Objective To determine the impact of Centering Pregnancy Ó-based group prenatal care for Hispanic... more Objective To determine the impact of Centering Pregnancy Ó-based group prenatal care for Hispanic gravid diabetics on pregnancy outcomes and postpartum follow-up care compared to those receiving traditional prenatal care. Methods A cohort study was performed including 460 women diagnosed with gestational diabetes mellitus (GDM) who received traditional or Centering Pregnancy Ó prenatal care. The primary outcome measured was completion of postpartum glucose tolerance testing. Secondary outcomes included postpartum visit attendance, birth outcomes, breastfeeding, and initiation of a family planning method. Results 203 women received Centering Pregnancy Ó group prenatal care and 257 received traditional individual prenatal care. Women receiving Centering Pregnancy Ó prenatal care were more likely to complete postpartum glucose tolerance testing than those receiving traditional prenatal care, (83.6 vs. 60.7 %, respectively; p \ 0.001), had a higher rate of breastfeeding initiation (91.0 vs. 69.4 %; p \ 0.001), had higher rates of strictly breastfeeding at their postpartum visit (63.1 vs. 46.3 %; p = 0.04), were less likely to need medical drug therapy compared to traditional prenatal care (30.2 vs. 42.1 %; p = 0.009), and were less likely to undergo inductions of labor (34.5 vs. 46.2 %; p = 0.014). When only Hispanic women were compared, women in the Centering group continued to have higher rates of breastfeeding and completion of postpartum diabetes screening. Conclusion for Practice Hispanic women with GDM who participate in Centering Pregnancy Ó group prenatal care may have improved outcomes. Keywords Gestational diabetes Á Group prenatal care Á Centering pregnancy Á Breastfeeding Á Postpartum visit Significance What is already known on this subject? Centering pregnancy group prenatal care can improve outcomes and readiness for childbirth compared to traditional prenatal care. What this study adds? Group care has not been reported for specific high-risk pregnancy conditions such as gestational diabetes. This retrospective cohort study describes and adapted Centering Pregnancy-based group prenatal care model used for Hispanic women diagnosed with gestational diabetes. It demonstrates that women in the group care had higher rates of breastfeeding and higher rates of postpartum diabetes screening compared to women with gestational diabetes who remained in traditional highrisk care. This suggests that for Hispanic women with gestational diabetes, group-based prenatal care is an option.
Purpose of Review This review serves to account for the published literature regarding the changi... more Purpose of Review This review serves to account for the published literature regarding the changing impact of the COVID-19 pandemic with a focus on neonatal nutrition in low-and middle-income countries. Recent Findings Initial national and international guidelines regarding breastfeeding were often contradictory. Lack of clear guidelines resulted in separation of mother-neonate dyads and the reliance on non-human sources of milk at institutional levels. Mothers and families were less likely to initiate and/or continue breastfeed during the pandemic due to confusion regarding guidelines, lack of support for lactation, and concern for infection transmission to their neonates. Continued research in neonatal nutrition, however, continues to support the use of breastmilk as the optimal nutritional source for neonates. Summary Despite concerns for increased risk of COVID-19 transmission with breastfeeding, the use of breastmilk with preserved and combined mother-baby care is associated with improved neonatal nutrition.
Obstetrics and Gynecology Clinics of North America, Jun 1, 2015
Placenta accreta can lead to hemorrhage, resulting in hysterectomy, blood transfusion, multiple o... more Placenta accreta can lead to hemorrhage, resulting in hysterectomy, blood transfusion, multiple organ failure, and death. Accreta has been increasing steadily in incidence owing to an increase in the cesarean delivery rate. Major risk factors are placenta previa in women with prior cesarean deliveries. Obstetric ultrasonography can be used to diagnose placenta accreta antenatally, which allows for scheduled delivery in a multidisciplinary center of excellence for accreta. Controversies exist regarding optimal management, including optimal timing of delivery, surgical approach, use of adjunctive measures, and conservative (uterine-sparing) therapy. We review the definition, risk factors, diagnosis, management, and controversies regarding placenta accreta.
