PAP. Randomized clinical trials should be designed to confirm these findings.
Support
N/A
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The association between platelet dysfunction and adverse outcomes in cardiac surgical patients. Anaesthesia 2019; 74:1130-1137. [PMID: 30932171 DOI: 10.1111/anae.14631] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2019] [Indexed: 11/30/2022]
Abstract
Haemostatic activation during cardiopulmonary bypass is associated with prothrombotic complications. Although it is not possible to detect and quantify haemostatic activation directly, platelet dysfunction, as measured with point-of-care-assays, may be a useful surrogate. In this study, we assessed the association between cardiopulmonary bypass-associated platelet dysfunction and adverse outcomes in 3010 cardiac surgical patients. Platelet dysfunction, as measured near the end of the rewarming phase of cardiopulmonary bypass, was calculated as the proportion of non-functional platelets after activation with collagen. Logistic regression and multivariable analyses were applied to assess the relationship between platelet dysfunction and a composite of in-hospital death; myocardial infarction; stroke; deep vein thrombosis or pulmonary embolism; and acute kidney injury (greater than a two-fold increase in creatinine). The outcome occurred in 251 (8%) of 3010 patients. The median (IQR [range]) percentage platelet dysfunction was less for those without the outcome as compared with those with the outcome; 14% (8-28% [1-99%]) vs. 19% (11-45% [2-98%]), p < 0.001. After risk adjustment, platelet dysfunction was independently associated with the composite outcome (p < 0.001), such that for each 1% increase in platelet dysfunction there was an approximately 1% increase in the composite outcome (OR 1.012; 95%CI 1.006-1.018). This exploratory study suggests that cardiopulmonary bypass-associated platelet dysfunction has prognostic value and may be a useful clinical measure of haemostatic activation in cardiac surgery.
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LONGITUDINAL QUADRICEPS STRENGTH AND FALL INJURIES IN MEDICARE CLAIMS: THE HEALTH ABC STUDY. Innov Aging 2018. [DOI: 10.1093/geroni/igy031.3635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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0537 Comparative Impact of Upper Airway Stimulation to Positive Airway Pressure in Changes in Epworth Sleepiness Scale, Blood Pressure and Adherence in Obstructive Sleep Apnea. Sleep 2018. [DOI: 10.1093/sleep/zsy061.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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DIABETES, IMPAIRED FASTING GLUCOSE, AND FALL INJURY RISK IN OLDER ADULTS: THE HEALTH ABC STUDY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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MEDICARE PAYMENTS FOR NON-FRACTURE AND FRACTURE FALL INJURIES: THE HEALTH ABC STUDY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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QUADRICEPS STRENGTH AND FALL INJURIES IN MEDICARE CLAIMS: THE HEALTH ABC STUDY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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0584 IMPACT OF HYPOGLOSSAL NERVE STIMULATION ON EARLY PATIENT REPORTED OUTCOMES: THE CLEVELAND CLINIC EXPERIENCE. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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347: Do low-risk women over the age of 40 with fetal growth restriction have a higher risk of stillbirth? Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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182: The risks of fetal and neonatal death in large-for-gestational age neonates: a population based study. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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392: The risks of remaining undelivered at term. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28: Does maternal insulin sensitivity improve immediately after delivery or do we need to wait until six weeks postpartum? Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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361: Is there a difference in body composition of infants with a maternal diagnosis of GDM using CC or IADPSG criteria compared to mothers with normal glucose tolerance? Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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242: The risk of hypertensive disorders of pregnancy with expectant management at term. Am J Obstet Gynecol 2014. [DOI: 10.1016/j.ajog.2013.10.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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691: The effect of maternal age on the risk of stillbirth if remaining undelivered. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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P02.84. A randomized trial of Polarity therapy for stress and pain reduction in American Indian and Alaska Native family dementia caregivers. Altern Ther Health Med 2012. [PMCID: PMC3373537 DOI: 10.1186/1472-6882-12-s1-p140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Human posture simulation to assess cumulative spinal load due to manual lifting. Part II: accuracy and precision. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2011. [DOI: 10.1080/14639220903490740] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Obese pregnant women develop severe insulin resistance and enhanced systemic and placental inflammation, suggesting associated modifications of endocrine and immune functions. Activation of innate immunity by endotoxins/lipopolysaccharides (LPS) has been proposed as a mechanism for enhancing metabolic alterations in disorders with insulin resistance. The aim of this study was to characterize the immune responses developed by the adipose tissue (AT) and their potential links to maternal endotoxemia in pregnancy with obesity. Blood and subcutaneous abdominal AT were obtained from 120 lean and obese women (term pregnancy) recruited at delivery. Gene expression was assessed in AT and stromal vascular cells isolated from a subset of 24 subjects from the same cohort. Doubling of plasma endotoxin concentrations indicated subclinical endotoxemia in obese compared with lean women. This was associated with significant increase in systemic C-reactive protein and interleukin-6 (IL-6) but not tumor necrosis factor-α (TNF-α) concentrations. AT inflammation was characterized by accumulation of CD68(+) macrophages with a threefold increased gene expression of the macrophage markers CD68, EMR1, and CD14. Gene expression for cytokines IL-6, TNF-α, IL-8, and monocyte chemotactic protein-1 (MCP1) and for LPS-sensing CD14, toll-like receptor 4 (TLR4), translocating chain-associated membrane protein 2 was 2.5-5-fold higher in stromal cells of obese compared to lean. LPS-treated cultured stromal cells of obese women expressed a 5-16-fold stimulation of the same cytokines upregulated in vivo. Our data demonstrate that subclinical endotoxemia is associated with systemic and AT inflammation in obese pregnant women. Recognition of bacterial pathogens may contribute to the combined dysfunction of innate immunity and the metabolic systems in AT.
