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Background: Open appendectomy, laparoscopic appendectomy, and non-surgical treatment are three options to treat acute appendicitis during pregnancy. Previous studies on the association of different treatment methods for acute appendicitis with pregnancy outcomes have been limited by small sample sizes and residual confounding, especially with respect to hospital-level factors. This study aimed to investigate the association of treatment method for acute appendicitis with pregnancy outcomes using a multi-level analysis. Methods: A retrospective cohort study was conducted based on a large electronic health records database in the United States during the period 2000 to 2016. All pregnancies diagnosed with acute appendicitis and treated in participating hospitals during the study period were included. We conducted multi-level hierarchical logistic regression to analyze both individual- and hospital-level factors for abortion, preterm labor, and cesarean section. Results: A total of 10,271 acute appendicitis during pregnancy were identified during the study period. Of them, 5,872 (57.2%) were treated by laparoscopic appendectomy, 1,403 (13.7%) by open appendectomy, and 2,996 (29.2%) by non-surgical treatment. Compared with open appendectomy, both laparoscopic appendectomy (adjusted OR, 0.6, 95% CI, 0.4, 0.9) and non-surgical treatment (adjusted OR, 0.4; 95% CI, 0.3–0.7) showed a decreased risk of preterm labor. Other important individual-level determinants of adverse pregnancy outcomes included maternal age, gestational hypertension, and anemia during pregnancy, the hospital-level determinant included the number of beds. Conclusions: Compared with open appendectomy, both laparoscopic appendectomy and non-surgical treatment may be associated with a lower risk of preterm labor, without increased risks of abortion and cesarean section. [ABSTRACT FROM AUTHOR]

Religious nonaffiliates who have high certainty in the existence of God or a higher power (theistic nones) have grown rapidly in size in the U.S. in the last 30 years, and are now the fourth largest American religious or secular category. This subgroup has been overlooked in prior research on religion, secularism, and health. We build on recent work on religion and health by distinguishing between atheists, agnostics, and nonaffliliated theists when examining the link between religious or secular identification and self-rated health. Specifically, we advance research on the heterogeneity of secular individuals and health by splitting nonaffiliated theists into two subgroups: those who report certainty in their beliefs about God or some higher power (i.e., theistic nones), and those who are less certain about their beliefs in God (i.e., doubting nones). We analyze 13 waves (1988–2018) of pooled data (N = 15,349) from the General Social Survey (GSS), a large, recurring, and nationally-representative sample of U.S. adults conducted on a periodic basis. Using the GSS, we assessed self-rated health across religious and secular categories in a well-controlled model. When compared with conservative Protestants, theistic nones and atheists had significantly higher levels of self-rated health, whereas agnostics and low-certainty nonaffiliated theists (doubting nones) did not report significantly higher levels of self-rated health. This study adds to previous research by differentiating between theistic and doubting nones among nonaffiliated theists in relation to overall health differences. The results suggest that the level of certainty in beliefs about God or a higher power are an important factor among religious nones for predicting health outcomes. These findings highlight the necessity of analyzing heterogenous subgroups within secular populations in studies of health and well-being. [ABSTRACT FROM AUTHOR]