Despite the authority that time holds in the discipline of studying events of the past, not all h... more Despite the authority that time holds in the discipline of studying events of the past, not all historians or writers analyzing the past use time to study history-some use space, including writers who write about and interact with an urban topography. The space used by these writers is built space, as well as inhabited and practiced "lived" space. Whereas time provides a transparent overview of history, the urban spaces tend to be opaque. Clarifying history through urban space is additionally troublesome, because built space and its attached memories are visibly forgotten and ignored as time advances. Despite the difficulties of working with and understanding urban space, some intellectuals specifically choose space as a tool of discernment of history. For these individuals, understanding history becomes an investigation of sensing, feeling, and divining human activity out of the mass of artifacts and used spaces. Hermine Cloeter is one such urban forensic historian. Cloeter's writings record and redeem a tangible history, one based on her physical movement through the city, experiencing and exploring built elements of the urban landscape. Recognizing that pieces of the city's spatial history are being lost, flaneuse Hermine Cloeter writes and records experiences of Vienna's past through her own explorations of space, preventing the essence and cultural richness of the city from being lost in the progression of time. To prove this hypothesis, I have broken down my argument into four chapters. In Chapter One, I use biographical and autobiographical sources to look at the development of Cloeter's use of urban forensics: her approach to Viennese history and the city's built environment. In Chapter Two, I tie Cloeter to the cultural figure of the flaneur by describing her methodology of reading the urban topography and by showing her own position as a flaneuse. In Chapter Three, I look at Cloeter's essay "Durch die engste Gasse von Wien" to illustrate her methods of urban hermeneutics. Finally, in Chapter Four, I analyze Cloeter's interaction with individual built and lived spaces and artifacts, showing that Cloeter reclaims Vienna's history by merging the current topography with the cultural richness of Vienna's past. ACKNOWLEDGMENTS To my parents and brothers, for putting up with me over the years and supporting me in all my dreams and endeavors. To my professors, teachers, and mentors throughout my education, for your inspiration and your belief in my abilities, even when I did not believe. To my family, friends, colleagues, both in America and Austria, for your incredible assistance, support, and amazing qualities of inspiration, love, and friendship.
American Journal of Obstetrics and Gynecology, 2015
Information obtained for each patient included demographic data, medical history, CS details, and... more Information obtained for each patient included demographic data, medical history, CS details, and recovery course during hospitalization and following discharge (power of 80% and 95% confidence level for a 50% reduction in SSI rates). RESULTS: We recruited 658 patients (Table). Demographic data were comparable between the groups. S. aureus nasal colonization rates were 20.1% and 13.2% in the intervention and control groups respectively (p¼0.019, Table). S. aureus eradication rate with Mupirocin treatment was 78.5%. SSI rates were similar in the intervention and control groups (13.1% vs. 11.7% respectively, p¼0.69) and in treated carriers, non-treated carriers, and non-carriers (7.4% vs. 11.5% vs. 12.8% respectively, p¼0.69). In a multivariate analysis including multiple risk factors for SSI, previous CS was the only factor found to independently predict SSI (RR 2.2, CI 1.08-4.55 p¼0.03). CONCLUSION: Nasal colonization of S. aureus does not increase SSI rates following cesarean delivery. Treatment of carriers with nasal Mupirocin does not reduce SSI rates. Screening for nasal S. aureus colonization does not appear to be an effective means in reducing SSI rates following cesarean delivery.
The impact of neglected tropical diseases on women and girl refugees: A call for increased awaren... more The impact of neglected tropical diseases on women and girl refugees: A call for increased awareness and strategic intervention.
As the number of forcibly displaced women and girls increases, it becomes ever important to recog... more As the number of forcibly displaced women and girls increases, it becomes ever important to recognize the negative health impacts of being displaced. Women and girl refugees are disproportionately affected by sexual and gender-based violence and mental health concerns. In addition to these health concerns in women, crowding and lack of clean water in refugee camps leads to the spread of infectious diseases in general. Neglected tropical diseases (NTDs) are infectious diseases of poverty found in tropical areas, and longstanding infections lead to significant morbidity. Particularly for women, these diseases can impact fertility, chronic disease in pregnancy, and social stigma. Despite being a high-risk group, there are minimal data on the impact of NTDs on the health of Women and girl refugees. Diseases such as schistosomiasis, soil-transmitted helminth infections, strongyloidiasis, and leishmaniasis have all been shown to affect Women and girl refugees, but the majority of these da...