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93: Women's reported weight: is there a discrepancy? Am J Obstet Gynecol 2011. [DOI: 10.1016/j.ajog.2010.10.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Physical and sedentary behavior in New Zealand children: Children's, parents’ and health professionals’ perceptions. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2010.10.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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834: Contribution of obesity to maternal hospitalization for non-obstetric complications. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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197: Relationship between neonatal body composition, birthweight percentiles, and maternal BMI in infants born to women with normal glucose tolerance tests. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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203: Increased systemic inflammation results from activation of innate immune mechanisms in adipose tissue of obese pregnant women. Am J Obstet Gynecol 2009. [DOI: 10.1016/j.ajog.2009.10.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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340: Variation in immune profiles of smoking versus non-smoking pregnant women. Am J Obstet Gynecol 2008. [DOI: 10.1016/j.ajog.2008.09.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Uncertainties in internal doses calculated for Mayak workers--a study of 63 cases. RADIATION PROTECTION DOSIMETRY 2008; 131:316-330. [PMID: 18689802 DOI: 10.1093/rpd/ncn181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study makes use of 63 cases of Mayak workers exposed to Pu-239 with autopsy data and some late-time urine bioassay data. In addition, air-concentration data--used to construct monthly average values--are available for each case, which provide the time dependence and potential magnitudes of normal inhalation intakes for each case. The purpose of the study is to develop and test Bayesian methods of dose calculation for the Mayak workers. The first part of the study was to quantitatively characterise the uncertainties of the bioassay data. Then, starting with three different published biokinetic models, the data are fit by varying intake and model perturbation parameters, e.g., parameters influencing the lung, thoracic lymph nodes, liver and bone retention. Statistical self-consistency arguments are used to check the measurement uncertainty parameters within the Poisson-lognormal model. The second part of the study is to set up and test Bayesian dose calculations, which use the point determinations of biokinetic parameters from the study cases within a discrete, empirical Bayes approximation. The main conclusion of the study is that these methods are now ready to be applied to the entire Mayak worker population.
