Iatrogenic ureteral injury during colorectal surgery has a significant impact on patient outcomes: a French multicentric retrospective cohort study.

AIM: The long-term urological sequelae after iatrogenic ureteral injury (IUI) during colorectal surgery are not clearly known. The aims of this work were to report the incidence of IUI and to analyse the long-term consequences of urological late complications and their impact on oncological results of IUI occurring during colorectal surgery through a French multicentric experience (GRECCAR group). METHOD: All the patients who presented with IUI during colorectal surgery between 2010 and 2019 were retrospectively included. Patients with ureteral involvement needing en bloc resection, delayed ureteral stricture or noncolorectal surgery were not considered. RESULTS: A total of 202 patients (93 men, mean age 63 ± 14 years) were identified in 29 centres, corresponding to 0.32% of colorectal surgeries (n = 63 562). Index colorectal surgery was mainly oncological (n = 130, 64%). IUI was diagnosed postoperatively in 112 patients (55%) after a mean delay of 11 ± 9 days. Intraoperative diagnosis of IUI was significantly associated with shorter length of stay (21 ± 22 days vs. 34 ± 22 days, p < 0.0001), lower rates of postoperative hydronephrosis (2% vs. 10%, p = 0.04), anastomotic complication (7% vs. 22.5%, p = 0.002) and thromboembolic event (0% vs. 6%, p = 0.02) than postoperative diagnosis of IUI. Delayed chemotherapy because of IUI was reported in 27% of patients. At the end of the follow-up [3 ± 2.6 years (1 month-13 years)], 72 patients presented with urological sequalae (36%). Six patients (3%) required a nephrectomy. CONCLUSION: IUI during colorectal surgery has few consequences for the patients if recognized early. Long-term urological sequelae can occur in a third of patients. IUI may affect oncological outcomes in colorectal surgery by delaying adjuvant chemotherapy, especially when the ureteral injury is not diagnosed peroperatively.

"Their Sleep Means More Harmony": Maternal Perspectives and Experiences of Preschoolers' Sleep in Ethnically and Socioeconomically Diverse Families in Aotearoa/New Zealand.

Viewing sleep through a socioecological lens, maternal perceptions, and experiences of preschoolers' sleep were explored using semistructured interviews with 15 Maori (indigenous) and 16 non-Maori mothers, with low- and high socioeconomic position. Thematic analysis identified four themes: child happiness and health, maternal well-being, comfort and connection, and family functioning and harmony. Mothers perceived healthy preschooler sleep as supporting children's mental and physical health, parents' sleep/wake functioning, family social cohesion and emotional connectedness, and poor preschooler sleep as negatively influencing child, maternal and family well-being. Although many experiences were shared, some perceptions of sleep and sleep practices differed between mothers. Influences included health paradigms, socioeconomic circumstances, maternal autonomy, employment, parenting approaches, and societal expectations. Healthy preschooler sleep is valued by mothers and may play a protective role in family health and resilience. Preschooler sleep initiatives need to be responsive to maternal perspectives and address societal drivers of sleep experiences.

The prevalence of symptoms of depression and anxiety, and the level of life stress and worry in New Zealand Maori and non-Maori women in late pregnancy.

OBJECTIVE: To describe the prevalence of symptoms of depression and anxiety, and the level of life stress and worry in late pregnancy for Maori and non-Maori women. METHODS: In late pregnancy, women completed a questionnaire recording their prior history of mood disorders; self-reported current depressive symptoms (⩾13 on the Edinburgh Postnatal Depression Scale), current anxiety symptoms (⩾6 on the anxiety items from the Edinburgh Postnatal Depression Scale), significant life stress (⩾2 items on life stress scale) and dysfunctional worry (>12 on the Brief Measure of Worry Scale). RESULTS: Data were obtained from 406 Maori women (mean age = 27.6 years, standard deviation=6.3 years) and 738 non-Maori women (mean age = 31.6 years, standard deviation=5.3 years). Depressive symptoms (22% vs 15%), anxiety symptoms (25% vs 20%), significant life stress (55% vs 30%) and a period of poor mood during the current pregnancy (18% vs 14%) were more prevalent for Maori than non-Maori women. Less than 50% of women who had experienced ⩾2 weeks of poor mood during the current pregnancy had sought help. Being young was an independent risk factor for depressive symptoms, significant life stress and dysfunctional worry. A prior history of depression was also consistently associated with a greater risk of negative affect in pregnancy. CONCLUSION: Antenatal mental health requires at least as much attention and resourcing as mental health in the postpartum period. Services need to specifically target Maori women, young women and women with a prior history of depression.