Background: To compare quality of life of patients treated with cetuximab with or without radiation therapy (±RT) vs. cisplatin±RT for locoregionally advanced squamous cell carcinoma of the head and neck (SCCHN) in the real-world setting.Methods: In this retrospective observational study, electronic medical records and Patient Care Monitor (PCM) survey data from the Vector Oncology Data Warehouse were utilized from adult patients in the United States who received initial treatment with cetuximab±RT or cisplatin±RT for locoregionally advanced SCCHN between January 1, 2007 and January 1, 2017. Quality of life was assessed using PCM index scores and individual PCM items. Cetuximab±RT and cisplatin±RT cohorts were balanced using propensity score weighting. Linear mixed models were used to assess the impact of baseline demographic and clinical characteristics on PCM endpoints.Results: Of 531 patients with locoregionally advanced SCCHN, 187 received cetuximab±RT, and 344 received cisplatin±RT. Before propensity score weighting, the cetuximab±RT cohort was older (mean [SD] age of 63.9 [9.6] years vs. 57.4 [8.6] years), and more likely to be white (82.4% vs. 72.4%) compared to the cisplatin±RT cohort. After propensity score weighting, the two cohort subsamples (cetuximab±RT, N = 60; cisplatin±RT, N = 177) with PCM data showed no significant differences in General Physical Symptoms, Treatment Side Effects, Impaired Ambulation, or Impaired Performance index scores. Patients in the cetuximab±RT cohort had higher Acute Distress index (p = 0.023), Despair index (p = 0.011), and rash (p = 0.003) scores but lower numbness/tingling scores (p = 0.022) than patients in the cisplatin±RT cohort.Conclusions: Significant group differences were observed in this comparative analysis, as the cetuximab±RT cohort had significantly higher Acute Distress index, Despair index, and rash scores compared with the cisplatin±RT cohort but lower numbness/tingling scores. These patterns of symptoms appear consistent with previously reported symptoms associated with the treatment of SCCHN. [ABSTRACT FROM AUTHOR]

Fulvestrant monotherapy is approved for postmenopausal women with hormone receptor‐positive, metastatic breast cancer (MBC) who progressed following antiendocrine therapy, or those with hormone receptor‐positive, human epidermal receptor 2‐negative advanced breast cancer (BC) not previously treated with endocrine therapy (ET). However, real‐world data are lacking. Retrospective reviews of 10 United States community oncology practices identified patients diagnosed with MBC between 1 January 2011 and 31 December 2015 who received fulvestrant as the first ET, either as initial therapy for metastatic disease or after progression following one line of chemotherapy. Endpoints were progression‐free survival (PFS) and overall survival (OS). Patients were classified as ET‐naïve or by relapse status following adjuvant ET ("early" recurrence during or ≤12 months of completing adjuvant ET, or "late" >12 months after completing adjuvant ET). Outcomes were evaluated using Kaplan‐Meier methods. Among 121 patients, median PFS (95% confidence interval) was 8.3 months (4.8‐12.3) for early relapse, 15.4 months (10.2‐21.2) for late relapse, and 18.7 months (10.1‐20.8) among ET‐naïve patients (P =.018). Median OS was 39.8 months (25.0‐55.1) for early relapse and 61.4 months (47.1‐61.4) for late relapse, but was not reached (NR; 55.6–NR) for ET‐naïve patients (P =.002). Fulvestrant monotherapy as the first ET after MBC diagnosis demonstrates PFS comparable to clinical study results; outcomes appeared better in patients without prior ET exposure and in patients with disease recurrence >12 months following adjuvant ET. These findings support fulvestrant monotherapy in patients with hormone receptor‐positive MBC. [ABSTRACT FROM AUTHOR]

Objective: We evaluate whether strong associations between unmet need and work interruption observed among informal elder caregivers are explained by caregiver personal characteristics, caregiving situations, or diminished caregiver well-being. Method: We analyze a proprietary survey of informal elder caregivers conducted by a single large U.S. employer (N = 642 caregivers). Results: Unmet need was about twice as common among those experiencing mild (29.79%) or severe interruption (35.00%) relative to those who did not interrupt work (16.87%). Although caregiver characteristics and aspects of caregiving situation show links to either unmet need or work interruption specifically, the association between unmet need and work interruption was not explained by these factors, or by caregiver well-being. Discussion: Needs-related work interruptions may arise by other workplace processes, such as organizational culture, that should be measured and tested explicitly by future research. [ABSTRACT FROM AUTHOR]

The aging of the academic workforce is becoming more relevant to policy discussions in higher education. Yet there has been no formal, large-scale analysis of institutional efforts to develop policies and programs for aging employees. We fielded a representative survey of human resource specialists at 187 colleges and universities across the United States and found that most institutions did not identify the aging workforce as a primary concern. Still, three out of every eight campuses had made some effort to implement age-targeted policies and programs; and these efforts were more likely to occur at institutions with a greater number of employees and with human resources staff who had training in issues related to an aging workforce. [ABSTRACT FROM AUTHOR]

