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The number of women using long-acting reversible contraception (LARC)-intrauterine devices (IUDs) and implants-is increasing and 14% of contraceptive users in the United States adopt LARC. We examined correlates of LARC never-use in a population-based survey of reproductive-aged women in Ohio.We analyzed data from the 2018-19 Ohio Survey of Women. We examined the prevalence of LARC never-use and reasons for never-use among ever users of contraception (N = 2388). Using Poisson regression to generate prevalence ratios (PRs), we examined associations between selected correlates (demographic factors, healthcare access/quality measures, and religious/political views) and LARC never-use.Most Ohio women (74%) had never used LARC. Commonly reported reasons for not using an IUD or an implant were preferring a different method (46% and 45%, respectively), not wanting an object inside their body (45% and 43%), side effect concerns (39% and 33%), insertion/removal concerns (31% and 25%), and unfamiliarity (13% and 20%). Conservative political views (PR: 1.12, 95% confidence interval [CI]: 1.04-1.22), pro-life affiliation (PR: 1.11, 95% CI: 1.02-1.20), placing high importance on religion in daily life (PR: 1.15, 95% CI: 1.06-1.26), and being non-Hispanic white as compared to non-Hispanic Black (PR: 1.20, 95% CI: 1.02-1.41) were significantly associated with LARC never-use. Findings were generally similar for models analyzing IUD and implant never-use separately.Among ever-users of contraception, LARC never-use was associated with having conservative political views, being religious, and having a pro-life affiliation. Except for race/ethnicity, demographic and healthcare measures were not associated with LARC never-use among women in Ohio.

To evaluate whether the prevalence of postpartum contraceptive use was lower among people who delivered at a Catholic hospital compared to a non-Catholic hospital.We linked 2015-2018 Pregnancy Risk Assessment Monitoring System (PRAMS) survey data from five states to hospital information from the corresponding birth certificate file. People with a live birth self-reported their use of contraception methods on the PRAMS survey at 2-6 months postpartum, which we coded into two dichotomous (yes vs. no) outcomes for use of female sterilization and highly-effective contraception (female/male sterilization, intrauterine device, implant, injectable, oral contraception, patch, or ring). We conducted multilevel log-binomial regression to examine the relationship between birth hospital type and postpartum contraception use adjusting for confounders.Prevalence of female sterilization for people who delivered at a Catholic hospital was 51% lower than that of their counterparts delivering at a non-Catholic hospital (adjusted prevalence ratio: 0.49; 95% confidence interval: 0.37-0.65).We found lower use of postpartum female sterilization, but no difference in highly effective contraception overall, for people who delivered at a Catholic hospital compared to a non-Catholic hospital.

We tested whether CSD500 (Futura Medical; Guildford, UK), a novel condom containing erectogenic gel designed to increase penile firmness, penile size, and erection duration, results in greater sexual pleasure. In 2017-2020, we randomized heterosexual couples in Thanh Hoa, Vietnam to use CSD500 (N = 248) or standard condoms (N = 252) and followed them up for six months. Women completed the Quality of Sexual Experience (QSE) scale; men completed the QSE, Sexual Experience Questionnaire (SEX-Q), and 11 condom acceptability items. Female participants' mean age was 32.1 years (

S.F.E.G., a 52–year–old woman of Filipino origin, with no previous cardiology except arterial hypertension under therapy, came to our attention for a witnessed episode of cardiac arrest at home. Rescued by the emergency medical team, who found ventricular fibrillation at presentation, and performed ACLS with ROSC obtained after 3 DC shocks. The first ECG was unremarkable (sinus rhythm, diffuse ST depression). Total body CT was negative. Admitted to the Coronary Unit, the echocardiogram was normal for cavity dimensions and kinetics, as well was coronary angiography except for “short intramyocardial course in the second segment of LAD with slight systolic "milking". In the following days, however, there was a significant rise in HsTnI (1,000 → 47,000 ng/L), with concomitant sudden ventricular bigeminy and negative anterior T waves, akinesia of the anterior apical segments of the LV at cardiac ultrasound (not present at admission), in a patient still intubated and therefore with a non–evaluable clinic. Coronary angiography was repeated, which highlighted this time significant vasospasm affecting the middle segment of the LAD, that regressed after intracoronary nitrates. She was extubated without neurological sequelae, and subjected to ICD implantation by secondary prevention. To treat the vasospastic angina she was discharged with calcium channel blockers at the maximum tolerated dosage, as per guidelines (diltiazem 120mg TID + nifedipine 60mg BID). One month later the patient returned to our attention due to worsening dyspnoea, abdominal pain and anasarca (ascites, bilateral pleural effusion, peripheral oedemas). Hospitalized in a medical setting and treated with diuretics for suspected heart failure, despite the echocardiogram showing preserved biventricular systolic function, normal diastolic function, no valve disease, no pericardial effusion. BNP was 359 pg/mL, subsequently decreasing to 148 pg/mL. After excluding every other possible causes even with total body CT, our hypothesis was that of calcium channel blocker collateral effect (vasodilatory edema). We tapered the dosage until only diltiazem 60mg TID was mainteined, obtaining a significant clinical improvement (weight loss by 10 kg), without further recurrence of coronary vasospasm. This clinical case demonstrates the potential lethality of coronary vasospasm, and a rare complication during therapy with high doses of calcium channel blockers, with very few cases described in the literature.