Environmental and behavioural factors associated with school children's sleep in Aotearoa/New Zealand.

AIM: To collect objective and subjective sleep data on 6- to 8-year-old children across the week and to identify factors within the family environment associated with sleep differences. METHODS: Data were collected (n = 52) using actigraphy and diaries for 7 consecutive days and nights and a questionnaire incorporating the Children's Sleep Habits Questionnaire was completed by parents. RESULTS: Children's actigraphic sleep periods averaged 10 h on school nights and 9.5 h on non-school nights and parents over-estimated children's sleep compared with actigraphy. One third (37%) of children had potential sleep problems. Children who shared a bedroom (31%) had shorter sleep onset latencies and those who consumed caffeinated drinks (33%) went to sleep and awoke later. Increased screen time was associated with later bedtimes on school nights and children with screens in bedrooms (12%) went to bed later and slept less on school nights, and had higher Children's Sleep Habits Questionnaire scores. Children living with a shift-working adult (27%) slept longer on non-school nights and had shorter sleep onset latencies on school nights. CONCLUSIONS: It is important to consider children's sleep within the wider family context and to be aware that parents may over-estimate their children's sleep. Simple strategies to promote sleep health in clinical settings or education programmes include regular weekend bedtimes that align with those on school nights, removing technology from bedrooms and minimising caffeine consumption. An awareness of potential sleep differences associated with shift-working adults may ensure children are supported to have consistent sleep routines that promote adequate sleep.

Inequities in adolescent sleep health in Aotearoa New Zealand: Cross-sectional survey findings.

OBJECTIVES: To investigate ethnic inequities in, and social determinants of, adolescent sleep health in Aotearoa New Zealand. METHODS: Analysis of self-report data from a cross-sectional survey of secondary school students (12- to 18-year-olds). Analyses included weighted prevalence estimates of good and poor sleep health stratified by ethnicity, and multivariable logistic regression models concurrently adjusted for ethnicity, school year, gender, rurality, neighborhood deprivation, school decile, housing deprivation, sleeping elsewhere due to lack of adequate housing, unsafe environment, and racism. RESULTS: Inequities in social determinants of health were evident for Maori (Indigenous peoples of Aotearoa New Zealand; n = 1528) and minoritized (Pacific n = 1204; Asian n = 1927; Middle Eastern, Latin American, and African [MELAA] n = 210; and 'Other' ethnicity n = 225) adolescents. A greater proportion of Maori, Pacific, Asian, MELAA, and 'Other' adolescents had short sleep, compared to European (n = 3070). Maori, Pacific, Asian, and MELAA adolescents were more likely to report late bedtimes (after midnight), and Maori, Pacific, and 'Other' adolescents were more likely to report early waketimes (5 AM-6 AM or earlier), on school days. Rurality, neighborhood deprivation, school-level deprivation, housing deprivation, sleeping elsewhere due to inadequate housing, unsafe environments, and racism partially, but not fully, explained associations between ethnicity and short sleep, late bedtimes, and early waketimes. CONCLUSIONS: Ethnic inequities exist in adolescent sleep health in Aotearoa New Zealand. Socio-political actions are needed to address racism and colonialism as root causes of ethnic inequities in adolescent sleep, to ensure all young people are afforded the basic human right of good sleep health and associated mental and physical well-being.

Management of adult intestinal stomas: The 2023 French guidelines.

