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To determine if suicide attempts increased during the first year of the pandemic among young adolescents in Quebec, Canada. We analyzed children aged 10–14 years who were hospitalized for a suicide attempt between January 2000 and March 2021. We calculated age-specific and sex-specific suicide attempt rates and the proportion of hospitalizations for suicide attempts before and during the pandemic and compared rates with patients aged 15–19 years. We used interrupted time series regression to measure changes in rates during the first (March 2020 to August 2020) and second (September 2020 to March 2021) waves and difference-in-difference analysis to determine if the pandemic had a greater impact on girls than boys. Suicide attempt rates decreased for children aged 10–14 years during the first wave. However, rates increased sharply during the second wave for girls, without changing for boys. Girls aged 10–14 years had an excess of 5.1 suicide attempts per 10,000 at the start of wave 2, with rates continuing to increase by 0.6 per 10,000 every month thereafter. Compared with the prepandemic period, the increase in the proportion of girls aged 10–14 years hospitalized for a suicide attempt was 2.2% greater than that of boys during wave 2. The pattern seen in girls aged 10–14 years was not present in girls aged 15–19 years. Hospitalizations for suicide attempts among girls aged 10–14 years increased considerably during the second wave of the pandemic, compared with boys and older girls. Young adolescent girls may benefit from screening and targeted interventions to address suicidal behavior. [ABSTRACT FROM AUTHOR]

To synthesize existing evidence on Black-White disparities in the prevalence of severe cardiovascular maternal morbidity. We searched MEDLINE, EMBASE, and CINAHL for observational studies published before July 31, 2021 that compared the risk of severe cardiovascular maternal morbidity between Black and White women. The outcome was severe cardiovascular maternal morbidity, including acute myocardial infarction, peripartum cardiomyopathy, and stroke during pregnancy, delivery, or postpartum. We extracted relevant information including adjusted and unadjusted effect estimates. We used random-effects models to estimate the pooled association between race and severe cardiovascular maternal morbidity, presented as odds ratios with 95% confidence intervals for the comparison of Black women relative to White women. We included 18 studies that met the eligibility criteria for systematic review and meta-analysis. All studies were conducted in the United States and included a total of 7,656,876 Black women and 26,412,600 White women. Compared with White women, Black women had an increased risk of any severe cardiovascular maternal morbidity (adjusted odds ratio, 1.90; 95% confidence interval, 1.54-2.33). Black women were at risk of acute myocardial infarction (adjusted odds ratio, 1.38; 95% confidence interval, 1.14-1.68), peripartum cardiomyopathy (adjusted odds ratio, 1.71; 95% confidence interval, 1.51-1.94), and stroke (adjusted odds ratio, 2.13; 95% confidence interval, 1.39-3.26). Black women have a considerably higher risk of severe cardiovascular maternal morbidity than White women, including acute myocardial infarction, peripartum cardiomyopathy, and stroke. Reducing inequality in adverse cardiovascular outcomes of pregnancy between Black and White women should be prioritized. [ABSTRACT FROM AUTHOR]

We examined long-term outcomes of toxic shock syndrome. We conducted a matched cohort study of 630 patients with toxic shock syndrome and 5009 healthy controls between 2006 and 2021 in Quebec, Canada. Outcomes included hospitalization for renal, cardiovascular, hepatic, and other morbidity during 15 years of follow-up. We estimated adjusted hazard ratios (HR) and 95% confidence intervals (CI) for the risk of these outcomes over time, comparing patients with toxic shock syndrome relative to matched controls. Compared with healthy controls, rehospitalization rates at 15 years were higher for men with toxic shock syndrome (52.0 vs 30.0 per 100) but not for women (38.7 vs 45.6 per 100). In men, toxic shock syndrome was associated with an elevated risk of renal (HR 17.43, 95% CI 6.35–47.82), cardiovascular (HR 2.57; 95% CI 1.52–4.34), and hepatic hospitalization (HR 19.83, 95% CI 4.72–83.34). In women, toxic shock syndrome was associated with renal hospitalization (HR 4.71, 95% CI 1.94–11.45). Streptococcal toxic shock was associated with a greater risk of rehospitalization than staphylococcal toxic shock. Toxic shock syndrome is associated with rehospitalization up to 15 years later, especially in men. These patients may benefit from continued follow-up to prevent long-term morbidity. • We followed 630 patients with toxic shock syndrome over a 15-year period. • Patients had an increased risk of renal, hepatic, and cardiovascular hospitalization. • Streptococcal toxic shock was associated with greater long-term morbidity. • Men were more likely to be hospitalized over time than women. • Patients who recover from toxic shock syndrome may benefit from closer follow-up. [ABSTRACT FROM AUTHOR]

