BackgroundThe experiences of UK ethnic minority healthcare workers are crucial to ameliorating the disproportionate COVID-19 infection rate and outcomes in the UKEM community. We conducted a qualitative study on UKEM healthcare workers’ perspectives on COVID-19 vaccine hesitancy in the UKEM community.MethodsParticipants were 15 UKEM healthcare workers. Data were collected using individual and joint interviews, and a focus group, and analyzed using thematic analysis.ResultsWe generated three themes: heterogeneity, mistrust, and mitigating. Therein, participants distinguished CVH in the UKEM community in educational (...) attainment and ethnicity. They pointed to the role of mistrust in CVH in the UKEM community. They opined that the mistrust underlying CVH in the UKEM community is rooted in history and religion, conspiracy theories, the speedy development and novelty of the vaccines, post-vaccination complications/side effects, false positive test results, and social media and social support/influence. Participants recommended that interventions targeted at mitigating CVH in the UKEM community need to, in a non-judgmental way, tackle dis/misinformation and provide education, and incorporate UKEM healthcare worker endorsement. They also suggested such interventions be community-oriented, enhance the convenience of vaccination centers and the possibility of vaccine choice, and appreciate that overcoming CVH and accepting vaccination is a gradual process involving personal assessment of risks and benefits.ConclusionCVH in the UKEM community is a multifaceted phenomenon requiring multicomponent interventions. (shrink)

Murphy etal. (1997) showed age-standardised twinning rates for Scotland and England & Wales 195281 and subsequently increased to about 11·5 per 1000 in 1992–94. The authors conclude their paper with the words: 'perhaps 15% oftwins nationally now follow treatment and the natural twinning rate mightstill be in decline'.

This study investigates the possible effects of pre-term births and low birth weight on infant mortality rates (IMRs) over a 15-year period in Ribeirão Preto, Brazil, based on surveys carried out in 1978/79 and 1994. The 1978/79 survey included 6750 births over a 12-month period and the 1994 survey 2846 births over a 4-month period. Infant deaths were retrieved monthly from the city register. Infant mortality rate decreased from 36·6 to 16·9 deaths per 1000 over 15 years. The (...) decrease in IMR was larger in the 25000·63); it increased to 0·57 (95% CI 0·350·97) when adjusted for length of gestation and other variables. The increase in pre-term births and low birth weight may have had, at most, a marginal effect on the IMR. Progress in the care of newborns may have decreased the mortality risk, but even mild pre-term birth still has an impact on infant mortality. There is room for further improvement in IMR by tackling the high rates of pre-term birth. (shrink)

The aim of this study is an analysis of the possible adaptive consequences of delivery of low birth weight infants. We attempt to reveal the cost and benefit components of bearing small children, estimate the chance of the infants’ survival, and calculate the mothers’ reproductive success. According to life-history theory, under certain circumstances mothers can enhance their lifetime fitness by lowering the rate of investment in an infant and/or enhancing the rate of subsequent births. We assume that (...) living in a risky environment and giving birth to a small infant may involve a shift from qualitative to quantitative production of offspring. Given high infant mortality rates, parents will have a reproductive interest in producing a relatively large number of children with a smaller amount of prenatal investment. This hypothesis was tested among 650 Gypsy and 717 non-Gypsy Hungarian mothers. Our study has revealed that 23.8% of the Gypsy mothers had low birth weight (<2,500 g) children, whose mortality rate is very high. These mothers also had more spontaneous abortions and stillbirths than those with normal weight children. As a possible response to these reproductive failures, they shortened birth spacing, gaining 2–4 years across their reproductive lifespan for having additional children. Because of the relatively short interbirth intervals, by the end of their fertility period, Gypsy mothers with one or two low birth weight infants have significantly more children than their ethnic Hungarian counterparts. They appear to compensate for handicaps associated with low birth weights by having a larger number of closely spaced children following the birth of one or more infants with a reduced probability of survival. The possible alternative explanations are discussed, and the long-term reproductive benefits are estimated for both ethnic groups. (shrink)

