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1. Using the Robson 10‐Group Classification System to Compare Cesarean Birth Utilization Between US Centers With and Without Midwives

   https://doi.org/10.1111/jmwh.13035  

   Smith, Denise Colter ; Phillippi, Julia C. ; Lowe, Nancy K. ; Breman, Rachel Blankstein ; Carlson, Nicole S. ; Neal, Jeremy L. ; Gutierrez, Eric ; Tilden, Ellen L. ( September 2019 , Journal of Midwifery & Women's Health)

   The Robson 10‐group classification system stratifies cesarean birth rates using maternal characteristics. Our aim was to compare cesarean birth utilization in US centers with and without midwifery care using the Robson classification.

   We used National Institute of Child and Human Development Consortium on Safe Labor data from 2002 to 2008. Births to women in centers with interprofessional care that included midwives (n = 48,857) were compared with births in non‐interprofessional centers (n = 47,935). To compare cesarean utilization, births were classified into the Robson categories. Cesarean birth rates within each category and the contribution to the overall rate were calculated. Maternal demographics, labor and birth outcomes, and neonatal outcomes were described. Logistic regression was used to adjust for maternal comorbidities.

   Women were less likely to have a cesarean birth (26.1% vs 33.5%,P< .001) in centers with interprofessional care. Nulliparous women with singleton, cephalic, term fetuses (category 2) were less likely to have labor induced (11.1% vs 23.4%,P< .001), and women with a prior uterine scar (category 5) had lower cesarean birth rates (73.8% vs 85.1%,P< .001) in centers with midwives. In centers without midwives, nulliparous women with singleton, cephalic, term fetuses with induction of labor (category 2a) were less likely to have a cesarean birth compared with those in interprofessional care centers in unadjusted comparison (30.3% vs 35.8%,P< .001), but this was reversed after adjustment for maternal comorbidities (adjusted odds ratio, 1.21; 95% CI, 1.12‐1.32;P< .001). Cesarean birth rates among women at risk for complications (eg, breech) were similar between groups.

   Interprofessional care teams were associated with lower rates of labor induction and overall cesarean utilization as well as higher rates of vaginal birth after cesarean. There was consistency in cesarean rates among women with higher risk for complications.

    

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2. Prevalence and Correlates of Long COVID Symptoms Among US Adults

   https://doi.org/10.1001/jamanetworkopen.2022.38804  

   Perlis, Roy H. ; Santillana, Mauricio ; Ognyanova, Katherine ; Safarpour, Alauna ; Lunz Trujillo, Kristin ; Simonson, Matthew D. ; Green, Jon ; Quintana, Alexi ; Druckman, James ; Baum, Matthew A. ; et al ( October 2022 , JAMA Network Open)

   Persistence of COVID-19 symptoms beyond 2 months, or long COVID, is increasingly recognized as a common sequela of acute infection.

   To estimate the prevalence of and sociodemographic factors associated with long COVID and to identify whether the predominant variant at the time of infection and prior vaccination status are associated with differential risk.

   This cross-sectional study comprised 8 waves of a nonprobability internet survey conducted between February 5, 2021, and July 6, 2022, among individuals aged 18 years or older, inclusive of all 50 states and the District of Columbia.

   Long COVID, defined as reporting continued COVID-19 symptoms beyond 2 months after the initial month of symptoms, among individuals with self-reported positive results of a polymerase chain reaction test or antigen test.

   The 16 091 survey respondents reporting test-confirmed COVID-19 illness at least 2 months prior had a mean age of 40.5 (15.2) years; 10 075 (62.6%) were women, and 6016 (37.4%) were men; 817 (5.1%) were Asian, 1826 (11.3%) were Black, 1546 (9.6%) were Hispanic, and 11 425 (71.0%) were White. From this cohort, 2359 individuals (14.7%) reported continued COVID-19 symptoms more than 2 months after acute illness. Reweighted to reflect national sociodemographic distributions, these individuals represented 13.9% of those who had tested positive for COVID-19, or 1.7% of US adults. In logistic regression models, older age per decade above 40 years (adjusted odds ratio [OR], 1.15; 95% CI, 1.12-1.19) and female gender (adjusted OR, 1.91; 95% CI, 1.73-2.13) were associated with greater risk of persistence of long COVID; individuals with a graduate education vs high school or less (adjusted OR, 0.67; 95% CI, 0.56-0.79) and urban vs rural residence (adjusted OR, 0.74; 95% CI, 0.64-0.86) were less likely to report persistence of long COVID. Compared with ancestral COVID-19, infection during periods when the Epsilon variant (OR, 0.81; 95% CI, 0.69-0.95) or the Omicron variant (OR, 0.77; 95% CI, 0.64-0.92) predominated in the US was associated with diminished likelihood of long COVID. Completion of the primary vaccine series prior to acute illness was associated with diminished risk for long COVID (OR, 0.72; 95% CI, 0.60-0.86).

   This study suggests that long COVID is prevalent and associated with female gender and older age, while risk may be diminished by completion of primary vaccination series prior to infection.

    

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3. Does Quality of End‐of‐Life Care Differ by Urban‐Rural Location? A Comparison of Processes and Family Evaluations of Care in the VA

   https://doi.org/10.1111/jrh.12351  

   del Rosario, Cindy ; Kutney‐Lee, Ann ; Sochalski, Julie ; Ersek, Mary ( February 2019 , The Journal of Rural Health)

   Several studies have identified differences in end‐of‐life (EOL) care between urban and rural areas, yet little is known about potential differences in care processes or family evaluations of care. The purpose of this study was to examine the relationship between rurality of residence and quality of EOL care within the Veterans Affairs health care system.