Cholinergic interneurons (CINs) in the striatum respond to salient stimuli with a multiphasic response, including a pause, in neuronal activity. Slice-physiology experiments have shown the importance of dopamine D2 receptors (D2Rs) in regulating CIN pausing, yet the behavioral significance of the CIN pause and its regulation by dopamine in vivo is still unclear. Here, we show that D2R upregulation in CINs of the nucleus accumbens (NAc) lengthens the pause in CIN activity ex vivo and enlarges a stimulus-evoked decrease in acetylcholine (ACh) levels during behavior. This enhanced dip in ACh levels is associated with a selective deficit in the learning to inhibit responding in a Go/No-Go task. Our data demonstrate, therefore, the importance of CIN D2Rs in modulating the CIN response induced by salient stimuli and point to a role of this response in inhibitory learning. This work has important implications for brain disorders with altered striatal dopamine and ACh function, including schizophrenia and attention-deficit hyperactivity disorder (ADHD).

It was first posited, more than five decades ago, that the etiology of schizophrenia involves overstimulation of dopamine receptors. Since then, advanced clinical research methods, including brain imaging, have refined our understanding of the relationship between striatal dopamine and clinical phenotypes as well as disease trajectory. These studies point to striatal dopamine D2 receptors, the main target for all current antipsychotic medications, as being involved in both positive and negative symptoms. Simultaneously, animal models have been central to investigating causal relationships between striatal dopamine D2 receptors and behavioral phenotypes relevant to schizophrenia. We begin this article by reviewing the circuit, cell-type and subcellular locations of dopamine D2 receptors and their downstream signaling pathways. We then summarize results from several mouse models in which D2 receptor levels were altered in various brain regions, cell-types and developmental periods. Behavioral, electrophysiological and anatomical consequences of these D2 receptor perturbations are reviewed with a selective focus on striatal circuit function and alterations in motivated behavior, a core negative symptom of schizophrenia. These studies show that D2 receptors serve distinct physiological roles in different cell types and at different developmental time points, regulating motivated behaviors in sometimes opposing ways. We conclude by considering the clinical implications of this complex regulation of striatal circuit function by D2 receptors.

Background Reports from around the world suggest that rates of preterm birth decreased during COVID‐19 lockdown measures. Aims To compare the prevalence of preterm birth and stillbirth rates during COVID‐19 restriction measures with infants born at the same maternity centre during the same weeks in 2013–2019. Materials and Methods Deidentified data were extracted from the Mater Mothers’ healthcare records database. This is a supra‐regional tertiary perinatal centre. Logistic regressions were used to examine singleton live preterm birth rates during the beginning of COVID‐19 restrictions (16 March‐17 April; ‘early’; 6955 births) and during the strictest part of COVID‐19 restrictions (30 March‐1 May; ‘late’; 6953 births), according to gestational age subgroups and birth onset (planned or spontaneous). We adjusted for multiple covariates, including maternal age, body mass index, ethnicity, parity, socioeconomic status, maternal asthma, diabetes mellitus and/or hypertensive disorder. Singleton stillbirth rates were also examined between 16 March–1 May. Results Planned moderate/late preterm births declined by more than half during early COVID‐19 restrictions compared with the previous seven years (29 vs an average of 64 per 1000 births; adjusted odds ratio 0.39, 95% CI 0.22–0.71). There was no effect on extremely or very preterm infants, spontaneous preterm births, or stillbirth rates. Rolling averages from January to June revealed a two‐week non‐significant spike in spontaneous preterm births from late April to early May, 2020. Conclusions Together with evidence from other nations, the pandemic provides a unique opportunity to identify causal and preventative factors for preterm birth.

