Obstetric Outcomes in Military Servicewomen: Emerging Knowledge, Considerations, and Gaps

2019 ◽  
Vol 37 (05/06) ◽  
pp. 215-221
Author(s):  
Kathryn Mezwa ◽  
Lee Adelsheim ◽  
Glenn Markenson
Keyword(s):  
Obstetric Outcomes ◽  
Health Care Needs ◽  
Care Needs ◽  
Occupational Risks ◽  
Increased Risk ◽  
Research Designs ◽  
Comparison Groups ◽  
Obstetric Population ◽  
The Military ◽  
The Impact

AbstractThe number of women in the U.S. military is dramatically increasing. Similarly, the roles of active-duty women are greatly expanding, thus exposing them to new occupational risks. Determining the impact of pregnancy outcomes for women while in the military is difficult due to changing exposures over time, difficulty in utilizing appropriate comparison groups, and the lack of prospective investigations. Despite these limitations, it was concerning that the available data suggest that servicewomen delivering within 6 months of their first deployment have an increased preterm birth risk (adjusted odds ratio [aOR]: 2.1), and those with three prior deployments have an even greater risk (aOR: 3.8). Servicewomen also have an increased risk of hypertensive disorders with a rate of 13% compared with 5% in the general obstetric population. Furthermore, depression is higher for women who deploy after childbirth and are exposed to combat when compared with those who have not deployed since the birth of their child (aOR: 2.01). Due to the importance of this issue, prospective research designs are necessary to better understand and address the unique health care needs of this population.

Trisomy 18 Pregnancies: Is there an Increased Maternal Risk?

2017 ◽  
Vol 34 (11) ◽  
pp. 1054-1057
Author(s):  
Kayli Senz ◽  
Whitney Humphrey ◽  
Vanessa Lee ◽  
Aaron Caughey ◽  
Sarah Dotters-Katz
Keyword(s):  
International Classification Of Diseases ◽  
Vital Statistics ◽  
Trisomy 18 ◽  
Trisomy 13 ◽  
Obstetric Outcomes ◽  
Maternal Risk ◽  
Increased Risk ◽  
Multiparous Women ◽  
Classification Of Diseases ◽  
The Impact

Objective Characterize the impact of a trisomy 18 (T18) fetus on maternal and obstetric outcomes in a cohort including T18-affected deliveries. Study Design Retrospective cohort study of singleton deliveries in California from 2005 to 2008 using linked vital statistics and the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) data to compare deliveries affected by T18 to those without known aneuploidy. Outcomes of interest included gestational diabetes mellitus (GDM), preterm delivery (PTD), preeclampsia, cesarean delivery (CD), and intrauterine fetal demise (IUFD). The χ2 and paired t-tests were used to compare the outcomes. Multiple logistic regression was used to further characterize these risks and control potential confounders. Results Of 2,029,000 deliveries, 298 involved T18. Compared with unaffected deliveries, T18 was associated with GDM (10.7 vs. 6.5%, p = 0.003), PTD < 37 (40.6 vs. 9.9%, p < 0.001) and < 32 weeks (14.8 vs. 1.4%, p < 0.001), and cesarean section (56 vs. 30.2%, p < 0.001), but not preeclampsia. In adjusted analyses, T18 pregnancies were associated with an increased risk of PTD < 37 and < 32 weeks (adjusted odds ratio [AOR]: 5.48, 95% confidence interval [CI]: 4.29, 6.99; AOR: 10.4, 95% CI: 7.26, 14.8), and an increased odd of CD for primiparous and multiparous women (AOR: 2.41, 95% CI: 1.48, 3.91; AOR: 5.42, 95% CI: 3.90, 7.53). Risk of GDM did not persist. Conclusion Unlike trisomy 13 (T13), pregnancies complicated by fetal T18 did not appear to result in an increased risk of preeclampsia. However, there is an increased risk of a range of other obstetric complications.

Military Service and Lifetime Arrests: Examining the Effects of the Total Military Experience on Arrests in a Sample of Prison Inmates

2015 ◽  
Vol 29 (1) ◽  
pp. 24-44 ◽  
Author(s):  
Erika J. Brooke ◽  
Jacinta M. Gau
Keyword(s):  
Criminal Justice ◽  
Military Service ◽  
Prison Inmates ◽  
Civilian Life ◽  
Military Experience ◽  
Entry Length ◽  
Life Trajectories ◽  
Increased Risk ◽  
The Military ◽  
The Impact

Service in the military is an important event that may shape veterans’ life trajectories. Research has shown that military service is associated with increased risk of alcohol and substance abuse, mental illness, and antisocial behaviors, yet it remains unclear whether service places veterans at elevated risk of criminal justice involvement. In addition, most prior research treats military service as a dichotomous variable and does not consider the specific components of the military experience that might affect the impact that service has upon veterans. In the present study, a large sample of state prison inmates is utilized to test for the potential impact of military service, by itself, as well as age of entry, length of service, combat exposure, discharge type, and branch status on lifetime arrests. Results have implications for both military and criminal justice policies in ensuring that veterans have the assistance they need as they re-enter civilian life.