Background: Our objective was to assess whether hyperemesis gravidarum is associated with the risk of endodermal, mesodermal, and ectodermal human chorionic gonadotropin (hCG) receptor+ cancer in women. Methods: We performed a longitudinal cohort study of 1,343,040 women who were pregnant between 1989 and 2019 in Quebec, Canada. We identified women with and without hyperemesis gravidarum and followed them over time to capture incident cancers, grouped by embryonic germ cell layer of origin and organ hCG receptor positivity. We used time-varying Cox regression to model hazard ratios (HR) and 95% confidence intervals (CI) for the association between hyperemesis gravidarum and cancer onset, adjusted for maternal age, comorbidity, multiple gestation, fetal congenital anomaly, socioeconomic deprivation, and time period. Results: Women with hyperemesis gravidarum had a greater risk of endodermal cancer compared with no hyperemesis gravidarum (5.8 vs. 4.8 per 10,000 person-years; HR, 1.36; 95% CI, 1.17-1.57), but not mesodermal or ectodermal cancer. Severe hyperemesis with metabolic disturbance was more strongly associated with cancer from the endodermal germ layer (HR, 1.97; 95% CI, 1.51-2.58). The association between hyperemesis gravidarum and endodermal cancer was driven by bladder (HR, 2.49; 95% CI, 1.37-4.53), colorectal (HR, 1.41; 95% CI, 1.08-1.84), and thyroid (HR, 1.43; 95% CI, 1.09-1.64) cancer. Conclusions: Women with hyperemesis gravidarum have an increased risk of cancers arising from the endodermal germ cell layer, particularly bladder, colorectal, and thyroid cancers. Impact: Future studies identifying the pathways linking hyperemesis gravidarum with endodermal tumors may help improve the detection and management of cancer in women. [ABSTRACT FROM AUTHOR]

Importance: Suicide attempts are prevalent among female youths, yet little is known about the subsequent development of substance use disorders.Objective: To assess the association between suicide attempts among females before 20 years of age and future risk of substance use disorders.Design, Setting, and Participants: In this longitudinal cohort study, females aged 8 to 19 years (hereafter referred to as youths) who attempted suicide were matched with female youths with no attempt between April 1, 1989, and March 31, 2019, in Quebec, Canada. The cohort was followed up for 31 years, for a total of 2 409 396 person-years, to identify subsequent substance use disorders.Exposures: Confirmed suicide attempts among females 8 to 19 years of age.Main Outcomes and Measures: The main outcome measure was hospitalization for a substance use disorder later in life. Hazard ratios (HRs) and 95% CIs for the association of suicide attempt with substance use disorders were estimated using Cox proportional hazards regression models adjusted for baseline age, mental illness, resource-limited socioeconomic status, and year at start of follow-up.Results: Among 122 234 female youths (mean [SD] age, 15.6 [1.9] years), 5840 (4.8%) attempted suicide and 4341 (3.6%) developed a substance use disorder. Compared with the 116 394 matched female youths who did not attempt suicide (95.2%), those who attempted suicide had a greater risk of hospitalization for any substance use disorder during the follow-up period (HR, 6.03; 95% CI, 5.39-6.77), especially sedative or hypnotic use disorders (HR, 32.24; 95% CI, 23.29-44.64). Suicide attempt was associated with the development of sedative or hypnotic use disorders up to 5 years (HR, 66.69; 95% CI, 34.72-128.09), although risks remained elevated up to 3 decades later for all substances. Compared with those without suicide attempt, female youths with 3 or more suicide attempts had 21.20 (95% CI, 13.53-32.90) times the risk of substance use disorders, whereas female youths with 1 attempt had 5.70 (95% CI, 5.08-6.41) times the risk of these disorders.Conclusions and Relevance: In this cohort study, female youths who attempted suicide had increased risk of subsequent substance use disorders compared with female youths who did not attempt suicide. These findings suggest that closer management and prevention of substance use among female youths who attempt suicide may be beneficial. [ABSTRACT FROM AUTHOR]

