Search Results (136)

In recent years, advances in organ transplantation medicine have led to an increase in pregnancies and births following transplantation. Pregnancy after organ transplantation is considered high-risk, and its impact on both the recipient and the child must be carefully evaluated. In this review, we summarize the current landscape of pregnancy and childbirth after organ transplantation, with a particular focus on uterus transplantation (UTx). Traditionally, organ transplants have involved vital organs; however, UTx, developed for women with absolute uterine factor infertility, represents a novel approach. Although the number of births following UTx remains limited, it is expected to grow due to the international expansion of this procedure. Importantly, the concept of pregnancy and delivery following UTx is fundamentally different from that of other organ transplants. UTx is a life-enhancing, non-vital, and temporary transplant uniquely intended to enable the creation of new life. Pregnancy after UTx carries specific risks such as a higher incidence of miscarriage, preterm birth, hypertensive disorders of pregnancy, and gestational diabetes. All deliveries are performed via cesarean section, and conception is typically allowed after a relatively short period following transplantation, given the temporary nature of the graft and the goal to minimize recipient burden, with generally good neonatal outcomes. As pregnancies after both solid organ transplantation and UTx continue to rise worldwide, the development of standardized, organ-specific perinatal management strategies, particularly for UTx, is essential. Multidisciplinary collaboration will be critical to supporting these high-risk pregnancies and ensuring the best possible maternal and neonatal outcomes. Full article

Multiple studies, starting with Preston’s work in 1975, have suggested that gross domestic product per capita (GDPPC) is an important explanatory factor for understanding differentials in life expectancy at birth (LEB) in countries around the world. This proposition was tested in the present study using two-period cross-sectional regression across a large number of both advanced and developing countries and 16 socioeconomic factors, including GDPPC. The best-performing regression equations in the periods around 2000 and 2015 included four to six of these factors (government effectiveness, safe sanitation, poverty and contraception, plus, in the circa-2000 period, the Gini index and CO₂ emissions); perhaps surprisingly, these equations did not include GDPPC. The results were examined in greater detail for the world’s 15 most populous countries, helping to identify key drivers of LEB growth for each of these countries from circa 2000 to 2015. The fact that GDPPC drops out of the best equations calls into question the view that economic growth is the correct primary target for nations seeking to increase their average life expectancy. Full article

Autosomal trisomy, a genetic disorder characterized by the presence of an extra autosome, is a rare but important chromosomal abnormality in horses, often associated with infertility, developmental abnormalities, and reduced life expectancy. This study represents the largest population-level screening for autosomal trisomy in horses; the analysis used single nucleotide polymorphism (SNP) panel genotype intensity data from 17,078 horses, 6601 of which were juveniles (i.e., ≤12 months of age) when genotyped. Using methodologies adapted from similar screening studies in cattle, the only aneuploidy detected was trisomy 27 in two juvenile male Irish Sport Horses (ISH) (0.03% prevalence among juveniles or 0.01% prevalence in the overall population). One ISH colt was cytogenetically confirmed and displayed no overt external phenotypic abnormalities, while cytogenetics was not undertaken on the other ISH colt, nor was it phenotypically assessed. Parentage analysis revealed that one ISH colt inherited two different copies of chr27 from the sire, demonstrating heterodisomy, likely due to a nondisjunction event during meiosis I in the sire. The other ISH colt inherited two different copies of chr27 from the dam, also indicating heterodisomy; the dam was 23 years of age when the colt was born. Based on the observed prevalence of autosomal trisomy, it can be estimated that at least 3 foals per 10,000 live births are likely to have autosomal trisomy. Though, given that only 74 (i.e., 0.004%) of horses were genotyped within a month of birth, this is likely an underestimate. The economic consequence of undiagnosed trisomy in high-value breeding horses that are potentially infertile could be substantial. As horse genotyping for parentage verification and discovery is transitioning to medium-density single nucleotide polymorphism panels, routine genomic screening for autosomal aneuploidy could be readily undertaken and potentially should form a standard screening prerequisite along with other genetic defects at horse sales. Currently, thoroughbred horses registered for racing are not genotyped, and only a limited number of sport horse studbooks are using SNP genotyping. This highlights an opportunity for those already genotyping to expand their support for breeders through low-cost, high-value chromosomal screening at the time of registration rather than incurring additional costs over the horse’s life cycle to determine the root cause of certain phenotypes owing to the undiagnosed trisomy. Full article