AIM: Digestive stoma are frequently performed. The last French guidelines have been published twenty years ago. Our aim was to update French clinical practice guidelines for the perioperative management of digestive stoma and stoma-related complications. METHODS: A systematic literature review of French and English articles published between January 2000 and May 2022 was performed. Only digestive stoma for fecal evacuation in adults were considered. Stoma in children, urinary stoma, digestive stoma for enteral nutrition, and rare stoma (Koch, perineal) were not included. RESULTS: Guidelines include the surgical landmarks to create digestive stoma (ideal location, mucocutaneous anastomosis, utility of support rods, use of prophylactic mesh), the perioperative clinical practice guidelines (patient education, preoperative ostomy site marking, postoperative equipment, prescriptions, and follow-up), the management of early stoma-related complications (difficulties for nursing, high output, stoma necrosis, retraction, abscess and peristomal skin complications), and the management of late stoma-related complications (stoma prolapse, parastomal hernia, stoma stenosis, late stoma retraction). A level of evidence was assigned to each statement. CONCLUSION: These guidelines will be very useful in clinical practice, and allow to delete some outdated dogma.

Sleep inequities and associations between poor sleep and mental health for school-aged children: findings from the New Zealand Health Survey.

In Aotearoa/New Zealand, ethnic inequities in sleep health exist for young children and adults and are largely explained by inequities in socioeconomic deprivation. Poor sleep is related to poor mental health for these age groups but whether sleep inequities and associations with mental health exist for school-aged children is unclear. We aimed to (1) determine the prevalence of poor sleep health including sleep problems by ethnicity, (2) examine social determinants of health associated with poor sleep, and (3) investigate relationships between poor sleep and mental health for 5-14-year-olds using cross-sectional New Zealand Health Survey data (n = 8895). Analyses included weighted prevalence estimates and multivariable logistic regression. Short sleep was more prevalent for Indigenous Maori (17.6%), Pacific (24.5%), and Asian (18.4%) children, and snoring/noisy breathing during sleep was more prevalent for Maori (29.4%) and Pacific (28.0%) children, compared to European/Other (short sleep 10.2%, snoring/noisy breathing 17.6%). Ethnicity and neighborhood socioeconomic deprivation were independently associated with short sleep and snoring/noisy breathing during sleep. Short sleep was associated with increased odds of anxiety, attention deficit hyperactivity disorder, and activity-limiting emotional and psychological conditions after adjusting for ethnicity, deprivation, age, and gender. In addition, long sleep was independently associated with increased odds of depression. These findings demonstrate that for school-aged children ethnic inequities in sleep exist, socioeconomic deprivation is associated with poor sleep, and poor sleep is associated with poor mental health. Sociopolitical action is imperative to tackle social inequities to support sleep equity and mental health across the lifecourse.

Implementation of an enhanced recovery program for complete cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in a referral center: a case control prospective study.

Objectives: Current recommendations regarding enhanced recovery programs (ERPs) after complete cytoreductive surgery (CCRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are based on a low level of evidence. The aim of this study is to evaluate the effect of implementing an adapted ERP for CCRS and HIPEC in a referral center. Methods: We conducted a study with a prospective group of 44 patients (post-ERP group) who underwent CCRS with HIPEC between July 2016 and June 2018, the period during which ERP was implemented. This group was compared to a second retrospective group of 21 patients who underwent CCRS with HIPEC between June 2015 and June 2016, during which ERP was not yet implemented (pre-ERP group). Results: The ERP compliance rate was 65% in the post-ERP group. The hospital length of stay (HLS) was shorter in the post-ERP group: 24.9 days (IQR 11-68, pre-ERP group) vs. 16.1 days (IQR 6-45, post-ERP group), as was the major morbidity rate (pre-ERP group=33.3% vs. post-ERP group=20.5%). The nasogastric tube, urinary catheter and abdominal drains were all retrieved faster in the post-ERP group. Conclusions: The implementation of an adapted ERP after CCRS with HIPEC procedures reduces morbidity and shortens the HLS.

Sleep timing and sleep problems of preschoolers in Aotearoa/New Zealand: relationships with ethnicity and socioeconomic position.

