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Objective: Prenatal care is a vital and important part of a healthy pregnancy, providing many maternal and health benefits. Despite Canada's publically funded health care system with universal access, inadequate rates of prenatal care continue to be observed. As a modifiable risk factor, the process variables that influence satisfaction with prenatal care in Canadian settings have received little attention. The objective of this study was to identify the predictors of satisfaction with prenatal care. Methods: A cross-sectional, descriptive, correlational design was used to examine the relationships between expectations, interpersonal processes of care, the quality of prenatal care, personal characteristics, and the type of provider with overall satisfaction, and with four dimensions of satisfaction. A convenience sample of 216 pregnant women was surveyed using self-administered questionnaires with women in their third trimester. Multiple linear regression analyses were used to identify predictors of satisfaction. Results: The quality of prenatal care and provider interpersonal style together explained 80% of the variance in overall satisfaction. Patient-centered decision-making was a significant predictor of satisfaction with information, while having a midwife was a predictor of satisfaction with system characteristics. Expectations were not related to satisfaction. Conclusions for Practice: Improving quality of care, provider interpersonal style and patient-centered decision making, and improving the structural characteristics of prenatal care may be effective in improving women's satisfaction and utilization of prenatal care. [ABSTRACT FROM AUTHOR]

Background. To examine the impact of educational attainment on the incidence of preclinical mobility disability (PCD). Methods. The Women's Health and Aging II Study is a prospective observational cohort study of 436 initially high-functioning community-dwelling women aged 70–79 years at baseline in Baltimore, Maryland. We measured the association of highest attained education level with preclinical mobility disability (PCD) over an 11-year period. PCD is defined as self-reported modification in any of four tasks without reporting difficulty in those tasks. The tasks were walking ½ mile, climbing up steps, doing heavy housework, and getting in/out of bed or chair. Results. Participants with less than 9 years of education were more likely to acquire incident PCD (hazard ratio: 3.1, 95% confidence interval = 1.2–7.7) than their counterparts with more education after adjusting for income, marital status, number of diseases, and high self-efficacy. Conclusions. Lower education level is an independent predictor of incident preclinical mobility disability. This association has important implications for primary and secondary prevention and can be easily assessed in clinical encounters. [ABSTRACT FROM PUBLISHER]

The article presents a study which aims to evaluate the rates of initializing osteoporosis treatment during the hospitalization of patients with acute fragility hip fracture. The study uses analysis of variance (ANOVA) or chi-square tests to assess the differences in the mean age and length of stay (LOS). The results show that osteoporosis treatment rates increases among patients with fragility fracture and can help reduce mortality and morbidity post fracture.

The article presents a study on the relationship between musculoskeletal injuries and anabolic-androgenic steroids. The study is undertaken to investigate the association between anabolic-androgenic steroids and the prevalence of musculoskeletal injuries common to a group of retired professional football players of the National Football League (NFL). It is undertaken through the use of a set of general health questionnaire answered by 2,552 retired professional football players of which survey data are collected. The results of the study are presented which concludes that the relationship between anabolic-androgenic steroid and musculoskeletal injuries may exist.

The article assesses the factors associated with discharge disposition to either inpatient rehabilitation or home after acute stroke hospitalization. The authors found that older age, a greater number of intensive care unit days, higher total therapy charges and lower poverty in their country of residence were associated with discharge to acute inpatient rehabilitation. The authors also report that factors associated with discharge to home included younger age, fewer intensive care unit days, lower therapy charges and higher poverty in their country of residence.

The article evaluates the association of race and acute discharge to inpatient stroke rehabilitation in the state of Maryland. The study used the data from the Maryland Health Services Cost Review Commission database for 2000 in determining the rate of disposition to inpatient rehabilitation facilities. Multiple logistic regression analyses were used to examine factors related with discharge to inpatient rehabilitation facilities in black patients. It was found that urban-dwelling black stroke patients were more likely to be discharged to inpatient rehabilitation facilities acutely after stroke.

The article presents a study that evaluates the connection between race and medical referral to cardiac rehabilitation programs in Baltimore, Maryland. It was revealed that racial disparities exist in recommendation for cardiac rehabilitation programs in city hospitals. White Americans tend to be referred for cardiac treatment than African Americans. Race is noted to be one of the factors that affects the accessibility of adequate health services. Researchers suggest the provision of educational programs to patients and healthcare providers about the services for cardiac rehabilitation initiatives.

