The association between alcohol outlet accessibility and adverse birth outcomes: A retrospective cohort study.

BACKGROUND: Alcohol outlet accessibility is positively associated with alcohol consumption, although this relationship has not been thoroughly examined in pregnant women. The present study examines the relationship between proximity and density of alcohol outlets and risk for low birth weight (LBW: <2,500 grams) and preterm birth (PTB: <37 weeks gestational age), and is the first Canadian study to investigate this association. METHODS: Maternal accessibility to alcohol outlets was specified using a gravity-type measure of accessibility, which provides the amount of accessibility that a given household has to liquor stores within 30-minutes of their home. All singleton newborns without congenital anomalies that were born between February 2009 and February 2014 at London Health Sciences Centre in London, Ontario, were included in this cohort. RESULTS: The sample consisted of 25,734 live births, of which 5.8% were LBW and 7.6% were PTB. Only 2.0% of women reported alcohol use during pregnancy. Alcohol outlet gravity was positively correlated with the percentage of mothers living in poverty (rs = 0.33, p < 0.001) and in single-parent families (rs = 0.39, p < 0.001), and who self-identify as visible minorities (rs = 0.45, p < 0.001). Alcohol outlet gravity increased the odds that mothers drank alcohol during pregnancy (OR 1.05; 95% CI: 1.02, 1.07), although the association was weak. Furthermore, alcohol outlet gravity did not increase the likelihood of a LBW or PTB infant. CONCLUSIONS: Women with high accessibility to alcohol outlets are more likely to consume alcohol during pregnancy, but greater alcohol outlet accessibility does not translate into poor birth outcomes.

Maternal characteristics and satisfaction associated with intrapartum epidural analgesia use in Canadian women.

BACKGROUND: The use of epidural analgesia for intrapartum pain relief has increased over recent decades, with rates varying among developed countries. The objective of this study was to determine the socio-demographic and obstetric characteristics and satisfaction associated with epidural analgesia use for intrapartum analgesia in Canadian women. METHODS: Using the Maternity Experiences Survey of the Canadian Perinatal Surveillance System, a randomly-selected sample of 5350 women who had attempted a vaginal birth was examined, representing 63900 Canadian women. Univariate and multivariate logistic regression models were used to determine the association between socio-demographic and obstetric characteristics and use of epidural analgesia. RESULTS: The rate of epidural analgesia use was 57.3% among women with a trial of vaginal birth. Women with higher education levels (OR 1.12, 95%CI 1.07-1.18) and higher income (OR 1.10, 95%CI 1.05-1.14) were more likely to use epidural analgesia. Women were less likely to use epidural analgesia if they were First Nations (OR 0.77, 95%CI 0.69-0.84), unemployed (OR 0.89, 95%CI 0.81-0.97) or a homemaker (OR 0.86, 95%CI 0.82-0.9), living in a rural area (OR 0.60, 95%CI 0.57-0.63), multiparous (OR 0.32, 95%CI 0.31-0.33) and seeing a midwife, family physician or nurse for prenatal (OR 0.6, 95%CI 0.53-0.67, OR 0.71, 95%CI 0.67-0.74, OR 0.75, 95%CI 0.56-0.99, respectively) and intrapartum care (OR 0.12, 95%CI 0.10-0.14, OR 0.58, 95%CI 0.55-0.61, OR 0.58, 95%CI 0.54-0.63, respectively). Maternal prenatal stressors were associated with epidural analgesia use in a non-linear fashion: compared with women with zero stressful events, women with one stressful event were more likely to use epidural analgesia (OR 1.07, 95%CI 1.02-1.12), but women with two or more events were less likely to use epidural analgesia (OR 0.88, 95%CI 0.84-0.92). Satisfaction with labor was high, regardless of type of analgesia used. CONCLUSIONS: Socio-demographic and obstetric characteristics, combined with a high satisfaction with labor regardless of the method of pain relief, support the existence of smaller rural obstetric centers unable to provide availability of continuous epidural labor analgesia.

Neonatal outcomes are associated with latency after preterm premature rupture of membranes.

OBJECTIVE: To determine factors associated with latency time to birth after preterm premature rupture of membranes (PPROM) and the impact on neonatal outcomes. STUDY DESIGN: Data on singleton pregnancies with PPROM (n=1535 infants) were prospectively collected in a computerized perinatal/neonatal database at a tertiary care perinatal center. Latency was characterized as ≤72h versus >72 h after PPROM. RESULT: The percentage of women with latency to birth >72 h decreased from 67% in very preterm (gestational age (GA) 25 to 28 weeks) to 10% in late preterm women (GA 33 to 36 weeks). PPROM women with latency ≤72 h were more likely to have pregnancy-induced hypertension and birth weight <3%; PPROM women with latency >72 h were more likely to have received steroids and develop clinical chorioamnionitis. PPROM <32 weeks GA with latency ≤72 h was associated with a two-fold higher incidence of severe neonatal morbidity, while PPROM between 29 to 34 weeks GA and latency ≤72 h was associated with a higher incidence of moderate neonatal morbidity. CONCLUSION: A latency period >72 h was associated with a decreased incidence of adverse neonatal outcomes up to 32 weeks GA for severe and 34 weeks GA for moderate morbidity indices.

Communication skills Assessed at OSCE are not Affected by Participation in the Adolescent Healthy Sexuality Program.

PURPOSE: We proposed that first year medical students who voluntarily participated in the Healthy Sexuality adolescent program would perform better than their peers on an adolescent counseling station at the year-end OSCE (Objective Structured Clinical Examination). In addition we compared medical students? communication skills at the time of the program as assessed by self, peers and participating adolescents. METHODS: Nineteen first year medical students voluntarily participated in the ongoing Healthy Sexuality program. Adolescent participants, medical student peer participants and medical students assessed communication comp onents on a 7-point Likert scale at the end of the program. At the year-end OSCE, all first year medical students at the University of Western Ontario were assessed at an adolescent counseling station by a standardized patient (SP) and a physician exa miner. Statistical analysis examined differences between the two groups. RESULTS: Students who participated in the Healthy Sexuality program did not perform better than their colleagues on the year-end OSCE. A statistically significant correlation between physician examiner and SP evaluations was found (r = 0.62). Adolescent participants communication skills assessments in the Healthy Sexuality Program demonstrated no significant correlation with medical student assessments (self or peer). CONCLUSIONS: Voluntary intervention with adolescents did not result in improved communication skills at the structured year-end examination. Further investigation will be directed towards delineating differences between SP and physician examiner assessments.

Serotonin-dependent cerebral activation: effects of methiothepin and other serotonergic antagonists.

In scopolamine-treated (5.0 mg/kg, s.c.) rats hippocampal rhythmical slow activity (RSA) and neocortical low voltage fast activity (LVFA) occur only in close correlation with head movements, spontaneous changes in posture, or locomotion (Type I behavior). Previous work indicates that such scopolamine-resistant RSA and LVFA are dependent on ascending serotonergic projections. A test of 9 serotonergic antagonists (methiothepin; ritanserin; ketanserin; pizotifen; mianserin; pirenperone; ICS-205-930; metoclopramide; methysergide) showed that methiothepin produces a partial reduction in RSA and LVFA in scopolamine-treated rats, while the other antagonists are completely inactive over a wide range of doses. It may be that serotonergic cerebral activation depends on both 5-HT1 and 5-HT2 receptors.