American Journal of Obstetrics and Gynecology, 2015
We sought to evaluate the rate of conversion of Society for Maternal-Fetal Medicine (SMFM) annual... more We sought to evaluate the rate of conversion of Society for Maternal-Fetal Medicine (SMFM) annual meeting abstract presentations to full manuscript publications over time. Full manuscript publications corresponding to all SMFM oral abstracts 2003 through 2010 inclusive, and SMFM poster abstracts in 2003, 2005, 2007, and 2009 were manually searched in PubMed. An abstract was considered to "match" a full publication if the abstract and publication titles as well as main methods and results were similar and the abstract first author was a publication author. In cases of uncertainty, the abstract-publication match was reviewed by a second physician researcher. Time to publication, publication rates over time, and publication rates among US vs non-US authors were examined. PubMed identification numbers were also collected to determine if >1 abstract contributed to a manuscript. Data were analyzed using Wilcoxon rank sum, analysis of variance, t test, and logistic regression. In all, 3281 abstracts presented at SMFM over the study period, including 629 orals (63 main plenary, 64 fellows plenary, 502 concurrent), were reviewed. Of 3281, 1780 (54.3%) were published, generating 1582 unique publications. Oral abstracts had a consistently higher rate of conversion to publications vs posters (77.1% vs 48.8%, P < .001). The median time to publication was 19 (interquartile range, 9-36) months, and was significantly shorter for orals vs posters (11 vs 21 months, P < .001). Over the study period, rates of publication of orals remained constant, but rates of publication of posters were lower in 2007 and 2009 compared to 2003 and 2005. Publications related to SMFM abstracts were published in 194 different journals, most commonly American Journal of Obstetrics and Gynecology (39.8%), Obstetrics and Gynecology (9.7%), and Journal of Maternal-Fetal and Neonatal Medicine (6.5%). Publication rates were higher if the abstract's first author was affiliated with a non-US institution (64.8% vs 51.1%, P < .001) and if the abstract received an award (82.7% vs 53.3%, P < .001). In regression models, oral presentation at SMFM, first author affiliation with a non-US institution, submission for American Journal of Obstetrics and Gynecology SMFM special issue, and year of abstract presentation at SMFM were associated with full manuscript publication. From 2003 through 2010, full manuscript publication rates of SMFM abstracts were high and consistent, and time to publication decreased/improved across the study period for oral presentations.
Background: Globally, there is greater awareness of the plight of women who have complications as... more Background: Globally, there is greater awareness of the plight of women who have complications associated with pregnancy or childbirth and who may continue to experience long-term problems. In addition, the health of women and their ability to perform economic and social functions are central to the Sustainable Development Goals. Methods: In 2012, WHO began an initiative to standardize the definition, conceptualization, and assessment of maternal morbidity. The culmination of this work was a conceptual framework: the Maternal Morbidity Measurement (MMM) Framework. Results: The framework underscores the broad ramifications of maternal morbidity and highlights what types of measurement are needed to capture what matters to women, service providers, and policy makers. Using examples from the literature, we explain the framework's principles and its most important elements. Conclusions: We express the need for comprehensive research and detailed longitudinal studies of women from early pregnancy to the extended postpartum period to understand how health and symptoms and signs of ill health change. With respect to interventions, there may be gaps in healthcare provision for women with chronic conditions and who are about to conceive. Women also require continuity of care at the primary care level beyond the customary 6 weeks postpartum.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2018
The maternal health agenda is undergoing a paradigm shift from preventing maternal deaths to prom... more The maternal health agenda is undergoing a paradigm shift from preventing maternal deaths to promoting women's health and wellness. A critical focus of this trajectory includes addressing maternal morbidity and the increasing burden of chronic and noncommunicable diseases (NCD) among pregnant women. The WHO convened the Maternal Morbidity Working Group (MMWG) to improve the scientific basis for defining, measuring, and monitoring maternal morbidity. Based on the MMWG's work, we propose paradigms for conceptualizing maternal health and related interventions, and call for greater integration between maternal health and NCD programs. This integration can be synergistic, given the links between chronic conditions, morbidity in pregnancy, and long-term health. Pregnancy should be viewed as a window of opportunity into the current and future health of women, and offers critical entry points for women who may otherwise not seek or have access to care for chronic conditions. Materna...
HERMINE CLOETER, FEUILLETONS, AND VIENNA: A FLANEUSE AND URBAN CULTURAL ARCHAEOLOGIST WANDERING T... more HERMINE CLOETER, FEUILLETONS, AND VIENNA: A FLANEUSE AND URBAN CULTURAL ARCHAEOLOGIST WANDERING THROUGH OPAQUE SPACES, BRIDGING PAST AND PRESENT TO RECLAIM WHAT COULD BE LOST Kelli D. Barbour Department of Germanic and Slavic Languages Masters of Arts in German Literature Despite the authority that time holds in the discipline of studying events of the past, not all historians or writers analyzing the past use time to study history—some use space, including writers who write about and interact with an urban topography. The space used by these writers is built space, as well as inhabited and practiced “lived” space. Whereas time provides a transparent overview of history, the urban spaces tend to be opaque. Clarifying history through urban space is additionally troublesome, because built space and its attached memories are visibly forgotten and ignored as time advances. Despite the difficulties of working with and understanding urban space, some intellectuals specifically choose spac...
