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Increased weight gain and decreased physical activity have been reported in some populations since the coronavirus disease 2019 (COVID-19) pandemic, but this has not been well characterized in pregnant populations.

Background:Rates of gestational diabetes are reported to be increasing in many jurisdictions, but the reasons for this are poorly understood. We sought to evaluate the relative contribution of screening practices for gestational diabetes (including completion and methods of screening) and population characteristics to risk of gestational diabetes in British Columbia, Canada, from 2005 to 2019.Methods:We used a population-based cohort from a provincial registry of perinatal data, linked to laboratory billing records. We used data on screening completion, screening method (1-step 75-g glucose test or 2-step approach of 50-g glucose screening test, followed by a diagnostic test for patients who screen positive) and demographic risk factors. We modelled predicted annual risk for gestational diabetes, sequentially adjusted for screening completion, screening method and risk factors.Results:We included 551 457 pregnancies in the study cohort. The incidence of gestational diabetes more than doubled over the study period, from 7.2% in 2005 to 14.7% in 2019. Screening completion increased from 87.2% in 2005 to 95.5% in 2019. Use of 1-step screening methods increased from 0.0% in 2005 to 39.5% in 2019 among those who were screened. Unadjusted models estimated a 2.04 (95% confidence interval [CI] 1.94–2.13) increased risk of gestational diabetes in 2019 (v. 2005). This increase was 1.89 (95% CI 1.81–1.98) after accounting for the rise in screening completion and 1.34 (95% CI 1.28–1.40) after accounting for changes in screening methods. Further accounting for demographic risk factors (e.g., age, body mass index, prenatal care) had a small impact (increase of 1.25, 95% CI 1.19–1.31).Interpretation:Most of the observed increase in the incidence of gestational diabetes was attributable to changes in screening practices (primarily changes in screening methods) rather than changing population factors. Our findings highlight the importance of understanding variation in screening practices when monitoring incidence rates for gestational diabetes.

Déterminer les risques et les avantages de l'accouchement du siège par voie vaginale planifié par rapport à la césarienne planifiée et recommander des critères de sélection, des paramètres de prise en charge intrapartum et des techniques d'accouchement du siège par voie vaginale.

To discern the risks and benefits of planned vaginal breech birth versus planned Caesarean section and to recommend selection criteria, intrapartum management parameters, and delivery techniques for vaginal breech birth.

Abstract:"Collaboration" has been a part of anthropology from its beginnings, though its early forms were arguably not collaboration as it is currently conceived. In the latter half of the 20th century, however, collaborative research relationships emerged as the research standard when working with marginalized communities, including Indigenous peoples, in response to criticism about the focuses, methodologies, and outcomes of social science research. Although a laudable goal and critical response to unethical and damaging research practices of the past, collaboration has its own weaknesses, and communities and researchers are constrained in their ability to fully realize its benefits. This paper attempts to operationalize principles of good research with Indigenous communities and explore the strengths and weaknesses of three models of research relationship: collaboration, employee-employer, and independent researcher. The conclusion is that all of the principles of good research can be achieved within each of the models, given a careful and committed researcher. There remains a need for a spectrum of relationships from which communities and researchers can choose, depending first and foremost on the wishes of the community, but also considering the constraints of the researcher and the subject of the research. The vilification of research that is not collaborative can narrow the options for research, hamper honesty in representing relationships, place a burden on communities, and erase the possibility of a critical examination of collaboration itself.

To examine trends in the frequency and method (one-step vs. two-step) of gestational diabetes mellitus (GDM) screening in British Columbia (BC), Canada, across subgroups of pregnant individuals in the context of changing local and national clinical practice guidelines.

A belief that prolonged head-to-body delivery interval endangers the newborn underpins the common obstetrical practice of delivering the baby’s trunk immediately after the head is born. Without intervention, however, birth typically occurs in two steps: once the fetal head is delivered there is usually a pause, and the rest of the infant is born with the next contraction. Allowing a two-step delivery does not increase the risk of fetal harm, and may lower the incidence of shoulder dystocia. A two-step approach to delivery should be considered physiologically normal. This has implications for the definition of shoulder dystocia.

