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Introduction: In 2021, Jamaica's maternal mortality ratio doubled as a result of COVID-19-related deaths. Yet, COVID-19 vaccination among pregnant Jamaican women remained low. In the United States, COVID-19 vaccination is lower among pregnant women who have had multiple pregnancies (multigravidas) versus women who were pregnant for the first time (primigravidas). We examined whether this pattern exists in Jamaica. Methods: A cross-sectional survey of a convenience sample of 79 pregnant Jamaican women recruited from a teaching hospital (May-July 2022) was used to assess self-reported COVID-19 vaccination and medical mistrust beliefs-operationalized as low vaccine confidence, government mistrust, and race-based mistrust-by gravidity. We used modified Poisson regression to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for vaccination by gravidity, adjusting for age, education, and comorbidities. Results: Thirty-nine (49%) of the participants were multigravidas. Socioeconomic status was similar between multigravidas and primigravidas. COVID-19 vaccination was lower in multigravidas (46%) than primigravidas (75%) after adjusting for age, education, and comorbidities (aPR = 0.67, 95% CI = 0.46-0.99; p = 0.044). Vaccine confidence was lower in multigravidas (p = 0.044). Government mistrust and race-based mistrust did not differ between the two groups. Conclusion: In Jamaica, multigravidas may have lower COVID-19 vaccine uptake and lower vaccine confidence compared with primigravidas. Understanding the distinct needs of pregnant subpopulations is essential for crafting effective maternal vaccination campaigns.

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Abstract The COVID-19 outbreak is increasing around the world in the number of cases, deaths, and affected countries. Currently, the knowledge regarding the clinical impact of COVID-19 on maternal, fetal, and placental aspects of pregnancy is minimal. Although the elderly and men were the most affected population, in previous situations, such as the 2009 H1N1 influenza pandemic and the Ebola epidemic, pregnant women were more likely to develop complications than nonpregnant women. There are unanswered questions specific to pregnant women, such as whether pregnant women are more severely affected and whether intrauterine transmission occurs. Additional information is needed to inform key decisions, such as whether pregnant health care workers should receive special consideration, whether to separate infected mothers and their new borns, and whether it is safe for infected women to breastfeed.

Resumo A COVID-19 está se disseminando em todo o mundo, expandindo o número de casos, mortes e países afetados. Atualmente, o conhecimento sobre o impacto da COVID-19 nos desfechos materno, fetal e placentário da gravidez é mínimo. A despeito de serem os homens e idosos a população mais afetada em situações anteriores, como a pandemia de influenza H1N1 de 2009 e a epidemia de Ebola, as gestantes foram mais propensas a desenvolver complicações do que as mulheres não grávidas. Em relação à gravidez, existem questões específicas a serem respondidas, tais como se as mulheres grávidas são mais gravemente afetadas e se ocorre transmissão intrauterina. São necessárias informações adicionais para embasar a tomada de decisões, tais como; se as profissionais de saúde grávidas devem receber atenção especial, se é necessário separar as mães infectadas dos seus recém-nascidos e se é seguro que as puérperas infectadas amamentem.

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Gravity retraction is an underutilized adjunct in neurosurgery. Gravity is gentler than retractor blades; it does not cause brain edema or injury, and it tends to open natural subarachnoidal plans to deep lesions.1-3 A good example of this is the supracerebellar infratrochlear approach4-7 in semisitting position for resection to a midbrain cavernous malformation. This approach was selected because the cavernous malformation was 1 mm under the lateral mesencephalic sulcus. The procedure was developed with the use of transesophageal ultrasound and physiological neuromonitoring. We present a 3-dimensional video of this surgery with all the tricks and details used in the procedure. The patient consented to the procedure and to publication of the photos and surgical video.