   This study was a retrospective, cross‐sectional analysis of 126,475 veterans who died from October 2009 through September 2016 in inpatient settings across 151 facilities. Using unadjusted and adjusted logistic regression, we compared quality of EOL care between urban and rural veterans using family evaluations of care and 4 quality of care indicators for receipt of (1) palliative care consult, (2) a chaplain visit, (3) death in an inpatient hospice unit, and (4) bereavement support.

   Veterans from rural areas had lower odds of dying in an inpatient hospice unit compared to veterans from urban areas, before and after adjustment (large rural OR 0.73, 95% CI: 0.70‐0.77;P< .001, small rural OR 0.81, 95% CI: 0.77‐0.86;P< .001, isolated rural OR 0.87, 95% CI: 0.81‐0.93;P< .001). Differences in comparisons of other quality of care indicators were small and of mixed significance. No significant differences were found in family ratings of care in fully adjusted models.

   Receipt of some EOL quality indicators differed with urban‐rural residence for some comparisons. However, family ratings of care did not. Our findings call for further investigation into unmeasured individual characteristics and facility processes related to rurality.

    

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4. Accelerated senescence as a cost of reproduction: Testing associations between oxidative stress and reproductive effort in rural and urban women

   https://doi.org/10.1002/ajhb.23537  

   Sancilio, Amelia ; Jasienska, Grazyna ; Panter‐Brick, Catherine ; Ziomkiewicz, Anna ; Nenko, Ilona ; Bribiescas, Richard G. ( November 2020 , American Journal of Human Biology)

   Oxidative stress is hypothesized to contribute to age‐related somatic deterioration. Both reproductive and ecological context may necessitate tradeoffs that influence this outcome. We examined whether measures of lifetime reproductive effort were related to levels of oxidative stress biomarkers in peri‐ and post‐menopausal women and whether associations were moderated by rural or urban residence.

   We surveyed 263 healthy women (age 62.1 ± 10.0 SD) from rural (N = 161) and urban Poland (N = 102), collecting sociodemographic data and urine samples to analyze biomarkers of oxidative stress (8‐oxo‐2′‐deoxyguanosine, 8‐OHdG) and antioxidative defense (copper‐zinc superoxide dismutase, Cu‐Zn SOD). Linear regression models, adjusted for residence, were used to test for associations between reproductive effort and 8‐OHdG and Cu‐Zn SOD.

   Univariate models demonstrated significant associations between gravidity and the biomarkers of oxidative stress (8‐OHdG:R² = 0.042,P ≤ .001; Cu‐Zn SOD:R² = 0.123,P ≤ .001). Multivariate models incorporating potential confounding variables, as well as cross‐product interaction terms, indicated that gravidity was associated with 8‐OHdG (P < .01,R²_adj = 0.067) and Cu‐Zn SOD (P = .01,R²_adj = 0.159). Residence (ie, urban vs rural) did not significantly moderate the associations between the biomarkers and reproductive effort.

   Higher lifetime reproductive effort contributes to increases in oxidative stress and antioxidative defenses. Our results provide evidence of potential mechanisms underlying the physiological tradeoffs influencing senescence for women with high reproductive effort. We illustrate the value of applying an evolutionary perspective to elucidate variation in human health and senescence.

    

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5. Mortality in infantile spasms: A hospital‐based study

   https://doi.org/10.1111/epi.16468  

   Harini, Chellamani ; Nagarajan, Elanagan ; Bergin, Ann M. ; Pearl, Phillip ; Loddenkemper, Tobias ; Takeoka, Masanori ; Morrison, Peter F. ; Coulter, David ; Harappanahally, Gita ; Marti, Candice ; et al ( March 2020 , Epilepsia)

   To determine risk factors and causes for mortality during childhood in patients with infantile spasms (IS). We describe the overall goals of care for those who died.

   This is a retrospective chart review of IS patients born between 2000 and 2011. We examined potential risk factors for mortality, including etiology, neurologic impairment, medication use, persistence of epileptic spasms, and comorbid systemic involvement (requirement for G‐tube feedings, respiratory interventions). For patients who died, we describe cause of death and resuscitation status or end‐of‐life care measures.

   We identified 150 IS patients with median follow‐up of 12 years. During the study period, 25 (17%) patients died, 13 before 5 years of age. Univariate analysis demonstrated that developmental delay, identifiable etiology, hormonal use for IS, persistence of epileptic spasms, polypharmacy with antiseizure medications, refractory epilepsy, respiratory system comorbidity, and the need for a G‐tube were significant risk factors for mortality. In a multivariate analysis, mortality was predicted by persistence of epileptic spasms (odds ratio [OR] = 4.30, 95% confidence interval [CI] = 1.11‐16.67,P = .035) and significant respiratory system comorbidity (OR = 12.75, 95% CI = 2.88‐56.32,P = .001). Mortality was epilepsy‐related in one‐third of patients who died with sudden unexpected death in epilepsy (SUDEP), accounting for 88% of epilepsy‐related deaths. Most deaths before age 5 years were related to respiratory failure, and SUDEP was less common (17%) whereas SUDEP was more common (45%) with deaths after 5 years. For the majority (67%) of patients with early mortality, an end‐of‐life care plan was in place (based on documentation of resuscitation status, comfort measures, or decision not to escalate medical care).

   Mortality at our single‐center IS cohort was 17%, and persistence of epileptic spasms and comorbid respiratory system disorders were the most important determinants of mortality. Early deaths were related to neurological impairments/comorbidities. SUDEP was more common in children who died after 5 years of age than in those who died younger than 5 years.

    

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