A response by Patricia C. Gregory, Thomas A. LaVeist and Crystal F. Simpson to a letter to the editor about their article "Racial Discrimination in Access to Cardiac Rehabilitation" is presented.

The article focuses on acute arterial occlusion, a serious but treatable complication of knee-joint arthroplasty. It claims that its threat from limb ischemia requires prompt evaluation to identify the location of the occlusion. In the case study presented, a prevalence of 0.03-0.17% has been cited in acute arterial occlusion after knee arthroplasty. It is presumed to be caused by the use of tourniquets, which cause pressure on preexisting atheromatous plaques. The use of torniquet is also claimed to produce an ischemic state that lessens blood loss, a clearer operating field, and a better environment for the cement-to-bone interface. Moreover, it resolves that careful monitoring of the neurovascular status of the limb in the postoperative phase is the key to early diagnosis and treatment.

Introduction: Use of substances during pregnancy is a global health concern. Interprofessional care teams can provide an optimal care approach to engage individuals who use substances during the perinatal period. The purpose of this scoping review is to provide a comprehensive summation of published literature reporting on interprofessional care models for perinatal individuals who use substances. Methods: We conducted a systematic search for articles from health-related databases. The Preferred Reporting Items for Systematic Reviews for Scoping Reviews (PRISMA-ScR) was followed. Data were extracted and synthesized to identify the interprofessional care team roles, program and/or provider characteristics, and care outcomes of these models. Results: We screened 645 publications for full text eligibility. Eleven articles met full inclusion criteria and were summarized. Programs were built on co-location of services, partnership with other agencies, available group/peer support and approaches inclusive of cultural care, trauma informed care, and harm reduction principles. Discussion: There is growing evidence supporting integrated care models that are inclusive of relational care providers from multiple health care professions to achieve wraparound care. Conclusions: Many of the interprofessional care models studied have successfully blended social, primary, pregnancy, and addictions care. The success and sustainability of programs varies, and more work is needed to evaluate program and patient outcomes. [ABSTRACT FROM AUTHOR]

A bibliography of reference sources recommended by the Reference and User Services Association (RUSA) is presented which includes "The Encyclopedia of Political Science" edited by George T. Kurian, "Green's Dictionary of Slang" by Jonathan Green, and "The Homer Encyclopedia" edited by Margalit Finkelberg.

Objective: To evaluate the effects of early pregnancy loss on subsequent health care use and costs. Data Sources: Linked administrative health databases from Manitoba, Canada. Study Design: This was a population‐based cohort study. The exposure of interest was first recorded ectopic pregnancy or miscarriage (EPM). Outcomes included visits to all ambulatory care providers, family physicians (FPs), specialists, and hospitals, as well as the costs associated with these visits. We also assessed the impact of EPM on a global measure of health service utilization and the incidence and costs of psychotropic medications. Data Collection/Extraction Methods: We identified women who experienced their first recorded loss (EPM) from 2003–2012 and created a propensity score model to match these women to women who experienced a live birth, with outcome measures available through 31 December 2014. We used a difference in differences approach with multivariable negative binomial models and generalized estimating equations (GEE) to assess the impact of EPM on the aforementioned health care utilization indicators. Principal Findings: EPM was associated with a short‐term increase in visits to, and costs associated with, certain ambulatory care providers. These findings were driven in large part by increased visits/costs to FPs (rate difference [RD]: $19.92 [95% CI: $16.33, $23.51]) and obstetrician‐gynecologists (OB‐GYNs) (RD $9.41 [95% CI: $8.42, $10.40]) in the year immediately following the loss, excluding care associated with the loss itself. We also detected an increase in hospital stays and costs and a decrease in the use of psychotropic medications relative to matched controls. Conclusion: Pregnancy loss may lead to subsequent increases in certain types of health care utilization. While the absolute costs associated with post‐EPM care are relatively small, the observed patterns of service utilization are informative for providers and policy makers seeking to support women following a loss. [ABSTRACT FROM AUTHOR]