OBJECTIVES: To provide descriptive sleep data and explore sleep inequities, we investigated maternal reports of when and how well Maori (Indigenous) and non-Maori preschoolers sleep, and examined relationships between ethnicity (child and maternal), socioeconomic position (SEP) and sleep timing and problems of 3-4 year old children in Aotearoa/New Zealand (NZ). METHODS: This study involved cross-sectional analysis of data from the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand longitudinal study. Log-binomial regression models were used to investigate associations between child and maternal demographic variables and preschooler bedtimes, social jetlag and maternally-reported sleep problems. Child models included child ethnicity, child gender, area- and individual-level deprivation. Maternal models included maternal ethnicity, maternal age, area- and individual-level deprivation. RESULTS: 340 Maori and 570 non-Maori preschoolers and their mothers participated. Maori preschoolers had later average bedtimes and wake times than non-Maori preschoolers. Ethnicity and area-level deprivation were independently associated with later bedtimes. Ethnicity was associated with social jetlag and sleep problems, independent of SEP. Individual-level deprivation was associated with problems falling asleep. Preschoolers of Maori mothers in least deprived areas were more likely to have problems falling asleep than preschoolers of non-Maori mothers in least deprived areas. CONCLUSIONS: Research is needed to understand what sleep timing differences mean for preschoolers' wellbeing in NZ. Fundamental causes of social and economic disadvantage experienced by Indigenous children and mothers and by families who hold low SEP must be addressed, in order to eliminate sleep health inequities in early childhood.

Maternal sleep disturbances in late pregnancy and the association with emergency caesarean section: A prospective cohort study.

OBJECTIVES: To investigate the association between measures of sleep quality, sleep duration and sleep disorder symptoms in late pregnancy and likelihood of emergency caesarean section. DESIGN: Population-based prospective cohort study SETTING: New Zealand PARTICIPANTS: 310 Maori (Indigenous New Zealanders) and 629 non-Maori women MEASUREMENTS: Multivariable logistic regression models were used to investigate the association between type of delivery (emergency caesarean section vs. spontaneous vaginal delivery) and self-reported sleep duration, sleep quality and sleep-related symptoms, (e.g. snoring, breathing pauses during sleep, legs twitching/jerking) in the third trimester of pregnancy. Models were adjusted by ethnicity (ref=non-Maori), age (ref=16-19 y), parity (ref=nulliparous), clinical indicators (any vs. none), area deprivation (ref=least deprived quintile), BMI and for some models smoking. RESULTS: Women who reported poor quality sleep as measured by the General Sleep Disturbance Scale in later pregnancy had almost twice the odds of delivering via emergency caesarean than women with good sleep quality (OR=1.98, 95% CI 1.18-3.31). Reporting current breathing pauses during sleep (OR=3.27, 95% CI 1.38-7.74) or current snoring (OR=1.65, 95% CI 1.00-2.72) were also independently associated with a higher likelihood of an emergency caesarean. Short sleep duration and leg twitching/jerking were not independently associated with emergency caesarean section in this study. CONCLUSIONS: Supporting healthy sleep during pregnancy could be a novel intervention to reduce the risks associated with emergency caesarean section. Research on the effectiveness of sleep interventions for reducing caesarean section risk is required.

Coupling CP-MD simulations and X-ray absorption spectroscopy: exploring the structure of oxaliplatin in aqueous solution.

