AUSTRALIA WILDFIRES

Burns victims struggling to pay

Indigenous families face multiple barriers in hospital

FLINDERS UNIVERSITY

Research News

 

Living away from community and country, Aboriginal families of children with severe burns also face critical financial stress to cover the associated costs of health care and treatment, a new study shows.

An Australian study, led by Flinders researchers Dr Courtney Ryder and Associate Professor Tamara Mackean, found feelings of crisis were common in Aboriginal families with children suffering severe burns, with one family reporting skipping meals and others selling assets to reduce costs while in hospital.

The economic hardship was found to be worse in families who live in rural areas - some households travelling more than five hours for treatment, creating undue financial strain.

Participants included families from SA, NSW and Queensland who are already part of the larger-Australia-wide Coolamon study on burns injuries in Aboriginal and Torres Strait Islander children.

Their children had sustained severe burns that required at least one night in hospital and follow up care.

So far, the Coolamon study has explored the health inequity of burns incidents and severity in Aboriginal children, with hospitalisation rates found to be 2-3 times greater than other Australian children.

This research conducted by Flinders University in conjunction with The George Institute for Global Health and UNSW School of Population Health also found Aboriginal and Torres Strait Islander children spent five times longer in hospital.

Dr Courtney Ryder, from Flinders University's College of Medicine and Public Health, says out-of-pocket health expenditure are costs not covered by Medicare or health insurance, and could include gap payments, pharmaceutical costs, and travel costs such as transport, car parking, food, and accommodation.

She says results were "astounding" with some families reaching credit card limits, not paying other bills or even selling assets to get by.

"Even though we have Medicare, there are always additional out-of-pocket expenses for health care, and I don't think it's understood the depth or breadth of cost for those Aboriginal families who have a child with an acute burns injury," Dr Ryder says.

"Burns injuries are quite intensive, very invasive and require a lot of follow up. While the expenses might be as simple as sterilised water and bandages, quite often there are additional expenses such as costs associated with travelling away from home.

"One family spoke about having to spend $700 each time they went to town, and they were even staying with family close to the tertiary setting."

Participants also reported not being made aware of government initiatives, such as the Patient Assisted Travel Scheme (PATS), aimed at South Australians who need to travel more than 100km to access medical services.

Dr Ryder says a review of PATS is needed, as Aboriginal and Torres Strait Islanders often face barriers in accessing the scheme, including families who still live in regional areas but within the 100km range.

"There was one family who, because of where they were located, couldn't get assistance through PATS," she says.

"They were having to travel for an hour or more every day to the hospital, then there were parking costs and time spent away from work, so it was still significant."

Despite the stress and financial burden reported by participants, they often commented on the significant role their family networks played in helping and keeping them away from significant financial burden.

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This research is supported by a National Health and Medical Research Council (NHMRC) project grant, while Dr Courtney Ryder was supported by an NHMRC postgraduate scholarship.

Ryder, C., Mackean, T., Hunter, K., Coombes, J., Holland, A.J. and Ivers, R. (2021), Yarning up about out?of?pocket healthcare expenditure in burns with Aboriginal families. Australian and New Zealand Journal of Public Health. https://doi.org/10.1111/1753-6405.13083

 DISARM, DEFUND, DISBAND

Law professor argues for removing police from traffic enforcement

A new legal framework could enhance public safety and equal treatment by eliminating 'pretextual' traffic stops, which have been tied to cases of police abuse and injustice

UNIVERSITY OF ARKANSAS

Research News

   

IMAGE: JORDAN BLAIR WOODS, UNIVERSITY OF ARKANSAS view more 

CREDIT: UNIVERSITY OF ARKANSAS

University of Arkansas law professor Jordan Blair Woods challenges the conventional wisdom that only police can enforce traffic laws.

In "Traffic Without Police," to be published in Stanford Law Review, Woods articulates a new legal framework for traffic enforcement, one that separates it from critical police functions, such as preventing and deterring crime, conducting criminal investigations and responding to emergencies.