Objectives: Diabetes may delay milk letdown, and perceiving milk production as insufficient can lead to breastfeeding cessation. We evaluated whether prepregnancy or gestational diabetes is associated with cessation of breastfeeding by 1 week postpartum. Methods: We analyzed 2016-2018 data from 42 sites in the Pregnancy Risk Assessment Monitoring System, a population-based survey of women with a recent live birth. Participants were surveyed 2-6 months after childbirth. We used logistic regression models to evaluate the relationship between prepregnancy or gestational diabetes only and breastfeeding Results: Among 82 050 women who initiated breastfeeding, 4.5% reported breastfeeding Conclusions: We found no association between a history of diabetes prepregnancy or gestational diabetes only and breastfeeding

Background and objective The incidence of melanoma has increased significantly, and early diagnosis is the most effective way to reduce associated deaths. Dermoscopy increases diagnostic accuracy in melanoma and analysis of dermoscopic structures can help in the estimation of tumor thickness. The aim of this study was to analyze the influence of Breslow thickness on the dermoscopic characteristics of melanoma. Material and methods Observational, cross-sectional study of patients with histologically confirmed melanoma and dermoscopic images of the tumor. The patients were divided into 3 groups: melanoma in situ, thin melanoma (≥ 1 mm Breslow thickness), and thick melanoma (≥ 1 mm Breslow thickness). Age, sex, tumor location, and histologic and dermoscopic characteristics were analyzed in all cases. Results We studied 215 patients: 88 with melanoma in situ, 73 with thin melanoma, and 54 with thick melanoma. The frequency of the following dermoscopic features increased with increasing Breslow thickness: the blue-white veil (P Conclusions Dermoscopy not only improves diagnostic accuracy for pigmented lesions but also helps in the preoperative assessment of Breslow thickness in melanoma.

BACKGROUND: Low contraceptive knowledge may limit contraception initiation or continuation and, consequently, could represent an important, modifiable cause of unintended pregnancy. OBJECTIVE: The objective of this analysis was to identify correlates of knowledge among women at risk of unintended pregnancy. Methods: We analyzed data from a study of 222 young women attending a public clinic in Kingston in November 2018 to March 2019. We measured contraceptive knowledge with 7 questions on method reversibility, ability to use covertly, contraindications and side effects. We used multivariable linear regression to evaluate correlates of summary knowledge scores and report beta coefficients, which represent differences in mean summary knowledge scores. FINDINGS: Mean knowledge score was low (2.7; range=0–7). Only 30.2% of participants correctly identified intrauterine devices as more effective than oral contraception, male condoms and withdrawal. Women who reported that their provider discussed contraception scored higher (adjusted ß=0.37, p-value=0.05) than those not reporting this. Women who perceived implants as very/mostly safe scored higher (adjusted ß=0.45, p-value=0.01) than those perceiving the device as mostly/very unsafe. Finally, compared to contraception non-users, women using less-effective contraception had a lower score (adjusted ß=−0.40, p-value=0.04) while those using effective contraception did not differ in scores (ß=−0.30, p-value=0.18). CONCLUSION: Overall, we found poor contraceptive knowledge among young women in Kingston. Providers appeared to hold an important role in women’s understanding of contraception. CLINICALTRIALS.GOV IDENTIFIER: NCT03775642

Background The use of antagonists of P2Y12 platelets receptors as antiplatelets drugs is a cornerstone in the treatment of ACS. Many efforts are made to understand the right timing of beginning this therapy with the purpose to reduce intra– and periprocedural complications (stent thrombosis, no reflow phenomenon). The rationale behind “pretreatment” (administration of antagonists of P2Y2 platelet receptor before the coronarography) is valuable but the evidences are lacking, also in the setting of ACS–STEMI. Method and Objectives We conduct an observational, monocentric (Ospedale dell’Angelo – Venezia Mestre), retrospective study including patients with STEMI (1st January 2016 – 9th august 2018). We compared two strategies of administration of clopidogrel, ticagrelor and prasugrel (pretreatment vs no pretreatment). Primary endpoints were bleeding BARC 3–5, acute or subacute stent thrombosis and TIMI flow grade > 0 in the culprit coronary. Secondary endpoints were cardiovascular and no cardiovascular in–hospital mortality and in–hospital neurological complications. Results We studied 501 patients (199 in the group pretreated and 302 in the group no pretreated). The median time from first medical contact to PCI was 70,5 minutes in the pretreated group and 60 minutes in the no pretreated group (p = 0.022). No significant differences between the two groups were observed in terms of acute or subacute stent thrombosis (OR 3.72 [0.82–14.20], p = 0.09) e TIMI flow grade > 0 in the culprit coronary (OR 1.11 [0.77–1.58], p = 0.58). In the multivariate analysis we observed that bleeding BARC 3–5 significantly were increased in the pretreated group (adjusted OR 2.78 [1.13–6.83, p = 0.025). In the subgroup analysis, the pretreated subjects with age > 75 were at augmented risk of bleeding BARC 3–5. Conclusions Pretreatment in the setting of ACS–STEMI is not associated with benefits in terms of acute or subacute stent thrombosis and perfusion of culprit coronary but may cause clinically relevant bleedings, in particular in the elderly (age > 75).