This article focuses on the organizational factors of environmental sustainability implementation in local government. We investigate the interactions, as well as direct and indirect impacts, of the framing of environmental sustainability and organizational culture and structure on implementation outcomes. We use a survey of 217 city/county planners and managers in 146 randomly selected American mid-sized cities and counties. The survey was specifically designed to tease out organizational features and their impacts. We model these impacts using structural equation modeling. We find that horizontally and vertically integrated organizational structure supports two essential dimensions of organizational culture: innovation adoption and consensus building. These cultural traits positively impact the framing of environmental sustainability at the core of organizations’ logic, which in turn significantly supports implementation outcomes. These findings provide important insights into city/county managers seeking to promote sustainability, and provide a base for future studies of the organizational factors of implementation. [ABSTRACT FROM PUBLISHER]

The bombshell arrest of Ivan Boesky on November 14, 1986 signaled the intention of then-US attorney for the southern district of New York, Rudy Giuliani, to increase enforcement of laws against insider trading. Looking at concurrent stock price changes, we find that New York companies were affected especially. More interestingly, New York firms with active political arms fared better than those without them; and New York firms connected to Mr. Giuliani's Republican Party fared better still. We find no such effects for non-New York firms. These findings suggest that political connectedness was valuable in the era of more rigorous legal enforcement associated with Mr. Giuliani's attack on insider trading. [ABSTRACT FROM AUTHOR]

In the arid western United States, wildlife water developments, or "guzzlers," are important water sources for wildlife, and consist of impermeable roof structures designed to intercept precipitation and small tanks for storing water. Guzzlers are typically installed in remote mid- to high-elevation basins, where precipitation data are often scarce. In this study, small-game guzzlers were examined for feasibility as potential sites for improving estimates of climatic parameters in remote Nevada catchments. Instruments measuring liquid precipitation and water level were installed at two guzzler field sites. Although one field site was vandalized during the study, field results indicated that water levels in the tank measured by Hobo pressure transducers corresponded well with precipitation events measured by the Texas Electronics tipping-bucket rain gauge, and that measured data were similar to Parameter-Elevation Regressions on Independent Slopes Model (PRISM) estimates. Minimum temperatures from the guzzler sites were similar to PRISM; however, maximum temperatures were a few degrees higher, possibly because temperature sensors were unshielded. With over 1600 guzzlers in Nevada and thousands more throughout the western United States, this study initiates exploration of the feasibility of augmenting individual guzzler sites to enhance climatic monitoring at a relatively low cost to improve the quality and density of climate observations, benefitting hydrologists, climatologists, and wildlife managers. [ABSTRACT FROM AUTHOR]

Abstract: Between 1997 and 2002, 16 cases of acute childhood leukemia were diagnosed in children who either lived in Churchill County, Nevada at the time of diagnosis or had lived in the county before their diagnosis. The cases were characterized as a cluster of like illnesses and the probability of having such a cluster occur by chance was estimated to be very small (approximately one in 2.33×108). This suggested that the cluster could be linked to one or more physical, limnological, chemical, or biological agents. This review discusses the setting in which the cluster took place, the epidemiological investigations carried out by the Nevada Bureau of Health Protection Services, the National Center for Environmental Health Centers for Disease Control and Prevention and the Agency for Toxic Substances and Disease Registry, and subsequent investigations supported by a special allocation of federal funds through the US Environmental Protection Agency’s Region IX office in San Francisco, CA. This review is meant as background for the papers in this special issue that report results from multi- and interdisciplinary research into environmental and biological factors potentially related to the Churchill County leukemia cluster. [Copyright &y& Elsevier]

Approximately one in six persons in the U.S. lacks medical insurance. Legislation permits only physicians to prescribe many common medicines. This state of affairs is unjust. A just society cannot have it both ways: legislation cannot say that the expertise of physicians is so precious that only they can prescribe medicine and that not everyone is guaranteed reasonable access to their services. If there is no guarantee of reasonable access, then physicians should not have a monopoly on writing prescriptions, and if there is a monopoly on writing prescriptions then people should have reasonable access to their services. To remedy this situation we must ensure that all citizens have reasonable access to medical services, or allow the uninsured to self-medicate. [ABSTRACT FROM AUTHOR]