In some regions, Aboriginal women have higher rates of cervical cancer compared to other Canadian women. However, little data are available regarding the co-factors of HPV infection in the Aboriginal population of Canada. We examined factors associated with high-risk human papillomavirus (HR-HPV) infection in a population of women (both Aboriginal and non-Aboriginal) in the Northwest Territories (NWT). We used a cross-sectional design using a convenience sample of all women aged 14 years or older presenting for Papanicolaou (Pap) testing across all regions of the NWT from March 2009 to March 2010. Women answered a questionnaire on demographic characteristics, sexual behaviour, and gynaecological and obstetrical events. We used multiple regression analysis to explore factors associated with HR-HPV infection according to age and cultural background. HPV typing was done using the Luminex assay. Of the total 1,279 participants, 178 had missing HPV results. We obtained data on 1,101 women and overall HR-HPV prevalence was 14.2%. Younger age, single marital status, Aboriginal background, current smoking, lifetime deliveries, use of hormonal contraceptives, and the numbers of sexual partners in the last year were associated with prevalent HR-HPV. Our findings tend to indicate that Aboriginal women have different predictors of HR-HPV than non-Aboriginal women that may affect HPV progression to cervical cancer. These findings can help to better target public health practices for the women at higher risk of HPV infection and cervical cancer. Dans certaines régions, les taux de cancer du col utérin des femmes autochtones sont plus élevés que ceux des autres Canadiennes. Il existe cependant peu de données sur les cofacteurs de l’infection à VPH dans la population autochtone du Canada. Nous avons examiné les facteurs associés à un risque élevé d’infection par le virus du papillome humain à haut risque oncogène (VPH-HR) dans une population de femmes (autochtones et non-autochtones) des Territoires du Nord-Ouest (T.N.-O.). Nous avons mené une étude transversale auprès d’un échantillon de commodité de l’ensemble des femmes de 14 ans et plus s’étant présentées pour un test de Papanicolaou (frottis) dans toutes les régions des T.N.-O. entre mars 2009 et mars 2010. Ces femmes ont répondu à un questionnaire sur leur profil démographique, leur comportement sexuel et leurs événements gynécologiques et obstétriques. Au moyen d’une analyse de régression multiple, nous avons étudié les facteurs associés aux infections à VPH-HR selon l’âge et le milieu culturel. Le typage du VPH a été effectué à l’aide de dosages par Luminex. Sur les 1 279 participantes, 178 n’avaient pas de résultats pour le VPH. Nous avons donc obtenu des données sur 1 101 femmes, chez qui globalement la prévalence du VPH-HR était de 14,2 %. La jeunesse, le fait d’être célibataire, les antécédents autochtones, l’usage actuel du tabac, les accouchements durant la vie, l’utilisation de contraceptifs hormonaux et le nombre de partenaires sexuels au cours de la dernière année étaient associés aux infections à VPH-HR prévalentes. Nos constatations tendent à indiquer que les prédicteurs du VPH-HR chez les femmes autochtones sont différents de ceux des femmes non autochtones, ce qui peut influer sur l’évolution du VPH en cancer du col utérin. Ces constatations pourraient contribuer à mieux cibler les pratiques de santé publique à l’égard des femmes plus vulnérables à l’infection à VPH et au cancer du col utérin.

Analyser la physiologie de l’accouchement du siège, discerner les risques et les avantages d’un essai de travail, par comparaison avec la césarienne planifiée, ainsi que recommander (aux obstétriciens, aux médecins de famille, aux sages-femmes, aux infirmières obstétricales, aux anesthésiologistes, aux pédiatres et aux autres fournisseurs de soins de santé) des critères de sélection, des paramètres de prise en charge intrapartum et des techniques d’accouchement pour un essai d’accouchement du siège par voie vaginale.

To review the physiology of breech birth; to discern the risks and benefits of a trial of labour versus planned Caesarean section; and to recommend to obstetricians, family physicians, midwives, obstetrical nurses, anaesthesiologists, pediatricians, and other health care providers selection criteria, intrapartum management parameters, and delivery techniques for a trial of vaginal breech birth.

This study investigated the effect of a study guide on learn ing by nurses using an independent study packet. One experimen tal group (N=18) received the packet with a study guide, another group (N=17) received the same materials without a study guide, and a control group (N=21) completed a post-test only. Both experimental groups had significantly greater mean post-test scores than did the control group, but the mean scores for the two experi mental groups were almost identical. Analysis of variance con ducted with the two experimental groups indicated a significant interaction between method of instruction and type of educational preparation for nursing as well as type of nursing employment. The potential influence of unmeasured and uncontrolled variables made it difficult to conclude that the study guide had no effect on learning. The results of the study suggest, however, that the com ponents of individual methods of adult education should be exam ined carefully to determine whether they are essential to adult learning, and in what form they should be provided if shown to be necessary.