Second-trimester abortion may result in a live birth, but the extent to which this outcome occurs is unknown. This study aimed to examine rates of live birth after pregnancy termination in the second trimester and identify associated risk factors. We conducted a retrospective cohort study of 13,777 second-trimester abortions occurring in hospital settings between April 1, 1989 and March 31, 2021 in Quebec, Canada. The exposure was induced abortion between 15 and 29 weeks of gestation, including the indication for (fetal anomaly, maternal emergency, other) and use of feticidal injection (intracardiac/intrathoracic or intraamniotic). The primary outcome was live birth following abortion. We measured the rate of live birth per 100 abortions and used adjusted log-binomial regression models to estimate risk ratios and 95% confidence intervals for the association of fetal and maternal characteristics with the risk of live birth. We assessed the extent to which feticidal injection reduced the risk. Among 13,777 abortions between 15 and 29 weeks of gestation, 1541 (11.2%) led to live birth. Fetal anomaly was a common indication for termination (48.1%), and most abortions were by labor induction (72.2%). Compared with abortion between 15 and 19 weeks, abortion between 20 and 24 weeks was associated with 4.80 times the risk of live birth (95% confidence interval, 4.20–5.48), whereas abortion between 25 and 29 weeks was associated with 1.34 times the risk (95% confidence interval, 1.00–1.79). Feticidal injection reduced the risk of live birth by 57% compared with no injection (risk ratio, 0.43; 95% confidence interval, 0.36–0.51). Intracardiac or intrathoracic injection was particularly effective at preventing live birth (risk ratio, 0.02; 95% confidence interval, 0.01–0.07). Second-trimester abortion carries a risk of live birth, especially at 20 to 24 weeks of gestation, although feticidal injection may protect against this outcome. [Display omitted] [ABSTRACT FROM AUTHOR]

Objective: We assessed whether bariatric surgery before pregnancy lowers the risk of severe maternal morbidity to a level comparable to no obesity. Summary of Background Data: Obesity is a risk factor for severe maternal morbidity, but the potential for bariatric surgery to reduce the risk has not been studied. Methods: We analyzed a retrospective cohort of 2,412,075 deliveries between 1989 and 2019 in Quebec, Canada. The main exposure measures were bariatric surgery before pregnancy and obesity without bariatric surgery, compared with no obesity. The outcome was severe maternal morbidity, a composite of life-threatening pregnancy complications. We estimated risk ratios (RR) and 95% confidence intervals (CI) for the association between bariatric surgery and severe maternal morbidity, adjusted for maternal characteristics. Results: A total of 2654 deliveries (0.1%) were in women who had bariatric surgery, and 70,041 (29.0 per 1000) were in women who had severe maternal morbidity. Risk of severe maternal morbidity was not significantly elevated for bariatric surgery (RR 1.20; 95% CI 0.98–1.46), but was greater for obesity compared with no obesity (RR 1.60; 95% CI 1.55–1.64). Bariatric surgery was not associated with morbidities such as severe preeclampsia, sepsis, and cardiac complications compared with no obesity, but obesity was associated with elevated risks of these and other severe morbidities. Bariatric surgery was associated, however, with intensive care unit admission, compared with no obesity. Conclusions: Pregnant women with prior bariatric surgery have similar risks as nonobese women for most types of severe maternal morbidity, except for intensive care unit admission. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text Objectives: Prenatal substance exposure is associated with abnormal visual evoked potentials in offspring, but whether ocular abnormalities are present past infancy is unclear. We determined the association between prenatal substance exposure and hospitalizations for eye disorders in childhood. Methods: We conducted a longitudinal cohort study of 794,099 infants born between 2006 and 2016 in all hospital centers in Quebec, Canada. We identified infants prenatally exposed to opioids, cocaine, cannabis, and other illicit substances and followed them over time to assess eye disorders that required in-hospital treatment, including retinal detachment and breaks, strabismus, and other ocular pathologies. We calculated incidence rates and hazard ratios (HR) with 95% confidence intervals (CI) for the association of prenatal substance exposure with risk of eye disorders, adjusted for patient characteristics. Results: Infants exposed to substances prenatally had a higher incidence of hospitalizations for eye disorders compared with unexposed infants (47.0 vs 32.0 per 10,000 person-years). Prenatal substance exposure was associated with 1.23 times the risk of hospital admission for any eye disorder during childhood compared with no exposure (95% CI 1.04–1.45). Risks were greatest for strabismus (HR 1.55, 95% CI 1.16–2.07) and binocular movement disorders (HR 1.96, 95% CI 1.00–3.83). Opioid use was strongly associated with the risk of ocular muscle disorders (HR 3.15, 95% CI 1.98–5.01). Conclusions: Prenatal substance exposure is significantly associated with future hospitalizations for eye disorders in childhood. Efforts to minimize substance use in women of reproductive age are needed in light of the current opioid epidemic. [ABSTRACT FROM AUTHOR]

