The effects of early pregnancy loss on health outcomes and health care utilization and costs

ObjectiveTo evaluate the effects of early pregnancy loss on subsequent health care use and costs.Data SourcesLinked administrative health databases from Manitoba, Canada.Study DesignThis was a population‐based cohort study. The exposure of interest was first recorded ectopic pregnancy or miscarriage (EPM). Outcomes included visits to all ambulatory care providers, family physicians (FPs), specialists, and hospitals, as well as the costs associated with these visits. We also assessed the impact of EPM on a global measure of health service utilization and the incidence and costs of psychotropic medications.Data Collection/Extraction MethodsWe identified women who experienced their first recorded loss (EPM) from 2003–2012 and created a propensity score model to match these women to women who experienced a live birth, with outcome measures available through 31 December 2014. We used a difference in differences approach with multivariable negative binomial models and generalized estimating equations (GEE) to assess the impact of EPM on the aforementioned health care utilization indicators.Principal FindingsEPM was associated with a short‐term increase in visits to, and costs associated with, certain ambulatory care providers. These findings were driven in large part by increased visits/costs to FPs (rate difference [RD]: $19.92 [95% CI: $16.33, $23.51]) and obstetrician‐gynecologists (OB‐GYNs) (RD $9.41 [95% CI: $8.42, $10.40]) in the year immediately following the loss, excluding care associated with the loss itself. We also detected an increase in hospital stays and costs and a decrease in the use of psychotropic medications relative to matched controls.ConclusionPregnancy loss may lead to subsequent increases in certain types of health care utilization. While the absolute costs associated with post‐EPM care are relatively small, the observed patterns of service utilization are informative for providers and policy makers seeking to support women following a loss.     

Biotypes and serotypes of thermophilic campylobacters isolated from cattle, sheep and pig offal and other red meats.

In this study we examined 730 faecal samples of offal (mainly liver), mince-meat and sausage meat collected from abattoirs and retail butchers'' shops for campylobacters. Campylobacter jejuni or C. coli were isolated from 30.6, 10.5 and 6% of sheep, cattle and pig offal samples respectively. Specimens collected from abattoirs were, in general, more often contaminated than material obtained from retail butchers'' shops. Only 1.4% of minced meats and sausage meats contained campylobacters. Most isolates (89.5%) were C. jejuni biotype 1 (Skirrow & Benjamin, 1980) of serotypes 1 and 2 (Penner & Hennessy, 1980). This study shows that animal offal is frequently contaminated with C. jejuni of biotypes and serotypes commonly isolated from human beings with campylobacter enteritis.     

Spontaneous rupture of the liver

A patient with systemic lupus erythematosus developed an acute surgical abdomen secondary to spontaneous rupture of the liver and died. Postmortem examination revealed an arteritis of the liver, pancreas, adrenal gland, skeletal muscle, and spleen. It appeared that an arteritis of the liver produced areas of infarction that ruptured and caused the clinical findings.     

Adults in All Body Mass Index Categories Underestimate Daily Energy Requirements

ObjectiveTo compare the difference between self-reported and calculated daily energy requirements of adults within different body mass index (BMI) categories.MethodsAdults (n = 978) self-reported daily energy requirements, demographic information, and height, weight, age, and physical activity level (PAL) to calculate total energy expenditure.ResultsThe main effects of BMI, gender, PAL, and dieting status on the difference between self-reported and calculated energy requirements for weight maintenance were significant (P < .05); age, race/ethnicity, level of education, and being in a health-related field had no effect. Individuals across all BMI categories underestimated their energy requirements, but obese individuals underestimated to the greatest degree. Males, current dieters, and those who reported a low-active or active PAL underestimated to the greatest extent in each category.Conclusions and ImplicationsThere is a lack of basic nutrition knowledge about personal energy needs in individuals across all BMI categories regardless of age, race/ethnicity, level of education, or work/training in a health-related field.     

Smoltification and seawater adaptation in Atlantic salmon (Salmo salar): plasma prolactin, growth hormone, and thyroid hormones

To obtain more information on the role of prolactin and growth hormone during the parr-smolt transformation of Atlantic salmon, a population of fish in fresh water was sampled from January to June during two consecutive years. Gill Na+,K+-ATPase activity increased steadily during smoltification and a plasma thyroxine peak was observed 2-3 weeks before the gill Na+,K+-ATPase peak. On the basis of these two parameters, smoltification was considered complete in our populations in April 1985 and May 1986. Two peaks in plasma growth hormone levels occurred in 1986, one in mid-April and the second in mid-May. In both cases, these peaks coincided with a peak in plasma triiodothyronine and preceded the thyroxine peak by 1-2 weeks. Moreover, the second peak which lasted for 1 month coincided with maximal gill Na+,K+-ATPase activity. A decrease in plasma prolactin levels was observed during smoltification of Atlantic salmon in 2 consecutive years. During this period of decreasing and low plasma prolactin levels, gill Na+,K+-ATPase activity increased to its highest values. Atlantic salmon smolts were also directly transferred into seawater. After 2 days or more in seawater, plasma prolactin levels were not significantly different from those on Day 0, whereas in fresh water they showed large fluctuations. All these data indicate that growth hormone may play an important role in the development of hypoosmoregulatory activity. Increased hypoosmoregulatory ability also appears to be associated with low prolactin levels.     

‘I learned more than from any lecture’ – Indigenous place and space for teaching Indigenous health to physiotherapy students

Background: Australian Indigenous health remains inequitable on a number of health outcomes compared to non-Indigenous Australians. Preventable chronic conditions make up a large proportion of the ‘gap’ in Indigenous health. Physiotherapists have expertise in the management of such conditions and health promotion in the areas of physical activity, pain and symptom management, managing the impact of co-morbidities and promoting self-management. However, there is little published literature regarding effective approaches of teaching Indigenous health to entry-to-practice physiotherapy students.

Objectives: This paper offers insights from an innovative Indigenous pedagogical approach for second year Doctor of Physiotherapy students at the University of Melbourne that explores indigenized place and space in the teaching of Indigenous health.

Major findings: Student feedback indicated that aspects of the session were effective in the context of ‘a productive tension’ evidenced by insightful, constructive, and empathic reflections.

Conclusions: A demonstrated willingness by students to engage with an indigenized place and to engage with the ‘tension’ indicated the shift required in the physiotherapy academic space.     

Stimulation of non-parietal cell secretion in canine Heidenhain pouches by 16,16-dimethyl prostaglandin E2

The permeability effects of topical and intravenous prostaglandin E2 (PGE2) and 16,16-dimethyl prostaglandin E2 (16DM) were studied in canine Heidenhain pouches using an acid-free perfusate, and changes in volume and HCO-3 content of the perfusate were measured. Topical and intravenous 16DM increased the apparent flux of Na+ and Cl-, and stimulated the secretion of fluid containing HCO-3. 16DM stimulates non-parietal cell secretion and therefore the movement of Na+ cannot be interpreted as passive flux in response to changes in permeability.