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An Examination of an Innovative Self-Insured Medical Center: The Case of Rosen Hotels and Resorts
Published in Frederick J. DeMicco, Ali A. Poorani, Medical Travel Brand Management, 2023
Frederick J. DeMicco, Abraham Pizam
RosenCare® also includes personalized and/or group counseling for smoking cessation and weight loss (Weight Watchers program which is subsidized by Rosen Hotels), in addition to physical therapy, chiropractic care, and wellness. Around 56% of their pregnancies are high risk as a result of high rates of advanced maternal age, hypertension, diabetes, and other diseases. RosenCare® is very proactive, assisting employees in managing pregnancies (as a premature birth can cost approximately $500,000!). RosenCare® has a premature delivery rate of 7% vs. the Orlando average of 10.5%. This focus on management of chronic conditions and pregnancy results in a drop in the development of new chronic conditions among associates.
The Genetic Risk of a Couple Aiming to Conceive
Published in Carlos Simón, Carmen Rubio, Handbook of Genetic Diagnostic Technologies in Reproductive Medicine, 2022
Joe Leigh Simpson, Svetlana Rechitsky, Anver Kuliev
For over 50 years, ethnicity-based screening has identified asymptomatic individuals who are heterozygous for selected disorders. Tay-Sachs disease and hemoglobinopathies were the initial targets of screening, meeting the requisite requirement for a protein-based gene product in which it was possible to distinguish between heterozygous and homozygous asymptomatic individuals. In recent years, it has become clear that the clinical usefulness of ethnicity-based screening was less than predicted, in part because not all individuals of a given ethnic group are aware of their own ancestry. Pan-ethnic screening of carriers, based on DNA sequencing, is now pursued, increasing the number of at-risk couples identified. The genetic basis for at least 5,000 rare Mendelian traits has been determined, so the potential benefit is enormous (1). Moreover, at least 100,000 robust associations have been identified between genomic regions and common genetic diseases (1). Although not yet practicable, aspirational goals include DNA sequencing of every embryo or every fetus in every pregnancy. Chromosomal abnormalities associated with advanced maternal age can be detected non-invasively during pregnancy. Advanced paternal age is not associated with chromosomal abnormalities but is correlated with increased frequency of de novo mutations causing single-gene disorders.
Amniotic Fluid Embolism
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Zaid Diken, Antonio F. Saad, Luis D. Pacheco
There are modifiable and non-modifiable risk factors for AFE [15]. Modifiable risk factors include medical induction of labor, instrumental vaginal delivery (forceps and vacuum assisted deliveries), cervical lacerations, uterine rupture, and cesarean section. Non-modifiable risk factors include advanced maternal age (more than 30 years old), African American race, eclampsia, polyhydramnios, male fetus, placenta previa, placental abruption, and multiple pregnancies [7, 9, 18–20].
The association between age-related infertility and deoxyribonucleic acid (DNA) integrity parameters of granulosa cells and lymphocytes
Published in Journal of Obstetrics and Gynaecology, 2022
Esra Nur Tola, Pınar Aslan Koşar, Esra Nal Sahin, Okan Sancer
Fecundity decreases with advanced maternal age (AMA) after 30s and age-related infertility in women has increased due to women’s lifestyle changes (Igarashi et al. 2015). AMA also has a remarkable negative effect on in vitro fertilisation (IVF) success with progressive decrease in pregnancy and live birth rates (LBRs) and increase in abortion rate (AR) despite recent developments in IVF techniques and laboratory (American College of Obstetricians and Gynecologists Committee on Gynecologic Practice and Practice Committee 2014; Igarashi et al. 2015). However, low IVF success rates in women with advanced age were neutralised in whom oocytes used were obtained from healthy young donors (Igarashi et al. 2015). Therefore, AMA-related infertility is attributed to a decrease in the quality of oocytes (Miao et al. 2009) rather than a decline in the number of oocytes and changes in endocrine function and endometrial receptivity (Igarashi et al. 2015).
Preeclampsia: state of art and future perspectives. A special focus on possible preventions
Published in Journal of Obstetrics and Gynaecology, 2022
Özge Kahramanoglu, Antonio Schiattarella, Oya Demirci, Giovanni Sisti, Franco Pietro Ammaturo, Carlo Trotta, Federico Ferrari, Agnese Maria Chiara Rapisarda
The prevalence of PE varies according to different factors such as race, ethnicity, age and genetic predisposition. Overall, PE affects 2–8% of all pregnancies (ACOG 2019a). The prevalence in White, Hispanic, African-American women is 5%, 9% and 11%, respectively (Fox et al. 2014; Arce-Sánchez et al. 2021). It is more common in nulliparous women, multiple pregnancies, and those with a previous history of PE and the risk of PE in first pregnancies is 1.5–2-fold higher compared with multiparous women (Mayrink et al. 2019). Although it often affects young pregnant women (<18 years of age), also advanced maternal age (>40) is associated with an increased risk (Dugoff et al. 2004; Gui et al. 2020). Nonetheless, comorbidities such as diabetes, chronic hypertension, chronic kidney disease, obesity, antiphospholipid syndrome, systemic lupus erythematosus and hydatidiform mole are other risk factors (Mol et al. 2016; Budak et al. 2019; Gui et al. 2020). Preeclampsia is more prevalent among IVF pregnancies (Poon and Nicolaides 2014; Watanabe et al. 2014) and paternal factors could impact on the development, maybe due to genetic interactions with maternal genetic factors (Galaviz-Hernandez et al. 2018). Low socioeconomic status, maternal low birth weight and family history are other risk factors for PE (Mol et al. 2016).
Parental germline mosaic transmission of 5p13.2 microduplication in two siblings of a Chinese family
Published in Journal of Obstetrics and Gynaecology, 2022
Qi Tian, Li-Li Xu, Dong-Zhi Li
An ultrasound at 12 weeks’ gestation revealed a single fetus with a crown-rump length of 54 mm and a nuchal translucency of 1.3 mm. Although the parents were explained that the recurrence risk is very low for a de novo duplication, chorionic villous sampling (CVS) was still required by the woman due to the indication of advanced maternal age. Unexpectedly, CNV-seq of the CVS sample detected again the familial 5p13 duplication. The karyotype was 46,XX. The pregnancy was terminated on parents’ request. Parental mosaicism was then considered in this family. The skin tissue of the aborted fetus, combined with the blood samples of the four family members, was sent for further investigation using whole genome sequencing (WGS) for the purpose of precise duplication determination, searching possible single-gene variants and single nucleotide polymorphism (SNP) genotyping. This approach detected a 1.1-Mb duplication on 5p13.2 (HG19:chr5:36,195,246-37,371,079) in the fetus and the male patient, but not in other family members. No potentially causative monogenic variants were detected in the patient. Paternal mosaicism was confirmed by the haplotype analysis of chromosome 5 in this family (Figure 1). Genomic DNA of a sperm sample was obtained from 1 ml semen of the father, and WGS detected a variant allelic fraction of 13. 8%. Thus far, the paternal germline mosaicism origin for the “de novo” duplication was clear.