Expanding the concept of the professional integrity of obstetrics during a public health emergency

2020 ◽  
Vol 48 (5) ◽  
pp. 435-437 ◽  
Author(s):  
Frank A. Chervenak ◽  
Amos Grünebaum ◽  
Eran Bornstein ◽  
Shane Wasden ◽  
Adi Katz ◽  
...  
Keyword(s):  
Public Health ◽  
New York ◽  
Clinical Judgment ◽  
Ethical Judgment ◽  
Population Based ◽  
Public Health Emergency ◽  
Ethical Challenge ◽  
Professional Integrity ◽  
Increased Risk ◽  
Obstetric Services

AbstractThe coronavirus disease 2019 (COVID-19) pandemic has placed great demands on many hospitals to maximize their capacity to care for affected patients. The requirement to reassign space has created challenges for obstetric services. We describe the nature of that challenge for an obstetric service in New York City. This experience raised an ethical challenge: whether it would be consistent with professional integrity to respond to a public health emergency with a plan for obstetric services that would create an increased risk of rare maternal mortality. We answered this question using the conceptual tools of professional ethics in obstetrics, especially the professional virtue of integrity. A public health emergency requires frameshifting from an individual-patient perspective to a population-based perspective. We show that an individual-patient-based, beneficence-based deliberative clinical judgment is not an adequate basis for organizational policy in response to a public health emergency. Instead, physicians, especially those in leadership positions, must frameshift to population-based clinical ethical judgment that focuses on reduction of mortality as much as possible in the entire population of patients served by a healthcare organization.

scholarly journals Consolidation of obstetric services in a public health emergency

2020 ◽  
Vol 44 (7) ◽  
pp. 151281
Author(s):  
Katherine H. Campbell ◽  
Christian M. Pettker ◽  
Dena Goffman
Keyword(s):  
Public Health ◽  
Public Health Emergency ◽  
Obstetric Services

scholarly journals Relationship Between The Place Of Living And Mortality In Patients With Advanced Heart Failure.

2020 ◽  
Author(s):  
Miguel-Angel Munoz ◽  
Raquel Garcia ◽  
Elena Navas ◽  
Julio Duran ◽  
José-Luis Del Val-Garcia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
New York ◽  
Rural Areas ◽  
Cox Regression ◽  
Heart Association ◽  
Population Based ◽  
Advanced Heart Failure ◽  
Functional Class ◽  
Increased Risk

Abstract Background Social and environmental factors in advanced heart failure (HF) patients may be crucial to cope with the end stages of the disease. This study analyzes health inequalities and mortality according to place of residence (rural vs urban) in HF patients at advanced stages of the disease.Methods Population-based cohort study including 1148 adult patients with HF attended in 279 primary care centers. Patients were followed for at least one year after reaching New York Heart Association IV functional class, between 2010 and 2014.Data came from primary care electronic medical records. Cox regression models were applied to determine the hazard ratios (HR) of mortality. Results Mean age was 81.6 (SD 8.9) years, and 62% were women. Patients in rural areas were older, particularly women aged >74 years (p=0.036), and presented lower comorbidity. Mortality percentages were 59% and 51% among rural and urban patients, respectively (p=0.030). Urban patients living in the most socio-economically deprived neighborhoods presented the highest rate of health service utilization, particularly with primary care nurses (p-trend <0.001). Multivariate analyses confirmed that men (HR 1.60, 95% confidence interval (CI) 1.34-1.90), older patients (HR 1.05, 95% CI 1.04-1.06), Charlson comorbidity index (HR 1.16, 95% CI 1.11-1.22), and residing in rural areas (HR 1.35, 95% CI 1.09 to 1.67) was associated with higher mortality risk.Conclusions Living in rural areas determines an increased risk of mortality in patients at final stages of heart failure.

