Background Concerns have been raised regarding a potential surge of COVID-19 in pregnancy, secondary to rising numbers of COVID-19 in the community, easing of societal restrictions, and vaccine hesitancy. Even though COVID-19 vaccination is now offered to all pregnant women in the UK, there are limited data on its uptake and safety. Objectives and study design : This was a cohort study of pregnant women who gave birth at St George’s University Hospitals NHS Foundation Trust, London, UK, between March 1 st and July 4 th 2021. The primary outcome was uptake of COVID-19 vaccination and its determinants. The secondary outcomes were perinatal safety outcomes. Data were collected on COVID-19 vaccination uptake, vaccination type, gestational age at vaccination, as well as maternal characteristics including age, parity, ethnicity, index of multiple deprivation score and co-morbidities. Further data were collected on perinatal outcomes including stillbirth (fetal death ≥24 weeks’ gestation), preterm birth, fetal/congenital abnormalities and intrapartum complications. Pregnant women who received the vaccine were compared with a matched cohort of propensity balanced pregnant women to compare outcomes. Effect magnitudes of vaccination on perinatal outcomes were reported as mean differences or odds ratios with 95% confidence intervals. Factors associated with antenatal vaccination were assessed with logistic regression analysis. Results Data were available for 1328 pregnant women of whom 141 received at least one dose of vaccine before giving birth and 1187 women who did not; 85.8% of those vaccinated received their vaccine in the third trimester and 14.2% in the second trimester. Of those vaccinated, 128 (90.8%) received an mRNA vaccine and 13 (9.2%) a viral vector vaccine. There was evidence of reduced vaccine uptake in younger women (P=0.002), those with high levels of deprivation (i.e., fifth quintile of Index of Multiple Deprivation, P=0.008) and women of Afro-Caribbean or Asian ethnicity, compared to Caucasian ethnicity (P<0.001). Women with pre-pregnancy diabetes had increased vaccine uptake (P=0.008). In the multivariable model adjusting for variables that had a significant effect according to the univariable analysis, fifth deprivation quintile (most deprived) was significantly associated with lower antenatal vaccine uptake (adjusted OR 0.09, 95% CI 0.02–0.39, P=0.002), while pre-pregnancy diabetes was significantly associated with higher antenatal vaccine uptake (adjusted OR 11.1, 95% CI 2.01–81.6, P=0.008). In a propensity score matched cohort, compared with non-vaccinated pregnant women, 133 women who received at least one dose of the COVID-19 vaccine in pregnancy (vs. those unvaccinated) had similar rates of adverse pregnancy outcomes (P>0.05 for all): stillbirth (0.0% vs 0.3%), fetal abnormalities (2.2% vs 2.7%), intrapartum pyrexia (3.7% vs 1.5%), postpartum hemorrhage ...

This model of care represents a promising collaboration between primary care and specialist care for improving care to frail older adults living in rural communities, potentially improving timely access to health care and crisis intervention.

This paper summarizes the body of literature about early-onset dementia (EOD) that led to recommendations from the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia. A broader differential diagnosis is required for EOD compared with late-onset dementia. Delays in diagnosis are common, and the social impact of EOD requires special care teams. The etiologies underlying EOD syndromes should take into account family history and comorbid diseases, such as cerebrovascular risk factors, that may influence the clinical presentation and age at onset. For example, although many EODs are more likely to have Mendelian genetic and/or metabolic causes, the presence of comorbidities may drive the individual at risk for late-onset dementia to manifest the symptoms at an earlier age, which contributes further to the observed heterogeneity and may confound diagnostic investigation. A personalized medicine approach to diagnosis should therefore be considered depending on the age at onset, clinical presentation, and comorbidities. Genetic counseling and testing as well as specialized biochemical screening are often required, especially in those under the age of 40 and in those with a family history of autosomal dominant or recessive disease. Novel treatments in the drug development pipeline for EOD, such as genetic forms of Alzheimer's disease, should target the specific pathogenic cascade implicated by the mutation or biochemical defect.