Transvaginal ultrasonographic cervical measurement as a predictor of successful labor induction

OBJECTIVE: Our purpose was to compare transvaginal cervical measurement and the Bishop score as indicators of duration of labor and successful induction of labor at term.Study Design: This prospective observational study recruited women with singleton gestations scheduled for induction of labor at > or =37 weeks. Transvaginal ultrasonographic measurement of cervical length was performed and the Bishop score was determined, each by operators masked to the other measurement. Data were collected on parity, gestational age, mode of delivery, induction agent, induction-to-delivery interval, Bishop score, and cervical length measurement. RESULTS: A total of 77 women were analyzed. Vaginal delivery occurred in 69%. Both Bishop score and cervical length showed linear correlation with duration of labor (R(2) = 0.43, P <. 001; R(2) = 0.48, P <.001; respectively). Women with cervical length <3.0 cm had shorter labors (P <.001) and were more likely to be delivered vaginally (P <.001). Women with a Bishop score >4 also had shorter labors and were more likely to be delivered vaginally, with similar P values. A logistic regression model identified cervical length and parity as the only independent predictors of vaginal delivery. CONCLUSIONS: Both ultrasonographically measured cervical length and Bishop score predict duration of labor and likelihood of vaginal delivery. However, only cervical length and parity were independent predictors of mode of delivery.     

Postoperative morbidity in the morbidly obese parturient woman: supraumbilical and low transverse abdominal approaches

OBJECTIVE: Our purpose was to determine the differences in postoperative morbidity in obese women who had a supraumbilical or a Pfannenstiel incision at cesarean delivery. STUDY DESIGN: A case-control retrospective review was conducted of all patients who were at >150% ideal body weight when undergoing cesarean delivery between 1989 and 1995 by means of either a supraumbilical or a Pfannenstiel incision. Patients were excluded if medical records were unavailable. A total of 15 women who had a supraumbilical incision and 54 who had a low transverse incision were included in the analysis. Antenatal complications were examined, as were age, weight, and training level of the surgeon. Postoperative complications were then compared. RESULTS: The groups were similar in age and antepartum complications. However, mean weight and percentage of ideal body weight in the supraumbilical group were both higher (P <.00001 and P <.0001, respectively), with the supraumbilical group 83 lb heavier on average. No significant differences were seen in any postoperative complication. CONCLUSION: Postoperative morbidity in morbidly obese women undergoing cesarean delivery does not differ between a supraumbilical approach and the low transverse abdominal incision.     

The influence of parenting change on pediatric weight control

OBJECTIVE: Parenting style was examined as a predictor of weight loss maintenance in behavioral family-based pediatric obesity treatment. RESEARCH METHODS AND PROCEDURES: Fifty obese children who participated in a behavioral family-based pediatric obesity treatment were studied. Hierarchical regression tested the incremental effect of baseline parenting and parenting during treatment on children's percentage overweight change over 12 months, beyond demographics and adherence to targeted behaviors. RESULTS: Children's percentage overweight significantly decreased at 6 (-16.3) and 12 (-11.1) months. Adherence to program goals significantly increased variance accounted for in the regression model by 10.8%, whereas adding baseline father acceptance and change in father acceptance accounted for another 20.5%. The overall model accounted for 40.6% of the variance in pediatric weight control. ANOVA showed significantly greater percentage overweight decrease from baseline for youth with fathers who increased their acceptance vs. those who decreased acceptance at 6 (-19.8 vs. -14.6) and 12 (-17.4 vs. -8.1) months. DISCUSSION: Youth who perceive an increase in father acceptance after treatment had better changes in percentage overweight over 12 months than youth with lower ratings of father acceptance. Future directions include examining how other parenting dimensions impact pediatric obesity treatment outcome and how parental acceptance can be enhanced to improve child weight control.     

Using large data sets in long-term care to measure and improve quality

The authors explore the evolution, potential uses, and limitations of four existing large data sets in long-term care: Minimum Data Set (MDS), Outcome Assessment and Information Set (OASIS), Online Survey and Certification Reporting System (OSCAR), and Consumer Surveys. They also describe the emerging Federal Nursing Home Quality Initiative and its potential for future research. All four existing large data sets have potential to be used to improve quality of care. Their utility is presently diminished because providers are not using the data for formal continuous quality improvement. However, the Center for Medicare and Medicaid Services (CMS) is currently engaged in a series of special studies designed to build and sustain a culture of continuous quality improvement in nursing homes and to make continuous, measurable improvement a growing part of the care of Medicare beneficiaries in those settings. These CMS studies, all of which will draw on the four existing large data sets in long-term care, offer the potential to develop, explicate and test theory about the assumed causal relationships between structure and process variables and related health care outcomes in long-term care.     

Is dietary fat intake related to liking or household availability of high- and low-fat foods?

OBJECTIVE: Despite the increasing availability of low- and reduced-fat foods, Americans continue to consume more fat than recommended, which may be a contributing factor to the obesity epidemic. This investigation examined relationships between liking and household availability of high- and low-fat foods and their association with dietary fat intake. RESEARCH METHODS AND PROCEDURES: A food frequency questionnaire assessed percent calories from fat consumed over the past year in 85 men and 80 women. Participants reported their degree of liking 22 "high-fat foods" (>45% calories from fat) and 22 "low-fat foods" (<18% calories from fat), and the number and percentage (number of high- or low-fat foods/total number of foods x 100) of these high- and low-fat foods in their homes. RESULTS: Hierarchical regression analyses examined the ability of liking and household availability of low- and high-fat foods to predict percent dietary fat intake. After controlling for age, sex, and BMI, liking ratings for high- and low-fat foods and the interaction of liking for low-fat foods by the percentage of low-fat foods in the household were significant predictors of percent dietary fat consumed. Greater liking of high-fat foods and lower liking of low-fat foods, both alone and combined with a lower percentage of low-fat foods in the home, were predictive of higher dietary fat intake. DISCUSSION: Interventions designed to reduce dietary fat intake should target both decreasing liking for high-fat foods and increasing liking for low-fat foods, along with increasing the proportion of low-fat foods in the household.     

Continuous wear silicone hydrogel contact lenses and microbial keratitis

Like other lens types, the new generation of silicone hydrogel contact lenses can be associated with a spectrum of ocular complications. Most tend to be very minor, but serious and sight-threatening complications can occur. We present four such cases with microbial keratitis following extended wear of these lenses. Cultures were positive for Pseudomonas aeruginosa in three cases and all three of these suffered lasting visual impairment. We describe our findings and discuss possible risk factors.