The principles of a national diabetic eye screening programme

2020 ◽  
pp. 111-122
Author(s):  
Paul Galsworthy
Keyword(s):  
Public Health ◽  
Young Person ◽  
Population Based ◽  
National Standards ◽  
Evidence Based ◽  
Independent Evidence ◽  
Eye Screening ◽  
Increased Risk ◽  
Diabetic Eye Screening ◽  
The Uk

Screening identifies apparently healthy people who may be at increased risk of a disease or condition, enabling earlier treatment or better-informed decisions. The NHS diabetic eye screening (DES) programme is one of the young person and adult NHS population screening programmes in the UK. The UK National Screening Committee (UK NSC), which makes independent, evidence-based recommendations to ministers in the four UK nations about the 11 population-based screening programmes. Public Health England (PHE)—Screening Quality Assurance Service (SQAS) ensures programmes are safe and effective by ensuring national standards are met.

The prevalence and influencing factors of anemia among pre-pregnant women in mainland China: A large population-based, cross-sectional study

2021 ◽  
pp. 1-31
Author(s):  
Jun Zhao ◽  
Xiaoyue Zhu ◽  
Qiaoyun Dai ◽  
Xiang Hong ◽  
Hongguang Zhang ◽  
...  
Keyword(s):  
Public Health ◽  
Pregnant Women ◽  
Population Based ◽  
Cross Sectional Study ◽  
Blood Type ◽  
Chinese Government ◽  
Severe Anemia ◽  
Sectional Study ◽  
Cross Sectional ◽  
Increased Risk

Abstract Anemia is a global public health problem affecting women worldwide, and reproductive-age women are at increased risk. We conducted a population-based cross-sectional study analyzing the prevalence of overall anemia and anemia according to severity in Chinese pre-pregnant women to update current knowledge on anemia epidemiology. Based on the National Free Preconception Check-up Projects supported by the Chinese government, 5,679,782 women participating in this project in 2017 were included in this study. The cyanmethemoglobin method was applied to assess hemoglobin concentrations. Univariate and multivariate logistic regressions were applied for associated factors. The prevalence of anemia among Chinese pre-pregnant women was 21.64% (mild anemia: 14.10%, moderate anemia: 7.17%, severe anemia: 0.37%). The prevalence of overall and severe anemia was the highest in Tibet and the lowest in Beijing among 31 provinces. Women’s age, region, ethnic origin, educational level, occupation, and pregnancy history were all correlated with anemia. Women with B blood type (aOR=0.89), higher BMIs (overweight: aOR=0.84; obesity: aOR=0.70), and alcohol consumption (aOR=0.69) were less likely to have anemia, while those with rhesus negative blood type (aOR=1.10), history of anemia (aOR=2.60), older age at menarche (aOR=1.19), heavy menstrual blood loss (aOR=1.39), longer menstrual period (aOR=1.09) and shorter menstrual cycle (aOR=1.08) were more likely to suffer from anemia. Meat or egg eaters were not significantly associated with severe anemia. Anemia is of moderate public health significance among Chinese pre-pregnant women. Interventions should be considered to prevent anemia to the greatest extent possible to avoid potential harm in this population.

scholarly journals Covid 19 & vertical transmission

2021 ◽  
Vol 2 (2) ◽  
pp. 278-283
Author(s):  
Kanad Dev Nayar ◽  
Shweta Gupta ◽  
Sabina Sanan ◽  
Preeti Mehra ◽  
Jaya Mishra ◽  
...  
Keyword(s):  
Public Health ◽  
Acute Respiratory Distress Syndrome ◽  
Vertical Transmission ◽  
Distress Syndrome ◽  
Case Fatality ◽  
Public Health Emergency ◽  
Cytokine Storm ◽  
Vulnerable Group ◽  
Increased Risk ◽  
Life Threatening