Objective: Low birth weight is a serious public health problem even in developed countries. The objective of this study was to assess the ability of machine learning to predict low birth weight rates in big cities in the USA on an ecological/population level. Study design: The study was based on publicly available data from the Big Cities Health Inventory Data Platform. The collected data related to the 35 largest, most urban cities in the United States from 2010 to 2022. The model-agnostic approach was used to assess and visualize the magnitude and direction of the most influential predictors. Results: The models showed excellent performance with R-squared values of 0.82, 0.81, 0.81, and 0.79, and residual root mean squared error values of 1.06, 0.87, 1.03, 0.99 for KNN, Best subset, Lasso, and XGBoost, respectively. It is noteworthy that the Best subset selection approach had a high RSq and the lowest residual root mean squared error, with only a four-predictor subset. Influential predictors that appeared in three/four models were rate of chlamydia infection, racial segregation, prenatal care, percentage of single-parent families, and poverty. Other important predictors were the rate of violent crimes, life expectancy, mental distress, income inequality, hazardous air quality, prevalence of hypertension, percent of foreign-born citizens, and smoking. This study was limited by the unavailability of data on gestational age. Conclusions: The machine learning algorithms showed excellent performance for the prediction of low birth weight rate in big cities. The identification of influential predictors can help local and state authorities and health policy decision makers to more effectively tackle this important health problem. Full article

In this study, thirty female dogs, aged one to five years and varying in weight, in the last week of gestation were evaluated. The animals were divided into two groups: GC, which comprised twenty-two bitches undergoing elective cesarean section, and GD, which consisted of eight dogs requiring therapeutic cesarean section as a treatment to dystocia. We found that cortisol levels in the amniotic fluid were significantly higher in pups delivered via elective cesareans (mean: 9.86 ng/mL) compared to those from therapeutic c-sections (mean: 4.11 ng/mL). This observation contrasted with previous studies that reported lower cortisol levels in elective procedures, suggesting complexities in the physiological responses to different delivery methods that warrant further investigation. Notably, our study observed no significant association between amniotic fluid meconium presence and other distress markers, indicating that meconium may be more closely associated with fetal maturation rather than distress (p > 0.05). Neonatal viability (Apgar score) revealed that 92.86% of the neonates from elective procedures demonstrated no distress shortly after delivery, contrasting with 56.25% in therapeutic c-section. Fetal distress can be a direct consequence of dystocia caused by various stressors, such as pain and hypoxia. These factors can impair the fetus’ ability to adapt to extrauterine life, often leading to lower Apgar scores. Notably, neonatal weight was directly related to fetal cortisol levels, while no significant associations were noted between the litter size or birth order and cortisol concentrations, irrespective of the delivery type. These findings underscore the need for ongoing investigation into the relationships between cesarean delivery types, maternal and neonatal stress markers, and resultant health outcomes, aiming to enhance care strategies for expectant canine mothers and their puppies. Full article

Studies have indicated that there was a disease interaction of pandemic influenza with respiratory tuberculosis (TB) in Malta, which could explain the heightened mortality recorded in young adults. We revisit the 1918/19 influenza and TB syndemic potential on the island of Malta. Borrowing from crisis studies that explore the harvesting effect, we used the method of assessing changes in pre-pandemic, pandemic, fallow, and post-pandemic mortality/life expectancy to reveal the syndemic experience. Pre-pandemic (1914–1917) life expectancy at birth was significantly higher, at 37.91 years, than during the pandemic (1918), when life expectancy dropped to 33.26 years (Z = 10.56, p < 0.0001). Post-pandemic (1919) life expectancy rose to 43.49 years, which was an even longer life expectancy than pre-pandemic (Z = 17.61, p < 0.0001). There were significant changes in TB mortality death rates during the four periods in those of reproductive age. Augmenting our framework for studies of syndemics involving short-term events, we proposed the identification of contributing, driving, and limiting factors. Underlying living conditions contributed to the syndemic. The exacerbation of housing conditions, the economy associated with the First World War, and meteorological measures—temperature, relative humidity, and rainfall—were driving factors. The early implementation of mitigation strategies, such as restrictions on mass gatherings, were limiting factors of the syndemic. Full article