• We studied the association between Halloween and risk of myocardial infarction. • We included 54,699 adults with myocardial infarction. • The likelihood of myocardial infarction was higher the day after Halloween. • Excessive junk food at Halloween may lead to myocardial infarction in adults. [ABSTRACT FROM AUTHOR]

Background and Aims The relationship between inflammatory bowel disease in pregnancy and birth defects is not understood. We evaluated whether Crohn's disease and ulcerative colitis in pregnant women were associated with the risk of birth defects in the offspring. Methods We undertook a retrospective cohort study of 2 184 888 pregnancies in Quebec, Canada, between 1989 and 2016. We calculated risk ratios [RR] and 95% confidence intervals [CI] for the association between inflammatory bowel disease and the risk of birth defects, using generalised estimating equations adjusted for maternal characteristics. We assessed associations in the period before 2000, when immunosuppressive biologic therapy and folic acid food fortification were not yet available, compared with the period after 2000 when these interventions were more widespread. Results This study included 13 099 women with Crohn's disease and 7798 with ulcerative colitis. Crohn's disease was associated with 1.90 times [95% CI 1.10–3.28] the risk of abdominal wall defects [gastroschisis, omphalocoele, and diaphragmatic hernia] and ulcerative colitis was associated with 1.53 times [95% CI 1.02–2.30] the risk of central nervous system defects. The association of Crohn's disease with abdominal wall defects was stronger before 2000 [RR 3.62, 95% CI 1.71–7.67] than after 2000 [RR 1.23, 95% CI 0.55–2.75]. Ulcerative colitis was associated with central nervous system defects regardless of time period. Conclusions These findings suggest that inflammatory bowel disease is associated with the risk of abdominal wall and central nervous system defects, and that introduction of immunobiologic medications is unlikely to be associated with added risk. Podcast This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast [ABSTRACT FROM AUTHOR]

Translanguaging claims to advance social justice as a transformative pedagogy. This paper analyses a tension which developed over the life span of a European research project which aimed to improve the educational experience for Eastern European Roma pupils through teachers' employment of a translanguaging pedagogy. Roma are ethnically and linguistically heterogeneous, but as a minority group face continued racism, whilst Roma pupils face educational exclusion. The voices of Roma parents, pupils and activists and academics alerted us to potential threats in utilising translanguaging as a political act for transformation in education. They revealed a central tension between recognition of linguistic pluralism for emancipation at school level (with possibilities for policy level changes at local or national levels) and unifying endeavours for collective action towards equality and human rights at a (trans)national level. To understand this tension we reframed it in light of the postmodernist positioning of translanguaging, and critiques of the de-politicizing tendencies of postmodernism. In proposing a way forward for research and pedagogy, we carve a path between pluralism and collectivism by placing translanguaging pedagogy and associated research into Nancy Fraser's integrative model of recognition and redistribution for transformation. [ABSTRACT FROM AUTHOR]