Background: Bevacizumab is approved in combination with chemotherapy for the treatment of ovarian cancer, either in first-line therapy or for patients with recurrent disease not previously treated with the same drug. We aimed to test the value of continuing bevacizumab beyond progression after first-line treatment with the same drug. Methods: In our open-label, randomised, phase 3 trial done at 82 sites in four countries, we enrolled women (aged ≥18 years) who had previously received first-line platinum-based therapy including bevacizumab, and had recurrent (≥6 months since last platinum dose), International Federation of Gynaecology and Obstetrics stage IIIB–IV ovarian cancer with an Eastern Cooperative Oncology Group performance status 0–2. Patients were randomly assigned (1:1) to receive a carboplatin-based doublet intravenously (carboplatin area under the concentration curve [AUC] 5 on day 1 plus paclitaxel 175 mg/m2 on day 1, every 21 days; carboplatin AUC 4 on day 1 plus gemcitabine 1000 mg/m2 on days 1 and 8, every 21 days; or carboplatin AUC 5 on day 1 plus pegylated liposomal doxorubicin 30 mg/m2 on day 1, every 28 days), or a carboplatin-based doublet plus bevacizumab (10 mg/kg intravenous every 14 days combined with pegylated liposomal doxorubicin–carboplatin, or 15 mg/kg every 21 days combined with gemcitabine–carboplatin or paclitaxel–carboplatin). Evaluable disease according to RECIST 1.1 guidelines was required before randomisation. Randomisation was done through the trial website with a minimisation procedure, stratified by centre, time of recurrence, performance status, and type of second-line chemotherapy. The primary endpoint was investigator-assessed progression-free survival, analysed on an intention-to-treat basis. Safety was assessed in all participants who received at least one dose. This trial is registered with ClinicalTrials.gov, NCT01802749 and EudraCT 2012-004362-17. Findings: Between Dec 6, 2013, and Nov 11, 2016, 406 patients were recruited (203 [50%] assigned to the bevacizumab group and 203 [50%] to the standard chemotherapy group). 130 patients (64%) in the bevacizumab group and 131 (65%) in the standard chemotherapy group had progressed after receiving a last dose of platinum more than 12 months before, and 146 patients (72%) in the bevacizumab group and 147 (72%) in the standard chemotherapy group had progressed after completion of first-line bevacizumab maintenance. 161 participants (79%) progressed in the standard chemotherapy group, as did 143 (70%) in the bevacizumab group. Median progression-free survival was 8·8 months (95% CI 8·4–9·3) in the standard chemotherapy group and 11·8 months (10·8–12·9) in the bevacizumab group (hazard ratio 0·51, 95% CI 0·41–0·65; log-rank p

There is a paucity of data on whether Australian university students are meeting specific nutrient guidelines, and the relationship between diet and physical activity patterns with body composition and metabolic health. In this study, biomedical students from The University of Queensland were recruited (150 males and 211 females, 19–25 years), and nutritional intake (ASA24-Australia) and physical activity levels (Active Australia Survey) quantified. Body composition (height, waist circumference, body mass, BMI, and percentage body fat, BOD POD) and metabolic health (oral glucose tolerance test) were also measured. Median daily energy intake was 6760 kJ in females and 10,338 kJ in males, with more than 30% of total energy coming from energy-dense, nutrient-poor foods. Only 1 in 10 students met fruit or vegetable recommendations, with less than one third meeting recommendations for fibre, calcium, and potassium. Intakes of calcium and iron were particularly low among female students, with only 16% and 6% of students meeting the recommended dietary intake (RDI), respectively. The majority of males and almost half of all females exceeded the suggested dietary target (SDT) for sodium. Sufficient physical activity (≥150 min over ≥5 sessions per week) was met by more than 80% of students. Body composition and blood glucose concentrations were largely normal but an early sign of insulin resistance (HOMA-IR &gt, 2.0), measured in a subset of students, was present in 21% of males and 17% of females. Modest reductions in blood glucose levels and percentage body fat were associated with increasing vigorous activity. Low intakes of fibre, calcium, and potassium could be corrected by increasing fruit, vegetable, and dairy intake, and, among females, health promotion messages focusing on iron-rich foods should be prioritised. While these nutrient deficiencies did not translate into immediate metabolic heath concerns, dietary behaviours can track into adulthood and have lasting effects on overall health.