Background: Pregnancy loss is common and several factors (e.g. chromosomal anomalies, parental age) are known to increase the risk of occurrence. However, much existing research focuses on recurrent loss; comparatively little is known about the predictors of a first miscarriage. Our objective was to estimate the population-level prevalence of miscarriages and to assess the contributions of clinical, social, and health care use factors as predictors of the first detected occurrence of these losses.Methods: In this population-based cohort study, we used linked administrative health data to estimate annual rates of miscarriage in the Manitoba population from 2003 to 2014, as a share of identified pregnancies. We compared the unadjusted associations between clinical, social, and health care use factors and first detected miscarriage compared with a live birth. We estimated multivariable generalized linear models to assess whether risk factors were associated with first detected miscarriage controlling for other predictors.Results: We estimated an average annual miscarriage rate of 11.3%. In our final sample (n = 79,978 women), the fully-adjusted model indicated that use of infertility drugs was associated with a 4 percentage point higher risk of miscarriage (95% CI 0.02, 0.06) and a past suicide attempt with a 3 percentage point higher risk (95% CI -0.002, 0.07). Women with high morbidity were twice as likely to experience a miscarriage compared to women with low morbidity (RD = 0.12, 95% CI 0.09, 0.15). Women on income assistance had a 3 percentage point lower risk (95% CI -0.04, -0.02).Conclusions: We estimate that 1 in 9 pregnant women in Manitoba experience and seek care for a miscarriage. After adjusting for clinical factors, past health care use and morbidity contribute important additional information about the risk of first detected miscarriage. Social factors may also be informative. [ABSTRACT FROM AUTHOR]

There is reported a clinical case of 37 years-old male patient affected by a Pindborg tumor located in the right side of the maxilar. The opportune detection of this injury was done by a fistolus trayectory in the palatin mucosa. Nevertheless, the relation that this disease has with retained or isolated dental organs make difficult the clinical diferencial diagnostic. [ABSTRACT FROM AUTHOR]

Background Socioeconomic disparities in the use of prenatal care (PNC) exist even where care is universally available and publicly funded. Few studies have sought the perspectives of health care providers to understand and address this problem. The purpose of this study was to elicit the experiential knowledge of PNC providers in inner-city Winnipeg, Canada regarding their perceptions of the barriers and facilitators to PNC for the clients they serve and their suggestions on how PNC services might be improved to reduce disparities in utilization. Methods A descriptive exploratory qualitative design was used. Semi-structured interviews were conducted with 24 health care providers serving women in inner-city neighborhoods with high rates of inadequate PNC. Content analysis was used to code the interviews based on broad categories (barriers, facilitators, suggestions). Emerging themes and subthemes were then developed and revised through the use of comparative analysis. Results Many of the barriers identified related to personal challenges faced by inner-city women (e.g., child care, transportation, addictions, lack of support). Other barriers related to aspects of service provision: caregiver qualities (lack of time, negative behaviors), health system barriers (shortage of providers), and program/service characteristics (distance, long waits, short visits). Suggestions to improve care mirrored the facilitators identified and included ideas to make PNC more accessible and convenient, and more responsive to the complex needs of this population. Conclusions The broad scope of our findings reflects a socio-ecological approach to understanding the many determinants that influence whether or not inner-city women use PNC services. A shift to community-based PNC supported by a multidisciplinary team and expanded midwifery services has potential to address many of the barriers identified in our study. [ABSTRACT FROM AUTHOR]

