Risk factors for re-hospitalization following neonatal discharge of extremely preterm infants in Canada.

OBJECTIVE: Survivors of extremely preterm birth are at risk of re-hospitalization but risk factors in the Canadian population are unknown. Our objective is to identify neonatal, sociodemographic, and geographic characteristics that predict re-hospitalization in Canadian extremely preterm neonates. METHODS: This is a retrospective analysis of a prospective observational cohort study that included preterm infants born 22 to 28 weeks' gestational age from April 1, 2009 to September 30, 2011 and seen at 18 to 24 months corrected gestational age in a Canadian Neonatal Follow-Up Network clinic. Characteristics of infants re-hospitalized versus not re-hospitalized are compared. The potential neonatal, sociodemographic, and geographic factors with significant association in the univariate analysis are included in a multivariate model. RESULTS: From a total of 2,275 preterm infants born at 22 to 28 weeks gestation included, 838 (36.8%) were re-hospitalized at least once. There were significant disparities between Canadian provincial regions, ranging from 25.9% to 49.4%. In the multivariate logistic regression analysis, factors associated with an increased risk for re-hospitalization were region of residence, male sex, bronchopulmonary dysplasia, necrotizing enterocolitis, prolonged neonatal intensive care unit (NICU) stay, ethnicity, Indigenous ethnicity, and sibling(s) in the home. CONCLUSION: Various neonatal, sociodemographic, and geographic factors predict re-hospitalization of extremely preterm infants born in Canada. The risk factors of re-hospitalization provide insights to help health care leaders explore potential preventative approaches to improve child health and reduce health care system costs.

Linking the presence of visual indicators of aquaculture deposition to changes in epibenthic richness at finfish sites installed over hard bottom substrates.

Effects of finfish aquaculture on benthic communities at hard bottom sites can be assessed using visual indicators of organic enrichment, namely bacterial mats, opportunistic polychaetes, and/or barren substrates (i.e., with no visible epifauna). Under some regulatory frameworks, the presence of visual indicators beyond a certain threshold proportion (e.g., > 70%) of mandatory sampling stations at a site signals an unacceptable degree of benthic organic loading. However, relationships between visual indicator presence and other biological characters such as epibenthic taxon richness are unclear, and should be examined to advise on the validity of existing legislative frameworks. Here, we used video data collected for regulatory purposes before and after aquaculture production to document (1) change in epibenthic taxon richness (TR) and its discriminatory power in determining aquaculture impact and (2) the association between TR change and the presence of visual indicators. Despite low richness values overall, our results show a significant post-production decrease in TR in the near-cage area, which was predicted to be affected by aquaculture. Decreases in TR were associated with visual indicator presence, validating the use of a suite of visual indicators to detect organic deposition. Importantly, visual indicators should be considered together in the context of regulation, given that relationships between TR and indicators were not linear when the latter are considered individually.

A National Survey of the Nursing Care of Infants With Prenatal Substance Exposure in Canadian NICUs.

BACKGROUND: Many communities are reporting increases in the number of infants requiring NICU care. Practices continue to vary and there is limited available evidence about nursing care. PURPOSE: The purpose of this study was to describe current nursing care practices for infants with prenatal substance exposure in the NICU setting and during transition to the community. Findings from this study were compared with an earlier Canadian survey (by Marcellus in 2002) to identify shifts in clinical nursing practice for this population. METHODS: This was a cross-sectional descriptive survey design. A 68-item survey composed of multiple-choice and open-ended questions was administered through FluidSurveys online software. A convenience sample of 62 clinical managers or clinical educators in hospitals with active maternal-infant clinical units with 500 deliveries or more annually and/or pediatric hospitals with a separate designated neonatal service (ie, Level 2 and 3 units) was chosen. RESULTS: A greater number of NICUs are using clinical guidelines to support the standardization of quality care. Improvements in nursing practice were identified and these included the consistent use of a withdrawal scoring tool and provision of education for team members in orientation. A decline in routine discharge planning meetings and routine parent teaching plans was discovered. IMPLICATIONS FOR PRACTICE: This survey has improved understanding of the current state of nursing care for infants with prenatal substance exposure and their families during this critical time of transition. The purpose of the survey was to compare findings with the 2002 study by Marcellus to identify any improved practices and describe current state nursing care practices in the NICU. Practice changes over the last decade have included keeping mothers and infants together, expanding concepts of the team, integrating programs and services across hospital and community settings, and creating opportunities for NICU teams to learn more about substance use, mental health, violence, and trauma. IMPLICATIONS FOR RESEARCH: Focus on discharge planning, parent teaching, and creation and implementation of national/hospital guidelines is essential for consistent evidence-based quality patient care.

Prior Injury, Health-Related Quality of Life, Disablement, and Physical Activity in Former Women's Soccer Players.

CONTEXT: Former collegiate athletes may be at risk for negative health outcomes such as lower health-related quality of life (HRQoL), greater disablement, and lower lifetime physical activity (PA) participation. A history of severe sport injury may play a role in these outcomes. OBJECTIVE: To assess the role of prior sport injury in self-reported HRQoL, levels of disablement, and PA behaviors of former National Collegiate Athletic Association Division I women's soccer players. DESIGN: Cross-sectional study. SETTING: Online survey. PATIENTS OR OTHER PARTICIPANTS: Former Division I women's soccer players (n = 382, age = 36.41 ± 7.76 years) provided demographics and injury history and completed the Patient-Reported Outcomes Measurement Information System (HRQoL), the Disablement in the Physically Active Scale (disablement), and the Godin Leisure Time Physical Activity Questionnaire (PA). MAIN OUTCOME MEASURE(S): The dependent variables were the physical and mental component summary scores for HRQoL and disablement and the frequency of moderate-to-vigorous PA. Means, SDs, and correlations among the main outcome variables were examined for those who reported a severe injury (n = 261) and those who did not (n = 121). To address our primary aim, we conducted multiple regression analyses to predict HRQoL, disablement, and PA based on a history of severe injury, accounting for age. RESULTS: Having a severe injury significantly predicted worse physical HRQoL and worse physical disablement. Severe injury predicted a >2-point decrease and 5-point increase on the respective scales. Injury status did not predict mental HRQoL, mental disablement, or PA. CONCLUSIONS: Most participants reported sustaining a prior severe soccer-related injury, which may have had a negative long-term effect on health outcomes for former women's soccer players. Athletic trainers should be aware of the risk for decreased HRQoL and increased disablement with injury and encourage continued monitoring of relevant patient-reported outcomes.