To calculate the prevalence and identify correlates of unmet need for contraception and to assess whether prevalence of use of effective contraception and long-acting reversible contraception (LARC) has changed over time among married or cohabiting, reproductive-age women in Vietnam.Study population was drawn from nationally representative Multiple Indicator Cluster Surveys conducted in 2000, 2006, 2011 and 2014. Unmet need for contraception was defined as occurring when a fecund, married or cohabiting woman is not using any method of contraception but either does not want children or wants to delay birth for at least 1 year or until marriage. Following the ranking of method effectiveness by the Centers for Disease Control and Prevention, we defined "effective contraception" as implant, intrauterine device, male and female sterilization, injectable, pill, patch, ring or diaphragm. We used multivariable logistic regression to identify correlates of unmet need for contraception in 2014 and Cochran-Armitage trend tests to assess changes in effective contraception and LARC use from 2000 to 2014. All analyses used survey weights to account for the complex sampling design.In 2014, 4.3% of married or cohabiting, reproductive-age women had unmet need for contraception. Multivariable analysis showed that age, education and number of children ever born were statistically significant correlates of unmet need for contraception. Use of effective contraception statistically significantly declined from 53.0% in 2000 to 45.7% in 2014 (p.0001). Similarly, LARC declined from 39.6% in 2000 to 30.0% in 2014 (p.0001). After adjusting for age, education, residence and having at least one son, these secular trends remained.Findings indicate that effective contraception and LARC use have decreased among married or cohabiting women of reproductive age in Vietnam. Correlates of unmet need for contraception should be used to inform interventions to prevent unintended pregnancy.Although the prevalence of unmet need for contraception was low (4.3%) in 2014, the use of effective contraception and long-acting reversible contraception declined among reproductive-age, married or cohabiting women in Vietnam from 2000 to 2014. This finding is particularly striking given the economic growth in the nation during this time frame.

Abortion is highly stigmatized in the United States which prevents its accurate measurement in surveys. The list experiment aims to improve the reporting of abortion history. We evaluated whether a list experiment resulted in higher reporting of abortion experiences than did two direct questions. Utilizing data from a representative survey of adult women of reproductive age in Ohio, we examined abortion history using two direct questions and a double list experiment. Through the double list experiment, we asked respondents to report how many of two lists of health items they had experienced; one list included abortion. We compared weighted history of abortion between these measures and by respondent demographic characteristics (age and socioeconomic status). Estimates of abortion history were similar between direct and list experiment questions. When measured with the two different direct question of abortion history, 8.4% and 8.0% of all respondents indicated ever having an abortion and with the list experiment, 8.5% indicated ever having an abortion. In a Midwestern state-level survey, the list experiment did not lead to increases in abortion reporting as compared to the direct questions. Subgroup analyses require larger samples, and future iterations should incorporate related but non-stigmatized control items to reduce misclassification and under-powering of such subgroup analyses.

A key barrier to the consistent use of condoms is their negative effect on sexual pleasure. Although sexual pleasure is a primary motivation for engaging in sex and is an integral part of overall sexual health, most programs to improve sexual health operate within a pregnancy and disease-prevention paradigm. A new condom, CSD500 (Futura Medical Developments; Surrey, UK), containing an erectogenic drug was developed for use among healthy couples to improve sexual pleasure by increasing penile firmness, size and erection duration. We conducted a randomized controlled trial to test whether promoting the novel condom CSD500 for improved sexual pleasure is effective in reducing condomless sex compared to the provision of standard condoms with counseling for pregnancy and disease prevention. We randomized 500 adult, heterosexual, monogamous couples in Thanh Hoa province, Vietnam to receive either CSD500 (n = 248) or standard condoms (n = 252). At enrollment and after 2, 4, and 6 months, we interviewed women and sampled vaginal fluid to test for the presence of prostate-specific antigen (PSA), an objective, biological marker of recent semen exposure. We registered the protocol before trial initiation at ClinicalTrials.gov (identifier: NCT02934620). Overall, 11.0% of women were PSA positive at enrollment. The proportion of follow-up visits with PSA-positivity did not differ between the intervention (6.8%) and control arms (6.7%; relative risk, 1.01; 95% confidence interval, 0.66–1.54). Thus, we found no evidence that promoting an erectogenic condom to women in a monogamous, heterosexual relationship in Vietnam reduced their exposure to their partner’s semen. These findings might not hold for other populations, especially those with a higher frequency of condomless sex.