A combined experimental-theoretical approach applying X-ray absorption spectroscopy and ab initio molecular dynamics (CP-MD) simulations is used to get insight into the structural determination of oxaliplatin, a third-generation anticancer drug of the cisplatin family, in aqueous solution. Experimental Pt L(III)-edge EXAFS and XANES spectra of oxaliplatin in water are compared with theoretical XAS spectra. The latter are obtained as statistically averaged spectra computed for a set of selected snapshots extracted from the MD trajectory of ethyldiamineoxalatoplatinum(II) (EDO-Pt) in liquid water. This compound is a simplified structure of oxaliplatin, where the outer part of the cyclohexane ring contained in the cyclohexanediamine ligand of oxaliplatin has been removed. We show that EDO-Pt is an appropriate model to simulate the spectroscopical properties of oxaliplatin given that the cyclohexane ring does not generate particular features in neither the EXAFS nor the XANES spectra. The computation of average EXAFS spectra using structures from the MD simulation in which atoms are selected according to different cutoff radii around the Pt center allows the assignment of spectral features to particular structural motifs, both in k and R-spaces. The outer oxygen atoms of the oxalate ligand (R(Pt-O(II)) = 3.97 +/- 0.03 A) are responsible for a well-defined hump at around 6.5 A(-1) in the k(2)-weighted EXAFS spectrum. The conventional EXAFS analysis data procedure is reexamined by its application to the simulated average EXAFS spectra. The structural parameters resulting from the fit may then be compared with those obtained from the simulation, providing an estimation of the methodological error associated with the global fitting procedure. A thorough discussion on the synergy between the experimental and theoretical XAS approaches is presented, and evidence for the detection of a slight hydration structure around the Pt complex is shown, leading to the suggestion of a new challenge to experimental XAS measurements.

"We're doing the best job we can": maternal experiences of facilitators and barriers to preschoolers sleeping well in Aotearoa/New Zealand.

OBJECTIVES: This study considered sleep from a social determinants of health and socioecological perspective. It aimed to explore facilitators and barriers to 4-year-old children sleeping well, as experienced by Maori and non-Maori mothers, with low and high socioeconomic position (SEP), in Aotearoa/New Zealand. DESIGN: Experiential qualitative research involving face-to-face, semistructured individual interviews. PARTICIPANTS: Fifteen Maori (low SEP = 7; high SEP = 8) and 16 non-Maori (low SEP = 7; high SEP = 9) mothers of preschoolers. MEASUREMENTS: Interviews were guided by questions about how preschoolers slept and what mothers thought made a difference to their child's sleep. Data were analyzed inductively using thematic analysis. RESULTS: Four themes were identified: "health, activity, and diet"; "sleep-promoting physical environments"; "consistency"; and "doing it our way." Children being healthy and active, sleep-conducive bedroom spaces, consistent routines, and supportive social environments assisted preschoolers to sleep well. However, broader contextual factors beyond mothers' control influenced the degree of autonomy they had over implementing sleep-supporting strategies that worked for their families. External influences included access to financial resources; parental work patterns; early childhood education service practices; access to quality housing; and affordable, culturally responsive, and respectful professional sleep advice. CONCLUSION: Efforts aimed at facilitating healthy sleep among preschoolers and effective preschooler sleep interventions must go beyond simply recommending individual-focused sleep-promoting tips to include actions on the social determinants of sleep and the sociopolitical drivers that influence these.

How long do preschoolers in Aotearoa/New Zealand sleep? Associations with ethnicity and socioeconomic position.

OBJECTIVES: To investigate potential sleep inequities in preschoolers in Aotearoa/New Zealand, by examining sleep durations and week/weekend sleep duration differences of Maori (indigenous) and non-Maori preschoolers; and independent associations between ethnicity (child and maternal), socioeconomic position (SEP) and preschoolers' sub-optimal and inconsistent week/weekend sleep durations. DESIGN: Cross-sectional analysis of questionnaire data from the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand longitudinal study when children were 3 to 4 years old. PARTICIPANTS: 340 Maori and 570 non-Maori preschoolers and their mothers. MEASUREMENTS: Measures included preschoolers' usual nighttime sleep duration on week nights (week nighttime sleep) and weekends (weekend nighttime sleep); usual sleep duration across 24 hours, including naps, on week nights (week sleep [24 h]) and weekends (weekend sleep [24 h]) (≪10 h/10-13 h/≫13 h); and the difference between week and weekend sleep durations per 24 hours (sleep [24 h] difference) (≫1 h/≤1 h). Log-binomial regression models investigated associations between child and maternal characteristics and sleep duration measures. Child models included child ethnicity, child gender and child SEP (area and individual socioeconomic deprivation). Maternal models included maternal ethnicity, maternal age and maternal SEP (area and individual socioeconomic deprivation). RESULTS: Ethnicity and low SEP were independently associated with week day sleep (24 h) ≪10 h, weekend sleep (24 h) ≪10 h, and with sleep (24 h) difference ≫1 h. CONCLUSIONS: Ethnic and socioeconomic inequities in sleep durations are evident as early as 3 to 4 years of age in NZ, highlighting the importance of addressing the socio-political drivers of sleep inequities early in the life course.

