Pregnancy and neonatal outcomes of COVID-19: co-reporting of common outcomes from PAN-COVID and AAP SONPM registries

OBJECTIVE: Few large cohort studies have reported data on maternal, fetal, perinatal and neonatal outcomes associated with SARS-CoV-2 infection in pregnancy. We report the outcome of infected pregnancies from a collaboration formed early during the pandemic between the investigators of two registries, the UK and global Pregnancy and Neonatal outcomes in COVID-19 (PAN-COVID) study and the US American Academy of Pediatrics Section on Neonatal Perinatal Medicine (AAP SONPM) National Perinatal COVID-19 Registry. METHODS: This was an analysis of data from the PAN-COVID registry (January 1st to July 25th 2020), which includes pregnancies with suspected or confirmed maternal SARS-CoV-2 infection at any stage in pregnancy, and the AAP SONPM National Perinatal COVID-19 registry (April 4th to August 8th 2020), which includes pregnancies with positive maternal testing for SARS-CoV-2 from 14 days before delivery to 3 days after delivery. The registries collected data on maternal, fetal, perinatal and neonatal outcomes. The PAN-COVID results are presented both overall for pregnancies with suspected or confirmed SARS-CoV-2 infection and separately in those with confirmed infection. RESULTS: We report on 4005 pregnant women with suspected or confirmed SARS-CoV-2 infection (1606 from PAN-COVID and 2399 from AAP SONPM). For obstetric outcomes, in PAN-COVID overall, those with confirmed infection in PAN-COVID and AAP SONPM, respectively, maternal death occurred in 0.5%, 0.5% and 0.2% of cases, early neonatal death in 0.2%, 0.3% and 0.3% of cases and stillbirth in 0.5%, 0.6% and 0.4% of cases. Delivery was pre-term (<37 weeks' gestation) in 12.0% of all women in PAN-COVID, in 16.2% of those women with confirmed infection in PAN-COVID and in 15.7% of women in AAP SONPM. Extremely preterm delivery (< 27 weeks' gestation) occurred in 0.5% of cases in PAN-COVID and 0.3% in AAP SONPM. Neonatal SARS-CoV-2 infection was reported in 0.8% of all deliveries in PAN-COVID, in 2.0% in those with confirmed infection in PAN-COVID and in 1.8% in AAP SONPM; the proportions of neonates tested were 9.5%, 20.7% and 87.2%, respectively. The rates of a SGA neonate were 8.2% in PAN-COVID overall, 9.7% in those with confirmed infection and 9.6% in AAP SONPM. Mean gestational age adjusted birth-weight z-scores were -0.03 in PAN-COVID and -0.18 in AAP SONPM. CONCLUSIONS: The findings from the UK and US registries of pregnancies with SARS-CoV-2 infection were remarkably concordant. Preterm delivery affected a higher proportion of women than expected based on historical and contemporaneous national data. The proportions of pregnancies affected by stillbirth, a small for gestational age infant or early neonatal death were comparable to those in historical and contemporaneous UK and US data. Although maternal death was uncommon, the rate was higher than expected based on UK and US population data, which is likely explained by under-ascertainment of women affected by milder or asymptomatic infection in pregnancy in the PAN-COVID study although not in the AAP SONPM study. The data presented support strong guidance for enhanced precautions to prevent SARS-CoV-2 infection in pregnancy, particularly in the context of increased risks of preterm delivery and maternal mortality, and for priority vaccination of women planning pregnancy. This article is protected by copyright. All rights reserved

Investigating the New Landscapes of Welfare: Housing Policy, Politics and the Emerging Research Agenda

As debates about housing form an increasingly important arena of political controversy, much has been written about the new fissures that have appeared as governments not only struggle to reduce public expenditure deficits but also attempt to address problems such as affordability and homelessness. It is widely anticipated that new conflicts will be played out in the private rental market as access to homeownership becomes unrealistic and the supply of social housing diminishes. However, what other tensions might surface; that hitherto have not been subject to the critical gaze of housing research? In this paper, we provide some thoughts on the nascent policy issues as well as the ideological schisms that are likely to develop in coming years, offering suggestions as to how the focus of housing policy research might be reoriented towards a “politics” framework to capture and better understand the conflicts that are likely to arise

Understanding community empowerment in urban regeneration and planning in England: putting policy and practice in context

Community involvement in the fields of town planning and urban regeneration includes a wide range of opportunities for residents and service users to engage with networks, partnerships and centres of power. Both the terminology and degree of the transfer of power to citizens varies in different policy areas and contexts but five core objectives can be identified. This article approaches the subject of community empowerment by exploring the theoretical literature; reviewing recent policy pronouncements relating to community involvement in England and by discussing a recent case study of an Urban II project in London. The conclusions suggest that community empowerment is always likely to be partial and contingent on local circumstances and the wider context

Housing Benefit reform and the private rented sector in the UK : on the deleterious effects of short-term, ideological "knowledge"