International Journal of Maternal and Child Health and AIDS (IJMA)
Background: Evidence on recent trends regarding the impact and cost-benefits of ultrasound in res... more Background: Evidence on recent trends regarding the impact and cost-benefits of ultrasound in resource-constrained settings is limited. This study presents a systematic review to determine recent trends in the utility and applicability of ultrasound use in low and middle income countries (LMIC). The review includes characterizing and evaluating trends in (1) the geographic and specialty specific use of ultrasound in LMICs, (2) the innovative applications and the accompanying research findings, and (3) the development of associated educational and training programs. Methods: The electronic databases Medline OVID, EMBASE, and Cochrane were searched from 2010 to 2018 for studies available in English, French, and Spanish. Commentaries, opinion articles, reviews and book chapters were excluded. Two categories were created, one for reported applications of ultrasound use in LMICs and another for novel ultrasound studies. Results: A total of 6,276 articles were identified and screened, 4,5...
Background The World Health Organization’s definition of maternal morbidity refers to “a negative... more Background The World Health Organization’s definition of maternal morbidity refers to “a negative impact on the woman’s wellbeing and/or functioning”. Many studies have documented the, mostly negative, effects of maternal ill-health on functioning. Although conceptually important, measurement of functioning remains underdeveloped, and the best way to measure functioning in pregnant and postpartum populations is unknown. Methods A cross-sectional study among women presenting for antenatal (N = 750) and postpartum (N = 740) care in Jamaica, Kenya and Malawi took place in 2015–2016. Functioning was measured through the World Health Organization Disability Assessment Schedule (WHODAS-12). Data on health conditions and socio-demographic characteristics were collected through structured interview, medical record review, and clinical examination. This paper presents descriptive data on the distribution of functioning status among pregnant and postpartum women and examines the relationship ...
International Journal of Gynecology & Obstetrics, May 1, 2018
Objective: To field test a standardized instrument to measure nonsevere morbidity among antenatal... more Objective: To field test a standardized instrument to measure nonsevere morbidity among antenatal and postpartum women. Methods: A cross-sectional study was conducted in Jamaica, Kenya, and Malawi (2015-2016). Women presenting for antenatal care (ANC) or postpartum care (PPC) were recruited if they were at least 28 weeks into pregnancy or 6 weeks after delivery. They were interviewed and examined by a doctor, midwife, or nurse. Data were collected and securely stored electronically on a WHO server. Diagnosed conditions were coded and summarized using ICD-MM. Results: A total of 1490 women (750 ANC; 740 PPC) averaging 26 years of age participated. Most women (61.6% ANC, 79.1% PPC) were healthy (no diagnosed medical or obstetric conditions). Among ANC women with clinical diagnoses, 18.3% had direct (obstetric) conditions and 18.0% indirect (medical) problems. Prevalences among PPC women were lower (12.7% and 8.6%, respectively). When screening for factors in the expanded morbidity definition, 12.8% (ANC) and 11.0% (PPC) self-reported exposure to violence. Conclusion: Nonsevere conditions are distinct from the leading causes of maternal death and may vary across pregnancy and the puerperium. This effort to identify and measure nonsevere morbidity promotes a comprehensive understanding of morbidity, incorporating maternal self-reporting of exposure to violence, and mental health. Further validation is needed.
Objective: To field test a standardized instrument to measure nonsevere morbidity among antenatal... more Objective: To field test a standardized instrument to measure nonsevere morbidity among antenatal and postpartum women. Methods: A cross-sectional study was conducted in Jamaica, Kenya, and Malawi (2015-2016). Women presenting for antenatal care (ANC) or postpartum care (PPC) were recruited if they were at least 28 weeks into pregnancy or 6 weeks after delivery. They were interviewed and examined by a doctor, midwife, or nurse. Data were collected and securely stored electronically on a WHO server. Diagnosed conditions were coded and summarized using ICD-MM. Results: A total of 1490 women (750 ANC; 740 PPC) averaging 26 years of age participated. Most women (61.6% ANC, 79.1% PPC) were healthy (no diagnosed medical or obstetric conditions). Among ANC women with clinical diagnoses, 18.3% had direct (obstetric) conditions and 18.0% indirect (medical) problems. Prevalences among PPC women were lower (12.7% and 8.6%, respectively). When screening for factors in the expanded morbidity definition, 12.8% (ANC) and 11.0% (PPC) self-reported exposure to violence. Conclusion: Nonsevere conditions are distinct from the leading causes of maternal death and may vary across pregnancy and the puerperium. This effort to identify and measure nonsevere morbidity promotes a comprehensive understanding of morbidity, incorporating maternal self-reporting of exposure to violence, and mental health. Further validation is needed.