If not the police, who then would enforce traffic laws? As Woods explains, jurisdictions would delegate most traffic enforcement to newly created traffic agencies. These public offices would operate independently from police departments and would hire their own traffic monitors to conduct and oversee traffic enforcement, including stops. Police officers would become involved in traffic stops only for serious violations that are a criminal offense or public threat.

"Traffic stops are the most frequent interaction between police and civilians today," Woods said. "And because we know traffic enforcement is a common gateway for funneling over-policed and marginalized communities into the criminal justice system, these stops are a persistent source of racial and economic injustice."

Previous research has shown that Black and Latinx motorists are disproportionately stopped by police for traffic violations. Compared to white motorists, these minority groups are also disproportionately questioned, frisked, searched, cited and arrested during traffic stops.

Many of these stops and intrusions are considered "pretextual," according to legal definition, meaning that they enable officers to initiate contact with motorists and to then search for evidence of non-traffic crime without reasonable suspicion or probable cause. In this sense, the traffic stop has functioned as a gateway unfairly targeting Black and Latinx motorists. Pretextual stops sometimes also lead to police mistreatment and abuse.

So far, there is one example of the reorganization that Woods articulates. In July 2020, as part of a comprehensive plan to make structural police reforms, the city of Berkeley, California, voted in favor of a proposal that removes police from conducting traffic stops. The proposal directs the city to create a transportation department staffed by unarmed civil servants who would be in charge of enforcing traffic laws. Other municipalities are considering similar reforms that would remove police from traffic enforcement to varying degrees.

In addition to the social benefits mentioned above, especially for minority communities, removing police from traffic enforcement and adopting traffic law reforms that Woods proposes could put an end to unfair and often subjective reliance on traffic ticket revenue to fund state and local budgets. Likewise, such reform could reduce or eliminate financial and professional incentives that contribute to aggressive and biased traffic enforcement, namely prohibiting the issuing of traffic tickets as a measure of professional performance.

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Woods' study can be downloaded at SSRN.

Woods is the faculty director of the Richard B. Atkinson LGBTQ Law & Policy Program at the University of Arkansas School of Law.

Firearms laws curb rates of gun violence across United States

Number of firearm laws significantly predicted suicide and homicide rates, Rutgers study finds

RUTGERS UNIVERSITY

Research News

 

States with stricter firearms laws reported lower suicide and homicide rates, according to a Rutgers study.

The study, conducted by the New Jersey Gun Violence Research Center, the Rutgers School of Public Health, the Rutgers University-Newark Department of Psychology, the Rutgers School of Criminal Justice, the Rutgers New Jersey Medical School and the Rutgers-Newark Department of Social Work, was published in the Journal of Public Health and examined the association between firearm laws and suicide and homicide rates.

Firearm violence is a major public health concern in the United States, with firearm suicide and homicide accounting for the majority of gun deaths. In 2017, 66,683 people died by suicide and homicide with a majority of the deaths resulting from a firearm: 48 percent for suicide and 74 percent for homicide.

Using the State Firearm Law Database, the Rutgers researchers compared suicide and homicide rates across the United States from 1991 to 2017 with the number of firearm laws in each state. The study found that even with several factors, such as unemployment and overall gun ownership rates, taken into account, the total number of firearm laws in a state was a significant predictor of suicide and homicide rates.

"As states' strictness increased, their suicide and homicide rates decreased," said lead author John F. Gunn III, a postdoctoral researcher at the Rutgers School of Public Health and New Jersey Gun Violence Research Center.

The researchers, who were the first to focus on the impact of the total number of firearms regulations in each state, utilized a general index of states' overall approach to firearms regulation by aggregating the total number of gun laws. This index broadly defined states as restrictive or lenient towards firearms.

"With close to 40, 000 deaths annually from firearm violence, regulations that can limit access to firearms appear to reduce state-level mortality," says senior study author Bernadette Hohl, an assistant professor at Rutgers School of Public Health. "Evidence-based implementation of firearm regulations across the whole of the United States has the potential to significantly reduce the toll of firearm violence."

Previous research supports associations between state suicide and homicide rates and specific gun laws, such as waiting periods and universal background checks, with most work finding that the presence of specific firearm laws is associated with reductions in gun mortality.