Women who deliver preterm are at risk of cardiovascular disease, but the reason for the association is unclear. We determined whether vascular disorders during pregnancy explain the association between preterm delivery and future maternal cardiovascular disease. We analyzed a longitudinal cohort of 1 199 364 pregnant women with 19 186 983 person-years of follow-up in Quebec between 1989 and 2017. We calculated incidence rates of myocardial infarction, ischemic stroke, and other cardiovascular hospitalizations. We used multivariable Cox regression to estimate adjusted hazard ratios and 95% CIs for the association of very and moderate preterm delivery with maternal cardiovascular hospitalization. We determined the proportion of the association that was due to preeclampsia, acute cardiac events at delivery, antepartum/postpartum hemorrhage, and heart defects. The incidence of maternal cardiovascular hospitalization was greater for very (43.7 per 10 000 person-years) and moderate (39.4 per 10 000) preterm delivery compared with term delivery (26.2 per 10 000). Very preterm delivery was associated with 1.67× the risk of cardiovascular hospitalization (95% CI, 1.56-1.79), and moderate preterm delivery was associated with 1.51× the risk (95% CI, 1.46-1.56). Vascular disorders during pregnancy explained 26.2% of the association of very preterm delivery and 24.0% of the association of moderate preterm delivery, with cardiovascular hospitalization. Preeclampsia was the largest contributor to these proportions. We conclude that vascular disorders during pregnancy, especially preeclampsia, explain up to a quarter of the association between preterm delivery and future maternal cardiovascular hospitalization. [ABSTRACT FROM AUTHOR]

Importance: Bulimia nervosa is associated with short-term cardiovascular complications in women, but its long-term consequences on cardiovascular health are unknown.Objective: To study the association of bulimia nervosa with the long-term risk of cardiovascular disease and mortality in women.Design, Setting, and Participants: In this longitudinal cohort study, 416 709 women hospitalized in Quebec, Canada, including women hospitalized for bulimia nervosa and those for pregnancy-related events as a comparison group, were followed up for 12 years from 2006 to 2018 to identify incidences of cardiovascular disease and death.Exposures: At least 1 hospitalization for bulimia nervosa.Main Outcomes and Measures: The study participants were followed up to identify future incidences of cardiovascular disease and deaths. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs to assess the association of bulimia nervosa with future outcomes after adjustment for patient characteristics.Results: The study population comprised 818 women who were hospitalized for bulimia nervosa (mean [SD] age, 28.3 [13.4] years) and 415 891 hospitalized for pregnancy-related events (mean [SD] age, 28.3 [5.4] years). Patients were followed up for a total of 2 957 677 person-years. The women hospitalized for bulimia nervosa had a greater incidence of cardiovascular disease compared with those hospitalized for pregnancy-related events (10.34 [95% CI, 7.77-13.76] vs 1.02 [95% CI, 0.99-1.06] per 1000 person-years). Incidence of future cardiovascular disease was even higher for women with 3 or more bulimia admissions (25.13 [95% CI, 13.52-46.70] per 1000 person-years). Women hospitalized for bulimia nervosa had 4.25 (95% CI, 2.98-6.07) times the risk of any cardiovascular disease and 4.72 (95% CI, 2.05-10.84) times the risk of death compared with women hospitalized for pregnancy-related events. Bulimia nervosa was found to be associated with ischemic heart disease (HR, 6.63; 95% CI, 3.34-13.13), atherosclerosis (HR, 6.94; 95% CI, 3.08-15.66), and cardiac conduction defects (HR, 2.99; 95% CI, 1.57-5.71). Bulimia was also associated with 21.93 (95% CI, 9.29-51.74) times the risk of myocardial infarction at 2 years of follow-up and 14.13 (95% CI, 6.02-33.18) times the risk at 5 years of follow-up.Conclusions and Relevance: This study's findings suggest that bulimia nervosa may be associated with the long-term risk of any cardiovascular disease, such as ischemic cardiac events and conduction disorders, as well as with death among women. The findings also suggest that women with a history of bulimia nervosa should be screened regularly for ischemic cardiovascular disease and may benefit from prevention of and treatment for cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Severe maternal morbidity is a composite indicator of maternal health and obstetrical care. Little is known about the risk of recurrent severe maternal morbidity in a subsequent delivery. This study aimed to estimate the risk of recurrent severe maternal morbidity in the next delivery after a complicated first delivery. We analyzed a population-based cohort study of women with at least 2 singleton hospital deliveries between 1989 and 2021 in Quebec, Canada. The exposure was severe maternal morbidity in the first hospital-recorded delivery. The study outcome was severe maternal morbidity at the second delivery. Log-binomial regression models adjusted for maternal and pregnancy characteristics were used to generate relative risks and 95% confidence intervals comparing women with and without severe maternal morbidity at first delivery. Among 819,375 women, 43,501 (3.2%) experienced severe maternal morbidity in the first delivery. The rate of severe maternal morbidity recurrence at second delivery was 65.2 vs 20.3 per 1000 in women with and without previous severe maternal morbidity (adjusted relative risk, 3.11; 95% confidence interval, 2.96–3.27). The adjusted relative risk for recurrence of severe maternal morbidity was greatest among women who had ≥3 different types of severe maternal morbidity at their first delivery, relative to those with none (adjusted relative risk, 5.50; 95% confidence interval, 4.26–7.10). Women with cardiac complication at first delivery had the highest risk of severe maternal morbidity in the next delivery. Women who experience severe maternal morbidity have a relatively high risk of recurrent morbidity in the subsequent pregnancy. In women with severe maternal morbidity, these study findings have implications for prepregnancy counseling and maternity care in the next pregnancy. [Display omitted] [ABSTRACT FROM AUTHOR]