Objective To determine the impact of Centering Pregnancy Ó-based group prenatal care for Hispanic... more Objective To determine the impact of Centering Pregnancy Ó-based group prenatal care for Hispanic gravid diabetics on pregnancy outcomes and postpartum follow-up care compared to those receiving traditional prenatal care. Methods A cohort study was performed including 460 women diagnosed with gestational diabetes mellitus (GDM) who received traditional or Centering Pregnancy Ó prenatal care. The primary outcome measured was completion of postpartum glucose tolerance testing. Secondary outcomes included postpartum visit attendance, birth outcomes, breastfeeding, and initiation of a family planning method. Results 203 women received Centering Pregnancy Ó group prenatal care and 257 received traditional individual prenatal care. Women receiving Centering Pregnancy Ó prenatal care were more likely to complete postpartum glucose tolerance testing than those receiving traditional prenatal care, (83.6 vs. 60.7 %, respectively; p \ 0.001), had a higher rate of breastfeeding initiation (91.0 vs. 69.4 %; p \ 0.001), had higher rates of strictly breastfeeding at their postpartum visit (63.1 vs. 46.3 %; p = 0.04), were less likely to need medical drug therapy compared to traditional prenatal care (30.2 vs. 42.1 %; p = 0.009), and were less likely to undergo inductions of labor (34.5 vs. 46.2 %; p = 0.014). When only Hispanic women were compared, women in the Centering group continued to have higher rates of breastfeeding and completion of postpartum diabetes screening. Conclusion for Practice Hispanic women with GDM who participate in Centering Pregnancy Ó group prenatal care may have improved outcomes. Keywords Gestational diabetes Á Group prenatal care Á Centering pregnancy Á Breastfeeding Á Postpartum visit Significance What is already known on this subject? Centering pregnancy group prenatal care can improve outcomes and readiness for childbirth compared to traditional prenatal care. What this study adds? Group care has not been reported for specific high-risk pregnancy conditions such as gestational diabetes. This retrospective cohort study describes and adapted Centering Pregnancy-based group prenatal care model used for Hispanic women diagnosed with gestational diabetes. It demonstrates that women in the group care had higher rates of breastfeeding and higher rates of postpartum diabetes screening compared to women with gestational diabetes who remained in traditional highrisk care. This suggests that for Hispanic women with gestational diabetes, group-based prenatal care is an option.
Purpose of Review This review serves to account for the published literature regarding the changi... more Purpose of Review This review serves to account for the published literature regarding the changing impact of the COVID-19 pandemic with a focus on neonatal nutrition in low-and middle-income countries. Recent Findings Initial national and international guidelines regarding breastfeeding were often contradictory. Lack of clear guidelines resulted in separation of mother-neonate dyads and the reliance on non-human sources of milk at institutional levels. Mothers and families were less likely to initiate and/or continue breastfeed during the pandemic due to confusion regarding guidelines, lack of support for lactation, and concern for infection transmission to their neonates. Continued research in neonatal nutrition, however, continues to support the use of breastmilk as the optimal nutritional source for neonates. Summary Despite concerns for increased risk of COVID-19 transmission with breastfeeding, the use of breastmilk with preserved and combined mother-baby care is associated with improved neonatal nutrition.
Obstetrics and Gynecology Clinics of North America, Jun 1, 2015
Placenta accreta can lead to hemorrhage, resulting in hysterectomy, blood transfusion, multiple o... more Placenta accreta can lead to hemorrhage, resulting in hysterectomy, blood transfusion, multiple organ failure, and death. Accreta has been increasing steadily in incidence owing to an increase in the cesarean delivery rate. Major risk factors are placenta previa in women with prior cesarean deliveries. Obstetric ultrasonography can be used to diagnose placenta accreta antenatally, which allows for scheduled delivery in a multidisciplinary center of excellence for accreta. Controversies exist regarding optimal management, including optimal timing of delivery, surgical approach, use of adjunctive measures, and conservative (uterine-sparing) therapy. We review the definition, risk factors, diagnosis, management, and controversies regarding placenta accreta.