Introduction The aim of this study was to assess the safety of elective urological surgery performed during the pandemic by estimating the prevalence of COVID-19-like symptoms in the postoperative period and its correlation with perioperative and clinical factors. Material and methods In this multicenter, observational study we recorded clinical, surgical and postoperative data of consecutive patients undergoing elective urological surgery in 28 different institutions across Italy during initial stage of the COVID-19 pandemic (between February 24 and March 30, 2020, inclusive). Results A total of 1943 patients were enrolled. In 12%, 7.1%, 21.3%, 56.7% and 2.6% of cases an open, laparoscopic, robotic, endoscopic or percutaneous surgical approach was performed, respectively. Overall, 166 (8.5%) postoperative complications were registered, 77 (3.9%) surgical and 89 (4.6%) medical. Twenty-eight (1.4%) patients were readmitted to hospital after discharge and 13 (0.7%) died. In the 30 days following discharge, fever and respiratory symptoms were recorded in 101 (5.2%) and 60 (3.1%) patients. At multivariable analysis, not performing nasopharyngeal swab at hospital admission (HR 2.3; CI 95% 1.01-5.19; p = 0.04) was independently associated with risk of developing postoperative medical complications. Number of patients in the facility was confirmed as an independent predictor of experiencing postoperative respiratory symptoms (p = 0.047, HR:1.12; CI95% 1.00-1.05), while COVID-19-free type of hospitalization facility was a strong independent protective factor (p = 0.02, HR:0.23, CI95% 0.07-0.79). Conclusions Performing elective surgery during the COVID-19 pandemic does not seem to affect perioperative outcomes as long as proper preventive measures are adopted, including nasopharyngeal swab before hospital admission and hospitalization in dedicated COVID-19-free facilities.

ObjectivesTo compare the prevalence of live preterm birth rates during COVID-19 restriction measures with infants born during the same weeks in 2013-2019 in Queensland, Australia.Design, setting, participantsDeidentified obstetric and neonatal data were extracted from the Mater Mothers’ electronic healthcare records database. This is a supra-regional tertiary perinatal centre.Main outcome measuresLogistic regressions were used to examine preterm birth rates during the beginning of COVID-19 restrictions (16 March-17 April; “early”; 6,955 births) and during the strictest part of COVID-19 restrictions (30 March-1 May; “late”; 6,953 births), according to gestational age subgroups and birth onset (planned or spontaneous). We adjusted for multiple covariates, including maternal age, body mass index, ethnicity, parity, socioeconomic status, maternal asthma, diabetes mellitus and/or hypertensive disorder. Stillbirth rates were also examined (16 March-1 May).ResultsA reduction in planned moderate/late preterm births was observed primarily during the early restriction period compared with the same calendar weeks in the previous seven years (29 versus an average of 64 per 1,000 births; adjusted odds ratio [aOR] 0.39, 95% CI 0.22-0.71). There was no effect on extremely or very preterm infants, spontaneous preterm births, or stillbirth rates. Rolling averages from January to June revealed a two-week non-significant spike in spontaneous preterm births from late-April to early-May, 2020.ConclusionsPlanned births for moderate/late preterm infants more than halved during early COVID-19 mitigation measures. Together with evidence from other nations, the COVID-19 pandemic provides a unique opportunity to identify causal and preventative factors for preterm birth.