Definition of the problem. During the last few years obstetricians have become concerned over an increasing rate of cesarean sections, especially an increasing rate of ”section on demand” for non-medical, but personal reasons of pregnant women. For physicians this is a question of risks and benefits for both mother and child. On the other hand, there is the duty to respect women’s autonomy. Arguments. Pregnant women are healthy and the act of giving birth to a child is (...) a physiological one. Thus, the indication has to be proved carefully for surgical intervention instead of vaginal delivery. Cesarean section for non-medical reasons may be helpful for women with an extreme fear of vaginal delivery or previous traumatic experiences. On the other hand the possibility for pregnant women to choose their preferred mode of delivery is combined with the question, whether cesarean section on demand fulfils their demand for a self-determined delivery. Conclusion. With a mode of delivery oriented to the person instead of to the method, self-determination can be realized. Cesarean Section on demand can achieve this in some individual cases. However women’s own ability, activity, and involvement in giving birth to a child may be a stronger manifestation of self-determination. (shrink)

ZusammenfassungDie Diskussion um die steigende Rate an Kaiserschnittentbindungen in der Geburtshilfe erlebt einen neuen Höhepunkt durch das Problem der sog. „Wunschsectio”. Für den Geburtshelfer stellt sich unter Beachtung seiner Fürsorgepflichten die Frage nach der Verantwortbarkeit einer ärztlichen Handlung aufgrund persönlicher Wünsche der Schwangeren, ohne medizinische Indikation, aber mit einem nicht zu vernachlässigenden Risiko. Für die betroffenen Frauen verbindet sich mit der Möglichkeit, die Form der Geburt frei zu wählen, die Frage, ob die Wunschsektio ihre Forderung nach einer selbstbestimmten Geburt (...) erfüllt. In einem „persönlichkeitsspezifischen” Geburtsereignis kann sich Selbstbestimmtheit verwirklichen und die normativ zugrunde liegende Autonomie der Frau gewahrt sein. Eine Wunschsektio kann dies im Einzelfall leisten. Eigene Initiative und Aktivität der Schwangeren dürften jedoch die Selbstbestimmtheit im Erleben der Geburt stärker fördern. (shrink)

Fundamental motor skills of children can be affected by different variables, such as executive functions, gender and relative age. However, the effects of these variables on FMS have been scarce studied, especially in early childhood, and show inconsistent results. To clarify these relationships, this study was carried out. Its aim was to analyze whether EF, gender and relative age influenced FMS in 43 Spanish kindergarteners. A multimethod and mixed methods approach was used. Kindergarteners’ teachers completed the Childhood Executive Functioning Inventory (...) to know the children level of EF. Kindergarteners’ parents complimented ad hoc questionnaire reporting the children gender and birth data. A Nomothetic/Punctual/Multidimensional observational design was used to observe children FMS in their habitual motor sessions at school. Two-way ANOVAs were performed to know the independent and interactive effects of working memory level, inhibition control level, gender and relative age on FMS. Results showed these variables have independent and interactive effects on some FMS, but not on others. FMS influenced by these variables vary depending what independent variable is/are considered. Therefore, it can be concluded that the influences of teacher-rated EF, gender and relative age on observed FMS in kindergarteners are complex and specific. Results obtained must be taken into to design and implement instructional and intervention strategies, as well as educational and sport policy changes, especially in early childhood, when FMS are more malleable. (shrink)

Home births continue to constitute only a small percentage of all deliveries in the United States, in part because of concerns about their safety. While the literature is decidedly mixed in regard to the degree of risk, there are several studies that report that home birth may at times entail a small absolute increase in perinatal risks in circumstances that cannot always be anticipated prior to the onset of labor. While the definition of “small” will vary between individuals, and (...) publications vary in the level of risk they ascribe to birth at home, studies with the least methodological flaws and with adequate power often cite an excess death rate in the range of one per thousand.Home birth is, in that regard, but one example of patients’ choices and plans that sometimes carry increased risk or include alternatives that individual physicians feel uncomfortable supporting or recommending. Our intention in this opinion piece is not to advocate for or against home birth. Rather, we recognize that home birth is but one example of a patient choice that might differ from what a provider feels is in a woman’s best interests.In this article we will discuss ethical considerations in such circumstances using home birth as an example. We consider in this article how the ethical principles of respect for autonomy and non-maleficence can be balanced using, among other examples, the choice by some for a home birth. We discuss how absolute rather than relative risk should guide individuals’ evaluation of patient choices. We also consider how in some circumstances, the value and safety added by a physician’s participation may outweigh a potentially small increment in absolute risk that might result from a patient’s decision to deliver at home because of a perceived physician endorsement.We recognize, however, that doctors and midwives participating in choices they have not recommended, or may even believe will lead to or increase risk for adverse outcomes, presents dilemmas and raises important questions. When does respect for patient choice and autonomy become support for poor decision making? When is participation not respectful but enabling? Finally we discuss the role and responsibility of organized medicine in making all births as safe as possible. (shrink)