Future research is required to continue to holistically examine the relationship between firearm laws and suicide and homicide rates. "Assessing the implications of law changes, regulation enforcement and if there is a correlation with violent crime decline will be necessary," Gunn said.

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Link to study: https://academic.oup.com/jpubhealth/advance-article-abstract/doi/10.1093/pubmed/fdab047/6225077?redirectedFrom=fulltext

DWP: DUM WHITE PEEPLE

Individuals in lower-income US counties or high support for former President Trump continue to be less likely to socially distance

A new nearly yearlong study in the American Journal of Preventive Medicine finds that lower-income and Republican-leaning communities are less likely to socially distance than other communities during the COVID-19 pandemic

ELSEVIER

Research News

 

IMAGE: COUNTY-LEVEL DISTANCE TRAVELED HAS BEEN AVERAGED BY MONTH AND NORMALIZED TO PRE-COVID-19 LEVELS. NEGATIVE VALUES REPRESENT GREATER PHYSICAL DISTANCING. DATES RANGE FROM MARCH 9, 2020 TO JANUARY 17, 2021. BASED... view more 

CREDIT: AMERICAN JOURNAL OF PREVENTIVE MEDICINE

Ann Arbor, April 22, 2021 - Using nearly a year of anonymous geolocation data from 15-17 million cell phone users in 3,037 United States counties, investigators have found that individuals with lower income per capita or greater Republican orientation were associated with significantly reduced social distancing throughout the study period from March 2020 through January 2021. Their findings are reported in the American Journal of Preventive Medicine, published by Elsevier.

The associations persisted after adjusting for a variety of county-level demographic and socioeconomic characteristics. Other county-level characteristics, such as the share of Black and Hispanic residents, were also associated with reduced distancing at various points during the study period.

"We started this project in April 2020 because we wanted to understand the social, economic, and political factors that drive people to engage in social distancing. We ended up tracking these factors for almost a year," explained lead investigator Nolan M. Kavanagh, MPH, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.

"A year is a long time to prepare policy responses and educate the public," he said. "Yet, the same kinds of communities that struggled to physically distance early on continue to struggle now."

To measure social distancing, the investigators used county-level averages of distance traveled per person using cell phone location data. They looked at the percentage change in average movement from the start of the pandemic relative to four pre-COVID-19 reference weeks. Statistical analysis was used to estimate the association between a variety of county-level demographic, socioeconomic, and political characteristics. Socioeconomic status was based on income per capita, and political orientation was based on the 2016 vote share for President Trump. Other county-level characteristics examined included the percentage of males, Black and Hispanic residents; share of residents over age 65; share of foreign-born residents; share of the workforce in industries most affected by COVID-19, such as retail, transportation and health, educational and social services; and the share of rural residential plots. These county-level characteristics were chosen based on their expected contribution to a community's ability to physically distance.

Investigators found a sharp reduction in average movement among US counties at the start of the COVID-19 pandemic and declaration of a national emergency in March 2020. Social distancing was greatest from late March to early June and then returned to baseline levels by June 2020. Distancing began to increase again in early September. However, even as a national trend evolved, the investigators found substantial variability in social distancing across counties.

While the share of racial and ethnic minorities, immigration, rurality, and employment in transportation were correlated with changes in average movement on many days, the single most consistent predictor of engagement in distancing across the study was higher per capita income. The single most consistent predictor of lack of engagement with distancing across the study was share of vote for President Trump.

Other county level-characteristics varied over time in their degree of association with physical distancing. During the early months of the study, counties with greater shares of Black and Hispanic residents were less likely to engage in social distancing. These adjusted racial and ethnic differences closed during the summer months before re-emerging in the fall. Similarly, rural counties were less likely to engage in distancing early on; by the end of the summer, rurality became the strongest negative predictor of physical distancing.

The investigators suggest a number of barriers that may underlie these findings. For example, lower-income or gig jobs may be incompatible with working from home, and lower income households may not have the necessary liquidity to shop in bulk, requiring more trips for groceries and essential household items. They observe that partisanship has dramatically shaped the government and public response to COVID-19 in the US. These findings show that political differences have continued to shape social distancing behavior, months into the pandemic and extending beyond the 2020 general election. As a result, both low-income and Republican-leaning communities are at greater risk for COVID-19.

