Limiting adverse birth outcomes in resource-limited settings (LABOR): protocol of a prospective intrapartum cohort study.

Background: Each year, nearly 300,000 women and 5 million fetuses or neonates die during childbirth or shortly thereafter, a burden concentrated disproportionately in low- and middle-income countries. Identifying women and their fetuses at risk for intrapartum-related morbidity and death could facilitate early intervention. Methods: The Limiting Adverse Birth Outcomes in Resource-Limited Settings (LABOR) Study is a multi-country, prospective, observational cohort designed to exhaustively document the course and outcomes of labor, delivery, and the immediate postpartum period in settings where adverse outcomes are frequent. The study is conducted at four hospitals across three countries in Ghana, India, and Zambia. We will enroll approximately 12,000 women at presentation to the hospital for delivery and follow them and their fetuses/newborns throughout their labor and delivery course, postpartum hospitalization, and up to 42 days thereafter. The co-primary outcomes are composites of maternal (death, hemorrhage, hypertensive disorders, infection) and fetal/neonatal adverse events (death, encephalopathy, sepsis) that may be attributed to the intrapartum period. The study collects extensive physiologic data through the use of physiologic sensors and employs medical scribes to document examination findings, diagnoses, medications, and other interventions in real time. Discussion: The goal of this research is to produce a large, sharable dataset that can be used to build statistical algorithms to prospectively stratify parturients according to their risk of adverse outcomes. We anticipate this research will inform the development of new tools to reduce peripartum morbidity and mortality in low-resource settings.

Physical activity patterns during pregnancy.

PURPOSE: The aim of the study was to describe the mode, frequency, duration, and intensity of physical activity among pregnant women, to explore whether these women reached the recommended levels of activity, and to explore how these patterns changed during pregnancy. METHODS: This study, as part of the third phase of the Pregnancy, Infection, and Nutrition Study, investigated physical activity among 1482 pregnant women. A recall of the different modes, frequency, duration, and intensity of physical activity during the past week was assessed in two telephone interviews at 17-22 and 27-30 wk of gestation. RESULTS: Most women reported some type of physical activity during both periods. Child and adult care giving, indoor household, and recreational activities constituted the largest proportion of total reported activity. The overall physical activity level decreased during pregnancy, particularly in care giving, outdoor household, and recreational activity. Women who were active during the second and the third trimesters reported higher levels of activity in all modes of activity than those who became active or inactive during pregnancy. The majority did not reach the recommended level of physical activity. CONCLUSION: These data suggest that self-reported physical activity decreased from the second to the third trimesters, and only a small proportion reached the recommended level of activity during pregnancy. Further research is needed to explore if physical activity rebounds during the postpartum period.

Dissecting the brain's internal clock: how frontal-striatal circuitry keeps time and shifts attention.

The ability of organisms to time and coordinate temporal sequences of events and to select particular aspects of their internal and external environments to which they will attend is vital to the organism's ability to adapt to the world around them. Numerous psychological theories have been proposed that describe how organisms might accomplish such stimulus selection and represent discrete temporal events as well as rhythm production. In addition, a large number of studies have demonstrated that damage to the frontostriatal circuitry appears to compromise the ability of organisms to successfully shift attention and behavior to adapt to changing temporal contexts. This suggests that frontostriatal circuitry is involved in the ability to make such shifts and to process temporal intervals. A selective review is accomplished in this article which focuses upon the specific neural mechanisms that may be involved in interval timing and set shifting. It is concluded that prefrontal cortex, substantia nigra pars compacta, pedunculopontine nucleus, and the direct and indirect pathways from the caudate to the thalamus may provide the neuroanatomical and neurophysiological substrates that underlie the organism's ability to shift its attention from one temporal context to another.