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Paediatric Anaesthesia Feb 2024This article gives the pediatric anesthesia perspective from Cameroon, Nigeria, Ghana, Liberia, and Gambia, five out of six countries in Anglophone West Africa. Over 40%... (Review)
Review
BACKGROUND
This article gives the pediatric anesthesia perspective from Cameroon, Nigeria, Ghana, Liberia, and Gambia, five out of six countries in Anglophone West Africa. Over 40% of the population of most of these countries are younger than 14 years and there is an increasing need for paediatric anesthesia services.
FINDINGS
Workforce density ranges from 0.08 to 0.58 physician anesthesia providers per 100,000 population. There are only 13 trained pediatric anesthetists; ratios range from 0 to 0.4 per 100,000 children, thus pediatric anesthesia services are provided by various cadres of physician and non-physician anesthesia providers. Physician anesthesia training is mostly carried out by the West African College of Surgeons as well as national postgraduate colleges. Pediatric anesthesia services are provided in tertiary (teaching), secondary (general), district, faith-based, military, private hospitals and through surgical missions. Challenges include lack of trained personnel, high morbidity from late presentation to health facilities and financial constraints, lack of health insurance for pediatric anesthesia services, unavailability of appropriate equipment and consumables, a narrow range of medications, very few pediatric-specific operating theaters, and inadequate critical care services.
SOLUTIONS
The lack of opportunities for sub-specialty training in pediatric anesthesia in West Africa is currently being addressed in Nigeria and Ghana. Non-governmental agencies fund programs and courses related to pediatric anesthesia and have also provided fully equipped operating theaters. Advocacy for pediatric anesthesia can be achieved through the National Surgical Obstetric Anesthesia and Nursing Plans Implementation Committee of the various countries. There is an urgent need for prioritization of health in the budgets of Anglophone West African countries and governments must deliberately provide support for anesthesia and surgical services. More international collaborations towards workforce training and creation of children's hospitals are needed.
PubMed: 38321802
DOI: 10.1111/pan.14852 -
Annals of Internal Medicine Jan 2024Severe maternal morbidity and mortality are worse in the United States than in all similar countries, with the greatest effect on Black women. Emerging research suggests... (Review)
Review
BACKGROUND
Severe maternal morbidity and mortality are worse in the United States than in all similar countries, with the greatest effect on Black women. Emerging research suggests that disrespectful care during childbirth contributes to this problem.
PURPOSE
To conduct a systematic review on definitions and valid measurements of respectful maternity care (RMC), its effectiveness for improving maternal and infant health outcomes for those who are pregnant and postpartum, and strategies for implementation.
DATA SOURCES
Systematic searches of Ovid Medline, CINAHL, Embase, Cochrane Central Register of Controlled Trials, PsycInfo, and SocINDEX for English-language studies (inception to July 2023).
STUDY SELECTION
Randomized controlled trials and nonrandomized studies of interventions of RMC versus usual care for effectiveness studies; additional qualitative and noncomparative validation studies for definitions and measurement studies.
DATA EXTRACTION
Dual data abstraction and quality assessment using established methods, with resolution of disagreements through consensus.
DATA SYNTHESIS
Thirty-seven studies were included across all questions, of which 1 provided insufficient evidence on the effectiveness of RMC to improve maternal outcomes and none studied RMC to improve infant outcomes. To define RMC, authors identified 12 RMC frameworks, from which 2 main concepts were identified: and frameworks. Disrespect and abuse components focused on recognizing birth mistreatment; rights-based frameworks incorporated aspects of reproductive justice, human rights, and antiracism. Five overlapping framework themes include freedom from abuse, consent, privacy, dignity, communication, safety, and justice. Twelve tools to measure RMC were validated in 24 studies on content validity, construct validity, and internal consistency, but lack of a gold standard limited evaluation of criterion validity. Three tools specific for RMC had at least 1 study demonstrating consistency internally and with an intended construct relevant to U.S. settings, but no single tool stands out as the best measure of RMC.
LIMITATIONS
No studies evaluated other health outcomes or RMC implementation strategies. The lack of definition and gold standard limit evaluation of RMC tools.