"These results suggest that policy responses to the pandemic have failed to level the playing field," said Mr. Kavanagh. "We have not addressed the challenges to physical distancing faced by low-income Americans, such as working from home. And messages by political and public health leaders have not reached populations who may have different beliefs about disease risk. Analyses such as this study that monitor disparities over time can help us target public health and economic interventions to the communities that need them the most."

Romantic relationships mitigate effects of trauma on alcohol use among college students

VIRGINIA COMMONWEALTH UNIVERSITY

Research News

 

Students who have been exposed to interpersonal trauma —  physical assault, sexual assault or unwanted sexual experiences — prior to college are more likely to engage in risky alcohol use. But romantic relationships mitigate these effects of trauma on a student’s drinking behavior, according to a new study led by Virginia Commonwealth University researchers.

The study investigates whether romantic relationships might play a role in mitigating or exacerbating the effects of trauma exposure on alcohol use among college students. It found that students who experienced interpersonal trauma during college consumed more alcohol than those without interpersonal trauma exposure, and that their drinking was more pronounced for those in a relationship with a partner with higher levels of alcohol use. It also found that a student’s satisfaction in their romantic relationship did not change the association between interpersonal trauma and alcohol use.

Previous research has found that college students who have been exposed to interpersonal trauma are more likely to engage in risky alcohol use. Yet not everyone who experiences interpersonal trauma goes on to misuse alcohol, raising questions about what factors might play a role in the interaction of trauma and drinking.

The study, “A Longitudinal Study of the Moderating Effects of Romantic Relationships on the Associations Between Alcohol Use and Trauma in College Students,” will be published in a forthcoming issue of the journal Addiction. It explores whether three aspects of romantic relationships — relationship status, relationship satisfaction and partner alcohol use — change the associations between interpersonal trauma and alcohol use.

“These findings are important because they help elucidate the ways that romantic relationships can improve or undermine health habits, particularly concerning alcohol consumption,” said lead author Rebecca Smith, a doctoral student in the Department of Psychology in the College of Humanities and Sciences. “A better understanding of the ways that social relationships can influence health behaviors might encourage people to carefully consider the people with whom they spend time. Moreover, these findings help us better understand alcohol use risk and protective factors across the lifespan, which can be used to inform prevention and treatment programs.”

Jessica Salvatore, Ph.D., an assistant professor in the Department of Psychology and the senior author on the study, said the findings “underscore the double-edged role that relationships and partners have on health behaviors in college.”

“On the one hand, we found that involvement in a committed relationship buffered the effects of interpersonal trauma exposure on students’ alcohol use,” she said. “On the other, we found that involvement with a heavier drinking partner amplified the association between exposure and alcohol use.”

Smith said she was surprised that relationship satisfaction was not a significant moderator of the associations between interpersonal trauma and alcohol use.

“Based on previous research suggesting that involvement in satisfying relationships is protective against stress and problematic drinking, we had hypothesized that high relationship satisfaction would buffer against the effects of interpersonal trauma on alcohol use,” she said.

The study relied on data collected through Spit for Science, a universitywide project at VCU in which student volunteers provide information on alcohol, substance use, emotional health and more, and contribute DNA samples that provide insight into the role of genetics. The study involved nearly 9,000 students who participated in Spit for Science between 2011 and 2014.

Participants completed baseline assessments during the fall of their freshman year and were invited to complete follow-up assessments every spring thereafter. Participants were included in the study if they completed surveys at baseline and at least one follow-up assessment.

“Each year, participants answered questions about stressful life events they may have experienced, their quantity and frequency of alcohol consumption, and their romantic relationships,” Smith said. “This allowed us to look at the interplay between interpersonal trauma, alcohol use and romantic relationship characteristics over time.”

The study’s findings could be valuable for efforts to increase awareness and education for college students about the ways in which our social ties can promote or undermine health behaviors, like alcohol use, Smith said.