The current coronavirus pandemic is a serious public health emergency and has led to widespread damage globally. Although there are many coronaviruses, the particular that is responsible for this pandemic is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).It has incubation period of around 2 to 7 days and most symptomatic patients can have fever, malaise, cough, or loss of taste or smell, with some cases developing into life threatening pneumonia and acute respiratory distress syndrome with case fatality rates range from 1% to 2%. Pregnancy is considered as a vulnerable group for any infection and knowledge regarding the possible risk of vertical transmission of this virus is very limited but is important for counseling regarding COVID-19 related pregnancy risks and for further management. COVID 19 infection in mothers basically leads to hypoxia, inflammatory response & cytokine storm. It appears around 10% of SARS- Cov-2 infected pregnant women require hospitalization with respiratory support    COVID-19 can infect the placenta as confirmed by the presence of SARSCoV- 2 viral RNA in the placenta and evidence of virions found within the syncytiotrophoblast. The possible neonatal outcomes are increased risk of

scholarly journals Who cannot work from home? Characterizing occupations facing increased risk during the COVID-19 pandemic using 2018 BLS data

2020 ◽  
Author(s):  
Marissa G. Baker
Keyword(s):  
Public Health ◽  
The United States ◽  
Public Health Emergency ◽  
Job Displacement ◽  
Public Health Emergencies ◽  
Work From Home ◽  
Working From Home ◽  
Increased Risk ◽  
The U.S ◽  
At Home

AbstractObjectivesNot all workers are employed in occupations in which working from home is possible. These workers are at an increased risk for exposure to infectious disease during a pandemic event, and are more likely to experience events of job displacement and disruption during all types of public health emergencies. Here, I characterized which occupational sectors in the United States are most able to work from home during a public health emergency such as COVID-19.Methods2018 national employment and wage data maintained by the U.S. Bureau of Labor Statistics (BLS) was merged with measures from the BLS O*NET survey data. The measures utilized rank the importance of using a computer at work, and the importance of working with or performing for the public, which relate to the ability to complete work at home.ResultsAbout 25% (35.6 M) of the U.S. workforce are employed in occupations which could be done from home, primarily in sectors such as technology, computer, management, administrative, financial, and engineering. The remaining 75% of U.S. workers (including healthcare, manufacturing, retail and food services, et al.) are employed in occupations where working from home would be difficult.ConclusionsThe majority of U.S. workers are employed in occupations that cannot be done at home, putting 108.4 M U.S. workers at increased risk for adverse health outcomes related to working during a public health emergency. These workers tend to be lower paid than workers who can work from home. During COVID-19, this could result in a large increase in the burden of mental health disorders in the U.S., in addition to increased cases of COVID-19 due to workplace transmission. Public health guidance to “work from home” is not applicable to the majority of the U.S. workforce, emphasizing the need for additional guidance for workers during public health emergencies.

Abstract P327: Risk Factors for Prehypertension in the Community

Circulation ◽  
2013 ◽  
Vol 127 (suppl_12) ◽  
Author(s):  
Lisa Rafalson ◽  
Richard P Donahue ◽  
Saverio Stranges
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
New York ◽  
Weight Gain ◽  
Waist Circumference ◽  
General Population ◽  
Population Based ◽  
Health Study ◽  
Increased Risk

Background: Prehypertension is an increasingly highly prevalent condition in the general population, and is associated with an increased risk for coronary heart disease and stroke. However, evidence from population-based studies of the risk factors for prehypertension is scant. We sought to examine the predictors of progression from normotension to prehypertension in a community-based population from Western New York. Methods: We conducted a longitudinal analysis, over six years of follow-up, among 569 men and women (51.8 years, 96% White, 70% female) who were free of prehypertension, hypertension, cardiovascular disease and type 2 diabetes at the baseline examination, in the Western New York Health Study (WNYHS). Incident prehypertension at follow-up was defined as systolic blood pressure of 120-139 mmHg and/or diastolic blood pressure of 80-89 mmHg. Results: In bivariate analyses, there were several correlates of incident prehypertension, including age, BMI and waist circumference, impaired fasting glucose (IFG), uric acid, and baseline blood pressure levels. After multivariate adjustment, IFG at baseline odds ratio (OR):1.69, 95%CI:1.06-2.67) and weight gain since age 25 (OR: 1.28, 1.11-1.58 per 10 lb. increase) were the strongest significant predictors of prehypertension at follow-up. Neither waist circumference nor current BMI were predictor variables in models when they were substituted for weight gain. Conclusions: Results from this study suggest early dysregulation of glucose metabolism and weight gain over the lifespan are likely to represent important risk factors for prehypertension in the general population.