This paper draws on the figurational sociology of Norbert Elias in understanding the current housing crisis in the UK: one which emphasizes the social interdependencies between individuals and groups, and the power relations that characterise them, in explaining household behaviour. It is argued that such an approach can contribute to a better understanding of housing processes and their differentiated outcomes. At the same time, this analysis exposes the myriad negative consequences that emerge from short-term housing policies based on static, over-simplified assumptions and applied to an ever-increasingly complex housing figuration, which is constantly in flux. These arguments are made with reference to empirical evidence on the impact of changes to Housing Benefit in the private rented sector, which shows how neoliberal housing policy contributes to long-term detrimental effects on marginalised households and groups. Through this example, it is argued that the governmental presentation of welfare reforms differs markedly from the reality of consequences on the ground and corresponds to 'neoliberal state-crafting'. It is suggested that any approach to understanding the complexities of the housing system must retain a focus on historical change, precedents and fluctuations in power balances to avoid the pernicious "retreat into the present" characteristic of policy

Complaints of rape and the criminal justice system: Fresh evidence on the attrition problem in England and Wales

The UK has one of the lowest conviction rates for rape in Europe. This article presents unique evidence on the factors that influence the attrition of rape allegations in the English criminal justice system. The study is based on a large, representative sample of rape allegations reported to the London Metropolitan Police, the UK’s biggest police force. The dataset contains unprecedented detail on the incident, victim, suspect and police investigation. The results lend support to the influence of some rape myths and stereotypes on attrition. These findings suggest that further central factors include the ethnicity of the suspect as well as what police officers and prosecutors perceive as evidence against the truthfulness of the allegation: the police record noting a previous false allegation by the victim, inconsistencies in the victim’s account of the alleged rape, and evidence or police opinion casting doubt on the allegation

Human preparedness: Relational infrastructures and medical countermeasures in Sierra Leone.

This paper examines health worker experiences in two areas of post-epidemic preparedness in Sierra Leone - vaccine trials and laboratory strengthening - to reflect on the place of people in current models of epidemic response. Drawing on ethnographic research and interviews with health workers in the aftermath of Ebola, it explores the hopes and expectations that interventions foster for frontline workers in under-resourced health systems, and describes the unseen work involved in sustaining robust response infrastructures. Our analysis focuses on what it means for the people who sustain health systems in an emergency to be 'prepared' for an epidemic. Human preparedness entails more than the presence of a labour force; it involves building and maintaining 'relational infrastructures', often fragile social and moral relationships between health workers, publics, governments, and international organisations. The COVID-19 pandemic has underscored the value of rethinking human resources from an anthropological perspective, and investing in the safety and support of people at the forefront of response. In describing the labour, personal losses, and social risks undertaken by frontline workers for protocols and practicality to meet in an emergency context, we describe the social process of preparedness; that is, the contextual engineering and investment that make response systems work

Chair based exercise in community settings: a cluster randomised feasibility study

Background: Some older people who find standard exercise programmes too strenuous may be encouraged to exercise while remaining seated - chair based exercises (CBE). We previously developed a consensus CBE programme (CCBE) following a modified Delphi process. We firstly needed to test the feasibility and acceptability of this treatment approach and explore how best to evaluate it before undertaking a definitive trial. Methods: A feasibility study with a cluster randomised controlled trial component was undertaken to 1. Examine the acceptability, feasibility and tolerability of the intervention and 2. Assess the feasibility of running a trial across 12 community settings (4 day centres, 4 care homes, 4 community groups). Centres were randomised to either CCBE, group reminiscence or usual care. Outcomes were collected to assess the feasibility of the trial parameters: level of recruitment interest and eligibility, randomisation, adverse events, retention, completion of health outcomes, missing data and delivery of the CCBE. Semi- structured interviews were conducted with participants and care staff following the intervention to explore acceptability. Results: 48% (89 out of 184 contacted) of eligible centres were interested in participating with 12 recruited purposively. 73% (94) of the 128 older people screened consented to take part with 83 older people then randomised following mobility testing. Recruitment required greater staffing levels and resources due to 49% of participants requiring a consultee declaration. There was a high dropout rate (40%) primarily due to participants no longer attending the centres. The CCBE intervention was delivered once a week in day centres and community groups and twice a week in care homes. Older people and care staff found the CCBE intervention largely acceptable. Conclusion: There was a good level of interest from centres and older people and the CCBE intervention was largely welcomed. The trial design and governance procedures would need to be revised to maximise recruitment and retention. If the motivation for a future trial is physical health then this study has identified that further work to develop the CCBE delivery model is warranted to ensure it can be delivered at a frequency to elicit physiological change. If the motivation for a future trial is psychological outcomes then this study has identified that the current delivery model is feasible

Asian urbanism

This chapter on Asian urbanism begins by examining how Asian urbanism can be seen as both actually existing and imagined, taking into consideration the ways in which Asian urbanism has entailed the use of successful Asian cities as reference points for other cities in the Global South on the one hand, and how such referencing practices often entail the rendering of Asian urbanism as imagined models and ideologies that are detached from the realities of the receiving end of the model transfer on the other. The ensuing section examines how Asian urbanism can be situated in the context of state-society relations, with a particular emphasis on the role of the Asian states that exhibited developmental and/or authoritarian orientations in the late twentieth century. The penultimate section explores the socio-spatiality of Asian urbanism, summarising some salient characteristics of Asian urbanism. The final section concludes with an emphasis on the need of avoiding Asian exceptionalism, and also of having a pluralistic perspective on Asian urbanism