Additionally, she said, the findings could be applied as part of treatment to reduce unsafe drinking.

“We know from previous research that exposure to interpersonal trauma is associated with risky alcohol use, so romantic partners can be included in treatment planning and aftercare to help trauma survivors cope with traumatic events in healthier ways and reduce engagement in risky drinking behaviors,” she said.

In addition to Smith and Salvatore, the study’s co-authors include Danielle Dick, Ph.D., Distinguished Commonwealth Professor in the Departments of Psychology and Human and Molecular Genetics at VCU; Ananda Amstadter, Ph.D., associate professor in the Virginia Institute for Psychiatric and Behavioral Genetics at VCU; Nathaniel Thomas, a doctoral student in the Department of Psychology; and the Spit for Science Working Group.

Urgent shortage of evidence for safe withdrawal from antidepressants

UNIVERSITY OF SOUTHAMPTON

Research News

 

A new study has highlighted that while much is known about the ever increasing uptake of antidepressant medications around the world, there is very little evidence on safe and effective approaches to discontinuing treatment.

In 2020 there were 78 million prescriptions for antidepressants in England and about half of patients treated have taken them for at least two years. Guidelines typically recommend that antidepressants be taken for up to 6 to 12 months after improvement, or for up to two years in people at risk of relapse, but many people take antidepressants for much longer. Surveys of antidepressant users suggest that up to a half of people on long-term antidepressant prescriptions have no clear medical reason to keep taking them. Long-term use can put people at risk of adverse events such as sleep disturbance, weight gain, sexual dysfunction, bleeding, and gastrointestinal problems, as well as feeling emotionally numb and unable to deal with problems in life without their medication.

In this new study for Cochrane, an international research team, including Professor Tony Kendrick from the University of Southampton, looked at the findings from 33 randomised control trials that included 4,995 participants who were prescribed antidepressants for 24 weeks or longer. In 13 studies, the antidepressant was stopped abruptly; in 18, it was stopped over a few weeks (known as 'tapering'); in four, psychological therapy support was also offered; and in one study, stopping was prompted by a letter to GPs with guidance on tapering. Most tapering schemes lasted four weeks or less and none of the studies used very slow tapering schemes beyond a few weeks - in contrast to new guidelines from the UK Royal College of Psychiatrists that recommend tapering over months or years to safely stop.

The authors were unable to make any firm conclusions about effects and safety of the approaches studied and did not have confidence in the results due to the low certainty of evidence they provided.

'We know the rise in long-term antidepressant use is a major concern around the world,' says lead author Dr Ellen Van Leeuwen from the University of Ghent, Belgium. 'As a GP myself, I see first-hand the struggles many patients have coming off antidepressants. It's of critical concern that we don't know enough about how to reduce inappropriate long-term use or what the safest and most effective approaches are to help people do this. For example, there are over 1,000 studies looking at starting antidepressants, yet we found only 33 trials around the world that examined stopping them. It's clear that this area needs urgent attention.'

Co-author Tony Kendrick, Professor of Primary Care at the University of Southampton is leading the REDUCE trial, testing online and psychologist telephone support for patients withdrawing from long-term antidepressants. He says "More than one in ten adults in England are now taking antidepressants but surveys of long-term users suggest that between a third and a half of these have no evidence-based reason to continue taking them, and they are associated with increasing side effects in the longer term."

A key issue identified by the research team is that previous studies have not distinguished between symptoms of a return of depression and withdrawal symptoms from the medication.

The difficulty of distinguishing between these symptoms presents a real challenge for patients, doctors and researchers alike - often resulting in inappropriate continuation of antidepressant medication and uncertain evidence on which to base healthcare decisions.

Dr Kendrick continues, "Antidepressants are often difficult to stop due to withdrawal symptoms. More research is needed to establish the incidence of withdrawal symptoms in patients, and large randomised controlled trials are needed to test different tapering strategies.