The article focuses on the experiment given to students of variety of ages about candle burning in the U.S. According to the author, the lesson began with the teacher posing a simple and tricky question "How does candle work?" though this question seemed to be easy to answer, however, most students would realize that they do not know how and why candles burn. In this experiment, students were also asked to observe the candle flaming and later on the teacher will ask students to share their ideas through a class discussion. The aim of the experiment is to help students find this process for themselves using good questioning and develop explanations for the phenomena.

Objective: To examine the association between maternal age, paternal age, and new-onset hypertension in late pregnancy. Methods: We carried out a retrospective cohort study of 9,302,675 pregnant women with live births in the United States between 1995 and 1998. Maternal and paternal ages were analyzed together using “couple age” in multivariate logistic regression models to reduce colinearity between maternal age and paternal age. The effect of paternal age was also analyzed with stratification of maternal age. Results: Compared with couples with both a maternal and paternal age of 20 to 34 years, an older maternal age (above 35 years) was associated with an increased risk for new-onset hypertension, except for couples with a very young father (below 20 years). Younger maternal age (below 20 years) was associated with a decreased risk for new-onset hypertension, except for couples with a very old father (above 45 years). There was no significant association between paternal age and new-onset hypertension with stratification of maternal age. Conclusion: Increased risk for new-onset hypertension in late pregnancy is significantly associated with advancing maternal age, whereas there is no association between paternal age and new-onset hypertension in late pregnancy. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to identify the gestational age with the lowest morbidity and mortality rates for twin pregnancies that reach term. Study design: A retrospective cohort study carried out with 60,443 twin pairs from the United States (1995–1997). Analysis was restricted to pregnancies that had reached at least 37 weeks of gestation; groups were created on the basis of the gestational ages of 37, 38, 39, and ≥40 weeks. The incidence of death and morbidity were calculated; multiple logistic regression models were used to estimate the independent effect of gestational age for twin A and B. Results: The neonatal mortality rate increased significantly after 40 weeks of gestation (twin A: odds ratio, 3.47 [95% CI, 2.29, 5.38]; twin B, odds ratio, 2.52 [95% CI, 1.75, 3.67]). There was also an increased risk of neonatal morbidity in the >40 weeks of gestation group for twin A and B (Apgar score, ≤3; odds ratio, 1.88 [95% CI, 1.18, 3.02], 1.74 [95% CI, 1.21, 2.52], respectively). There was a decreased risk of assisted ventilation in the 38 and 39 weeks of gestation group for twin A (odds ratio, 0.86 [95% CI, 0.77, 0.97], odds ratio, 0.83 [95% CI, 0.72, 0.95], respectively) and a decreased risk in the 39 and >40 weeks of gestation groups for twin B (assisted ventilation: odds ratio, 0.83 [95% CI, 0.73, 0.93], odds ratio, 0.81 [95% CI, 0.72, 0.92], respectively). Conclusion: This study suggests that the optimal date of delivery for twins should be <40 weeks of gestation; there was no compelling evidence for delivering at <38 weeks of gestation. [ABSTRACT FROM AUTHOR]