Background/Objectives: Patients with chronic myeloid leukemia (CML) have a long life expectancy due to modern treatment. However, treatment may have adverse effects that hamper work ability. Methods: Patients aged 25–60 years diagnosed in 2002–2020 were included in this nationwide matched cohort study examining work ability from diagnosis (index date), including the need for permanent disability compensation (flexible job or disability pension). Each patient was matched 1:5 on sex, birth year, and level of comorbidity with citizens from the general Danish population without CML. The risks of requiring flexible job and disability pension were calculated by cause-specific hazard ratios (HRs) using Cox proportional hazards regression, and the Aalen–Johansen estimator was used to determine cumulative risks. Results: A total of 489 patients with CML and 2445 matched comparators were included. The median age was 46 years, and males comprised 59.5% of the cohort. Matched comparators were more likely to work at index date and 1, 3, 5, and 10 years after the index date (p < 0.001). The HRs of requiring both flexible job (HR 8.7 (95% confidence interval (CI): 6.1;12.2, p < 0.001)) and disability pension (HR 3.7 (95% CI: 2.8;4.9, p < 0.001)) were higher among patients diagnosed with CML compared to matched comparators. The cumulative risk of requiring flexible job and disability pension also increased in patients with CML compared to matched comparators (p < 0.001). Conclusions: Patients with CML have a reduced work ability compared to the general population. More research is needed to determine the cause of their loss of ability to work. Full article

Background/Objectives: The objective of this research was to analyze the experiences and factors associated with perinatal grief in mothers in the urban context of Santa Cruz de la Sierra, Bolivia. Methods: The sample consisted of seven mothers who experienced a loss during pregnancy up to the second month after the baby’s birth, occurring between 2015 and 2020 in the city of Santa Cruz de la Sierra. The mean age of the mothers was 34.86 years (SD = 3.13), and they belonged to middle or upper-middle socioeconomic levels. Data were collected through semi-structured interviews and analyzed using descriptive qualitative analysis. Results: The identified characteristics of perinatal grief were sadness, anger, guilt, emotional numbness, social isolation, and anxiety. Factors contributing to grief processing included support from the partner and family, when they accommodated and respected the mother’s needs. Factors hindering the grieving process included social and cultural environments that often silence and minimize the loss, a history of previous losses, the desire to be pregnant, and the mother’s life expectations and projects focused on motherhood. Conclusions: In conclusion, this research suggests that perinatal losses in the Bolivian context may be influenced by factors such as knowledge of the cause of death, previous loss experiences, and their emotional effects. The limitations of the study include the lack of diversity in participants’ educational and socioeconomic backgrounds and the restriction of the sample to an urban area in Bolivia. Emotional interventions to support these bereaved mothers in those complex moments should be integrated in the Bolivian healthcare system. Full article

Neuromuscular diseases (NMDs) encompass various hereditary conditions affecting motor neurons, the neuromuscular junction, and skeletal muscles. These disorders are characterized by progressive muscle weakness and can manifest at different stages of life, from birth to adulthood. NMDs, such as Duchenne and Becker muscular dystrophies, myotonic dystrophy, and limb–girdle muscular dystrophies, often involve cardiac complications, including cardiomyopathies and arrhythmias. Underlying genetic mutations contribute to skeletal and cardiac muscle dysfunction, particularly in the DMD, EMD, and LMNA genes. The progressive nature of muscle deterioration significantly reduces life expectancy, mainly due to respiratory and cardiac failure. The early detection of cardiac involvement through electrocardiography (ECG) and cardiac imaging is crucial for timely intervention. Pharmacological treatment focuses on managing cardiomyopathies and arrhythmias, with an emerging interest in gene therapies aimed at correcting underlying genetic defects. Heart transplantation, though historically controversial in patients with muscular dystrophies, is increasingly recognized as a viable option for individuals with advanced heart failure and moderate muscle impairment, leading to improved survival rates. Careful patient selection and management are critical to optimizing outcomes in these complex cases. Full article