"Ultimately we really need more deprescribing studies - especially in primary care given that's where most prescribing takes place - before we can make more definitive conclusions. In the meantime, we hope this review provides a starting point to help GPs openly discuss continuing or stopping antidepressants with their patients. We also want to raise awareness that withdrawal symptoms from antidepressants are common and can be mistaken for relapse of the underlying condition. Experiencing withdrawal symptoms isn't a sign that the patient has relapsed - it might be that they need to taper more gradually down to much lower doses instead, before eventually stopping."

WTF

Cannabis use disorder rate rose among pregnant women between 2001-2012

Study finds resulting adverse outcomes for infants: preterm births, low birth weight and small size

UNIVERSITY OF CALIFORNIA - SAN DIEGO

Research News

 

A study of almost 5 million live births in California by researchers at the Herbert Wertheim School of Public Health and Human Longevity Science at University of California San Diego reports that babies born to mothers diagnosed with cannabis use disorder were more likely to experience negative health outcomes, such as preterm birth and low birth weight, than babies born to mothers without a cannabis use disorder diagnosis.

The findings are published online in the April 22, 2021 issue of the journal Addiction. The National Institute on Drug Abuse, part of the National Institutes of Health, funded the study.

Cannabis use disorder is a diagnostic term with specific criteria that defines continued cannabis use despite consequent, clinically significant impairments. The research team, led by first author Yuyan Shi, PhD, associate professor at The Herbert Wertheim School of Public Health, conducted a retrospective cohort study of 4.83 million mothers who delivered live, single births in California from 2001 to 2012.

They identified 20,237 women who were discharged after delivery with a diagnosis of cannabis use disorder. Not all people who use cannabis meet the criteria for cannabis use disorder. The study authors stated the actual incidence of cannabis use disorder is likely higher than reported numbers.

The researchers found that diagnoses of cannabis use disorder, based on medical records at time of delivery, rose from 2.8 to 6.9 per 1000 deliveries from 2002 to 2012. Compared to a matched control group of 40,474 mother-infant pairs, infants born to women with cannabis use disorder were more likely to be born preterm, have a low birth weight and be small for their gestational age -- all factors that can require greater or more intense medical care or presage later health issues.

Additionally, researchers found that, though rare overall (less than 1 percent), the risk of infant mortality was greater for infants born to women with cannabis use disorder. These infants were 35 percent more likely to die within a year of birth than infants in the control group. Conversely, these infants were also less likely to be hospitalized within the first year of life than control group infants.

"Because we are looking only at medical records, there is a lot we don't know about the mothers and infants in this study," said first author Shi, "but our analysis supports the recommendation that health professionals screen for and address cannabis use disorders in their pregnant clients -- to protect both their health and potentially the health of their infants."

Currently, screening for cannabis use or related disorders is not standard practice during pregnancy health care, though marijuana is the illicit drug most commonly used by pregnant women, typically to self-treat depression, anxiety, stress, pain, nausea and vomiting, often during the first trimester. It is also not standard of care to provide counsel on the lack of safety data around cannabis use during pregnancy. Both strategies may be helpful, as well as encouraging patients to discontinue use of cannabis during pregnancy and while breastfeeding and referring to treatment when appropriate.

According to a 2018 published study, approximately 7 percent of pregnant women self-reported marijuana use, with rates as high as 10 percent among women ages 18 to 25. Rates based on urine toxicology were even higher, with 19 percent of pregnant women ages 18 to 25 screening positive for marijuana use.

Previous research has found that tetrahydrocannabinol (THC), the psychoactive compound in cannabis, can reach fetuses and infants through the placenta and breastmilk, respectively. THC disrupts the normal function of the endocannabinoid system, which has been shown to play a key role in pregnancy, including implantation of the embryo in the uterus and maintenance of the placenta.

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Co-authors include: Bin Zhu, UC San Diego; and Di Liang, UC San Diego and Fudan University, China.

Immune system, not COVID virus, may pose greatest risk to pregnant women

YALE UNIVERSITY

Research News 

For reasons not yet clear, pregnant women infected with the virus that causes COVID-19 are more likely to experience preterm births, pre-eclampsia, and other neonatal problems than non-infected women.