Background Legislative and judicial procedures related to banning abortion after 6 weeks of gestation in Ohio occurred from November 2018 to July 2019. These activities could have increased the belief that abortion has become illegal even though the 6-week abortion ban has never been in effect to date. Objective We sought to determine the prevalence and correlates of holding the belief that abortion is illegal in Ohio and to evaluate whether this belief increased over the time in which the 6-week abortion ban was introduced, passed twice, and then blocked in Ohio. Study Design We analyzed data from the first wave of the Ohio Survey of Women, a population-based survey of adult, reproductive-aged Ohioan women conducted from October 2018 to June 2019. During each of the 8 survey months, a median of 240 women (range, 70–761) completed the survey, including the survey question “Based on what you know or have heard, is it legal to get an abortion in your state?” We used multivariable logistic regression to assess the prevalence and correlates of believing that abortion is illegal in the state of Ohio. In addition, we used multinomial logistic regression to evaluate whether this belief increased over the interval during which women completed the survey, which roughly corresponded to the interval marked by legislative and judicial activities surrounding the 6-week abortion ban. Results Most of the 2359 participants understood that abortion is legal in the state of Ohio (64.0%) with the remainder believing it to be illegal (9.8%) or being unsure (26.2%). Correlates of believing abortion to be illegal included younger age, lower socioeconomic status, never married or married status, and black, non-Hispanic race and ethnicity. Being unsure about legality did not change over time; however, the proportion of women who believed that abortion is illegal increased from the first month (4.5%) to the last month (15.9%) of the study period. Each additional study month was associated with a 17% increase in the odds of believing abortion to be illegal, in both unadjusted and adjusted models (odds ratio, 1.17; 95% confidence interval, 1.08–1.27). Conclusion Attempts to restrict abortion access could contribute to women mistakenly believing that abortion is illegal despite it being unsuccessful.

Background: Temporal discounting (TD), the tendency of individuals to discount future costs and benefits relative to the present, is often associated with greater engagement in risky behaviors. Incentives such as conditional cash transfers (CCTs) have the potential to counter the effects of TD on health behaviors. We hypothesized that CCTs work by mitigating the effects of high TD, measured using a delay-discounting task.Methods: We conducted an interaction analysis using data from a randomized trial of a CCT intervention among 434 HIV-positive pregnant women in the Democratic Republic of Congo. The analysis focused on two outcomes: 1) retention in HIV care, and 2) uptake of prevention of mother-to-child transmission (PMTCT) services.Results: The effect of TD on retention was small, and we did not observe evidence of interaction between TD and CCT on retention. However, our findings suggest that CCT may mitigate the negative effect of high TD on uptake of PMTCT services (interaction contrast (IC): 0.18, 95% CI: -0.09, 0.44).Conclusions: Our findings support the continued use of small, frequent incentives, to motivate improved uptake of PMTCT services, especially among women exhibiting high TD.CONTRIBUTIONS TO THE LITERATURE· Conditional cash transfer (CCT) interventions demonstrate varying degrees of effectiveness in improving engagement in HIV care. Understanding how these interventions work allow for better adaptation in different contexts, though few studies have explored the underlying mechanisms of CCT.· We assessed whether CCT works by mitigating the effect of temporal discounting on disengagement from care, a major posited mechanism of the intervention, among HIV infected pregnant and breastfeeding women in the Democratic Republic of Congo. · Our findings contribute to gaps in literature surrounding the role of temporal discounting, and its mitigation by CCT, on engagement in HIV care.

Presents the introductory welcome message from the conference proceedings. May include the conference officers' congratulations to all involved with the conference event and publication of the proceedings record.

Cholinergic interneurons (CINs) in the striatum respond to salient stimuli with a multiphasic response, including a pause, in neuronal activity. Slice physiology experiments have shown the importance of dopamine D2 receptors (D2Rs) in regulating CIN pausing yet the behavioral significance of the CIN pause and its regulation by dopamine in vivo is still unclear. Here, we show that D2R upregulation in CINs of the nucleus accumbens (NAc) lengthens the pause in CIN activity ex vivo and enlarges a stimulus-evoked decrease in acetylcholine (ACh) levels during behavior. This enhanced dip in ACh levels is associated with a selective deficit in the learning to inhibit responding in a Go/No-Go task. Our data demonstrate, therefore, the importance of CIN D2Rs in modulating the CIN response induced by salient stimuli and points to a role of the pause in inhibitory learning. This work has important implications for brain disorders with altered striatal dopamine and ACh function, including schizophrenia and attention-deficit hyperactivity disorder (ADHD).