Chronic granulomatous disease (CGD) mimicking neoplasms: a suspected mediastinal teratoma unmasking as thymic granulomas due to X-linked CGD, and 2 related cases.

Patients with chronic granulomatous disease (CGD) suffer from severe bacterial and fungal infections and deregulated inflammation, which are often associated with granuloma formation. We describe a 2-year-old boy who was seemingly healthy at the age of 1 year when a conventional chest radiograph was taken to exclude pulmonary aspiration of a piece of apple. Incidentally, a space-occupying mediastinal mass was revealed that was further evaluated by magnetic resonance imaging. Varying solid and also cystic, septated parts of the mass could be discerned and it was considered to be a teratoma. Removal of the mass by surgery was arduous because of adhesiveness to surrounding areas and led to severe complications. Unexpectedly, histopathologic examination revealed massive acute granulomatous inflammation with liquefied thymic cysts. X-linked CGD was subsequently diagnosed by a dihydrorhodamine 123 assay and sequencing of the CYBB gene (hotspot mutation c.742-743insA). This is the third example that we are aware of, where CGD granulomas were mistaken for neoplasms. The other 2 patients were initially believed to have tumors of the stomach and the urinary bladder, respectively. All patients initially received inadequate treatment. We discuss possible strategies to avoid such tragic confusions.

Sleep and Adiposity in Preadolescent Children: The Importance of Social Jetlag.

BACKGROUND: While short and poor quality sleep have been associated with childhood obesity, no known studies have examined social jetlag. Social jetlag is the discrepancy between an individual's circadian clock and social rhythms, and is measured as the difference in hours between the midpoint of sleep during work/school days and on free (weekend) days. This study investigated the independent associations between sleep duration, sleep disturbances, and social jetlag with adiposity in children. METHODS: A cross-sectional study, including 341 children (50% female) aged 8-10 years. Five dependent variables: body fat (%), fat mass (kg), fat mass index (FMI, kg/m2), waist to hip ratio, and body mass index (kg/m2). Three independent variables: average sleep duration, sleep disturbances, and social jetlag. RESULTS: Following adjustment for confounders, sleep duration was not associated with any variable, and sleep disturbances were associated with FMI (ß = 0.047, 95% CI: 0.002, 0.093 kg/m2), while social jetlag was associated with all five adiposity variables, including an absolute 3% greater body fat (ß = 2.963, 95% CI: 0.40, 5.53%) per 1 hour of social jetlag. CONCLUSIONS: Social jetlag may be an important and measurable public health target in children.

Blood-brain barrier disruption and lesion localisation in experimental autoimmune encephalomyelitis with predominant cerebellar and brainstem involvement.

The role of the blood-brain barrier (BBB) in determining lesion distribution was assessed in an atypical model of experimental autoimmune encephalomyelitis (EAE) induced in C3H/HeJ mice by immunisation with peptide 190-209 of myelin proteolipid protein, which can result in two distinct types of EAE, each with distinct lesion distribution. Areas of the BBB showing constitutively greater permeability in naive mice did not correlate with the lesion distribution in EAE. BBB disruption occurred only in sites of inflammatory cell infiltration. Irrespective of the clinical type, the BBB was disrupted in the cerebellum and brainstem. Pertussis toxin had no effect on lesion distribution. Thus, lesion distribution is not influenced solely by BBB permeability.

Self-reported sleep in late pregnancy in relation to birth size and fetal distress: the E Moe, Mama prospective cohort study.