National Differences in Regional Emergency Department Boarding Times: Are US Emergency Departments Prepared for a Public Health Emergency?

2016 ◽  
Vol 10 (4) ◽  
pp. 576-582 ◽  
Author(s):  
Jennifer S. Love ◽  
David Karp ◽  
M. Kit Delgado ◽  
Gregg Margolis ◽  
Douglas J. Wiebe ◽  
...  
Keyword(s):  
Public Health ◽  
At Risk ◽  
Emergency Department ◽  
The United States ◽  
Public Health Emergency ◽  
Study Cohort ◽  
American Hospital ◽  
American Hospital Association ◽  
Hospital Referral ◽  
Increased Risk

AbstractObjectivesBoarding admitted patients decreases emergency department (ED) capacity to accommodate daily patient surge. Boarding in regional hospitals may decrease the ability to meet community needs during a public health emergency. This study examined differences in regional patient boarding times across the United States and in regions at risk for public health emergencies.MethodsA retrospective cross-sectional analysis was performed by using 2012 ED visit data from the American Hospital Association (AHA) database and 2012 hospital ED boarding data from the Centers for Medicare and Medicaid Services Hospital Compare database. Hospitals were grouped into hospital referral regions (HRRs). The primary outcome was mean ED boarding time per HRR. Spatial hot spot analysis examined boarding time spatial clustering.ResultsA total of 3317 of 4671 (71%) hospitals were included in the study cohort. A total of 45 high-boarding-time HRRs clustered along the East/West coasts and 67 low-boarding-time HRRs clustered in the Midwest/Northern Plains regions. A total of 86% of HRRs at risk for a terrorist event had high boarding times and 36% of HRRs with frequent natural disasters had high boarding times.ConclusionsUrban, coastal areas have the longest boarding times and are clustered with other high-boarding-time HRRs. Longer boarding times suggest a heightened level of vulnerability and a need to enhance surge capacity because these regions have difficulty meeting daily emergency care demands and are at increased risk for disasters. (Disaster Med Public Health Preparedness. 2016;10:576–582)

scholarly journals Effect of the Place of Living on Mortality in Patients with Advanced Heart Failure

2020 ◽  
Author(s):  
Miguel-Angel Munoz ◽  
Raquel Garcia ◽  
Elena Navas ◽  
Julio Duran ◽  
José-Luis Del Val-Garcia ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
New York ◽  
Rural Areas ◽  
Cox Regression ◽  
Heart Association ◽  
Population Based ◽  
Advanced Heart Failure ◽  
Rural And Urban ◽  
Increased Risk

Abstract BackgroundSocial and environmental factors in advanced heart failure (HF) patients may be crucial to cope with the end stages of the disease. This study analyzes health inequalities and mortality according to place of residence (rural vs urban) in HF patients at advanced stages of the disease.MethodsPopulation-based cohort study including 1148 adult patients with HF attended in 279 primary care centers. Patients were followed for at least one year after reaching New York Heart Association IV, between 2010 and 2014.Data came from primary care electronic medical records. Cox regression models were applied to determine the hazard ratios (HR) of mortality.ResultsMean age was 81.6 (SD 8.9) years, and 62% were women. Patients in rural areas were older, particularly women aged >74 years (p=0.036), and presented lower comorbidity. Mortality percentages were 59% and 51% among rural and urban patients, respectively (p=0.030). Urban patients living in the most socio-economically deprived neighborhoods presented the highest rate of health service utilization, particularly with primary care nurses (p-trend <0.001). Multivariate analyses confirmed that men (HR 1.60, 95% confidence interval (CI) 1.34-1.90), older patients (HR 1.05, 95% CI 1.04-1.06), Charlson comorbidity index (HR 1.16, 95% CI 1.11-1.22), and residing in rural areas (HR 1.35, 95% CI 1.09 to 1.67) was associated with higher mortality risk.ConclusionsLiving in rural areas determines an increased risk of mortality in patients at final stages of heart failure.

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