Background: The reasons why women do not obtain prenatal care even when it is available and accessible are complex. Despite Canada's universally funded health care system, use of prenatal care varies widely across neighborhoods in Winnipeg, Manitoba, with the highest rates of inadequate prenatal care found in eight inner-city neighborhoods. The purpose of this study was to identify barriers, motivators and facilitators related to use of prenatal care among women living in these inner-city neighborhoods. Methods: We conducted a case-control study with 202 cases (inadequate prenatal care) and 406 controls (adequate prenatal care), frequency matched 1:2 by neighborhood. Women were recruited during their postpartum hospital stay, and were interviewed using a structured questionnaire. Stratified analyses of barriers and motivators associated with inadequate prenatal care were conducted, and the Mantel-Haenszel common odds ratio (OR) was reported when the results were homogeneous across neighborhoods. Chi square analysis was used to test for differences in proportions of cases and controls reporting facilitators that would have helped them get more prenatal care. Results: Of the 39 barriers assessed, 35 significantly increased the odds of inadequate prenatal care for inner-city women. Psychosocial issues that increased the likelihood of inadequate prenatal care included being under stress, having family problems, feeling depressed, "not thinking straight", and being worried that the baby would be apprehended by the child welfare agency. Structural barriers included not knowing where to get prenatal care, having a long wait to get an appointment, and having problems with child care or transportation. Attitudinal barriers included not planning or knowing about the pregnancy, thinking of having an abortion, and believing they did not need prenatal care. Of the 10 motivators assessed, four had a protective effect, such as the desire to learn how to protect one's health. Receiving incentives and getting help with transportation and child care would have facilitated women's attendance at prenatal care visits. Conclusions: Several psychosocial, attitudinal, economic and structural barriers increased the likelihood of inadequate prenatal care for women living in socioeconomically disadvantaged neighborhoods. Removing barriers to prenatal care and capitalizing on factors that motivate and facilitate women to seek prenatal care despite the challenges of their personal circumstances may help improve use of prenatal care by inner-city women. [ABSTRACT FROM AUTHOR]

Highlights: [•] The severity of positive symptoms inversely correlated with the serum leptin levels among SZ patients. [•] There was no correlation between leptin levels and negative symptoms or neurocognition. [•] A role of leptin in symptoms of SZ is suggested, in particular SZ positive symptoms. [ABSTRACT FROM AUTHOR]

Background: To examine the impact of educational attainment on the incidence of preclinical mobility disability (PCD).Methods: The Women's Health and Aging II Study is a prospective observational cohort study of 436 initially high-functioning community-dwelling women aged 70-79 years at baseline in Baltimore, Maryland. We measured the association of highest attained education level with preclinical mobility disability (PCD) over an 11-year period. PCD is defined as self-reported modification in any of four tasks without reporting difficulty in those tasks. The tasks were walking ½ mile, climbing up steps, doing heavy housework, and getting in/out of bed or chair.Results: Participants with less than 9 years of education were more likely to acquire incident PCD (hazard ratio: 3.1, 95% confidence interval = 1.2-7.7) than their counterparts with more education after adjusting for income, marital status, number of diseases, and high self-efficacy.Conclusions: Lower education level is an independent predictor of incident preclinical mobility disability. This association has important implications for primary and secondary prevention and can be easily assessed in clinical encounters. [ABSTRACT FROM AUTHOR]

Introduction: the aim was to evalúate the effectiveness of the low powered GaAlAs in the bone calcífication. Methodology: dependent variable bone calcification (acid phosphatase, calcium, collagen and osteoblasts) was selected and the Independent variable, the application of lowpowered Ga-Al-As láser. Twenty four rabbits New Zealand, which develop osteotomies in the vestibular cortical of left maxillar, after application láser radiation, during 7 days, sacrificing the specimens at the 1st, 3rd and 7th week, obtaining corresponding blood samples and sending surgical pieces to histopathology examination. Results: low powered GaAlAs laser, induce a calcification of the bone defects for the periapical lesions or endoperiodontal that provoke resorption and compromise permanence of tooth in the oral cavity of the functional way. Conclusion: low powered GaAlAs laser device is an altemative in endodontics for the induction bone calcification like the periapical lesions, can give more scientific forcefulness over the behavior of the bone neoformation. [ABSTRACT FROM AUTHOR]

Background: The Centers for Disease Control and Prevention’s School Health Index (SHI), a guide for completing a coordinated school-based program needs assessment relative to healthy eating, physical activity, a tobacco-free lifestyle, and prevention of other health risk behaviors and conditions, was used to assess current programming at 3 midwestern middle schools. Methods: Employing somewhat different procedures, data were collected from focus groups comprising school administrators, teachers, parents, community members, and students. Participants responded to SHI module questions and provided comments based on their perceptions. Both quantitative and qualitative data were recorded for each module, after which participants answered 3 planning questions intended to guide prioritization of actions to improve policies and programs based on importance, cost, time, commitment, and feasibility. Results: Each school developed recommendations and strategies based on highest priority needs related to community involvement, professional development, health screenings, and health education materials in classrooms. Conclusions: The experience of completing the SHI in 3 different schools provided important insights about the data collection process as well as assessment results that have implications for the design and implementation of prevention programs. [ABSTRACT FROM AUTHOR]