The rate of obstetric anal sphincter injuries in Finnish obstetric units as a patient safety indicator

Objective

To study whether there are significant differences in the rate of obstetric anal sphincter injuries (OASIS) between the different sized delivery units in Finland.

Study design

The study was performed as a population based registry study in Finland, including all births (294 725) between 2006 and 2010. All the Finnish delivery units (34) were categorized by the number of annual deliveries and the OASIS rate was then compared between the different sized delivery units using a logistic regression analysis adjusting for maternal age and parity. The Robson ten group classification was used for more accurate comparison.

Results

The OASIS rate was significantly elevated, both in the largest units with 5000 annual deliveries or more (OR 1.46, 95% CI 1.11–1.92) and in the smallest units with less than 500 annual deliveries (OR 1.33, 95% CI 1.22–1.45). In the Robson's group 1 (primiparous, single cephalic term pregnancy, spontaneous labour) the risk for OASIS was the highest in the largest units (OR 1.44, 95% CI 1.28–1.61) while in the Robson's group 3 (multiparous, single cephalic term pregnancy, spontaneous labour) the highest risk was found in the smallest units (OR 2.90, 95% CI 1.68–5.02).

Conclusions

There is significant inter-hospital variation in OASIS rates suggesting significant differences in obstetric practices. Robson's ten group classification should be used to enhance the inter-hospital comparison.     

Motivating for infrastructure change: toward a communicatively accessible,participation-based stroke care system for all those affected by aphasia

This paper provides a rationale for changing the base upon which healthcare services for individuals with stroke and aphasia can be provided. It is a nuts-and-bolts summary of the interactions between the Aphasia Institute and the West Greater Toronto Stroke Network who worked together to effect meaningful change. Further, the article provides a practical set of guidelines for others to use, should they wish to effect such change. Learning outcomes: As a result of reading this article, the participant will be able to (1) develop a strong rationale changing the infrastructure related to healthcare services for individuals and families who have incurred stroke and aphasia; (2) describe the activities undertaken at the Aphasia Institute for accomplishing these changes; (3) refer to a practical set of guidelines for effecting infrastructural change.     

Pain and musculoskeletal pain syndromes related to computer and video game use in adolescents

The objective of the present study was to evaluate the presence of pain and musculoskeletal pain syndromes in adolescents and associate them to computer and video game use. A cross-sectional study was performed on the entire adolescent population (n=833) of a private situated in the city of São Paulo. The research included a questionnaire and physical examination of the musculoskeletal system. Statistical analysis was carried out with Fisher, chi-square, Mann Whitney tests and logistic regression. A total of 791 adolescent was evaluated. A computer was used by 99% and video games by 58%. Pain was reported by 312 (39.4%) students: 23% complained of back pain, 9% of upper limb pain, 4% of diffuse pain and 4% of pain in the trapezium muscle. A clinical examination was carried out in 359 students, and one or more musculoskeletal pain syndromes were present in 56 students (15.6%): benign joint hypermobility syndrome in 10%, myofascial syndrome in 5%, tendonitis in 2% and fibromyalgia in 1%. In the multivariate analysis, the logistical regression showed that the independent variables in the prediction of pain were sex [odds ratio (OR): 2.19, 95% confidence interval (95% CI): 1.33–3.61] and age (OR: 1.17, 95% CI: 1.07–1.28) and that the prediction of musculoskeletal pain syndromes were sex (OR: 3.17, 95% CI: 1.69–6.22) and number of days a week using the computer (OR: 1.22, 95% CI: 1.05–1.42). However, the variations in the dependent variables by the mathematical regression models were low. Despite the frequent use of computer and video games among adolescents, this was not associated with the presence of pain and musculoskeletal pain syndromes.     

Factors affecting intake,metabolism and health benefits of phenolic acids: do we understand individual variability?

European Journal of Nutrition - Phenolic acids are important phenolic compounds widespread in foods, contributing to nutritional and organoleptic properties. The bioavailability of these compounds...     

Anaesthesia with remifentanil infusion in diabetic versus non-diabetic patients undergoing vitrectomy. A Holter-controlled study