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Purpose To evaluate the compliance and degree of satisfaction of nulligravida (has not given birth) and parous (had already given birth) women who are using intrauterine devices (IUDs). Methods A cross-sectional cohort study was conducted comparing nulligravida and parous women who had had an IUD inserted between July 2009 and November 2011. A total of 84 nulligravida women and 73 parous women were included. Interviews were conducted with women who agreed to participate through telephone contact. Statistical analysis was performed with Student s t-test and Mann-Whitney test for numeric variables; Pearson s chi-square test to test associations; and, whenever pertinent, Fisher s exact test for categorical variables. A survival curve was constructed to estimate the likelihood of each woman continuing the use of the IUD. A significance level of 5% was established. Results When compared with parous women, nulligravida women had a higher education level (median: 12 vs. 10 years). No statistically significant differences were found between the nulligravida and parous women with respect to information on the use of the IUD, prior use of other contraceptive methods, the reason for having chosen the IUD as the current contraceptive method, reasons for discontinuing the use and adverse effects, compliance, and degree of satisfaction. The two groups did not show any difference in terms of continued use of the IUD (p = 0.4). Conclusion There was no difference in compliance or the degree of satisfaction or continued use of IUDs between nulligravida and parous women, suggesting that IUD use may be recommended for women who have never been pregnant.

Objetivo Avaliar a adesão e o grau de satisfação de nuligestas emulheres com partos anteriores usuárias do dispositivo intrauterino (DIU). Métodos Realizamos um estudo de corte transversal comparando-se um grupo de nuligestas commulheres com partos anteriores que tinham sido submetidas à inserção do DIU no período de julho de 2009 a novembro de 2011. Foram incluídas 84 nuligestas e 73mulheres compartos anteriores. Uma entrevista foi realizada comas mulheres que concordaram em participar por meio de contato telefônico. Para se verificar as diferenças entre os dois grupos foram utilizados os testes t de Student e Mann- Whitney para as variáveis numéricas, e os testes qui-quadrado de associação e exato de Fisher, quando pertinente, para as variáveis categóricas. Realizou-se análise de sobrevivência de Kaplan-Meyer para continuidade do uso do DIU. Adotou-se o nível de significância de 5%. Resultados As nuligestas apresentaram escolaridade (mediana: 12 anos) superior às mulheres com um ou mais partos anteriores (mediana: 10 anos). Não houve diferença entre as nuligestas e mulheres comparto anterior em relação à informação sobre o uso do dispositivo intrauterino (DIU), uso prévio de outrosmétodos contraceptivos,motivo da escolha do DIU como método contraceptivo atual, motivos para descontinuidade, efeitos colaterais, adesão e grau de satisfação. A continuidade do uso do dispositivo intrauterino foi diminuída como passar do tempo emambos os grupos e sem diferença significativa (p = 0,4). Conclusão A adesão, o grau de satisfação e a continuidade do uso do DIU entre as nuligestas e mulheres com parto anterior são semelhantes, sugerindo que o DIU pode ser recomendado para mulheres que nunca engravidaram.

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There is considerable intraspecific variation in metabolic rates and locomotor performance in aquatic ectothermic vertebrates; however, the mechanistic basis remains poorly understood. Using pregnant Trinidadian guppies (Poecilia reticulata), a live-bearing teleost, we examined the effects of reproductive traits, pectoral fin use and burst-assisted swimming on swimming metabolic rate, standard metabolic rate (O2std) and prolonged swimming performance (Ucrit). Reproductive traits included reproductive allocation and pregnancy stage, the former defined as the mass of the reproductive tissues divided by the total body mass. Results showed that the metabolic rate increased curvilinearly with swimming speed. The slope of the relationship was used as an index of swimming cost. There was no evidence that reproductive traits correlated with swimming cost, O2std or Ucrit. In contrast, data revealed strong effects of pectoral fin use on swimming cost and Ucrit. Poecilia reticulata employed body-caudal fin (BCF) swimming at all tested swimming speeds; however, fish with a high simultaneous use of the pectoral fins exhibited increased swimming cost and decreased Ucrit. These data indicated that combining BCF swimming and pectoral fin movement over a wide speed range, presumably to support swimming stability and control, is an inefficient swimming behaviour. Finally, transition to burst-assisted swimming was associated with an increase in aerobic metabolic rate. Our study highlights factors other than swimming speed that affect swimming cost and suggests that intraspecific diversity in biomechanical performance, such as pectoral fin use, is an important source of variation in both locomotor cost and maximal performance.

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