Association of chorioamnionitis and its duration with adverse maternal outcomes by mode of delivery: a cohort study.

OBJECTIVE: To investigate the association of chorioamnionitis and its duration with adverse maternal outcomes by mode of delivery. DESIGN: A retrospective cohort study. SETTING: Data from the Consortium on Safe Labor Study in the USA (2002-2008). POPULATION: Singleton deliveries at ≥23 weeks of gestation (221 274 assessed deliveries, 62 331 by caesarean section). METHODS: The association of chorioamnionitis, and secondarily the duration of chorioamnionitis estimated from intrapartum antibiotic use, with adverse maternal outcomes was analysed using logistic regression with generalised estimating equations, adjusting for age, parity, race, pregestational diabetes, chronic hypertension, gestational age at delivery, study site and delivery year. Analyses were stratified by vaginal versus caesarean delivery. MAIN OUTCOME MEASURES: The composite adverse maternal outcome included: postpartum transfusion, endometritis, wound/perineal infection/separation, venous thromboembolism, hysterectomy, admission to intensive care unit and/or death. RESULTS: Chorioamnionitis was associated with higher odds of the composite adverse maternal outcome with caesarean delivery (adjusted odds ratio 2.31; 95% CI 1.97-2.71); and the association persisted regardless of whether a woman had a trial of labour, preterm delivery or maternal group B streptococcus colonisation. The most common adverse outcomes after caesarean section were postpartum transfusion (56.0%) and wound/perineal infection or endometritis (38.6%). Chorioamnionitis was not associated with adverse maternal outcomes after vaginal delivery. The duration of chorioamnionitis as the exposure did not alter the association between chorioamnionitis and adverse maternal outcomes. CONCLUSIONS: Chorioamnionitis, but not the estimated duration, was associated with increased odds of adverse maternal outcomes with caesarean delivery. This finding has implications for care programmes to prevent maternal morbidity after a caesarean section complicated by chorioamnionitis. TWEETABLE ABSTRACT: Chorioamnionitis, but not its duration, increases the risk of adverse maternal outcomes with caesarean delivery.

Lipoprotein particle concentration measured by nuclear magnetic resonance spectroscopy is associated with gestational age at delivery: a prospective cohort study.

OBJECTIVE: To estimate the association between lipoprotein particle concentrations in pregnancy and gestational age at delivery. DESIGN: Prospective cohort study. SETTING: The study was conducted in the USA at the University of North Carolina. POPULATION: We assessed 715 women enrolled in the Pregnancy, Infection, and Nutrition study from 2001 to 2005. METHODS: Fasting blood was collected at two time points (<20 and 24-29 weeks of gestation). Nuclear magnetic resonance (NMR) quantified lipoprotein particle concentrations [low-density lipoprotein (LDL), high-density lipoprotein (HDL), very-low density lipoprotein (VLDL)] and 10 subclasses of lipoproteins. Concentrations were assessed as continuous measures, with the exception of medium HDL which was classified as any or no detectable level, given its distribution. Cox proportional hazards models estimated hazard ratios (HR) for gestational age at delivery adjusting for covariates. MAIN OUTCOME MEASURES: Gestational age at delivery, preterm birth (<37 weeks of gestation), and spontaneous preterm birth. RESULTS: At <20 weeks of gestation, three lipoproteins were associated with later gestational ages at delivery [large LDLNMR (HR 0.78, 95% CI 0.64-0.96), total VLDLNMR (HR 0.77, 95% CI 0.61-0.98), and small VLDLNMR (HR 0.78, 95% CI 0.62-0.98], whereas large VLDLNMR (HR 1.19, 95% CI 1.01-1.41) was associated with a greater hazard of earlier delivery. At 24-28 weeks of gestation, average VLDLNMR (HR 1.25, 95% CI 1.03-1.51) and a detectable level of medium HDLNMR (HR 1.90, 95% CI 1.19-3.02) were associated with earlier gestational ages at delivery. CONCLUSION: In this sample of pregnant women, particle concentrations of VLDLNMR , LDLNMR , IDLNMR , and HDLNMR were each independently associated with gestational age at delivery for all deliveries or spontaneous deliveries <37 weeks of gestation. These findings may help formulate hypotheses for future studies of the complex relationship between maternal lipoproteins and preterm birth. TWEETABLE ABSTRACT: Nuclear magnetic resonance spectroscopy may identify lipoprotein particles associated with preterm delivery.

Factors influencing law enforcement decisions to adopt an evidence-based robbery prevention program.