The health of different countries evolves in parallel with their economic development. Communicable diseases play a more prominent role in low-income countries compared with high-income countries, while non-communicable diseases (NCDs) have become dominant in developing and developed economies. This transition has been accompanied by public health efforts to prevent NCDs, resulting in improvements in total life expectancy at birth (TLE). It is recognized that health determinants are not confined to healthcare systems, but that social determinants play a key role in health inequalities. The rapid increase in life expectancy at birth has led to increasing numbers of older adults, where health inequalities are accentuated. The current UN Decade of Healthy Aging calls for a life-course approach to building intrinsic capacity, maintaining function, and avoiding dependency with age instead of avoiding mortality and morbidity. TLE in Hong Kong is one of the highest in the world as a result of public health preventive efforts and an essentially free hospital system. However, the increase in TLE has not been accompanied by the same magnitude of increase in health span, resulting in an increasing dependency burden. Geography, culture, dietary and smoking habits, physical activity, urban planning, and neighbourhood cohesion are some of the social determinants affecting TLE and also health inequalities. With population ageing, it would be appropriate to focus on the social determinants affecting health span to maintain functional independence rather than prolonging life. A whole-of-society response instead of relying solely on the adaptation of health and social care systems would be needed, together with more nuanced metrics to measure health span. Full article

Background: Parents of children with life-limiting or life-threatening illnesses and/or medical complexity experience intense stress and pain soon after the birth and lifelong. Understanding parents’ experiences and coping strategies is the prerequisite to provide tailored support to families. Aim: To explore the experiences of parents of children with medical complexity (CMCs) during hospitalization in a Family-Centered Care (FCC) neonatal unit and after discharge. Design: Qualitative study. Methods: Semi-structured interviews were administered to the parents of children with medical complexity admitted to the Neonatal Intensive Care Unit (NICU) of Modena between October 2016 and January 2024. The interview was developed based on three time points: birth, hospitalization, and discharge, focusing on parents’ experiences, emotions, and communication with healthcare professionals. The interviews were analyzed using the template analysis. Results: A total of 10 parents were interviewed. Four domains were identified, encompassing eight significant themes in the parents’ experiences and their communication with healthcare professionals. The relevant emotions included anxiety and fear for survival, fatigue, and guilt over the child’s suffering, alongside hope and trust that parents felt entitled to nurture. Relationships with professionals were characterized by expectations and frustrations; mothers and fathers had different perceptions and reactions to the situation they were facing. Conclusions: This qualitative study explores the experiences of parents of CMCs in a neonatal intensive care unit adopting FCC. From admission to discharge, parents’ emotions were influenced by the child’s unique clinical history. Active listening and the humane attitude of healthcare professionals were the aspects most appreciated by parents. Full article

Background/Objectives: Respiratory syncytial virus (RSV) is a leading cause of respiratory infections in children. A novel RSVpreF vaccine for use among pregnant women for the prevention of RSV in infants is expected to be licensed in Mexico. Hence, the clinical and economic burden of RSV among infants in Mexico, with and without a year-round RSVpreF maternal vaccination program, was estimated. Methods: A cohort model was developed to project clinical and economic outcomes of RSV from birth to 1 year of age for maternal vaccination and no intervention. Incremental cost-effectiveness ratios were calculated from direct cost outcomes, life years, and quality-adjusted life years (QALYs). The value per dose of the RSVpreF for which the program would be cost-effective was explored. Analyses were conducted from the healthcare system perspective, with direct costs (2024 Mexican Pesos [MXN]) and outcomes discounted at 5% annually; scenario and sensitivity analyses tested the robustness of model settings and inputs. Results: Compared to no intervention, a year-round RSVpreF vaccine administered to 1891 M pregnant women would prevent 15,768 hospitalizations, 5505 emergency department cases, and 5505 physician office visits annually, averting MXN 1754 M in direct medical costs with an increase of 3402 life years or 3666 QALYs. The RSVpreF vaccine would be cost-saving up to MXN 1301/dose and cost-effective up to MXN 2105–MXN 3715/dose under an assumed cost-effectiveness threshold range of 1–3× the gross domestic product (GDP) per capita (MXN 247,310) per QALY gained. Conclusions: Year-round RSVpreF maternal vaccination would substantially reduce RSV’s clinical and economic burden among infants in Mexico and likely be a cost-effective program. Full article