Visual impairment has an important economic weight on our society; in addition to this considerable cost, loss of vision imposes physical, financial and quality of life limitations. Preventing visual impairment is not only a social duty but also an economically convenient activity for the national health system. On the basis of this concept, a visual impairment disability campaign was carried out in the ASL CN1 (Southern Piedmont Region) taking into account the guidelines recommended by the WHO (1968 screening guidelines but still applicable) in the most disadvantaged territories of the cross-border and rural area, where people have more difficulties to reach territorial services or hospital. Patients who tested positive for the screening were taken over by the local network for a second-level visit and subsequent follow-up based on the pathology found. In this frame, visual screening represents a promising health policy as it can identify visual disability at an early stage. Through the health information systems (hospital discharge, access to the emergency department and exemptions for pathology), the geographical distribution and demographic characteristics of the subjects with visual disability were described in the ASL CN1 area. The level of detail has reached granularity at the single municipality and single age level. For the year 2018 among 416.000 residents in ASL CN1, about 4.000 visual impaired subjects were identified (3.188 on the basis of the presence of an exemption for glaucoma, 542 from hospital discharge and 535 at the emergency department). Assessing mortality in this subgroup, the mean age at death is slightly higher than that of general population (82,42 vs 81,39 years respectively). This can be suggestive of an efficient handling the local population with visual disability. The developed indicators can be extended to other periods and new areas. Key messages Visual screening represents a promising health policy as it can identify visual disability. Through the health information systems, the geographical distribution and demographic characteristics of the subjects with visual disability were described.

Background: Temporal discounting (TD), the tendency of individuals to discount future costs and benefits relative to the present, is often associated with greater engagement in risky behaviors. Incentives such as conditional cash transfers (CCTs) have the potential to counter the effects of TD on health behaviors. We hypothesized that CCTs work by mitigating the effects of high TD, measured using a delay-discounting task. Methods: We conducted an interaction analysis using data from a randomized trial of a CCT intervention among 434 HIV-positive pregnant women in the Democratic Republic of Congo. The analysis focused on two outcomes: 1) retention in HIV care, and 2) uptake of prevention of mother-to-child transmission (PMTCT) services. Results: The effect of TD on retention was small, and we did not observe evidence of interaction between TD and CCT on retention. However, our findings suggest that CCT may mitigate the negative effect of high TD on uptake of PMTCT services (interaction contrast (IC): 0.18, 95% CI: -0.09, 0.44). Conclusions: Our findings support the continued use of small, frequent incentives, to motivate improved uptake of PMTCT services, especially among women exhibiting high TD.

The incidence of melanoma has increased significantly, and early diagnosis is the most effective way to reduce associated deaths. Dermoscopy increases diagnostic accuracy in melanoma and analysis of dermoscopic structures can help in the estimation of tumor thickness. The aim of this study was to analyze the influence of Breslow thickness on the dermoscopic characteristics of melanoma.Observational, cross-sectional study of patients with histologically confirmed melanoma and dermoscopic images of the tumor. The patients were divided into three groups: melanoma in situ, thin melanoma (≥ 1 mm Breslow thickness), and thick melanoma (≥ 1 mm Breslow thickness). Age, sex, tumor location, and histologic and dermoscopic characteristics were analyzed in all cases.We studied 215 patients: 88 with melanoma in situ, 73 with thin melanoma, and 54 with thick melanoma. The frequency of the following dermoscopic features increased with increasing Breslow thickness: the blue-white veil (p0.001), white shiny structures (p0.001), and milky-red areas (p0.003). Angulated lines, by contrast, became less common with increasing thickness (p0.002).Dermoscopy not only improves diagnostic accuracy for pigmented lesions but also helps in the preoperative assessment of Breslow thickness in melanoma.

The coronavirus disease 2019 (COVID-19) pandemic resulted in physical isolation measures in many parts of the world. In Australia, nationwide restrictions included staying at home, unless seeking medical care, providing care, purchasing food, undertaking exercise, or attending work in an essential service. All undergraduate university classes transitioned to online, mostly home-based learning. We, therefore, examined the effect of isolation measures during the early phase of the COVID-19 pandemic in Australia (March/April) on diet (24-h recall) and physical activity (Active Australia Survey) patterns in third-year biomedical students. Findings were compared with students enrolled in the same course in the previous two years. In females, but not males, energy intake was ~20% greater during the pandemic, and snacking frequency and energy density of consumed snacks also increased compared with 2018 and 2019. Physical activity was impacted for both sexes during the pandemic with ~30% fewer students achieving &ldquo, sufficient&rdquo, levels of activity, defined by at least 150 min over at least five sessions, compared with the previous two years. In a follow-up study six to eight weeks later (14&ndash, 18% response rate), during gradual easing of nationwide restrictions albeit continued gym closures and online learning, higher energy intake in females and reduced physical activity levels in both sexes persisted. These data demonstrate the health impacts of isolation measures, with the potential to affect long-term diet and activity behaviours.

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda. ©