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654: Longitudinal neonatal outcomes among women with mobiluncus species on 1st trimester gram stain. Am J Obstet Gynecol 2007. [DOI: 10.1016/j.ajog.2007.10.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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90: Impact of remote antenatal corticosteroid exposure on neonatal outcomes. Am J Obstet Gynecol 2007. [DOI: 10.1016/j.ajog.2007.10.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mapping vernacular geography: web-based GIS tools for capturing 'fuzzy' or 'vague' entities. ACTA ACUST UNITED AC 2007. [DOI: 10.1504/ijtpm.2007.014547] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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35
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Variation in CRP at 1 month post-partum by etiology of preterm birth: Data from the preterm prevention project. Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gestational age at presentation and duration of latency in twins vs. Singleton pregnancies with pre-term premature rupture of membranes (pPROM). Am J Obstet Gynecol 2006. [DOI: 10.1016/j.ajog.2006.10.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cumulative spinal loading exposure methods for manual material handling tasks. Part 1: is cumulative spinal loading associated with lower back disorders? THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2006. [DOI: 10.1080/14639220500111392] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cumulative spinal loading exposure methods for manual material handling tasks. Part 2: methodological issues and applicability for use in epidemiological studies. THEORETICAL ISSUES IN ERGONOMICS SCIENCE 2006. [DOI: 10.1080/14639220500111459] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Newborn anthropometric measurements in twin pregnancies exposed to multiple courses of antenatal steroids. Am J Obstet Gynecol 2005. [DOI: 10.1016/j.ajog.2005.10.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Neonatal hearing assessment in very low birth weight infants exposed to antenatal steroids. Am J Obstet Gynecol 2005. [DOI: 10.1016/j.ajog.2005.10.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Interval head growth for infants exposed to multiple doses of antenatal steroids. Am J Obstet Gynecol 2004. [DOI: 10.1016/j.ajog.2004.10.278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Outcomes of pregnancies diagnosed with gestational hypertension who develop subjective symptoms of preeclampsia. Am J Obstet Gynecol 2004. [DOI: 10.1016/j.ajog.2004.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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The economic impact of intermittent high-dose intravenous versus oral corticosteroid treatment of juvenile dermatomyositis. ACTA ACUST UNITED AC 2003; 13:360-8. [PMID: 14635311 DOI: 10.1002/1529-0131(200012)13:6<360::aid-art5>3.0.co;2-q] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To perform a cost-identification and cost-effectiveness analysis comparing oral corticosteroids (OCS) with high-dose intermittent intravenous corticosteroid (IVCS) regimens in the treatment of juvenile dermatomyositis (JDM). METHODS Children previously diagnosed and treated for JDM (without myositis-specific or myositis-associated autoantibodies) at a single medical center by a single provider were identified. Two treatment protocols were compared: OCS and IVCS. Data on initial disease severity, time to remission, resource use, and costs generated were collected from patient records. Incremental cost-effectiveness ratios (ICE) were constructed. RESULTS Patients treated with IVCS achieved median remission 2 years earlier at median increased cost of $13,736. The ICE ratio comparing IVCS to OCS is $6,868 per year of disease avoided. CONCLUSION This study suggests that, although IVCS treatments are costly, they are cost-effective.
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Multifetal pregnancies: evolution of methods of initiation and impact of REI certification for patients seeking reduction. Fetal Diagn Ther 2003; 18:132-6. [PMID: 12576750 DOI: 10.1159/000068550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2002] [Accepted: 05/03/2002] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Multifetal pregnancy as a result of ovulation induction (OI) and assisted reproductive technologies (ART) correlate with Board certification in reproductive endocrinology and infertility (REI). DESIGN Retrospective chart analysis of 304 patients referred to Wayne State University (WSU) and Thomas Jefferson University (TJU) for multifetal pregnancy reduction (MFPR) from March 1986 to January 1995 compared to 275 patients referred from January 1 to December 31, 2000 at MCP Hahnemann University. MATERIAL AND METHODS Chart review for fetal number, pregnancy generation (OI or ART) and physician REI Board certification from the American Board of Specialties Obstetrics and Gynecology. Information was available on 296 of 304 patients studied in the 1986-1995 WSU cohort and 275 patients studied from the MCP Hahnemann 2000 cohort. RESULTS Analysis of 296 multifetal pregnancies at WSU and TJU for REI Board status showed non-REI Board-certified (NREI) physicians generated 174 pregnancies with quadruplets or more compared to 122 quadruplets or more by REI Board-certified physicians. Board certification did not impact quadruplet or more rates for OI or ART (p < 0.368). Of 275 patients with triplets or more at MCP Hahnemann, 156 (56.7%) were from ARTs versus 41.2% from 1986-1995 (chi(2) = 13.1, p < 0.001). Quintuplets or more decreased from 18.5 to 9.7% (chi(2) = 8.3, p = 0.004), and for REIs from 22.1 to 9.6% (chi(2) = 4.7, p < 0.01), while 14.4% of cases coming from non-REIs had quintuplets versus 9.6% from REIs (p = NS). CONCLUSIONS Cases of MFPR from ARTs have risen, while percentage of cases with quintuplets have fallen in half. We found no difference in quintuplets between REIs and non-REIs overall, but REI quintuplets fell significantly, and NREI has not.
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Abstract
Home health care workers have high rates of back injuries and other musculoskeletal problems. This article addresses issues surrounding work-related overexertion injuries in home health care workers, including summaries of relevant research on workers in home settings as well as in traditional health care settings such as hospitals and nursing homes. The main work factors associated with these injuries are forceful exertions and awkward postures during patient- care tasks, especially while lifting and moving patients. Ergonomics-the design of work tasks to best accommodate natural human capabilities-is the most promising approach for preventing injuries, and for enhancing the comfort and safety of workers and patients.