CONCLUSION
Frameworks for RMC are well described but vary in their definitions. Tools to measure RMC demonstrate consistency but lack a gold standard, requiring further evaluation before implementation in U.S. settings. Evidence is lacking on the effectiveness of implementing RMC to improve any maternal or infant health outcome.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality. (PROSPERO: CRD42023394769).
Topics: Infant; Pregnancy; Female; Humans; Maternal Health Services; Respect; Obstetrics; Delivery, Obstetric; Postpartum Period; Quality of Health Care
PubMed: 38163377
DOI: 10.7326/M23-2676 -
BMC Pregnancy and Childbirth Nov 2023Respectful maternity care (RMC) - a fundamental human right for all women - prioritizes autonomy and rights of pregnant and birthing women throughout the entire...
Respectful maternity care (RMC) - a fundamental human right for all women - prioritizes autonomy and rights of pregnant and birthing women throughout the entire childbirth journey. Despite increasing acknowledgment of the importance of RMC for optimal maternal and new-born outcomes, women often experience disrespectful and abusive practices during pregnancy and childbirth. This Editorial points to the need for development of international guidelines for the implementation of RMC programs globally.
Topics: Pregnancy; Female; Humans; Quality of Health Care; Maternal Health Services; Attitude of Health Personnel; Delivery, Obstetric; Respect; Parturition
PubMed: 37978465
DOI: 10.1186/s12884-023-06118-y -
International Journal of Public Health 2023To compare obstetric and neonatal characteristics and birth outcomes between Syrian refugees and native women in Jordan. We used the Jordan Stillbirths and Neonatal...
To compare obstetric and neonatal characteristics and birth outcomes between Syrian refugees and native women in Jordan. We used the Jordan Stillbirths and Neonatal Deaths Surveillance System to extract sociodemographic and obstetric characteristics of the mothers and birth characteristics of newborns. Multivariate analysis was used to compare the characteristics of 26,139 Jordanian women (27,468 births) and 3,453 Syrian women refugees (3,638 births) who gave birth in five referral hospitals (May 2019 and December 2020). The proportions of low birthweight (14.1% vs. 11.8%, < 0.001) and small for gestational age (12.0% vs. 10.0%, < 0.001) newborns were significantly higher for those born to Syrian women compared to those born to Jordanian women. The stillbirth rate (15.1 vs. 9.9 per 1,000 births, = 0.003), the neonatal death rate (21.2 vs. 13.2 per 1,000 live births, < 0.001), and perinatal death rate (21.2 vs. 13.2 per 1,000 births, < 0.001) were significantly higher for the Syrian births. After adjusting for sociodemographic and obstetric characteristics of women, only perinatal death was statistically significantly higher among Syrian babies compared to Jordanian babies (OR = 1.3, 95% CI: 1.1-1.7, = 0.035). Syrian refugee mothers had a significantly higher risk of adverse obstetric and neonatal outcomes including higher rate of perinatal death compared to Jordanian women.
Topics: Pregnancy; Infant; Infant, Newborn; Female; Humans; Refugees; Jordan; Perinatal Death; Syria; Retrospective Studies; Stillbirth
PubMed: 38024216
DOI: 10.3389/ijph.2023.1605645 -
Sexual and Reproductive Health Matters Dec 2023Obstetric violence has been documented throughout the world, yet this human rights issue has mostly been investigated in middle- and low-income countries where the... (Review)
Review
Obstetric violence has been documented throughout the world, yet this human rights issue has mostly been investigated in middle- and low-income countries where the intensity and brutality of abuse and mistreatment is more easily recognised as problematic. This integrative review aimed to analyse sources about obstetric violence in high-income countries with the objective of identifying gaps in the research, challenges to the study of obstetric violence, and solutions to framing research that meets those challenges. A systematic search was conducted using the PubMed and CINAHL databases from February to June 2022. Empirical and non-empirical sources, published in English, with no date restrictions, were retrieved. Citation searching was also done. Forty-six sources were included. Identified gaps in the research were: (a) scarce attention to obstetric violence in most high-income countries; (b) most US sources are non-scientific and from outside the healthcare disciplines; (c) inconsistencies in terminology; (d) most studies were conducted with samples of women who had given birth, with scant research about healthcare providers and obstetric violence, and (e) the association between obstetric violence and traumatic birth was under-recognised. Identified challenges to the study of obstetric violence were: (1) factors that enable and perpetuate obstetric violence are multilevel and nonlinear; (2) the phenomenon is contextually complex; and (3) blind spots from routinised harmful practices and normalised mistreatment can prevent healthcare providers and birthing people from recognising obstetric violence. A systems approach and complexity theory are guiding frameworks recommended as solutions to the challenges of studying and correcting obstetric violence.