Despite the authority that time holds in the discipline of studying events of the past, not all h... more Despite the authority that time holds in the discipline of studying events of the past, not all historians or writers analyzing the past use time to study history-some use space, including writers who write about and interact with an urban topography. The space used by these writers is built space, as well as inhabited and practiced "lived" space. Whereas time provides a transparent overview of history, the urban spaces tend to be opaque. Clarifying history through urban space is additionally troublesome, because built space and its attached memories are visibly forgotten and ignored as time advances. Despite the difficulties of working with and understanding urban space, some intellectuals specifically choose space as a tool of discernment of history. For these individuals, understanding history becomes an investigation of sensing, feeling, and divining human activity out of the mass of artifacts and used spaces. Hermine Cloeter is one such urban forensic historian. Cloeter's writings record and redeem a tangible history, one based on her physical movement through the city, experiencing and exploring built elements of the urban landscape. Recognizing that pieces of the city's spatial history are being lost, flaneuse Hermine Cloeter writes and records experiences of Vienna's past through her own explorations of space, preventing the essence and cultural richness of the city from being lost in the progression of time. To prove this hypothesis, I have broken down my argument into four chapters. In Chapter One, I use biographical and autobiographical sources to look at the development of Cloeter's use of urban forensics: her approach to Viennese history and the city's built environment. In Chapter Two, I tie Cloeter to the cultural figure of the flaneur by describing her methodology of reading the urban topography and by showing her own position as a flaneuse. In Chapter Three, I look at Cloeter's essay "Durch die engste Gasse von Wien" to illustrate her methods of urban hermeneutics. Finally, in Chapter Four, I analyze Cloeter's interaction with individual built and lived spaces and artifacts, showing that Cloeter reclaims Vienna's history by merging the current topography with the cultural richness of Vienna's past. ACKNOWLEDGMENTS To my parents and brothers, for putting up with me over the years and supporting me in all my dreams and endeavors. To my professors, teachers, and mentors throughout my education, for your inspiration and your belief in my abilities, even when I did not believe. To my family, friends, colleagues, both in America and Austria, for your incredible assistance, support, and amazing qualities of inspiration, love, and friendship.
American Journal of Obstetrics and Gynecology, 2015
Information obtained for each patient included demographic data, medical history, CS details, and... more Information obtained for each patient included demographic data, medical history, CS details, and recovery course during hospitalization and following discharge (power of 80% and 95% confidence level for a 50% reduction in SSI rates). RESULTS: We recruited 658 patients (Table). Demographic data were comparable between the groups. S. aureus nasal colonization rates were 20.1% and 13.2% in the intervention and control groups respectively (p¼0.019, Table). S. aureus eradication rate with Mupirocin treatment was 78.5%. SSI rates were similar in the intervention and control groups (13.1% vs. 11.7% respectively, p¼0.69) and in treated carriers, non-treated carriers, and non-carriers (7.4% vs. 11.5% vs. 12.8% respectively, p¼0.69). In a multivariate analysis including multiple risk factors for SSI, previous CS was the only factor found to independently predict SSI (RR 2.2, CI 1.08-4.55 p¼0.03). CONCLUSION: Nasal colonization of S. aureus does not increase SSI rates following cesarean delivery. Treatment of carriers with nasal Mupirocin does not reduce SSI rates. Screening for nasal S. aureus colonization does not appear to be an effective means in reducing SSI rates following cesarean delivery.
The impact of neglected tropical diseases on women and girl refugees: A call for increased awaren... more The impact of neglected tropical diseases on women and girl refugees: A call for increased awareness and strategic intervention.
As the number of forcibly displaced women and girls increases, it becomes ever important to recog... more As the number of forcibly displaced women and girls increases, it becomes ever important to recognize the negative health impacts of being displaced. Women and girl refugees are disproportionately affected by sexual and gender-based violence and mental health concerns. In addition to these health concerns in women, crowding and lack of clean water in refugee camps leads to the spread of infectious diseases in general. Neglected tropical diseases (NTDs) are infectious diseases of poverty found in tropical areas, and longstanding infections lead to significant morbidity. Particularly for women, these diseases can impact fertility, chronic disease in pregnancy, and social stigma. Despite being a high-risk group, there are minimal data on the impact of NTDs on the health of Women and girl refugees. Diseases such as schistosomiasis, soil-transmitted helminth infections, strongyloidiasis, and leishmaniasis have all been shown to affect Women and girl refugees, but the majority of these da...