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Impact of vaginal antifungal products on utilization of health care services: evidence from physician visits. THE JOURNAL OF THE AMERICAN BOARD OF FAMILY PRACTICE 2000; 13:178-82. [PMID: 10826865 DOI: 10.3122/15572625-13-3-178] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Recently many medications formerly available only by prescription have been approved for over-the-counter (OTC) status. In 1990, clotrimazole became the first available OTC drug to treat candidal vaginitis. Subsequently several other prescription antifungal medications have also been available in OTC products. One proposed benefit of these switches from prescription to OTC status is a reduction in the utilization of health care services. METHODS Using National Ambulatory Medical Care Survey data, the average numbers of annual visits for vaginal complaints were estimated for 1985, 1990, and 1994. These years were chosen because they represented periods before, close to, and after the approval of the OTC antifungal preparations. The estimated visits for each year were compared using a chi-square analysis with a sample weight correction. RESULTS There was a 15% decline in the number of vaginitis visits from 1990 to 1994 that potentially could be attributed to the availability of the OTC antifungal preparations. The decrease in physician visits results in approximately $45 million in direct cost savings and another $18.75 million in indirect savings by reducing time lost from work. CONCLUSIONS It appears that the availability of OTC anticandidal fungal preparations reduces the number of physician visits for vaginitis, resulting in cost savings.
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Valuing clinical strategies early in development: a cost analysis of allogeneic peripheral blood stem cell transplantation. Bone Marrow Transplant 1999; 24:555-60. [PMID: 10482942 DOI: 10.1038/sj.bmt.1701945] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Allogeneic peripheral blood stem cell transplantation (alloPBSCT) is an emerging technology. As this technology develops, transplant centers are concerned with looking for technologic advances that will result in improvements in clinical outcomes and lower costs. We provide comparative estimates of costs and resource use for alloPBSCT in comparison to allogeneic bone marrow transplantation (alloBMT) for persons with hematologic malignancies from the time of harvest to 100 days post transplant. A retrospective, cost-identification analysis was conducted for patients in two consecutive phase II clinical trials at the University of Nebraska Medical Center. Identical preparative regimens, graft-versus-host disease prophylaxis, post-transplant hematopoietic colony-stimulating factor treatment regimens, and discharge criteria were used. Total median costs were $18,304 lower for alloPBSCT, with lower costs during recovery; specifically for hospitalization, platelet products, hematopoietic growth factors, intravenous hyperalimentation, supportive care agents, supplies, and antibacterial agents. This study provides preliminary evidence for short-term cost savings associated with alloPBSCT. However, concerns exist over the potential for higher costs due to preliminary reports of higher rates of chronic graft-versus-host disease, as well as more intensive induction regimens that may result in lower relapse rates. The premature adoption of new technologies based on short-term economic factors, in the absence of adequate clinical trial data, may prove to be ill-advised, particularly for complex medical treatments such as allogeneic transplantation.
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The "prescription-to-OTC switch" movement. Its effects on antifungal vaginitis preparations. ARCHIVES OF FAMILY MEDICINE 1999; 8:297-300. [PMID: 10418534 DOI: 10.1001/archfami.8.4.297] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
More than 600 over-the-counter (OTC) products have ingredients or dosages that were previously available by prescription only. The criteria for switching drugs include a low potential for misuse or abuse, safety and efficacy, and the ability for effective use by the average person. In addition, the conditions the drugs treat should be benign and self-limited. In 1990, the first topical imidazole for candidal vaginitis was approved by the Food and Drug Administration for over-the-counter use. Suggested benefits of this switch were increased patient autonomy and reduced costs. Risks include potential for misdiagnoses, resulting in inappropriate use, unnecessary use, or delay in treatment, which could lead to increased cost and morbidity. Despite the wide use of these products, there is little evidence examining the outcome of the switch. Limited available data suggest that the switch of the antifungal preparations reduces costs with little objective evidence of harm resulting from the switch.
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Patients' and caregivers' transition from hospital to home: needs and recommendations. Home Health Care Serv Q 1999; 17:27-48. [PMID: 10351068 DOI: 10.1300/j027v17n03_03] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Given the greatly decreased length of hospital stays, concern about the transition from hospital to home has increased. This descriptive study focused on a sample of hospitalized patients discharged to home with home care services. Patient and caregiver interviews revealed that satisfaction with home care services was positively related to receipt of information from the home care staff about medications, equipment/supplies, and self-care. Caregiver burden was inversely related to receiving this information. Recommendations for improving the transition from hospital to home included providing more information, more reassurance and emotional support, and more household assistance. Several possible methods of implementing these recommendations are proposed.
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