Homicide is the leading cause of workplace death among small retail and service businesses in the United States. Evidence-based programs have been shown to reduce robbery and robbery-related crimes in small retail businesses; however, reaching small businesses with programs has been difficult. As small businesses typically have no corporate backing or trade affiliation, police departments have been identified as potential vehicles for program dissemination. A national sample of 300 law enforcement agencies was surveyed to identify facilitators and barriers to adoption and sustainability of an evidence-based program. The questionnaire was developed using behavioral theory concepts and administered via telephone. Preliminary findings suggest the primary facilitators to program adoption included organizational capacity factors such as staff buy-in, dedicated personnel and financial support. Competing responsibilities was the primary barrier identified by agencies. Agency size and program complexity were identified as potential predictors of program adoption. Identifying agency and program-specific characteristics that influence program adoption by law enforcement agencies will be valuable for marketing programs to agencies that have the infrastructure to support and sustain program dissemination. Understanding these factors will optimize the reach of evidence-based strategies to small businesses.

Disability and risk of non-fatal residential injuries among adults.

OBJECTIVE: Many unintentional injuries occur in the home, but little research has considered the specific vulnerability of people with disabilities. DESIGN: Cross-sectional study examining nationally representative data from the 2004-2006 National Health Interview Surveys. SUBJECTS: Adults aged 18 and older who reported having an unintentional, non-motor vehicle-related injury in the home (n = 2189) or outside the home (n = 2072) and those who reported no injuries (n = 81,919) 3 months before their interview. MAIN OUTCOME MEASURE: Non-fatal, unintentional, non-motor vehicle-related injuries. RESULTS: Among respondents experiencing a residential injury, 21.2% reported one type of disability, 11.2% reported two disabilities, and 9.1% reported three or more disabilities. As the number of disabilities increased, the odds of reporting a residential injury increased. Adults with three or more disabilities had three times the odds of reporting a residential injury (adjusted odds ratio = 3.2, 95% CI 2.7 to 3.9), compared with adults reporting no injury. CONCLUSION: The risk of injury in the residential environment among adults with disabilities increases with increasing numbers of disabilities. Attention to home safety issues for residents with disabilities is needed.

Differential strength of association of child injury prevention attitudes and beliefs on practices: a case for audience segmentation.

OBJECTIVE: Many injuries to children cannot be prevented without some degree of active behavior on the part of parents. A better understanding of social and cognitive determinants of parents' injury prevention behavior and the identification of potential subgroups for targeted message delivery could advance the effectiveness of educational and behavioral interventions. This study assessed the degree to which parents' injury prevention behavior is associated with theoretical determinants and examined whether this relation differs by age or birth order of child. DESIGN: Cross sectional observational study. SETTING: Three Midwestern pediatric clinics. SUBJECTS: 594 parents of children ages 0-4 attending routine well child visits. MEASURES: Injury prevention attitudes, beliefs, and practices. RESULTS: Overall, only modest relations were observed between injury beliefs and attitudes and injury prevention behaviors. However, these relations differed substantially by child age and birth order, with stronger associations observed for parents of older first born children. Outcome expectations and social norms were more strongly related to injury prevention behavior among parents of preschool children than among parents of infants and toddlers, while attitudes were more predictive for parents of first born children than parents of later born children. CONCLUSIONS: These findings highlight the complexity of relations between theorized determinants and behavior, and suggest the potential utility of using audience segmentation strategies in behavioral interventions addressing injury prevention.

Prevalence of stimulant use for attentional dysfunction in children with phenylketonuria.

Recent data suggest that children with phenylketonuria (PKU) and poor metabolic control may have an increased prevalence of attentional dysfunction. However, few formal studies have addressed this topic in detail. We reviewed the medical records of 38 school-aged children with early and continuously treated PKU to determine the prevalence of stimulant use for attentional dysfunction, and to determine the relationship between metabolic control and attentional symptoms. Twenty-six per cent of the PKU children used a stimulant medication for attentional dysfunction. This is significantly higher than in an age- and sex-matched control group consisting of children with type I diabetes mellitus (6.5%, p <0.006), and also considerably higher than population norms for attention deficit hyperactivity disorder (ADHD) (5%). We also found a significant relationship between phenylalanine levels and stimulant use or attentional symptoms. Mean plasma phenylalanine concentration was 486 micromol/L in the non-stimulant-using group and 792 micromol/L in the stimulant-using group (p <0.02). Mean phenylalanine concentration was 462 micromol/L in the group not reporting attentional symptoms, and was 702 micromol/L in the symptomatic group (p <0.05). Parents of the stimulant-using children felt that the stimulants were efficacious in treating their child's attentional symptoms. Stimulant use and parent reports of attentional dysfunction are quite common in our PKU patients and appear to be strongly related to higher phenylalanine concentrations.