A team of Yale scientists decided to investigate whether the virus could be affecting placental tissue of infected expectant mothers. Their analysis found that while evidence of the virus in the placenta is rare, the placenta in infected mothers tended to exhibit a much higher level of immune system activity than those of non-infected pregnant women, they report April 22 in the journal Med.

"The good news is the placenta is mounting a robust defense against an infection that is far distant, in lungs or nasal tissue," said Shelli Farhadian, assistant professor of internal medicine (infectious diseases) and neurology at Yale and co-corresponding author. "On the other hand, the high level of immune system activity might be leading to other deleterious effects on the pregnancy."

The team headed by Farhadian and Akiko Iwasaki, the Waldemar Von Zedtwitz Professor of Immunobiology at Yale, analyzed blood and placental tissue in 39 infected and as well as COVID-free expectant mothers at different stages of pregnancy. While they found evidence of the virus in only two samples of placental tissue, they did find ACE2 receptors -- which the SARS-CoV-2 virus uses to enter cells -- in the placentas of most women during the first trimester of pregnancy. Those receptors had largely disappeared in healthy women at later stages of pregnancy.

"It is very important to closely monitor expectant mothers who become infected early in pregnancy," Farhadian said.

Immune system activity in the placenta during infections like COVID-19 has not been extensively studied and it is not known whether other types of infections would behave similarly to SARS-CoV-2, she said.

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Alice Lu-Culligan is lead author of the study, which was primarily funded by the National Institutes of Health and the Emergent Ventures Fund at the Mercatus Center at George Mason University.

Pregnant women with COVID-19 face high mortality rate

Worldwide study also found that 11% of babies contracted the novel coronavirus from their mothers

UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE/UW MEDICINE

Research News

 

In a worldwide study of 2,100 pregnant women, those who contracted COVID-19 during pregnancy were 20 times more likely to die than those who did not contract the virus.

UW Medicine and University of Oxford doctors led this first-of-its-kind study, published today in JAMA Pediatrics. The investigation involved more than 100 researchers and pregnant women from 43 maternity hospitals in 18 low-, middle- and high-income nations; 220 of the women received care in the United States, 40 at UW Medicine. The research was conducted between April and August of 2020.

The study is unique because each woman affected by COVID-19 was compared with two uninfected pregnant women who gave birth during the same span in the same hospital.

Aside from an increased risk of death, women and their newborns were also more likely to experience preterm birth, preeclampsia and admission to the ICU and/or intubation. Of the mothers who tested positive for the disease, 11.5% of their babies also tested positive, the study found.

Although other studies have looked at COVID-19's effects on pregnant women, this is among the first study to have a concurrent control group with which to compare outcomes, said Dr. Michael Gravett, one of the study's lead authors.

"The No. 1 takeaway from the research is that pregnant women are no more likely to get COVID-19, but if they get it, they are more likely to become very ill and more likely to require ICU care, ventilation, or experience preterm birth and preeclampsia," he said. Gravett is a professor of obstetrics and gynecology at the University of Washington School of Medicine. Co-investigator Dr. Lavone Simmons is a UW acting assistant professor of OB-GYN.

One caveat, Gravett noted, was that women whose COVID-19 was asymptomatic or mild were not found to be at increased risk for ICU care, preterm birth or preeclampsia. About 40% of the women in this study were asymptomatic. Pregnant women who were obese or had hypertension or diabetes were at the greatest risk for severe disease, the findings showed.

Babies of the women infected with COVID-19 were more likely to be born preterm; but their infections were usually mild, the study found. Breastfeeding seemed not to be related to transmitting the disease. Delivery by Caesarean section, however, might be associated with an increased risk of having an infected newborn, the study found.

Gravett suggested that these and parallel research findings compelled U.S. states' decisions to open vaccine eligibility to pregnant women - who were initially considered a population at low risk for severe COVID-19.

"I would highly recommend that all pregnant women receive the COVID-19 vaccines," based on this research, he said.

The study demonstrates the importance of collecting large-scale, multinational data quickly during a health crisis, Gravett said. Researchers were able to complete the investigation and report findings in only nine months, using infrastructure already in place from the INTERGROWTH-21st Project, which emerged in 2012 to study fetal growth and neonatal outcomes

Why the human body has not evolved to make childbirth easier -- or has it?