American Journal of Obstetrics and Gynecology, 2015
We sought to evaluate the rate of conversion of Society for Maternal-Fetal Medicine (SMFM) annual... more We sought to evaluate the rate of conversion of Society for Maternal-Fetal Medicine (SMFM) annual meeting abstract presentations to full manuscript publications over time. Full manuscript publications corresponding to all SMFM oral abstracts 2003 through 2010 inclusive, and SMFM poster abstracts in 2003, 2005, 2007, and 2009 were manually searched in PubMed. An abstract was considered to "match" a full publication if the abstract and publication titles as well as main methods and results were similar and the abstract first author was a publication author. In cases of uncertainty, the abstract-publication match was reviewed by a second physician researcher. Time to publication, publication rates over time, and publication rates among US vs non-US authors were examined. PubMed identification numbers were also collected to determine if >1 abstract contributed to a manuscript. Data were analyzed using Wilcoxon rank sum, analysis of variance, t test, and logistic regression. In all, 3281 abstracts presented at SMFM over the study period, including 629 orals (63 main plenary, 64 fellows plenary, 502 concurrent), were reviewed. Of 3281, 1780 (54.3%) were published, generating 1582 unique publications. Oral abstracts had a consistently higher rate of conversion to publications vs posters (77.1% vs 48.8%, P < .001). The median time to publication was 19 (interquartile range, 9-36) months, and was significantly shorter for orals vs posters (11 vs 21 months, P < .001). Over the study period, rates of publication of orals remained constant, but rates of publication of posters were lower in 2007 and 2009 compared to 2003 and 2005. Publications related to SMFM abstracts were published in 194 different journals, most commonly American Journal of Obstetrics and Gynecology (39.8%), Obstetrics and Gynecology (9.7%), and Journal of Maternal-Fetal and Neonatal Medicine (6.5%). Publication rates were higher if the abstract's first author was affiliated with a non-US institution (64.8% vs 51.1%, P < .001) and if the abstract received an award (82.7% vs 53.3%, P < .001). In regression models, oral presentation at SMFM, first author affiliation with a non-US institution, submission for American Journal of Obstetrics and Gynecology SMFM special issue, and year of abstract presentation at SMFM were associated with full manuscript publication. From 2003 through 2010, full manuscript publication rates of SMFM abstracts were high and consistent, and time to publication decreased/improved across the study period for oral presentations.
Background: Globally, there is greater awareness of the plight of women who have complications as... more Background: Globally, there is greater awareness of the plight of women who have complications associated with pregnancy or childbirth and who may continue to experience long-term problems. In addition, the health of women and their ability to perform economic and social functions are central to the Sustainable Development Goals. Methods: In 2012, WHO began an initiative to standardize the definition, conceptualization, and assessment of maternal morbidity. The culmination of this work was a conceptual framework: the Maternal Morbidity Measurement (MMM) Framework. Results: The framework underscores the broad ramifications of maternal morbidity and highlights what types of measurement are needed to capture what matters to women, service providers, and policy makers. Using examples from the literature, we explain the framework's principles and its most important elements. Conclusions: We express the need for comprehensive research and detailed longitudinal studies of women from early pregnancy to the extended postpartum period to understand how health and symptoms and signs of ill health change. With respect to interventions, there may be gaps in healthcare provision for women with chronic conditions and who are about to conceive. Women also require continuity of care at the primary care level beyond the customary 6 weeks postpartum.
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2018
The maternal health agenda is undergoing a paradigm shift from preventing maternal deaths to prom... more The maternal health agenda is undergoing a paradigm shift from preventing maternal deaths to promoting women's health and wellness. A critical focus of this trajectory includes addressing maternal morbidity and the increasing burden of chronic and noncommunicable diseases (NCD) among pregnant women. The WHO convened the Maternal Morbidity Working Group (MMWG) to improve the scientific basis for defining, measuring, and monitoring maternal morbidity. Based on the MMWG's work, we propose paradigms for conceptualizing maternal health and related interventions, and call for greater integration between maternal health and NCD programs. This integration can be synergistic, given the links between chronic conditions, morbidity in pregnancy, and long-term health. Pregnancy should be viewed as a window of opportunity into the current and future health of women, and offers critical entry points for women who may otherwise not seek or have access to care for chronic conditions. Materna...
HERMINE CLOETER, FEUILLETONS, AND VIENNA: A FLANEUSE AND URBAN CULTURAL ARCHAEOLOGIST WANDERING T... more HERMINE CLOETER, FEUILLETONS, AND VIENNA: A FLANEUSE AND URBAN CULTURAL ARCHAEOLOGIST WANDERING THROUGH OPAQUE SPACES, BRIDGING PAST AND PRESENT TO RECLAIM WHAT COULD BE LOST Kelli D. Barbour Department of Germanic and Slavic Languages Masters of Arts in German Literature Despite the authority that time holds in the discipline of studying events of the past, not all historians or writers analyzing the past use time to study history—some use space, including writers who write about and interact with an urban topography. The space used by these writers is built space, as well as inhabited and practiced “lived” space. Whereas time provides a transparent overview of history, the urban spaces tend to be opaque. Clarifying history through urban space is additionally troublesome, because built space and its attached memories are visibly forgotten and ignored as time advances. Despite the difficulties of working with and understanding urban space, some intellectuals specifically choose spac...
