Effectiveness of Childbirth Education on Nulliparous Women’s Knowledge of Childbirth Preparation, Pregnancy Anxiety and Pregnancy Outcomes

Background: The emerging number of cesarean sections among nulliparous women due to high pregnancy-related anxiety is a major concern of maternity care providers. Childbirth preparations enable women to cope with pregnancy anxiety and enhance pregnancy outcomes. Limited studies evaluated the impact of childbirth educational interventions on pregnancy-specific anxiety and pregnancy outcomes. Objectives: The aim of this study was to evaluate the effectiveness of childbirth educational intervention on nulliparous women’s knowledge on childbirth preparation, pregnancy anxiety, and pregnancy outcomes. Methods: A randomized controlled trial approach with a two-group pretest/ posttest design was used among hundred nulliparous third trimester pregnant women. All participants were pretested for their knowledge on childbirth preparation and pregnancy anxiety level using knowledge questionnaire, state trait anxiety inventory, and pregnancy-specific anxiety inventory. The experimental group (n = 50) received three sessions of childbirth education. All participants were post- tested before delivery, and their pregnancy outcomes were noted from labor records. Data were collected from a major maternity hospital in Kerala, India. GLM repeated measures analysis and paired t-test were used for data analysis. Results: The experimental group demonstrated a significantly higher level of knowledge on childbirth preparation (P < 0.001), with high reported mean knowledge scores of (54.30 ± 3.86) childbirth preparation than the control group (31.08 ± 1.96). A lower mean scores of pregnancy-specific anxiety among experimental group (102 ± 4.65) (P < 0.001) compared to control group (139.96 ± 4.9) signifies the relevance of childbirth education in reducing pregnancy-specific anxiety. Significant reductions of caesarean birth (50%) among nulliparous women along with a 12% increase in newborn’s birth weights were the main positive birth outcomes. Conclusions: Childbirth education significantly reduced pregnancy-specific anxiety and the adverse pregnancy outcomes. The emerging number of cesarean sections on maternal request due to childbirth anxiety could be reduced by empowering nulliparous women through childbirth education

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

Involvement of two signature k-mers within gp120 in the formation of the bridging sheet and exposure of the V3 loop.

<p><b>(A)</b> The pre-fusion closed state (structure 4TVP [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185959#pone.0185959.ref045" target="_blank">45</a>]) and <b>(B)</b> the CD4-bound state (structure 2B4C [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185959#pone.0185959.ref046" target="_blank">46</a>]). The V3 loops from two gp120 monomers are in orange and 4 spheres represent its tip (GPGQ/R residues 312–315). The two signature segments are shown in turquoise (AA192-207) and in yellow (AA425-437) labeled c and e, respectively, as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185959#pone.0185959.t001" target="_blank">Table 1</a> and <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185959#pone.0185959.g004" target="_blank">Fig 4</a>. Segments c and e map to the bridging sheet corresponding to sites AA119-126, AA196-205, and AA422-436. In the CD4-bound state, the bridging sheet is formed and the V3 loop is released and becomes more accessible to V3 antibodies.</p

Pairwise distances between breakthrough sequences and each Env vaccine sequence or Env Consensus B.

<p>Participant-specific mean distances of breakthrough sequences to the subtype A, B, and C Env vaccine sequences and the Consensus B sequence (labeled VRC-A, VRC-B, VRC-C and Cons.B, respectively). Distances from breakthrough sequences from vaccine recipients are in red and placebo recipients in blue. Distances are based on Env-gp120 sequences with the hypervariable segments deleted (HXB2 positions from signal peptide 10–16; V1 loop 132–152; V2 loop 186–191; V3 loop 309–310; V4 loop 392–413; and V5 loop 460–464). Two-sided Mann-Whitney p-values comparing the vaccine and placebo groups are shown above the panels.</p

Intra-host mean pairwise diversity among amino acid sequences.

<p>Intra-host mean pairwise diversity values were calculated among all the sequences from a given participant separately for each protein corresponding to a vaccine insert, with vaccine recipients in red and placebo recipients in blue. The upper panel included all participants; the lower panel included only participants with single HIV-1 founder viruses. Two-sided Mann-Whitney p-values comparing the vaccine and placebo groups are shown above the panels.</p

Overlap between HIV-1 Env-gp120 k-mer, AA site and mAb footprint signatures identified with different scanning methods.

<p>Positive sieve effects, i.e., greater divergences of sequences from vaccine recipients than from placebo recipients from the vaccine strain, were detected for all 34 CD4bs, CD4i and V3 footprints (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185959#pone.0185959.s015" target="_blank">S15 Table</a>). The figure represents signatures detected with a Q-value ≤ 0.2 across Env-gp120 (gray bands identify the HIV-1 features labeled at the top of the figure): six k-mer regions are shown as orange bands (labeled a-f as in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185959#pone.0185959.t001" target="_blank">Table 1</a>); two individual sites, 133 and 429, are labeled in bold on the x-axis; and the 19 of 34 CD4bs, CD4i, and V3 mAb footprints with a Q-value ≤ 0.2 are indicated by dark blue points and labeled on the y-axis in bold font. The 15 mAb footprints that are not statistically significant signatures are indicated by light blue points and labeled on the y-axis in gray. Footprint site sets were grouped by mAb class (CD4bs, CD4i, and V3) and ranked within class by P-value. Footprint site sets for mAb classes where no significant effect was identified are not shown (Quarternary, Env-gp41, and Glycan; see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185959#pone.0185959.s015" target="_blank">S15 Table</a>).</p

Distance-specific vaccine efficacy.

<p>Boxplots of hamming distances of <i>mindist</i> sequences to the subtype B vaccine strain by treatment group for three sets of Env-gp120 sites: <b>(A)</b> all Env-gp120 sites that could be aligned with confidence (n = 432); <b>(C)</b> the 93 CD4bs antibody contact sites; and <b>(E)</b> 54 sites corresponding to the 4 k-mers overlapping the CD4bs where significant sieve effects were found (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185959#pone.0185959.t001" target="_blank">Table 1</a>). The mid-line of the box denotes the median and the ends of the box denote the 25^th and 75^th percentiles. The whiskers that extend from the top and bottom of the box extend to the most extreme data points that are no more than 1.5 times the interquartile range or if no value meets this criterion, to the data extremes. <b>(B, D, F)</b> Distance-specific hazard ratio based on the corresponding distances shown in panels A, C, and E, respectively. The solid black lines show the estimated hazard ratio as a function of distance, and the dashed red lines represent a 95% point-wise confidence interval (CI) around that estimate. The ‘Sieve test’ 2-sided p-value reports the result of the test of [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0185959#pone.0185959.ref030" target="_blank">30</a>] for whether the hazard ratio varies with distance.</p

Maximum likelihood phylogenetic tree including 774 <i>envelope gp120</i> nucleotide sequences.

<p>Sequences from HVTN 505 vaccine (in red) and placebo (in blue) recipients (n = 486) are depicted along with 288 HIV-1 subtype B sequences from the US and sampled since 2005. Sequences from two vaccine recipients who were each dually-infected (with two independent strains) are highlighted with orange and magenta shading. Subjects with multiple founder variants are highlighted with yellow shading.</p