[Combined surgical procedures in strabismus]. / Interventii chirurgicale combinate în strabologie.

PURPOSE: This is a study about the simultaneous horizon-to-vertical surgery and about the myopexia associated with the horizontal rectus muscles surgery. The aim of this article is to demonstrate necessity of these simultaneous operations into different etiopathogenetical strabismus forms. METHODS: A number of 30 patients were included in the first lot. In this cases we used a simultaneous horizontal and vertical rectus muscles surgery interventions. The second lot--163 patients--has been operated through classical methods on rectus associated with myopexia. RESULTS AND CONCLUSIONS: The action on the etiopathogenetical factors of strabismus explains this favorable results (more than 80% after 6 months) obtained through combinated surgery intervetions. That is why this operations are indicated in any strabismus forms.

[The therapeutic aspects in intermittent divergent strabismus]. / Consideratii terapeutice în strabismele divergente intermitente.

PURPOSE: Is to evaluate the possibilities of treatment in intermittent divergent squint at children and young adults. MATERIALS AND METHOD: We studied an group of 66 patients treated in the University Clinic of Ophthalmology from Cluj-Napoca. RESULTS: The most frequent type of intermiTtent divergent squint (IDS) is the type of excess of divergency (25.76%). In 46.9% the onset was between 2-6 years. In 69.7% visual acuities were equal and stereopsis was present in 74.24%. Hyperopia +/- astigmatism was present in 69.7%. The treatment of intermittent exodeviation was conservative in 51.5% and surgical for first intention in 39.3%. CONCLUSIONS: 1. The most frequent type of intermittent exodeviation is by excess of divergency. 2. The treatment of exodeviation is an optical, orthoptic and surgical treatment. 3. The surgical technique depends on the type of intermittent exodeviation.

[Surgical treatment in strabismus with a vertical component]. / Tratamentul chirurgical în strabismele cu componenta verticala.

In the paper we studied 87 patients with vertical or combined deviations treated in Eye Clinic from Cluj-Napoca between 1994-1998. The most patients show vertical deviation due to inferior muscle overaction (70 patients). 17 patients had a vertical deviation due to another causes (superior oblique paresis, III-nerve paresis and dissociated vertical deviations). We treated vertical deviation due to superior oblique muscle overaction only when was an important deviation in the primary position of gate. In superior muscle paresis we did a superior oblique muscle resection or weaken of inferior oblique muscle secondary overacting. In III-nerve paresis with contralateral superior rectus muscle overaction we did recession of this muscle. The results are favourable: the deviation disappear in the primary position of the gaze and decrease or disappear in the lateral gaze.

[The conservative treatment and evolution of intermittent divergent strabismus]. / Tratamentul conservator si evolutia strabismelor divergente intermitente.

We study 43 children with intermittent exotropia treated in Eye Clinic, Cluj. 83.7% shows excess divergence exotropia and only 16.3% convergence insufficiency exotropia. The children are treated with optical correction, prisms and orthoptics.

[Oculomotor disorders due to general causes]. / Tulburari oculomotorii de cauza generala.

The paper presents the clinical course and the problems appeared in making positive and etiological diagnosis for three cases of oculomotor disorders with diplopia, in adult patients. These are two cases of thyroid ophthalmopathy and one of myasthenia gravis. Atypical evolution in one case of thyroid ophthalmopathy and in that one with myasthenia gravis, made difficult the diagnosis and requested complex investigations.

[Contralateral surgery in palpebral ptosis after common oculomotor nerve paresis]. / Chirurgie contralaterala pentru rezolvarea ptozei palpebrale prin pareza de oculomotor comun.

Congenital palpebral ptosis is a disease which make problems about surgery timing and surgical method used. A child, three years old, presents partial palpebral ptosis at left eye after congenital paresis of the oculomotor common nerve. Ocular statistical exam underlines one deviation by ten degrees and dorsal vergence by fifteen degrees at left eye. After covering the right eye, the left eye assumes fixation and the upper eyelid elevates. On practise liberality of the right superior muscle at the right eye (Faden method and recoil by 5 mm), which establishes the disparition of the left eye deviation and of the ptosis. Orthoptic exam must direct the decision about the surgical method in these situations.

[Prismatic and surgical block in nystagmus]. / Blocarea prismatica si chirurgicala a nistagmusului.

After the speech of some teoretical notions (classification, ethyology, clinical description, treatment) about nystagmus are presented the summaries of dossiers of five patients consultated in our clinic with the diagnostic of nystagmus. At two from them realised the complete blockade at the contractions with prisms and at two from en the partial blockade too with prisms. One of them presenting nystagmus associate with strabismus was surgical solved.

