Partner- and partnership-related risk factors for preterm birth among low-income women in Lima,Peru

A woman's partner and the characteristics of their partnership can play an important role in the health of her pregnancy. Yet, with the notable exception of intimate partner violence, there has been little previous research addressing the associations between partner- or partnership-related factors and birth outcomes. This analysis tested the hypothesis that risk factors related specifically to partner or partnership characteristics increased the risk for preterm birth. Between 2003 and 2005, a total of 580 preterm cases (20–36 weeks gestational age at delivery) and 633 term controls (≥37 weeks) were selected from women delivering at an obstetric hospital in Lima, Peru. Each woman completed a confidential, structured interview and provided biological specimens within 48 h after delivery. Multivariable logistic regression was used to assess associations between partner and partnership characteristics and preterm birth. After adjustment for behavioral, demographic, and obstetric risk factors, ever having had a partner with a history of drug use (aOR = 1.91, 95% CI 1.22–2.99), ever having had anal sex (aOR = 1.40, 95% CI 1.07–1.84), having a current partner with a history of visiting prostitutes (aOR = 1.69, 95% CI 1.22–2.33), and perceiving one's current partner as a “womanizer” (aOR = 1.34, 95% CI 1.02–1.77) were significantly associated with an elevated risk of preterm birth when tested in separate models. These four factors were then used to create a composite partnership risk score, which showed an increasing dose-response relationship with preterm birth risk (per additional partner risk factor: aOR = 1.31, 95% CI 1.16–1.49). These results highlight the importance of considering a broader set of risk factors for preterm birth, specifically those related to a woman's partner and partnership characteristics. Further research could clarify the specific mechanisms through which these partner and partnership characteristics may increase the risk of preterm birth.     

Response of lumbar paraspinal muscles spindles is greater to spinal manipulative loading compared with slower loading under length control.

BACKGROUND CONTEXT: Spinal manipulation (SM) is a form of manual therapy used clinically to treat patients with low back and neck pain. The most common form of this maneuver is characterized as a high-velocity (duration <150 ms), low-amplitude (segmental translation <2 mm, rotation <4 degrees , and applied force 220-889 N) impulse thrust (high-velocity, low-amplitude spinal manipulation [HVLA-SM]). Clinical skill in applying an HVLA-SM lies in the practitioner's ability to control the duration and magnitude of the load (ie, the rate of loading), the direction in which the load is applied, and the contact point at which the load is applied. Control over its mechanical delivery is presumably related to its clinical effects. Biomechanical changes evoked by an HVLA-SM are thought to have physiological consequences caused, at least in part, by changes in sensory signaling from paraspinal tissues. PURPOSE: If activation of afferent pathways does contribute to the effects of an HVLA-SM, it seems reasonable to anticipate that neural discharge might increase or decrease in a nonlinear fashion as the thrust duration approaches a threshold value. We hypothesized that the relationship between the duration of an impulsive thrust to a vertebra and paraspinal muscle spindle discharge would be nonlinear with an inflection near the duration of an HVLA-SM delivered clinically (<150 ms). In addition, we anticipated that muscle spindle discharge would be more sensitive to larger amplitude thrusts. STUDY DESIGN/SETTING: A neurophysiological study of spinal manipulation using the lumbar spine of a feline model. METHODS: Impulse thrusts (duration: 12.5, 25, 50, 100, 200, and 400 ms; amplitude 1 or 2 mm posterior to anterior) were applied to the spinous process of the L6 vertebra of deeply anesthetized cats while recording single unit activity from dorsal root filaments of muscle spindle afferents innervating the lumbar paraspinal muscles. A feedback motor was used in displacement control mode to deliver the impulse thrusts. The motor's drive arm was securely attached to the L6 spinous process via a forceps. RESULTS: As thrust duration became shorter, the discharge of the lumbar paraspinal muscle spindles increased in a curvilinear fashion. A concave-up inflection occurred near the 100-ms duration eliciting both a higher frequency discharge compared with the longer durations and a substantially faster rate of change as thrust duration was shortened. This pattern was evident in paraspinal afferents with receptive fields both close and far from the midline. Paradoxically, spindle afferents were almost twice as sensitive to the 1-mm compared with the 2-mm amplitude thrust (6.2 vs. 3.3 spikes/s/mm/s). This latter finding may be related to the small versus large signal range properties of muscle spindles. CONCLUSIONS: The results indicate that the duration and amplitude of a spinal manipulation elicit a pattern of discharge from paraspinal muscle spindles different from slower mechanical inputs. Clinically, these parameters may be important determinants of an HVLA-SM's therapeutic benefit.     