Obstetric Outcomes in U.S. Veterans: Emerging Knowledge, Considerations, and Gaps

2019 ◽  
Vol 37 (01) ◽  
pp. 017-023
Author(s):  
Michele Hugin ◽  
Jonathan G. Shaw
Keyword(s):  
Mental Health ◽  
Women Veterans ◽  
Perinatal Outcomes ◽  
Poor Mental Health ◽  
Obstetric Outcomes ◽  
Physical And Mental Health ◽  
Current Effort ◽  
Increased Risk ◽  
Reproductive Aged Women ◽  
The Military

AbstractIn the post-9/11 era, the number of young women serving, and deploying, in the military grew rapidly; as they exit service, there is tremendous increase in reproductive-aged women Veterans. Here, we review the limited but growing research regarding Veterans' pregnancy and obstetric outcomes. U.S. women Veterans returning from deployment carry a high burden of physical and mental health conditions, and often trauma. As poor mental health is known to predict poorer maternal and infant sequelae, there are unique concerns around perinatal outcomes in Veterans. Accordingly, there is new attention to their reproductive risks and needs—evidenced by recent research and programmatic efforts within the VA. Emerging research suggests that the unique health profiles of pregnant Veterans, including prevalent posttraumatic stress disorder, predict increased risk of preterm birth, preeclampsia, and gestational diabetes. In the most contemporary large study, relying on California birth data, Veterans who relied on VA for their health care coverage were high risk, with increased rates of preeclampsia and Cesarean delivery. Additionally, Veterans' infants (compared with non-Veterans') were more likely to require NICU care. Additional research is needed to explore upstream factors leading to these poorer outcomes. Current effort to coordinate VA and non-VA care for Veteran mothers is warranted.

The Impact of Sperm and Egg Donation on the Risk of Pregnancy Complications

2018 ◽  
Vol 36 (02) ◽  
pp. 205-211 ◽  
Author(s):  
Baha Sibai ◽  
Yossi Bart ◽  
Avi Shina ◽  
Shali Mazaki-Tovi ◽  
Irit Eisen ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Preterm Labor ◽  
Intrauterine Insemination ◽  
Care Center ◽  
Tertiary Care ◽  
Egg Donation ◽  
Obstetric Outcomes ◽  
Donor Sperm ◽  
Increased Risk ◽  
The Impact

Objective The aim of this study was to evaluate obstetric outcomes in relation to the extent of donor sperm exposure with and without egg donation. Materials and Methods This is a retrospective cohort study in a single tertiary care center. All women with a singleton pregnancy who conceived following sperm donation (SD) were included. Obstetrics and neonatal outcomes for pregnancies following single SD were compared with pregnancies following repeat SD from the same donor. In a secondary analysis, we compared pregnancy outcomes among three modes of assisted reproductive technology (intrauterine insemination [IUI-SD], in vitro fertilization [IVF-SD], and IVF sperm + egg donation [IVF-SD + ED]). Results A total of 706 pregnant women met the inclusion criteria, 243 (34.4%) following the first SD and 463 (65.6%) following repeat donations. Compared with repeat SDs, single donation was not associated with higher rates of preterm delivery (12.8 vs. 12.7%, respectively, p = 0.99), preeclampsia (7.0 vs. 6.9%, p = 0.999), and intrauterine growth restriction (4.1 vs. 3.9%, p = 0.88). Pregnancies following IVF-SD + ED had increased risk for preeclampsia (adjusted odds ratio [AOR], 3.1; 95% confidence interval [CI], 1.5–6.6), preterm labor (AOR, 2.4; 95% CI, 1.1–5.4), and cesarean section (AOR, 2.1; 95% CI, 1.0–4.3) compared with IUI-SD and IVF-SD. Conclusion The extent of donor sperm exposure did not correlate with obstetrics complications, but double gamete donation was associated with increased risk for preeclampsia, preterm labor, and cesarean section.

scholarly journals The impact of delayed mobilization on post-discharge outcomes after emergency abdominal surgery: A prospective cohort study in older patients