Topics: Pregnancy; Female; Humans; United States; Developed Countries; Violence
PubMed: 38590127
DOI: 10.1080/26410397.2024.2322194 -
Obstetrics and Gynecology Sep 2023Sepsis in obstetric care is one of the leading causes of maternal death in the United States, with Black, Asian/Pacific Islander, and American Indian/Alaska Native...
Sepsis in obstetric care is one of the leading causes of maternal death in the United States, with Black, Asian/Pacific Islander, and American Indian/Alaska Native obstetric patients experiencing sepsis at disproportionately higher rates. State maternal mortality review committees have determined that deaths are preventable much of the time and are caused by delays in recognition, treatment, and escalation of care. The "Sepsis in Obstetric Care" patient safety bundle provides guidance for health care teams to develop coordinated, multidisciplinary care for pregnant and postpartum people by preventing infection and recognizing and treating infection early to prevent progression to sepsis. This is one of several core patient safety bundles developed by AIM (the Alliance for Innovation on Maternal Health) to provide condition- or event-specific clinical practices that should be implemented in all appropriate care settings. As with other bundles developed by AIM, the "Sepsis in Obstetric Care" patient safety bundle is organized into five domains: Readiness, Recognition and Prevention, Response, Reporting and Systems Learning, and Respectful, Equitable, and Supportive Care. The Respectful, Equitable, and Supportive Care domain provides essential best practices to support respectful, equitable, and supportive care to all patients. Further health equity considerations are integrated into the elements of each domain.
Topics: Female; Pregnancy; Humans; Maternal Health; Consensus; Sepsis; Advisory Committees
PubMed: 37590980
DOI: 10.1097/AOG.0000000000005304 -
The Journal of Obstetrics and... Jul 2023To make a bibliometric analysis on post-traumatic growth (PTG) after childbirth. (Review)
Review
AIM
To make a bibliometric analysis on post-traumatic growth (PTG) after childbirth.
METHODS
The topic advanced search strategy extracted the information from the Web of Science Core Collection. Descriptive statistics were performed using Excel, and bibliometric analysis was performed using VOSviewer.
RESULTS
A total of 362 publications were published in 199 journals were obtained in the WoSCC from 1999 to 2022. Postpartum post-traumatic growth is in a trend of fluctuating growth, and the United States (N = 156) and Bar-Ilan University (N = 22) were the top contributing countries and institutions, respectively. Research hotspots mainly focus on theoretical models of PTG, postpartum post-traumatic stress disorder (PTSD) as a predictor of PTG, facilitators of PTG, and the relationship between mother-infant attachment and PTG.
CONCLUSION
This bibliometric study provides a comprehensive overview of the current state of research on PTG after childbirth, an area that has received considerable scholarly attention in recent years. However, research on post-traumatic growth after childbirth is lacking, and further research is needed.
Topics: Infant; Female; Pregnancy; Humans; Posttraumatic Growth, Psychological; Parturition; Delivery, Obstetric; Postpartum Period; Bibliometrics
PubMed: 37231962
DOI: 10.1111/jog.15675 -
Frontiers in Public Health 2023To determine whether the different pelvic floor disorders are associated with changes in perceived quality of life (QoL), globally and in its sub-dimensions. (Observational Study)
Observational Study
OBJECTIVE
To determine whether the different pelvic floor disorders are associated with changes in perceived quality of life (QoL), globally and in its sub-dimensions.
METHODS
An observational study was conducted with women in Spain between 2021 and 2022. Information was collected using a self-developed questionnaire on sociodemographic data, employment, history and health status, lifestyle and habits, obstetric history, and health problems. The SF-12 questionnaire was used to assess quality of life. The Pelvic Floor Distress Inventory (PFDI-20) was used to assess the presence and impact of pelvic floor problems, and includes the POPDI-6 subscales for prolapse, CRADI- 8 for colorectal symptoms, and UDI-6 for urinary symptoms. Crude (MD) and adjusted mean differences (aMD) were estimated with their respective 95% confidence intervals (CI).