Study objective: To analyse the contextual effect of area poverty rate on never having been screened for breast, cervical, and colorectal cancer by (1) describing the extent of the variation in screening behaviours among 98 US metropolitan areas; (2) determining if the variation in lack of screening can be explained by differences in the characteristics of the persons who resided in these areas; and (3) determining if living in a metropolitan area with a higher poverty rate increased the likelihood of never having been screened for cancer over and above individual characteristics. Design: Cross sectional survey using data from the 2002 Behavioral Risk Factor Surveillance System. Multilevel logistic regression included both individual level factors as well as area poverty rate. Setting: Ninety eight areas across the USA. Participants: Over 118 000 persons residing in 98 areas; a sample aimed at estimating 48.3% of the US population age 18 or older. Main results: After adjustment for individual level factors, increasing area level poverty rate (per 5%) remained associated with never having had a mammogram (odds ratio (OR)= 1.28, 95% confidence interval (CI): 1.03 to 1.37); clinical breast examination (OR = 1.28, 95% CI: 1.11 to 1.48), colonoscopy/sigmoidoscopy (OR= 1.10, 95% CI: 1.01 to 1.19), and a faecal occult blood test (OR= 1.19, 95% CI: 1.12 to 1.27). Poverty rate was not independently associated with never having had a Pap smear (OR = 1.12; 95% CI: 0.90 to 1.41). The size of the variance among metropolitan or micropolitan statistical areas (MMSAs) varied by type of screening test, with intraclass correlation coefficients ranging from 4.9% (never having had a Pap smear) to 1.2% (never having had o colonoscopy/sigmoidoscopy). Conclusions: Area poverty rate was independently associated with never having been screened for breast and colorectal cancer, but not cervical cancer. The size of the variance among MMSAs was modest at best. [ABSTRACT FROM AUTHOR]

The Safe Drinking Water Act of 1974 regulates water quality in public drinking water supply systems but does not pertain to private domestic wells, often found in rural areas throughout the country. The recent decision to tighten the drinking water standard for arsenic from 50 parts per billion (ppb) to 10 ppb may therefore affect some households in rural communities, but may not directly reduce health risks for those on private wells. The article reports results from a survey conducted in a U.S. arsenic hot spot, the rural area of Churchill County, Nevada. This area has elevated levels of arsenic in groundwater. We find that a significant proportion of households on private wells are consuming drinking water with arsenic levels that pose a health risk. The decision to treat tap water for those on private wells in this area is modeled, and the predicted probability of treatment is used to help explain drinking water consumption. This probability represents behaviors relating to the household's perception of risk. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to assess the risk of neonatal death in the second twin. Study design: We carried out a retrospective cohort study of 128,219 live born second twins in the United States for the years 1995 through 1997. The study subjects were divided into 3 groups: second twins who were delivered by cesarean delivery after vaginal delivery of the first twin (group 1), both twins delivered vaginally (group 2), and both twins delivered by cesarean delivery (group 3). Results: The risk of asphyxia-related neonatal deaths was increased in groups 1 and 2; the increased risk in group 1 was stronger in term births than in preterm births. Conclusion: The risk of neonatal deaths, especially for term infants with asphyxia-related deaths, is increased for the second twins who are delivered by cesarean delivery after vaginal delivery of the first twins. [ABSTRACT FROM AUTHOR]

Objective: This study was undertaken to assess the risk of neonatal morbidity in the second twins. Study design: We carried out a cohort study of 128,219 live born second twins in the United States, 1995 through 1997. The study subjects were divided into 3 groups: second twins delivered by cesarean section after vaginal delivery of the first twin (V-C), both twins delivered vaginally (V-V), and both twins delivered by cesarean section (C-C). Results: The rates of low 5-minute Apgar score, mechanical ventilation, and seizure were higher in the V-C group (8.27%, 13.39%, and 0.31%) than in the V-V (3.07%, 7.51%, and 0.08%) and the C-C (2.66%, 8.53%, and 0.06%) groups. The V-C associated increase in risk remained after adjustment for confounding factors and was more evident at term than preterm. Conclusion: The risk of neonatal morbidity is increased in second twins who had a cesarean section after vaginal delivery of the first twin, especially at term. [ABSTRACT FROM AUTHOR]