Objectives: We investigated trends in cannabis-related hospitalizations among youth before and after legalization of recreational cannabis in Canada on October 17, 2018. Methods: We computed rates of cannabis-related hospitalizations and the proportion of substance-related hospitalizations involving cannabis by age and sex in the months before and after legalization in Quebec, Canada. Results: In boys aged 10 to 14 years, cannabis-related hospitalization rates increased from 5.2 per 100,000 one year before legalization [95% confidence interval (CI) 2.9-9.3] to 9.5 per 100,000 after legalization (95% CI 6.2-14.6), although the increase was not statistically significant. Cannabis was reported in 39.3% of substance-related hospitalizations in boys aged 10 to 14 years before legalization, compared with 70.0% after legalization, representing a difference of 30.7% (95% CI 2.8-58.6). There was no increase in cannabis-related hospitalizations among girls or boys aged 15 to 19 years. Conclusions: This study suggests that cannabis legalization in Canada did not increase the risk of short-term cannabis-related hospitalization among girls and older boys. However, legalization may have contributed to an increase in the risk in boys under 15 years. Further data are needed to clarify trends after legalization for younger adolescents. [ABSTRACT FROM AUTHOR]

Background Environmental noise exposure is associated with a greater risk of hypertension, but the link with preeclampsia, a hypertensive disorder of pregnancy, is unclear. Objectives We sought to determine the relationship between environmental noise pollution and risk of preeclampsia during pregnancy. Methods We analyzed a population-based cohort comprising 269,263 deliveries on the island of Montreal, Canada between 2000 and 2013. We obtained total environmental noise pollution measurements (LA eq24 , L den , L night ) from land use regression models, and assigned noise levels to each woman based on the residential postal code. We computed odds ratios (OR) and 95% confidence intervals (CI) for the association of noise with preeclampsia in mixed logistic regression models with participants as a random effect, and adjusted for air pollution, neighbourhood walkability, maternal age, parity, multiple pregnancy, comorbidity, socioeconomic deprivation, and year of delivery. We assessed whether noise exposure was more strongly associated with severe or early onset preeclampsia than mild or late onset preeclampsia. Results Prevalence of preeclampsia was higher for women exposed to elevated environmental noise pollution levels (LA eq24h  ≥ 65 dB(A) = 37.9 per 1000 vs. <50 dB(A) = 27.9 per 1000). Compared with 50 dB(A), an LA eq24h of 65.0 dB(A) was not significantly associated the risk of preeclampsia (OR 1.09, 95% CI 0.99–1.20). Associations were however present with severe (OR 1.29, 95% CI 1.09–1.54) and early onset (OR 1.71, 95% CI 1.20–2.43) preeclampsia, with results consistent across all noise indicators. The associations were much weaker or absent for mild and late preeclampsia. Conclusions Environmental noise pollution may be a novel risk factor for pregnancy-related hypertension, particularly more severe variants of preeclampsia. [ABSTRACT FROM AUTHOR]