UNIVERSITY OF TEXAS AT AUSTIN

Research News

 

IMAGE: RESEARCHERS USED FINITE ELEMENT ANALYSIS, TYPICALLY DEPLOYED TO TEST STRUCTURES FOR STRESS EVENTS LIKE EARTHQUAKES, TO STUDY THE PELVIC FLOOR IN WOMEN. view more 

CREDIT: THE UNIVERSITY OF TEXAS AT AUSTIN.

AUSTIN, Texas -- Despite advances in medicine and technology, childbirth isn't likely to get much easier on women from a biological perspective.

Engineers at The University of Texas at Austin and University of Vienna revealed in new research a series of evolutionary trade-offs that have created a near-perfect balance between supporting childbirth and keeping organs intact on a day-to-day basis. Human reproduction is unique because of the comparatively tight fit between the birth canal and baby's head, and it is likely to stay that way because of these competing biological imperatives.

The size of the pelvic floor and canal is key to keeping this balance. These opposing duties have constrained the ability of the pelvic floor to evolve over time to make childbirth easier because doing that would sacrifice the ability to protect organs.

"Although this dimension has made childbirth more difficult, we have evolved to a point where the pelvic floor and canal can balance supporting internal organs while also facilitating childbirth and making it as easy as possible," said Krishna Kumar, an assistant professor in the Cockrell School of Engineering's Department of Civil, Architectural and Environmental Engineering who led the research published this week in the journal Proceedings of the National Academy of Sciences.

The pelvic floor in women is a band of muscles that stretches across the bottom of the abdomen from the tailbone to the pubic bone. It supports pelvic organs, including the uterus, bladder and bowel, and it helps stabilize the spine.

A larger pelvic floor and canal would facilitate easier childbirth. But the larger it becomes without additional bones or tissue to support it, the more likely it is to deform under the weight of organs and cause them to fall downward.

These trade-offs, referred to as the pelvic floor hypothesis, were known in the scientific community. But the theory had been difficult to test until this research team used engineering tools to investigate it.

Kumar first started thinking about the problem by comparing the pelvic floor to a trampoline. A bigger trampoline will drop further as weight is applied, whereas a smaller trampoline will hold its structure better.

In addition to studying the size of the pelvic floor, the researchers also looked at thickness. In theory, a thicker pelvic floor could continue to support organs and an expanded size for childbirth. But it did not turn out that way.

"We found that thicker pelvic floors would require quite a bit higher intra-abdominal pressures than humans are capable of generating to stretch during childbirth," said Nicole Grunstra, an affiliated researcher at the University of Vienna's Unit for Theoretical Biology in the Department of Evolutionary Biology. "Being unable to push the baby through a resistant pelvic floor would equally complicate childbirth, despite the extra space available in the birth canal, and so pelvic floor thickness appears to be another evolutionary 'compromise,' in addition to the size of the birth canal."

The team got to this conclusion by applying principles common in civil engineering. Kumar used a Finite Element analysis, a computerized model often deployed to test the design of structures to see whether they will break or wear down when facing high levels of pressure and stress. In this case, Finite Element analysis allowed the team to model the pelvic floor, change its parameters and see how it responds to the stresses of childbirth and protecting organs, which is otherwise impossible to test using clinical data.

This is the first time Finite Element analysis has been used to explore an evolutionary question. However, it isn't the first time Kumar has applied engineering tools to biology.

While at the University of Cambridge in the U.K., where he met his co-authors who are now at the University of Vienna, Kumar applied a transportation analysis technique to herpes to learn more about how it first spread among humans.

This collaboration shows that engineering approaches and tools are relevant to important problems that, at first glance, may seem well outside the discipline, said Kumar, whose primary research involves numerical models for earthquakes, landslides and other disasters.

"You can abstract all the biology away, and it comes down to what happens if you apply stress, what does it do to bodies and structures with different material properties," Kumar said. "If you squint your eyes, a large landslide can look like a pelvic floor."

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