International Journal of Maternal and Child Health and AIDS (IJMA)
Background: Evidence on recent trends regarding the impact and cost-benefits of ultrasound in res... more Background: Evidence on recent trends regarding the impact and cost-benefits of ultrasound in resource-constrained settings is limited. This study presents a systematic review to determine recent trends in the utility and applicability of ultrasound use in low and middle income countries (LMIC). The review includes characterizing and evaluating trends in (1) the geographic and specialty specific use of ultrasound in LMICs, (2) the innovative applications and the accompanying research findings, and (3) the development of associated educational and training programs. Methods: The electronic databases Medline OVID, EMBASE, and Cochrane were searched from 2010 to 2018 for studies available in English, French, and Spanish. Commentaries, opinion articles, reviews and book chapters were excluded. Two categories were created, one for reported applications of ultrasound use in LMICs and another for novel ultrasound studies. Results: A total of 6,276 articles were identified and screened, 4,5...
Background The World Health Organization’s definition of maternal morbidity refers to “a negative... more Background The World Health Organization’s definition of maternal morbidity refers to “a negative impact on the woman’s wellbeing and/or functioning”. Many studies have documented the, mostly negative, effects of maternal ill-health on functioning. Although conceptually important, measurement of functioning remains underdeveloped, and the best way to measure functioning in pregnant and postpartum populations is unknown. Methods A cross-sectional study among women presenting for antenatal (N = 750) and postpartum (N = 740) care in Jamaica, Kenya and Malawi took place in 2015–2016. Functioning was measured through the World Health Organization Disability Assessment Schedule (WHODAS-12). Data on health conditions and socio-demographic characteristics were collected through structured interview, medical record review, and clinical examination. This paper presents descriptive data on the distribution of functioning status among pregnant and postpartum women and examines the relationship ...
International Journal of Gynecology & Obstetrics, May 1, 2018
Objective: To field test a standardized instrument to measure nonsevere morbidity among antenatal... more Objective: To field test a standardized instrument to measure nonsevere morbidity among antenatal and postpartum women. Methods: A cross-sectional study was conducted in Jamaica, Kenya, and Malawi (2015-2016). Women presenting for antenatal care (ANC) or postpartum care (PPC) were recruited if they were at least 28 weeks into pregnancy or 6 weeks after delivery. They were interviewed and examined by a doctor, midwife, or nurse. Data were collected and securely stored electronically on a WHO server. Diagnosed conditions were coded and summarized using ICD-MM. Results: A total of 1490 women (750 ANC; 740 PPC) averaging 26 years of age participated. Most women (61.6% ANC, 79.1% PPC) were healthy (no diagnosed medical or obstetric conditions). Among ANC women with clinical diagnoses, 18.3% had direct (obstetric) conditions and 18.0% indirect (medical) problems. Prevalences among PPC women were lower (12.7% and 8.6%, respectively). When screening for factors in the expanded morbidity definition, 12.8% (ANC) and 11.0% (PPC) self-reported exposure to violence. Conclusion: Nonsevere conditions are distinct from the leading causes of maternal death and may vary across pregnancy and the puerperium. This effort to identify and measure nonsevere morbidity promotes a comprehensive understanding of morbidity, incorporating maternal self-reporting of exposure to violence, and mental health. Further validation is needed.
Objective: To field test a standardized instrument to measure nonsevere morbidity among antenatal... more Objective: To field test a standardized instrument to measure nonsevere morbidity among antenatal and postpartum women. Methods: A cross-sectional study was conducted in Jamaica, Kenya, and Malawi (2015-2016). Women presenting for antenatal care (ANC) or postpartum care (PPC) were recruited if they were at least 28 weeks into pregnancy or 6 weeks after delivery. They were interviewed and examined by a doctor, midwife, or nurse. Data were collected and securely stored electronically on a WHO server. Diagnosed conditions were coded and summarized using ICD-MM. Results: A total of 1490 women (750 ANC; 740 PPC) averaging 26 years of age participated. Most women (61.6% ANC, 79.1% PPC) were healthy (no diagnosed medical or obstetric conditions). Among ANC women with clinical diagnoses, 18.3% had direct (obstetric) conditions and 18.0% indirect (medical) problems. Prevalences among PPC women were lower (12.7% and 8.6%, respectively). When screening for factors in the expanded morbidity definition, 12.8% (ANC) and 11.0% (PPC) self-reported exposure to violence. Conclusion: Nonsevere conditions are distinct from the leading causes of maternal death and may vary across pregnancy and the puerperium. This effort to identify and measure nonsevere morbidity promotes a comprehensive understanding of morbidity, incorporating maternal self-reporting of exposure to violence, and mental health. Further validation is needed.
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Papers by Kelli Barbour