Induction of Labor According to Medical Indications: A Critical Evaluation through a Prospective Study

Background: The induction of labor (IOL) is a common obstetric intervention, steadily increasing (one out four pregnancies) in the last years. This procedure should be considered only when there is a medical indication, and when the benefits outweigh the maternal and/or fetal risks of waiting for spontaneous onset of labor. Therefore, this study aims to compare the efficacy of the IOL in terms of induction to delivery time, mode of delivery, and neonatal well-being among different evidence-based and non-evidence-based indications. Methods: This prospective study was conducted at the University Hospital of Modena, between January and December 2020. We included singleton pregnant women undergoing IOL, at the term. Intrauterine deaths, small for gestational age fetuses <5th centile as well women with hypertensive disorders were excluded. Women have been subdivided into 3 groups based on the indication to IOL: premature rupture of membranes (PROM), post-date pregnancy (>41 weeks + 3 days), and non-evidence-based indications (NEBI). The primary outcome is the time occurring between IOL and delivery (TIME), analyzing separately by parity. Moreover, mode of delivery and neonatal wellbeing were evaluated. Results: A total of 585 women underwent IOL in the study period. Overall, the median TIME between IOL and delivery was 19 hours, and the mean cesarean section CS rate was 15.5% (91/585). Pregnancies induced for postdate and non-evidencebased indications registered respectively a significantly higher mean time (p < 0.001), compared with women induced for PROM. This occurred both in nulliparous and multiparous women. Moreover, at multivariate analysis, the IOL TIME ≥24 hours was significantly influenced by Bishop score (p = 0.000) and NEBI (p = 0.02) in nulliparous and by gestational age (p = 0.000) and NEBI (p = 0.02) in multiparous. Moreover, CS rate was significantly influenced by Bishop score (p = 0.003) in nulliparous and by gestational age (p = 0.01) in multiparous. Finally, neonatal intensive care unit (NICU) admission resulted significantly influenced only by gestational age (p = 0.002) in multiparous. Conclusions: Our study confirms that IOL in non-evidence-based indications, leads to an increase in induction to delivery time comparing with women induced for PROM, both in nulliparous and multiparous women, thus it should be justified and carefully evaluated. Further randomized controlled trials (RCT) conducted in European/Italian settings are needed to determine the perinatal outcomes of IOL in non-evidence-based indications

Stillbirth occurrence during COVID-19 pandemic: A population-based prospective study

Objectives: Data collected worldwide on stillbirth (SB) rates during the Covid-19 pandemic are contradictory. Variations may be due to methodological differences or population characteristics. The aim of the study is to assess the changes in SB rate, risk factors, causes of death and quality of antenatal care during the pandemic compared to the control periods. Methods: This prospective study is based on the information collected by the Emilia-Romagna Surveillance system database. We conducted a descriptive analysis of SB rate, risk factors, causes of death and quality of cares, comparing data of the pandemic (March 2020-June 2021) with the 16 months before. Results: During the pandemic, the SB rate was 3.45/1,000 births, a value in line with the rates of previous control periods. Neonatal weight >90th centile was the only risk factor for SB that significantly changed during the pandemic (2.2% vs. 8.0%; p-value: 0.024). No significant differences were found in the distribution of the causes of death groups. Concerning quality of antenatal cares, cases evaluated with suboptimal care (5.2%) did not change significantly compared to the control period (12.0%), as well as the cases with less than recommended obstetric (12.6% vs. 14%) and ultrasound evaluations (0% vs. 2.7%). Conclusions: During the COVID-19 pandemic, no significant differences in SB rates were found in an area that maintained an adequate level of antenatal care. Thus, eventual associations between SB rate and the COVID-19 infection are explained by an indirect impact of the virus, rather than its direct effect

False-negative RT-PCR in SARS-CoV-2 disease: experience from an Italian COVID-19 unit

False-negative cases of COVID19 are being increasingly reported. Laboratory diagnosis through RT-PCR testing alone lacks adequate sensitivity to be recommended as the only valid criterion to confirm COVID-19 diagnosis