Diabetic patients are known to have additional risks in surgery. We evaluated haemodynamic profiles, incidence of arrhythmias and post-operative recovery when remifentanil infusion was used for vitrectomies. We compared 22 diabetics with 22 age-matched controls undergoing vitrectomy. ECG Holter monitoring was continued throughout the operation and until 20 hours postoperatively. Autonomic tests including breathing and stand up were performed in the beginning of Holter-monitoring. Anaesthesia was induced with a bolus of remifentanil (1 microg/kg) and continued with 0.4 microg/kg/ h. Thereafter, propofol, 0.5 mg/kg, was given with additional doses of 0.25 mg/kg if needed. Anaesthesia was maintained with 40% oxygen in air and 0.5% isoflurane. After the operation time to obey commands, pain scores, nausea and vomiting, and haemodynamic parameters were registered. Both breathing and stand up tests differed statistically between the groups (p = 0.001 and p = 0.000, respectively). Diabetic patients needed less remifentanil (p = 0.039) than controls. Hypotensive periods were more frequent in diabetic patients (p = 0.013) and they needed more etilefrine than controls (p = 0.014). Holter recordings revealed no ischaemic episodes in either group. Periods of short ventricular and supraventricular extra beats occurred without any clinical relevance in both groups. Time to obey commands or need for pain medicine postoperatively did not differ between the groups. Diabetic patients were haemodynamically more instable with more frequent hypotensive periods during anaesthesia despite of less amount of remifentanil compared to controls. On the other hand, during remifentanil infusion no ischaemic or clinically significant arrhythmic episodes occurred in either group.     

Excitatory action of an immature glycinergic/GABAergic sound localization pathway

Most mammals determine the azimuthal direction of incoming sound using auditory cues arising from differences in interaural sound intensity. The first station in the ascending auditory pathway, which processes interaural intensity differences, is the lateral superior olive (LSO), a binaural nucleus in the auditory brainstem. LSO neurons encode interaural intensity differences by integrating excitatory input from the ipsilateral cochlea and inhibitory input from the contralateral cochlea. Both inputs converge on single neurons in a highly organized, frequency-specific manner. The correct development of the precise arrangement of these inputs and their physiological properties depends on neuronal activity. Previous studies have shown that inhibitory, glycinergic/GABAergic inputs to the LSO are transiently depolarizing, and it has been hypothesized that this depolarizing action enables developing inhibitory inputs to act as excitatory inputs. In support of this hypothesis, we recently demonstrated that depolarizing glycinergic/GABAergic inputs can increase the intracellular calcium concentration in immature LSO neurons and elicit action potentials. These results provide support for the notion that the influence of glycinergic/GABAergic synaptic activity on development of the LSO involves calcium-dependent signaling mechanisms.     

Targeted Screening for Chronic Q Fever,the Netherlands

Early detection of and treatment for chronic Q fever might prevent potentially life-threatening complications. We performed a chronic Q fever screening program in general practitioner practices in the Netherlands 10 years after a large Q fever outbreak. Thirteen general practitioner practices located in outbreak areas selected 3,419 patients who had specific underlying medical conditions, of whom 1,642 (48%) participated. Immunofluorescence assay of serum showed that 289 (18%) of 1,642 participants had a previous Coxiella burnetii infection (IgG II titer >1:64), and 9 patients were suspected of having chronic Q fever (IgG I y titer >1:512). After medical evaluation, 4 of those patients received a chronic Q fever diagnosis. The cost of screening was higher than estimated earlier, but the program was still cost-effective in certain high risk groups. Years after a large Q fever outbreak, targeted screening still detected patients with chronic Q fever and is estimated to be cost-effective.     

Genetic Variants in One-Carbon Metabolism and Their Effects on DHA Biomarkers in Pregnant Women: A Post-Hoc Analysis

The delivery of docosahexanoic acid (DHA) to the fetus is dependent on maternal one-carbon metabolism, as the latter supports the hepatic synthesis and export of a DHA-enriched phosphatidylcholine molecule via the phosphatidylethanolamine N-methyltransferase (PEMT) pathway. The following is a post-hoc analysis of a choline intervention study that sought to investigate whether common variants in one-carbon metabolizing genes associate with maternal and/or fetal blood biomarkers of DHA status. Pregnant women entering their second trimester were randomized to consume, until delivery, either 25 (n = 15) or 550 (n = 15) mg choline/d, and the effects of genetic variants in the PEMT, BHMT, MTHFD1, and MTHFR genes on DHA status were examined. Variant (vs. non-variant) maternal PEMT rs4646343 genotypes tended to have lower maternal RBC DHA (% total fatty acids) throughout gestation (6.9% vs. 7.4%; main effect, p = 0.08) and lower cord RBC DHA at delivery (7.6% vs. 8.4%; main effect, p = 0.09). Conversely, variant (vs. non-variant) maternal MTHFD1 rs2235226 genotypes exhibited higher cord RBC DHA (8.3% vs. 7.3%; main effect, p = 0.0003) and higher cord plasma DHA (55 vs. 41 μg/mL; main effect, p = 0.05). Genotype tended to interact with maternal choline intake (p < 0.1) to influence newborn DHA status for PEMT rs4646343 and PEMT rs7946. These data support the need to consider variants in one-carbon metabolic genes in studies assessing DHA status and requirements during pregnancy.