The concept of well-being is multifaceted, influenced by a range of factors, including economic, social, perceptual, and personal, and varies considerably between individuals, countries, and continents. The objective of this research paper is to achieve an efficient grouping of countries according to several indicators that measure overall happiness. The indicators utilized in this study, derived from the World Happiness Report, are as follows: Life Ladder, Log GDP (Gross Domestic Product) per capita, Social Support, Healthy Life Expectancy at Birth, Freedom to Make Life Choices, Generosity, Perceptions of Corruption, Positive Affect, and Negative Affect. Consequently, following the identification, filtering, and collection of data on the countries in the study, cluster analysis, discriminant analysis, and neural network training were employed to obtain a classification of the countries into heterogeneous groups with a minimum error rate. Finally, for Romania, scenarios and policies were developed to facilitate ascent from the initial class to a class with a superior level of well-being. Full article

Institutional quality (InQ) plays an important role in shaping economic growth (ECG), influencing how economies develop and perform. The literature addresses the nexus between InQ and ECG and the link between health and ECG; findings are often contradictory, creating knowledge gaps. Importantly, research on the interplay between InQ, health, and ECG in Sub-Saharan African (SSA) countries is particularly limited. This study aims to address this gap by evaluating how health impacts ECG, with an emphasis on the mediating role of InQ in the health–growth nexus in SSA. This study examines these interplays across 35 SSA countries from 2012 to 2022. The life expectancy at birth (LEX) and real gross domestic product per capita (GDP) are used as proxies for health outcomes and ECG, respectively. The system generalised method of moments estimator is employed to analyse data. Results show that the LEX has a strong positive effect on economic growth in SSA countries. Furthermore, the InQ indicators (such as control of corruption, government effectiveness, rule of law and political stability, and absence of violence) are positively correlated with ECG. When the LEX interacts with InQ indicators, InQ is identified as a key channel through which LEX influences ECG. The findings confirm that InQ plays a crucial role in the health–growth nexus, with the positive impact of LEX on ECG being more pronounced in countries with higher levels of InQ, while the effect is weaker in countries with lower levels of InQ. The findings of this study have crucial policy implications, highlighting the intricate link among institutional quality, health outcomes, and economic growth. This study’s findings provide essential insights for policymakers to design focused strategies that improve InQ and health outcomes to achieve sustained ECG in SSA. Full article

Background/Objectives: Childbirth is a profoundly personal experience that often does not align with expectations. The World Health Organization has established guidelines for best practises; in this sense, it is crucial to understand the childbirth experiences of Portuguese women in comparison with these guidelines. Methods: A quantitative, descriptive, correlational, and cross-sectional study was conducted to achieve this. In total, 615 women completed a sociodemographic questionnaire and the Labour and Childbirth Experience questionnaire, which comprised 39 statements based on the WHO’s recommendations. Additionally, the study utilized the Life Satisfaction Scale and gathered insights into participants’ overall perception of care during this phase. Results: The results were categorized as follows: (1) practises influencing the labour experience; (2) practises influencing the experience of vaginal birth; (3) practises affecting the experience of caesarean birth; and (4) emotional experience during labour and birth. Conclusions: Notably, the study found that practises discouraged by the WHO are still prevalent, potentially enabling obstetric violence. However, a robust and statistically significant correlation was observed between the childbirth experience and the overall perception of care. Full article