Exercise During Pregnancy and Cesarean Delivery: North Carolina PRAMS, 2004–2005

Background: The current rate of cesarean delivery in the United States is 31 percent. Previous studies have suggested that exercise during pregnancy may be associated with a lower risk of cesarean delivery, but sample sizes were small and methods often inadequate. This study examined whether or not an association exists between prenatal exercise and delivery mode using data from the 2004 and 2005 North Carolina Pregnancy Risk Assessment Monitoring System (PRAMS) survey. Methods: PRAMS postpartum questionnaire responses about frequency of exercise during the last 3 months of pregnancy for 1,955 women without a prior cesarean delivery were linked to birth certificates. Results: Among 1,342 women delivering at term, exercise was not associated with delivery mode in this data set: compared with women exercising less than once a week, neither women exercising one to four times per week nor those exercising five times or more per week had an altered risk of cesarean (risk ratio [RR] [95% confidence limit] [CL] 0.89 [0.69–1.15], 1.04 [0.66–1.64], respectively, adjusted for parity, gestational age, hypertension). Among 613 women delivering preterm, the results were also not statistically significant, but a compelling trend toward a protective effect could be seen (RR [95% CL] 0.65 [0.38–1.13], 0.62 [0.29–1.33]). Conclusions: Maternal self‐reported frequency of exercise during pregnancy was not associated with a reduced risk of cesarean delivery. Larger studies with better exposure ascertainment may provide a more definitive answer.     

Nutrition Measures for Managed Care Report Cards

Health plan “report cards,” that is, published summaries of health plan performance, are a new way to help consumers select a health plan on the basis of cost and quality. The Health Plan Employer Data and Information Set (HEDIS) includes a set of health plan performance measures, standardized definitions, and methods for data collection. HEDIS is used as the basis for many report card initiatives and is the preferred tool of the managed care industry for measuring health plan performance. Nevertheless, the current list of HEDIS performance measures omits many health services, including medical nutrition therapy. Nutrition measures have the potential for wide appeal among health care stakeholders (ie, payers, consumers, and providers). Four measures related to medical nutrition therapy are proposed for managed care report cards: staffing for nutrition services and medical nutrition therapy for high cholesterol level, gestational diabetes, and cardiovascular disease. Barriers to adopting medical nutrition therapy measures in HEDIS include the need to address technical issues before considering new measures and competition from other potential measures. Steps to create support for medical nutrition therapy measures in HEDIS should focus on influencing representatives of health plans and employers to include these measures. The involvement of registered dietitians in the dynamic process of health plan evaluation is an important extension of ongoing efforts for strategic positioning in the managed care market. J Am Diet Assoc. 1996; 96:374-380.     

缺血性脑卒中急性期神经保护治疗的研究进展

0 引言 缺血性脑卒中是脑卒中的主要类型,约占脑卒中总发病率的70%～80%.其早期治疗主要有两种途径:血管再通和神经保护治疗.溶栓治疗受限于其过窄的时间窗和对出血等并发症的担心,尚不能广泛应用.     

Preparation and characterization of hydrophobic polymeric films that are thromboresistant via nitric oxide release

The preparation of hydrophobic polymer films (polyurethane and poly(vinyl chloride)) containing nitric oxide (NO)-releasing diazeniumdiolate functions is reported as a basis for improving the thromboresistivity of such polymeric materials for biomedical applications. Several different approaches for preparing NO-releasing polymer films are presented, including: (1) dispersion of diazeniumdiolate molecules within the polymer matrix; (2) covalent attachment of the diazeniumdiolate to the polymer backbone; and (3) ion-pairing of a diazeniumdiolated heparin species to form an organic soluble complex that can be blended into the polymer. Each approach is characterized in terms of NO release rates and in vitro biocompatibility. Results presented indicate that the polymer films prepared by each approach release NO for variable periods of time (10-72 h), although they differ in the mechanism, location and amount of NO released. In vitro platelet adhesion studies demonstrate that the localized NO release may prove to be an effective strategy for improving blood compatibility of polymer materials for a wide range of medical devices.