This study contributes to the growing body of work aimed at optimizing management of bleeding disorder patients through pregnancy and the postpartum period, showing patients are at a higher risk of PPH as they age. Risk factors such as low third trimester VWF:RCo have been identified. Treatment with tranexamic acid in the postpartum period is associated with a reduced incidence of abnormal postpartum bleeding.
Background Practitioners and researchers in the midst of overwhelming coronavirus disease 2019 (COVID-19) outbreaks are calling for new ways of looking at such pandemics, with an emphasis on human behavior and holistic considerations. Viral outbreaks are characterized by socio-behaviorally-oriented public health efforts aimed at reducing exposure and prevention of morbidity/mortality once infected. These efforts involve different points-of-view, generally, than do those aimed to understand the virus’ natural history. Rampant spread of SARS-CoV-2 infection in cities clearly signals that urban areas contain conditions favorable for rapid transmission of the virus. Main text The Critical Medical Ecology model is a multidimensional, multilevel way of viewing pandemics comprehensively, rooted simultaneously in microbiology and in anthropology, with shared priority for evolution, context, stressors, homeostasis, adaptation, and power relationships. Viewing COVID-19 with a Critical Medical Ecological lens suggests three important interpretations: 1) COVID-19 is equally — if not more — a socially-driven disease as much as a biomedical disease, 2) the present interventions available for primary prevention of transmission are social and behavioral interventions, and 3) wide variation in COVID-19 hospitalization/death rates is not expected to significantly be attributable to a more virulent and rapidly-evolving virus, but rather to differences in social and behavioral factors — and power dynamics — rather than (solely) biological and clinical factors. Cities especially are challenged due to logistics and volume of patients, and lack of access to sustaining products and services for many residents living in isolation. Conclusions In the end, SARS-CoV-2 is acting upon dynamic social human beings, entangled within structures and relationships that include but extend far beyond their cells, and in fact beyond their own individual behavior. As a comprehensive way of thinking, the Critical Medical Ecology model helps identify these elements and dynamics in the context of ecological processes that create, shape, and sustain people in their multidimensional, intersecting environments.
The WHO/UNAIDS suggests that digital tools – such as social media and online training opportunities, can connect providers in difficult social and medical contexts to providers elsewhere for guidance, support, and advice. Social media is emerging as an innovative option for connecting clinicians together and for enhancing access to professional resources. In Romania, characterized by an atypical HIV/AIDS epidemic which is further challenged by a range of access complexities, it is unclear how often – and which kinds of – social media clinicians use to support clinical care. This study was conducted to ascertain social media use for clinical providers based in two regions of Romania (Transylvania and Moldavia) who face distance challenges that could potentially be alleviated by social media interaction. We used an online survey to understand what social media are currently popular and perceived to be useful for learning clinical information. Descriptive and bivariate analyses were conducted. Providers indicated Facebook and WhatsApp were the most common social media platforms, with 62% and 45% reporting daily use, respectively. Providers who used one media platform were significantly more likely to use another social media platform (p < .05). These data are helpful for creating an online training platform on HIV/AIDS for Romanian clinical providers.
Background Diabetes is endemic in Pacific Island jurisdictions where complex colonial relationships arose from the Spanish Empire, Japanese and German occupation in World Wars 1 and 2, and the Pacific Trust Territory era of the USA. Since diabetes reflects a cluster of ecological processes involving sociobehavioural, medical, and environmental constructs, interpretation of the diabetes epidemic requires both an ecological and intervention framework with an economic and political perspective that accounts for historical and contemporary power relations.Methods We conducted qualitative interviews with 272 local residents (totalling 3440 h) of seven Pacific Island communities (Majuro, Pohnpei, Palau, Kayangel Atoll, Saipan, Tinian, and Rota). Interviews were recorded and an inductive analytical plan implemented (analysed for themes within and across sites). An ecological interpretive framework that situates humans within their bodily and environmental context-combined with historical socioeconomic power dynamics (and agency)-informed the generation of findings and implications.Findings Communities attribute diabetes in their islands to the direct result of rapid shifts in lifestyle brought from the Japanese (World War 2) and US (Trust Territory) periods of colonial history. The replacement of local starches with rice during the Japanese period, combined with the replacement of local protein sources with US canned meats, fish, and instant foods, catalysed a diabetogenic diet. Shifts in food economies replaced local forms of trade, barter, and reciprocity. Local forms of physical activity-procurement of local food (fishing, gardening)-became devalued in the new food environment, further creating metabolic disease. Individuals from more remote locales are more likely to see their way of life as healthier than their counterparts in central population hubs, and attribute this asset to the slower reach of development, the subsequent lower processed food consumption, greater engagement with traditionally meaningful local activities, and a stronger reliance on local medicine, with less access to Western medicine.Interpretation Island communities are aware of the dynamics historically that led to their present food and health environment. Cultural and community assets-perceived as resilience by community members-could be promoted to support social norms that contribute to growing local pride, traditional thinking and behaviours, and a redefinition of "healthy".
BackgroundThe COVID-19 pandemic has led to widespread public health measures to reduce transmission, morbidity, and mortality attributed to the SARS-CoV-2 virus. While much research and focus surrounds COVID-19 vaccine development, testing, and supportive management, little is known about the determinants of non-medical, personal impact of COVID-19 prevention policies. We aimed to understand determinants of non-medical COVID-19 impact and to account for its multileveled, intersectional nature of associations.MethodsThis cross-sectional, multi-level, convergent mixed-methods study assessed a range of beliefs, practices, and experiences relating to COVID-19. We recruited a global sample (n=7,411) using both Facebook and Amazon mTURK platforms. We constructed a novel data-driven non-medical COVID-19 Impact Score and four subcomponents (“Personal Action,” “Supply-related,” “Cancellations,” and “Livelihood” impacts). We used generalized estimating equation models with identity link functions to determine concomitant association of individual, household, and country-level variables on the impact scores. We also classified 20,015 qualitative excerpts from 6859 respondents using an 80-code codebook.ResultsTotal and component impact scores varied significantly by region with Asia, Africa, and Latin America and the Caribbean observing the highest impact scores. Multilevel modeling indicated that individual-level sociocultural variables accounted for much of this variation with COVID-related worry, knowledge, struggles in accessing food and supplies, and worsening mental health most strongly associated with non-medical impact. Family responsibilities, personal COVID medical experience, and health locus of control – in addition to country-level variables reflecting social and health challenge – were also significantly and independently associated with non-medical impact.DiscussionNon-medical personal impact of COVID-19 affects most people internationally, largely in response to shutdowns, implementing prevention requirements, and through economic consequences. In the context where most of the world’s population does not have direct medical experience with COVID-19, this phenomena of non-medical impact is profound, and likely impacts sustainability of public health interventions aimed at containing COVID-19.
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