[The incidence of refractive errors in strabismus with an early onset]. / Incidenta viciilor de refractie în strabismele cu debut precoce.

The paper represents one study effected at a number of two hundred and fifty children under three years old, examinated in Ophthalmological Clinic between 1992 and 1995. It was examinated strabismic deviation, visual acuity, state of binocular-eyesight refraction. Most of children (59%) present to hypermetropia under three dioptry; 23.3% medium hypermetropia (3-6 dioptries). Little percentage under 10% present others refraction vices: big hypermetropia, astigmatism, anisometropia, myopia. After optic correction and occlusion, most of deviations remained unaltered requiring surgical subsequent correction. This fact certifys the preponderence of neurogenic pathogenesis and not adjustment in strabismus with precocious debut.

["Baby Vision", the first steps at the Ophthalmological Clinic in Cluj]. / "Bebe Vision", primii pasi în Clinica Oftalmologica din Cluj.

The paper presents a survey done in the Ophthalmological Clinic of Cluj on 140 children, 3 years old, for which the "Baby Vision" was applied. The examination consisted of strabismic angle determination, alternance estimation, visual acuity, stereoscopy, optokinetic nystagmus, refraction and eye fundus investigation. The results, particularities and difficulties in the examination and treatment of those little children are summarized.

[A re-update of the indications for the Fadenoperation and the results obtained]. / Reactualizarea indicatiilor fadenoperatiei si rezultatele obtinute.

The paper presents the clinic's experience regarding the utilization of the Thread operation in strabismus surgery. This surgical technique was done on 27 patients with convergent strabismus for correcting the spastic component of the deviation angle. The post-operation results are promising; the control done one month after the intervention showed in all cases solving of the variable component of the strabismic deviation angle, orthophoria in 17 cases, remaining deviation angle under 5 grades in 8 cases, and above 5 grades in 2 cases.

[New concepts in the approach to congenital strabismus]. / Noi concepte în abordarea strabismului congenital.

The first part of the paper reviews the clinical symptoms of congenital strabismus. Congenital strabismus passes four stages during its evolution. Spontaneous evolution becomes either alternant strabismus (stage IV a) or monolateral strabismus (stage IV b). The early treatment is to direct the evolution to the "a" form of stages III and IV and mainly consists of optical correction and occlusion.

[Clinico-statistical observations on malignant ocular tumors surgically resolved at the Cluj-Napoca Ophthalmological Clinic between 1970 and 1990]. / Consideratii clinico-statistice asupra tumorilor maligne oculare rezolvate chirurgicale în Clinica oftalmologica din Cluj-Napoca între anii 1970-1990.

During the period mentioned above there ware hospitalized 54 patients having epibulbar tumours. The anatomopathological exam which was effectuated for 33 patients hes shown Bowen's disease for 14 cases, spinocellular carcinoma for 15 patients and basocellular for 3 patients. There were 4 cases for epibulbar precancerous. There was retinoblastoma for 19 cases; it had been practiced the enucleation of ocular globe for 17 patients and for two cases it had been practiced the exenteration of the eye socket. At the same period there were 91 uveal melanosis 6 of which having iridial localization, 10 cases of ciliary body [correction of cylar corpus], 75 cases of choroid. The hepatic scintigraphy was practiced for 56 patients and had shown for 8 cases hepatic metastasis. The histopathological exam of the melanomata of ciliary and choroidal corpus had shown type A fusiform cells for 22 cases, type B for 43 cases, epithelioid cells for 6 cases and mixed type cells for 13 cases. The hepatic metastasis were epithelioid cells for all the cases and, for 2 cases there were with mixed type cells, It is necessary an active discovering of intraocular and episcleral malign tumours, for increasing the chance of an earlier diagnosis during a stadium that would be able to be treated as conservator as possible be.

[The serology of toxoplasmosis in uveitis]. / Aspecte ale serologiei toxoplasmozei în uveite.

Determinations for decelerating the antitoxoplasma anticorps that have been effectuated for 696 uveas proved positivity at 123 aerums (17.6%). The repartition of the positive serology concerning the clinic form of the uvea has proved 48 iridocyclitis, 26 serous central corioretinals, 23 in panuveitis, 13 in posterior uveitis, 11 muscular chorioretinitis, 2 in hyalitis. Taking into consideration only the equal or less than 1:160 titrures, these have been at 7 iridocyclitis, 4 serous central chorioretinitis, 4 panuveitis, 3 posterior uveitis and 3 atrophic central chorioretinitis. It is shown that the diagnosis of ocular toxoplasma must be effectuated just corroborating the clinic data with the positive serology. The antiparasitic treatment doesn't influence upon the low titrures of serous anticorps, which generally maintain at the same value all the life.