Preterm birth is defined as delivery occurring before 37 weeks gestation.1 Infants born prematurely have increased risks of morbidity and mortality throughout life, especially during the first year. These risks increase as the gestational age at birth decreases.2 Additionally, there are significant racial and ethnic differences in preterm birth rates. In 2022, the rate of preterm birth among non-Hispanic black women was approximately 50% higher than that observed in non-Hispanic white women.1 The outcomes for these (...) infants are also disparate–preterm birth and low birth weight are the second-leading causes of infant mortality (deaths before 1 year of age). Notably, among preterm neonates, infants born to non-Hispanic black women have a mortality rate more than double that of infants born to non-Hispanic white mothers.3 Importantly, there is a small but significant group of neonates that can be classified as severely premature (those born <28 weeks). Infants born before 28 weeks have varied and uncertain outcomes. While this group accounts for only 0.4% of preterm births, it also accounts for 40% of deaths among preterm neonates.4 As noted by Romanis and Adkins, the advent of artificial amnion and placenta technology (AAPT) holds promise for its potential to address the physiologic complications and mortality risks of extreme prematurity by introducing amniotic substitutes that mimic in vivo placental oxygenation and substrate delivery. In contrast …. (shrink)

Reconstruction of human ecosystems and their stability over time provides knowledge of the processes of adaptability developed by isolated communities. Seasonality of vital events is a good indicator of the effects of different lifestyles, which in turn depend on the ecological context in which a population developed specific subsistence models. Seasonality of births reflects the cultural attitude towards the best time to conceive, in relation to work activities and loads; the latter may also affect physiological functions related to fertility. The (...) present research concerns gross birth rates and seasonality of births and conceptions during four centuries in south-central Italy. Birth rates were between 33·0 and 36·5 per 1000. The pattern of seasonality of births and, by extension, of conceptions defines a southern-type agricultural area for the earlier periods. However, it also shows a progressive shift towards an increasing concentration of conceptions in spring namely from April to August – with a large increase in summer in the 19th century with respect to the previous periods. The new 19th century pattern is reported by Crisafulli, Dalla Zuanna & Solero (2000) as being representative of the central Adriatic region, a geographical classification to which Abruzzo can also be attributed. (shrink)

Cesarean delivery rates have been steadily increasing worldwide. In response, many countries have introduced target goals to reduce rates. But a focus on target goals fails to address practices embedded in standards of care that encourage, rather than discourage, cesarean sections. Obstetrical standards of care normalize use of technology, creating an imperative to use technology during labor and birth. A technological imperative is implicated in rising cesarean rates if physicians or patients fear refusing use of technology. Reproductive autonomy is (...) at stake since a technological imperative undermines patients’ ability to choose cesareans or refuse use of technology increasing the likelihood of cesareans. To address practices driven by a technological imperative I outline three physician obligations that are attached to respecting patient autonomy. These moral obligations show that a focus on respect for autonomy may prove not only an ideal ethical response but also an achievable practical response to lowering cesarean rates. (shrink)

Researchers in psychology have focused a great deal of attention on the potential greater predisposition to achievement among first-born children relative to their siblings. Focusing on the United States as an example, a time series of the first birth ratio is used to show how the changing prevalence of first births relative to higher order births has altered the composition of birth cohorts, and the ratio is decomposed into four factors. Results show that the ratio increased significantly in (...) the 1960s and early 1970s, but changed only slightly in the following decades. While more recent birth cohorts are composed of larger proportions of first-born children, the majority of children are still born as siblings. Contrary to expectations, the primary source of change was the proportion childless rather than decreasing higher order birth rates. (shrink)