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0241554 ◽  
Author(s):  
Jenelle L. Pederson ◽  
Raj S. Padwal ◽  
Lindsey M. Warkentin ◽  
Jayna M. Holroyd-Leduc ◽  
Adrian Wagg ◽  
...  
Keyword(s):  
Abdominal Surgery ◽  
Tertiary Care ◽  
Functional Decline ◽  
Surgical Patients ◽  
Care Needs ◽  
Post Discharge ◽  
Clinical Frailty Scale ◽  
Increased Risk ◽  
The Impact ◽  
Emergency Abdominal Surgery

Surgeons are increasingly treating seniors with complex care needs who are at high-risk of readmission and functional decline. Yet, the prognostic importance of post-operative mobilization in older surgical patients is under-investigated and remains unclear. Thus, we evaluated the relationship between post-operative mobilization and events after hospital discharge in older people. Overall, 306 survivors of emergency abdominal surgery aged ≥65y who required help with <3 activities of daily living were prospectively followed at two Canadian tertiary-care hospitals. Time until mobilization after surgery was attained from hospital charts and a priori defined as ‘delayed’ (≥36h) or ‘early’ (<36h). Primary outcomes for 30-day and 6-month all-cause readmission/death after discharge were assessed in multivariable logistic regression. Patients had a mean age of 76 ± 7.7 years, 45% were women, 41% were ‘vulnerable-to-moderately-frail’, according to the Clinical Frailty Scale. Most common reasons for admission were gallstones (23%), intestinal obstructions (21%), and hernia (17%). Median time to post-operative mobilization was 19h (interquartile range 9−35); 74 (24%) patients had delayed mobilization. Delayed mobilization was independently associated with higher risk of 30-day readmission/death (19 [26%] vs. 22 [10%], P<0.001; adjusted odds ratio [aOR] 2.24, 95%CI 0.99–5.06, P = 0.05), but this was not statistically significant at 6-months (38 [51%] vs. 64 [28%], P<0.001; aOR 1.72, 95%CI 0.91−3.25, P = 0.1). One-quarter of older surgical patients stayed in bed for 1.5 days post-operatively. Delayed mobilization was associated with increased risk of short-term readmission/death. As older, more frail patients undergo surgery, mobilization of older surgical patients remains an understudied post-operative factor. Trial registration: clinicaltrials.gov identifier: NCT02233153

Evaluating User Centered Design of E-Health for Older Adults

2016 ◽  
Vol 1 (2) ◽  
pp. 24-50
Author(s):  
Tracy L. Mitzner ◽  
Katinka Dijkstra
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Technology Acceptance ◽  
Aging In Place ◽  
Health Care Needs ◽  
User Centered Design ◽  
Care Needs ◽  
Older Users ◽  
The Impact ◽  
User Centered

Health care related technology, or E-health, has the potential to lessen the impact of the growing aging population on the health care system and support older adults' preference for aging in place. However, for technologies to be adopted by older users, research is needed to understand older adults' unique health care needs, their preferences for support, and their perceptions of technologies designed for health care. Specifically directed toward older users, this article highlights the need for user-centered design and the implications for technology acceptance, and describes studies that employed systematic subjective methods such as focus groups, interviews, and questionnaires to provide a rich, detailed depiction of older users' interactions with E-health. User-centered design evaluations involving older adults can help designers create products and services that are more likely to be adopted by older adult end users.

Underinsurance in Children with Special Health Care Needs: The Impact of Definition on Findings

2012 ◽  
Vol 17 (8) ◽  
pp. 1478-1487 ◽  
Author(s):  
Julie K. Preskitt ◽  
Rene P. McEldowney ◽  
Beverly A. Mulvihill ◽  
Martha S. Wingate ◽  
Nir Menachemi
Keyword(s):  
Health Care ◽  
Special Health Care Needs ◽  
Health Care Needs ◽  
Care Needs ◽  
Special Health Care ◽  
The Impact ◽  
Special Health

Teaching Teachers About School Health Emergencies

2001 ◽  
Vol 17 (6) ◽  
pp. 316-322 ◽  
Author(s):  
Jena Clayton Barrett
Keyword(s):  
Health Care ◽  
School Health ◽  
Special Health Care Needs ◽  
Care Plan ◽  
Health Care Needs ◽  
Care Needs ◽  
Normal Children ◽  
Special Health Care ◽  
Increased Risk ◽  
Special Health

The passage of laws requiring that all children receive appropriate public education in the least restrictive environment means children with special health care needs who are at increased risk for health emergencies have entered regular public classrooms. Therefore, teachers must deal not only with health emergencies of normal children, but with emergencies of children with special health care needs. The purpose of this study was to evaluate the effectiveness of a nurse-led educational intervention for 324 teachers on their knowledge of and anxiety about management of children having health emergencies. The intervention resulted in increased knowledge and decreased anxiety about emergency response. This study demonstrated the feasibility and value of nurses educating teachers about school emergencies and in placing the individual health care plan into action.

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