An experiment in medical education. A critical analysis using traditional criteria

In 1984, in addition to its standard traditional curriculum, Rush Medical College (Chicago, Ill) developed a Socratic problem-based method of teaching basic science material called the alternative curriculum. As part of an evaluation of this new curriculum, students in the two curricula were compared using three traditional measurements: (1) test scores from the National Board of Medical Examiners, Part I; (2) test scores from the National Board of Medical Examiners, Part II; and (3) performance on an oral examination. Alternative curriculum students did not differ significantly from their traditional curriculum classmates on National Board of Medical Examiners, Part I and Part II total scores, although their subset scores on Part I did tend to be lower, reaching significance in one subset area. Differences in performance favoring the traditional curriculum were primarily seen in the early years of the program. Alternative curriculum students in the class matriculated in 1987 scored significantly higher in three of five categories on the oral examination.     

A simple nutrition screening tool for hemodialysis nurses.

OBJECTIVE: To assess the reliability of a nurse-performed nutrition screening tool (NST) for hemodialysis (HD) patients to identify nutritionally at-risk patients. DESIGN: Tool reliability assessment. SETTING AND PARTICIPANTS: The setting was nine non-hospital private (n = 3) and public (n = 6) HD units in Australia (two rural and seven metropolitan). Participants were 112 HD patients. RESULTS: A total of 112 HD patients (male = 65, female = 47) from 9 non-hospital HD units in Australia (seven metropolitan and two rural) were screened with the NST and the outcome of dietitian referral compared with Standard Dietitians Assessment. The mean age of patients was 57.6 years. Overall, the NST showed a sensitivity of 0.84 (range, 0.71 to 0.94; P < .05) and a specificity of 0.9 (range, 0.82 to 0.98; P < .05). The NST was more sensitive (sensitivity, 0.93 [range, 0.87 to 0.99; P < .05]) and was more specific for men (specificity, 0.92 [range, 0.85 to 0.99; P < .05]). Specificity was very strong in metropolitan patients (specificity, 0.94 [range, 0.87 to 1.01; P < .05]). CONCLUSIONS: The tool was more sensitive and specific than the NST previously reported by the same investigators. The tool is particularly specific in that it screens those patients not requiring dietitian intervention. The use of this tool may benefit HD units that do not have on-site or regular dietetic support to prioritize patients needing dietitian intervention.     

Perceptions and attitudes of Canadian orthodontists regarding digital and electronic technology.

INTRODUCTION: To plan for future acceptance and implementation of computer-related technology, it is necessary to understand orthodontists' current perceptions and attitudes toward emerging technologies. METHODS: An anonymous, self-administered, mail-out survey of Canadian orthodontists was conducted. The response rate was 45.6% (304/667). RESULTS: Most orthodontists indicated that computer technology could improve current practice efficiency and quality of patient care. Only 15% reported that digital models are quite or very useful; 73.6%, 69.1%, 55%, and 37.4% agreed or strongly agreed with using digital and electronic technology to consult with other dental specialists, other orthodontists, general dentists, and the public, respectively. Cost of the technology was reported as a significant or insurmountable obstacle by 54% of the respondents. Interprovincial legislation, unclear consultation remuneration guidelines, and lack of comfort with the technology were not perceived as significant obstacles. Only 36% reported security or privacy issues as a significant or insurmountable obstacle. CONCLUSIONS: Canadian orthodontists seem to view digital and electronic technology as useful and capable of improving their offices' efficiency and production. Although they are sensitive to some potential obstacles, they are willing to overcome these and incorporate the technology into their practices.