RESULTS
Thousand four hundred and forty six women participated in the study with a mean age of 44.27 (SD = 14.68). A statistical association was observed between all the pelvic floor disorders and QoL, overall and in all its dimensions ( <.001), in the bivariable analysis. The lowest scores were observed in the emotional component. After adjusting for confounding factors, the pelvic floor disorders in general (aMD -0.21, 95% CI: -0.23 to -0.20), the impact of uterine prolapse symptoms (aMD -0.20, 95% CI: -0.27 to -0.12), the colorectal-anal symptoms (aMD -0.15, 95% CI: -0.22 to -0.09), and urinary symptoms (aMD -0.07, 95% CI: -0.13 to -0.03) was negatively associated on the score on the SF-12 questionnaire ( <.05).
CONCLUSIONS
Women who have a pelvic floor dysfunction, symptoms of pelvic organ prolapse, colorectal-anal symptoms, or urinary symptoms, have a worse perceived quality of life in all dimensions. Prolapse symptoms have the biggest impact, and the emotional component of QoL is the most affected sub-domains.
Topics: Pregnancy; Female; Humans; Adult; Pelvic Floor Disorders; Quality of Life; Pelvic Organ Prolapse; Uterine Prolapse; Colorectal Neoplasms
PubMed: 37942254
DOI: 10.3389/fpubh.2023.1180907 -
BMC Medicine Jul 2023Gestational diabetes mellitus (GDM) is associated with both short- and long-term risks, although it is unknown if risks vary by severity, timing, and duration of...
Random capillary glucose levels throughout pregnancy, obstetric and neonatal outcomes, and long-term neurodevelopmental conditions in children: a group-based trajectory analysis.
BACKGROUND
Gestational diabetes mellitus (GDM) is associated with both short- and long-term risks, although it is unknown if risks vary by severity, timing, and duration of gestational hyperglycemia. We aimed to identify trajectories of random capillary glucose (RCG) levels throughout pregnancy and assess their associations with both obstetric/neonatal outcomes and children's risk of neurodevelopmental conditions (NDCs) (i.e., autism, intellectual disability, and attention-deficit/hyperactivity disorders [ADHD]).
METHODS
A population-based cohort study was conducted involving 76,228 children born to 68,768 mothers without pregestational diabetes. Group-based trajectory modeling was utilized to identify distinct glucose trajectories across RCG values throughout the course of pregnancy. The associations between these trajectory groups and obstetric/neonatal outcomes as well as children's NDCs were then assessed using generalized estimating equation models with a logit link. The Benjamini-Hochberg (BH) procedure was employed to adjust P-values for multiple comparisons, controlling the false discovery rate (FDR).
RESULTS
Five distinct glucose trajectory groups were identified, each with varying percentages diagnosed with GDM. Their associations with obstetric/neonatal outcomes as well as children's NDCs varied. For example, when compared to the "Persistently Low" group, other groups exhibited varying degrees of increased risk for large-for-gestational-age babies, with the exception of the "High in Early Pregnancy" group. Compared to the "Persistently Low" group, all other trajectory groups were associated with NDC outcomes, except the "High in Mid-Pregnancy" group. However, none of the associations with offspring NDCs remained significant after accounting for the FDR correction.
CONCLUSIONS
Persistent high glucose levels or moderately elevated glucose levels throughout pregnancy, as well as transient states of hyperglycemia in early or mid-pregnancy, were found to be associated with increased risks of specific obstetric and neonatal complications, and potentially offspring NDCs. These risks varied depending on the severity, timing, duration, and management of hyperglycemia. The findings underscore the need for continuous surveillance and individualized management strategies for women displaying different glucose trajectories during pregnancy. Limitations such as potential residual confounding, the role of mediators, and small sample size should be addressed in future studies.
Topics: Pregnancy; Infant, Newborn; Humans; Female; Child; Cohort Studies; Diabetes, Gestational; Mothers; Hyperglycemia; Glucose
PubMed: 37468907
DOI: 10.1186/s12916-023-02926-3 -
Seminars in Perinatology Aug 2023
Topics: Pregnancy; Female; Humans; Umbilical Cord Clamping; Umbilical Cord; Delivery, Obstetric
PubMed: 37357044
DOI: 10.1016/j.semperi.2023.151782