Background: One of every 6 United Status birth certificates contains no information on fathers. There might be important differences in the pregnancy outcomes between mothers with versus those without partner information. The object of this study was to assess whether and to what extent outcomes in pregnant women who did not have partner information differ from those who had. Methods: We carried out a population-based retrospective cohort study based on the registry data in the United States for the period of 1995-1997, which was a matched multiple birth file (only twins were included in the current analysis). We divided the study subjects into three groups according to the availability of partner information: available, partly missing, and totally missing. We compared the distribution of maternal characteristics, maternal morbidity, labor and delivery complications, obstetric interventions, preterm birth, fetal growth restriction, low birth weight, congenital anomalies, fetal death, neonatal death, post-neonatal death, and neonatal morbidity among three study groups. Results: There were 304466 twins included in our study. Mothers whose partner's information was partly missing and (especially) totally missing tended to be younger, of black race, unmarried, with less education, smoking cigarette during pregnancy, and with inadequate prenatal care. The rates of preterm birth, fetal growth restriction, low birth weight, Apgar score <7, fetal mortality, neonatal mortality, and post-neonatal mortality were significantly increased in mothers whose partner's information was partly or (especially) totally missing. Conclusions: Mothers whose partner's information was partly and (especially) totally missing are at higher risk of adverse pregnant outcomes, and clinicians and public health workers should be alerted to this important social factor. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine whether serum and red blood cell folate levels were decreased in pregnant women who smoke and whether total plasma homocysteine levels were elevated.Study Design: In this cross-sectional study, serum folate, red blood cell folate, and homocysteine were measured in pregnant first- and early second-trimester pregnant women who smoked (case subjects) and pregnant women who did not smoke (control subjects). In addition, vitamin B(12), albumin, creatinine, cotinine, and hematocrit levels and methylenetetrahydrofolate reductase status were determined and compared between groups.Results: Pregnant women who smoked had significantly lower concentrations of serum folate (22.7 vs 29.4 nmol/L; P =.001) and lower concentrations of red blood cell folate (766 vs 900 nmol/L; P =.038 [not significant]) than pregnant women who did not smoke. Dietary folate intake was not significantly different between pregnant women who smoked and pregnant women who did not smoke. Homocysteine levels were also not significantly different between the groups. For each genotype of methylenetetrahydrofolate reductase, lower levels of serum folate were observed in pregnant women who smoked, with the lowest folate levels seen in homozygous mutant methylenetetrahydrofolate reductase 677TT (18.6 nmol/L in pregnant women who smoked vs 24.2 nmol/L in pregnant women who did not smoke).Conclusion: Both serum folate and red blood cell folate are lower in pregnant women who smoked than in pregnant women who did not smoke, although homocysteine levels are not significantly different. There is an important gene environment interaction between methylenetetrahydrofolate reductase gene activity and tobacco exposure on serum folate levels. Lower levels of serum folate may account for the higher rate of miscarriage, stillbirth, abruptio placentae, and fetal anomalies that are observed in pregnant women who smoke. Pregnant women who smoke may benefit from higher doses of folic acid periconceptionally. [ABSTRACT FROM AUTHOR]

Reviews the experiences of the authors in managing patients who sustained penetrating neck trauma at Grady Memorial Hospital, Atlanta, Georgia. Potential of transcervical neck injuries; Classification of zones of the neck; Types of neck injuries.

Focuses on the leveraged lease financing ventures of industrial companies to finance expansion of capital equipment in the United States. Impact of lease financing on the airline industry; Difference of leveraged lease from classical equipment trust; Obligations of a lessee under lease financing arrangements.

Background: MOREOB (Managing Obstetrical Risk Efficiently) is a patient safety program for health care providers and administrators in hospital obstetric units. MOREOB has been implemented widely in Canada and gradually spread to the United States. The main goal of MOREOB is to build a patient safety culture and improve clinical outcomes. In 2013, 26 Ontario hospitals voluntarily accepted provincial funding to participate in MOREOB. The purpose of our study was to assess the effect of MOREOB on participant knowledge, organizational culture, and experiences implementing and participating in the program at these 26 Ontario hospitals.Methods: A convergent parallel mixed-methods study in Ontario, Canada, with MOREOB participants from 26 hospitals. The quantitative component used a descriptive pre-post repeated measures design to assess participant knowledge and perception of culture, administered pre-MOREOB and after each of the three MOREOB modules. Changes in mean scores were assessed using mixed-effects regression. The qualitative component used a qualitative descriptive design with individual semi-structured interviews. We used content analysis to code, categorize, and thematically describe data. A convergent parallel design was used to triangulate findings from data sources.Results: 308 participants completed the knowledge test, and 329 completed the culture assessment at all four time points. Between baseline and post-Module 3, statistically significant increases on both scores were observed, with an increase of 7.9% (95% CI: 7.1 to 8.8) on the knowledge test and an increase of 0.45 (on a scale of 1-5, 95% CI: 0.38 to 0.52) on the culture assessment. Interview participants (n = 15) described improvements in knowledge, interprofessional communication, ability to provide safe care, and confidence in skills. Facilitators and barriers to program implementation and sustainability were identified.Conclusions: Participants were satisfied with their participation in the MOREOB program and perceived that it increased health care provider knowledge and confidence, improved safety for patients, and improved communication between team members. Additionally, mean scores on knowledge tests for obstetric content and culture assessment improved. The MOREOB program can help organizations and individuals improve care by concentrating on the human and organizational aspects of patient safety. Further work to improve program implementation and sustainability is required. [ABSTRACT FROM AUTHOR]

