Is mode of delivery associated with postpartum depression at 6 weeks: a prospective cohort study.

OBJECTIVE: To examine the relationship between delivery mode and postpartum depression at 6 weeks following hospital discharge. DESIGN: A prospective cohort study. SETTING: Eleven hospitals in Ontario, Canada. SAMPLE: A total of 2560 women ≥16 years of age who delivered singleton, live infants at term. METHODS: Women completed a questionnaire in hospital and 74% (n = 1897) participated in a structured telephone interview 6 weeks after discharge. Additional data were extracted from labour and delivery records. Generalised estimating equations (GEEs) were used to investigate factors associated with postpartum depression. MAIN OUTCOME MEASURE: Women were screened for depression at 6 weeks following hospital discharge using the Edinburgh Postnatal Depression Scale (EPDS). A score of ≥12 on the EPDS was used as a measure of the primary outcome, depression. RESULTS: Mode of delivery was not independently associated with postpartum depression, and did not factor into the main-effects model. The multivariable analysis identified 11 predictor variables for depression: young maternal age (OR 5.27; 95% CI 2.73-10.15); maternal hospital readmission (OR 3.02; 95% CI 1.46-6.24); non-initiation of breastfeeding (OR 2.02; 95% CI 0.99-4.11); good, fair, or poor self-reported postpartum health (OR 1.82; 95% CI 1.19-2.80); urinary incontinence (OR 1.79; 95% CI 1.06-3.03); multiparity (OR 1.59; 95% CI 1.22-2.08); low mental health functioning (OR 1.20; 95% CI 1.15-1.25); low subjective social status (OR 1.16; 95% CI 1.02-1.33); high number of unmet learning needs in hospital (OR 1.12; 95% CI 1.03-1.22); low social support (OR 1.06; 95% CI 1.03-1.09); and low physical health functioning (OR 1.03; 95% CI 1.003-1.055). An exploratory interaction model revealed that caesarean section was associated with higher odds of becoming depressed in Canadian-born women, but that in women born outside of Canada it was associated with a lower risk of becoming depressed. CONCLUSIONS: Delivery mode had no significant impact on the development of postpartum depression in the main-effects model. However, it may interact with place of birth and other unmeasured factors to create a risk for depression.

Scoping Review on Maternal Health among Immigrant and Refugee Women in Canada: Prenatal, Intrapartum, and Postnatal Care.

The last fifteen years have seen a dramatic increase in both the childbearing age and diversity of women migrating to Canada. The resulting health impact underscores the need to explore access to health services and the related maternal health outcome. This article reports on the results of a scoping review focused on migrant maternal health within the context of accessible and effective health services during pregnancy and following delivery. One hundred and twenty-six articles published between 2000 and 2016 that met our inclusion criteria and related to this group of migrant women, with pregnancy/motherhood status, who were living in Canada, were identified. This review points at complex health outcomes among immigrant and refugee women that occur within the compelling gaps in our knowledge of maternal health during all phases of maternity. Throughout the prenatal, intrapartum, and postnatal periods of maternity, barriers to accessing healthcare services were found to disadvantage immigrant and refugee women putting them at risk for challenging maternal health outcomes. Interactions between the uptake of health information and factors related to the process of immigrant settlement were identified as major barriers. Availability of appropriate services in a country that provides universal healthcare is discussed.

[The intraosseous infusion in adult]. / La perfusion intraosseuse chez l'adulte.

Intraosseous infusion is an old knowledge, abandoned in the 1950s in favor of the peripheral vein, and it was essentially described in pediatrics and military medicine. Since 2005, this way is experiencing a resurgence of interest in emergency medicine particularly in adults after the failure's installation of a peripheral vein in order not to waste the time of care and administration of treatment. New devices that allow intraosseous infusion are currently used in humans. We propose to review the different kind of catheters used, to know the main technical characteristics, indications, contraindications and potential complications. We propose a comparison with the peripheral vein and a comparison between the different catheters.

[A complication of epidural anaesthesia: the breaking of a catheter]. / Une complication de l'anesthésie péridurale: la rupture d'un cathéter.

We report the breaking of an epidural catheter, which occurred during the procedure of insertion. If such a breaking is a rare event, it is due in this case to an aberrant trajectory of the catheter. By studying the literature, we also analyzed the mechanisms which can lead to the breaking of an epidural catheter. We recommend a precise radiological examination to localise the trapped catheter among the nervous structures.

[Helium-sevoflurane association: a rescue treatment in case of acute severe asthma]. / Association hélium-sévoflurane : une thérapeutique de sauvetage dans l'asthme aigu grave.

We report the case of a severe acute asthma, which required, after optimal medical therapy, helium and sevoflurane CO-administration after tracheal intubation. The Anesthetic Conserving Device allowed sevoflurane use with intensive care unit's ventilator. The helium-sevoflurane association was maintained during 9 days to decrease the bronchospasm, waiting for the efficiency of an aetiologic treatment. We discuss the suitability of this association to treat severe acute asthma, and its administration modalities.

Tooth surface and pulp chamber temperatures developed during electrothermal bonding.

The rationale of electrothermal bonding is based on the premise that when an electric current is passed across the beaks of tweezers holding a stainless steel orthodontic bracket, heat will be generated by virtue of the electrical resistance of the steel bracket. This study was carried out to evaluate the temperatures generated on the tooth surface at the bracket/tooth interface and within the pulp chamber during electrothermal bonding. Temperatures were recorded with 5 and 7.5 A current levels applied as a 1 second pulse with time intervals between pulses of 1, 2, 3, and 4 seconds. The data showed that after three pulses with a 5 A current, the temperature on the tooth surface ranged between 43.3 degrees C (4 second intervals) to 53.6 degrees C (1 second intervals). By using a 7.5 A current, the temperature ranged from 77.5 degrees C (4 second intervals) to 85.9 degrees C (1 second intervals). The pulp chamber temperatures were evaluated in vitro for a mandibular incisor, the maxillary central and lateral incisors, a canine, a premolar, and a molar. The pulp chamber temperature of a mandibular incisor responded most, whereas that of premolars and molars responded least to temperature changes on the labial surface. The increase in mandibular incisor pulp chamber temperature after three pulses was 2.1 degrees C for 5 A and 2.8 degrees C for 7.5 A current while for a premolar the increase ranged from 0.9 degree C to 1.6 degrees C. On the basis of current evidence the increase in pulp chamber temperatures during electrothermal bonding may be considered to be clinically safe.

Factors influencing the accuracy of home blood pressure measurement.

BACKGROUND: Hypertension is a common disorder, affecting approximately 50 million Americans. Because many people have this disorder and its sequela, it is important not only to detect hypertension but also to monitor adequacy of control. Over the past few years, blood pressure monitoring devices (BPMDs) have become available for individuals to measure their blood pressure (BP) in the convenience of their home. These instruments are touted as being accurate. METHODS: We conducted a study with volunteers who use BPMDs to see how they are used and to assess their accuracy. A BP reading was considered accurate if the differences between the volunteers' and technicians' systolic and diastolic readings were both 10 mm Hg or less. RESULTS: Of 91 patients, 31 (34%) obtained inaccurate readings. The inaccuracy could not be attributed to the type of the instrument, the cost of the instrument, the educational level of the user, or the age of the instrument. CONCLUSIONS: This study shows, despite other studies purporting accuracy, that a significant number of inaccurate readings are obtained by patients using BPMDs. Supervision of their use needs to be incorporated into the physician follow-up to ensure that there is a reasonable correlation between values obtained using the mercury sphygmomanometer and the BPMD.