Assessing Inclusion Behaviors and Impact of Inclusion within the Fleet

NPS NRP Project PosterThis project supports the Navy’s efforts to promote diversity and inclusion (D&I), which are recognized as strategic imperatives that give the Navy a warfighting advantage against our adversaries. The study utilizes both quantitative and qualitative approaches to understand the major contributing factors to an inclusive and diverse command, accomplishing four research objectives: (1) developing metrics to assess behaviors of inclusion within the fleet; (2) assessing inclusion behaviors within the fleet using the developed metrics; (3) determining the most impactful D&I competencies for building inclusion; and (4) identifying command practices that contribute to greater acceptance of diversity. We develop and introduce a survey instrument to assess Personal Inclusion Factors (individuals’ feelings of being personally included within their command) and Command Core Inclusion Competencies (individuals’ beliefs about how their commands demonstrate practices that promote diversity and inclusion) suitable for a Navy context. The instrument captures best practices and validated metrics for promoting and assessing D&I in organizations and tailors them to the Navy and Sailors’ work. We fielded this survey to 489 active-duty Navy personnel (enlisted and officers) asking them to report on both their current and past commands. We find that females across all race/ethnicities on average report lower feelings of inclusion and rate commands lower on Core Command Inclusion Competencies than their male counterparts. This gender difference is stronger for sea versus shore commands. Participants also answered open-ended questions about the competencies that they believed were most important for promoting D&I in the fleet. "Inclusive leadership" emerged as a dominant theme; in particular, participants felt most included in commands where leadership valued their perspectives and ideas and where Sailors felt heard on a day-in, day-out basis.N1 - Manpower, Personnel, Training & EducationThis research is supported by funding from the Naval Postgraduate School, Naval Research Program (PE 0605853N/2098). https://nps.edu/nrpChief of Naval Operations (CNO)Approved for public release. Distribution is unlimited.

Assessing Inclusion Behaviors and Impact of Inclusion within the Fleet

NPS NRP Executive SummaryThis project supports the Navy’s efforts to promote diversity and inclusion (D&I), which are recognized as strategic imperatives that give the Navy a warfighting advantage against our adversaries. The study utilizes both quantitative and qualitative approaches to understand the major contributing factors to an inclusive and diverse command, accomplishing four research objectives: (1) developing metrics to assess behaviors of inclusion within the fleet; (2) assessing inclusion behaviors within the fleet using the developed metrics; (3) determining the most impactful D&I competencies for building inclusion; and (4) identifying command practices that contribute to greater acceptance of diversity. We develop and introduce a survey instrument to assess Personal Inclusion Factors (individuals’ feelings of being personally included within their command) and Command Core Inclusion Competencies (individuals’ beliefs about how their commands demonstrate practices that promote diversity and inclusion) suitable for a Navy context. The instrument captures best practices and validated metrics for promoting and assessing D&I in organizations and tailors them to the Navy and Sailors’ work. We fielded this survey to 489 active-duty Navy personnel (enlisted and officers) asking them to report on both their current and past commands. We find that females across all race/ethnicities on average report lower feelings of inclusion and rate commands lower on Core Command Inclusion Competencies than their male counterparts. This gender difference is stronger for sea versus shore commands. Participants also answered open-ended questions about the competencies that they believed were most important for promoting D&I in the fleet. "Inclusive leadership" emerged as a dominant theme; in particular, participants felt most included in commands where leadership valued their perspectives and ideas and where Sailors felt heard on a day-in, day-out basis.N1 - Manpower, Personnel, Training & EducationThis research is supported by funding from the Naval Postgraduate School, Naval Research Program (PE 0605853N/2098). https://nps.edu/nrpChief of Naval Operations (CNO)Approved for public release. Distribution is unlimited.

Minimal clinically important difference for asthma endpoints: an expert consensus report

Minimal clinically important difference (MCID) can be defined as the smallest change or difference in an outcome measure that is perceived as beneficial and would lead to a change in the patient's medical management.The aim of the current expert consensus report is to provide a "state-of-the-art" review of the currently available literature evidence about MCID for end-points to monitor asthma control, in order to facilitate optimal disease management and identify unmet needs in the field to guide future research.A series of MCID cut-offs are currently available in literature and validated among populations of asthmatic patients, with most of the evidence focusing on outcomes as patient reported outcomes, lung function and exercise tolerance. On the contrary, only scant and partial data are available for inflammatory biomarkers. These clearly represent the most interesting target for future development in diagnosis and clinical management of asthma, particularly in view of the several biologic drugs in the pipeline, for which regulatory agencies will soon require personalised proof of efficacy and treatment response predictors

Environmental risk analysis procedure applied to artificial turf sports fields

Introduction. Owing to the extensive use of artificial turfs worldwide, over the past ten years there has been much discussion about the possible health and environmental problems originating from Styrene-Butadiene Recycled rubber (SBRr). Materials and methods. In this paper the authors performed a Tier-2 environmental-sanitary risk analysis on five artificial turf sports fields located in the city of Turin (Italy) with the aid of RISC4 software. Two receptors (adult player and child player) and three routes of exposure (direct contact with crumb rubber, contact with rainwater soaking the rubber mat, inhalation of dusts and gases from the artificial turf fields) were considered in the conceptual model. Results and discussion. For all the fields and for all the routes, the cumulative carcinogenic risk proved to be lower than 10-6 and the cumulative non-carcinogenic risk lower than 1. The outdoor inhalation of dusts and gases was the main route of exposure for both carcinogenic and non-carcinogenic substances. The results given by the inhalation pathway were compared with those of a risk assessment carried out on a citizen breathing gases and dusts from traffic emissions every day in Turin. Conclusions. For both classes of substances and for both receptors, the inhalation of atmospheric dusts and gases from vehicular traffic gave risk values of one order of magnitude higher than those due to playing soccer on an artificial fiel