No previous study has examined the association between paternal race and birth weight among twins.To examine the association of parents'' race and birth weight among twins.Population-based retrospective cohort study to examine the association between parents'' race and birth weight, and its two components, gestation duration and fetal growth among four group of infants: both parents blacks (FB-MB), father white and mother black (FW-MB), father black and mother white (FB-MW), and both parents whites (FW-MW), with “risk-free” analysis to control confounding factors.Twin births (304,466 twins) registered in the United States in 1995–1997.The means of birth weight, gestational age, and birth-weight-for-gestational age z score, and rates of very low birth weight (VLBW, <1500 g), very preterm birth (VPTB, <32 weeks of gestation), and fetal growth restriction (FGR, <10th percentile of z score).Means of birth weight, gestational age, and z score were 2234.0, 2301.9, 2361.1, and 2433.8, and 35.02, 35.24, 35.65, and 35.78, and −0.136, −0.070, −0.039, and 0.063, respectively, and the rates of VLBW, VPTB, and FGR were 14.5, 12.3, 10.5, and 8.1, and 16.0, 13.0, 11.6, and 9.2, and 12.6, 11.1, 10.8, and 8.7, respectively, in the FB-MB, FW-MB, FB-MW, and FW-MW groups. Excluding subjects with various risk factors by risk-free analysis did not change the results.Both parents'' races are important determinants of birth weight, gestational age, and fetal growth among twin pregnancies, with higher effect on gestational age and greater maternal influence than paternal influence. [Copyright &y& Elsevier]

Persistent post-concussive symptoms are reported by 10-15% of individuals who suffer mild traumatic brain injury (mTBI), but their basis is often uncertain. One such symptom is disequilibrium, a sensation of impaired balance during standing and walking. The hypothesis for this study was that this subjective symptom is associated with objective and measurable deficits in static and dynamic postural stability. An infrared motion tracking system was used to record body motion during quiet standing and in response to waist perturbations in fourteen veterans (age 22-40 years, 13 male) of the Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF), who had a history of mTBI that occurred 7 months to 7 years prior to testing. We compared body sway between veterans with mTBI reporting persistent disequilibrium (TD, n=8) and those with no vestibular symptoms (n=6), as well as to a group of non-veterans with no balance symptoms (n=10). Static postural stability was reduced in TD veterans in comparison to each of the other two groups (p<0.0002), most notably on a compliant surface with eyes closed. The TD group also had decreased dynamic stability of the upper trunk (p<0.05) and enhanced postural oscillations (p<0.02) following waist perturbations. Our findings support a physiological basis for persistent disequilibrium after mTBI and are consistent with impaired vestibular processing. Disruption of semicircular canal inputs is unlikely to be the cause, as head impulse responses were normal in all groups. The unexpected finding of dynamic postural oscillations requires further study but may indicate enhanced instability in sensorimotor networks responsible for postural control. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To examine impact of cesarean delivery in first pregnancy on neonatal mortality and morbidity in second pregnancy. Study design: Retrospective cohort study using 1995–2002 US birth registration data. Neonatal mortality and morbidity in second pregnancy of cesarean deliveries in the first pregnancy were compared with vaginal deliveries in the first pregnancy. Results: A total of 9,643,175 singleton second births were eligible in the analysis after excluding those with unknown delivery method (1,801,339 with a previous cesarean delivery and 7,841,836 with a previous vaginal delivery). Compared with vaginal delivery group, infants born to mothers with a previous cesarean delivery had increased risks of assisted ventilation (OR=1.47, 95% CI 1.46, 1.49), low Apgar''s score (OR=1.14, 95% CI 1.12, 1.17), seizure (OR=1.36, 95% CI 1.27, 1.45), fetal distress (OR=1.46, 95% CI 1.44, 1.47), and asphyxia-related neonatal death (OR=1.40, 95% CI 1.29, 1.52). The association between mode of delivery in first pregnancy and neonatal outcomes in second pregnancy remained the same after excluding women with chronic health problems or adverse birth history and adjusting for potential confounding factors. Conclusion(s): Cesarean delivery in first pregnancy is associated with increased risks of neonatal morbidity and mortality in second pregnancy. [Copyright &y& Elsevier]

OBJECTIVE: To estimate the occurrence and to assess clinical predictors of emergent cesarean delivery in the second twin after vaginal delivery of the first twin. METHODS: We conducted a population-based cohort study, using the 1995–1997 linked mother/infant twin data from the United States. The adjusted risk ratios and population attributable risks of clinical predictors of emergent cesarean delivery in second twins were estimated for the overall study sample and for those born at less than 36 or 36 weeks or more of gestation. RESULTS: Among the 61,845 second twin births with the first twin delivered vaginally, 5,842 (9.45%) were delivered by cesarean. The cesarean delivery rate was increased in infants born to mothers with medical or labor and delivery complications. Breech and other malpresentations were the most important predictors of emergent cesarean delivery for the second twin (population attributable risk 33.2%; 95% confidence interval 31.8%, 34.6%). Operative vaginal delivery of the first twin was associated with a decreased risk of cesarean delivery for the second twin. Prediction of emergent cesarean for the second twin by clinical factors was stronger in term births than preterm births. CONCLUSION: In the general population, the cesarean delivery rate for the second twin after vaginal delivery of the first twin is approximately 9.5%. With the presence of breech and other malpresentations, the need for emergent cesarean delivery of the second twin after vaginal delivery of the first twin is increased by 4-fold. [ABSTRACT FROM AUTHOR]

Summary: Objective: To examine the association between trimethoprim/sulfamethoxazole, other US Food and Drug Administration (FDA) C and D anti-infectives, and non anti-infective FDA C, D, and X drugs used during pregnancy with preterm birth and low birth weight. Methods: We carried out a retrospective cohort study based on a 50% random sample of women who gave birth in the Canadian province of Saskatchewan from 1997 to 2000. The association between trimethoprim/sulfamethoxazole, other FDA C and D anti-infectives (fluconazole, clarithromycin, doxycycline, and tetracycline), and non anti-infective FDA C, D, and X drugs used during pregnancy with preterm birth and low birth weight was evaluated using multiple logistic regression, with adjusted odds ratios (aORs) and 95% confidence intervals (CIs) as association measures. Results: A total of 17 939 women were included in the final analysis. Trimethoprim/sulfamethoxazole was associated with significantly increased risks for preterm birth (aOR 1.51, 95% CI 1.10, 2.08) and low birth weight (aOR 1.67, 95% CI 1.14, 2.46). Exposure to non anti-infective FDA category C, D and X drugs was also associated with increased risks for preterm birth (aOR 1.17, 95% CI 1.09, 1.31) and low birth weight (aOR 1.14, 95% CI 0.92, 1.42), but to a lesser degree. Other FDA C and D anti-infectives were not (statistically) significantly associated with increased risks for preterm birth (aOR 0.93, 95% CI 0.49, 1.77) or low birth weight (aOR 0.65, 95% CI 0.27, 1.60). Conclusions: Among FDA C, D and X drugs, trimethoprim/sulfamethoxazole, a folic acid antagonist, has the strongest association with preterm birth and low birth weight. [Copyright &y& Elsevier]