OBJECTIVES: To explore associations between features of sleep during pregnancy and adverse outcomes for the infant. SETTING: E Moe, Mama is a cohort study in Aotearoa/New Zealand that investigates self-reported sleep and maternal health in late pregnancy and the postpartum period. PARTICIPANTS: Women (N=633; 194 Maori) reported detailed information on their sleep duration, quality, disturbances, disorders (snoring, breathing pauses, twitching legs, restless legs) and daytime sleepiness between 35 and 37 weeks gestation. OUTCOME MEASURES: Birthweight and fetal distress during labour were extracted from medical records. Associations between each sleep variable and small or large for gestational age (SGA/LGA) using customised birthweight centile or fetal distress were estimated using multinomial/logistic regression, controlling for potential confounders. Secondary analyses considered differences in associations between Maori and non-Maori women. RESULTS: There was some indication that breathing pauses (a measure of sleep apnoea) were associated with both SGA (OR 2.8, 95% CI 0.9 to 9.0, p=0.08) and LGA (OR 2.0, 95% CI 0.7 to 5.7, p=0.20), with the association for LGA being stronger when only pregnancy-onset breathing pauses were considered (OR 3.5, 95% CI 1.3 to 9.6, p=0.01). There was also some evidence that pregnancy-onset leg twitching (OR 3.3, 95% CI 1.1 to 10.0, p=0.03) and frequent sleep disturbance due to feeling too hot or too cold (OR 1.7, 95% CI 0.9 to 3.6, p=0.13) were associated with higher risk of fetal distress. Other sleep measures, including snoring, were not associated with SGA, LGA or fetal distress. Many of the associations we observed were considerably stronger in Maori compared with non-Maori women. CONCLUSIONS: We did not find evidence of previously reported associations between snoring and SGA. Our findings tentatively suggest that self-reported breathing pauses and leg twitching in late pregnancy are associated with infant outcomes, and highlight ethnic inequalities.

Chemokines and chemokine receptors: potential therapeutic targets in multiple sclerosis.

Multiple sclerosis (MS) is a common inflammatory and demyelinating disease of the central nervous system (CNS), which causes progressive neurological disability. The disease is characterised pathologically by destruction of the myelin sheaths, which surround nerve fibres in the CNS. It is believed that this tissue damage in the brain and spinal cord of MS patients is caused by an inflammatory response that is initiated when autoreactive T cells, specific for myelin antigens, cross the blood-brain barrier and detect their antigen within the CNS. As a result, most therapies to date have been immunosuppressive and/or anti-inflammatory in nature, targeting the processes involved in activation and migration of leukocytes and promotion of the immune response. Over the last decade, a family of chemotactic cytokines called chemokines, have been found to be involved in the trafficking of leukocytes in both the normal and pathological states. The expression of these chemokines and their receptors is increased during the acute phase of MS and also in the animal model of MS, experimental autoimmune encephalomyelitis (EAE). As a result, these chemokines have become an emerging focus for research into novel therapeutics for EAE and ultimately MS. This review will briefly describe the structure and function of chemokines and their receptors, before discussing the latest advances in developing pharmacological agents to block the effects of chemokines involved in promoting the inflammatory response in EAE and MS.

Breast milk transmission of group B streptococcal infection.

A term female infant developed late onset group B streptococcal disease on Day 12 of life. The source of the organism appeared to be expressed maternal breast milk in the absence of clinical mastitis. Asymptomatic excretion of group B Streptococcus in breast milk may be an underrecognized cause of neonatal infection.

Prevalence of abnormal sleep duration and excessive daytime sleepiness in pregnancy and the role of socio-demographic factors: comparing pregnant women with women in the general population.

OBJECTIVES: To compare the prevalence of self-reported abnormal sleep duration and excessive daytime sleepiness in pregnancy among Maori (indigenous New Zealanders) and non-Maori women versus the general population, and to examine the influence of socio-demographic factors. METHODS: Self-reported total sleep time (TST) in 24-hrs, Epworth Sleepiness Scale scores and socio-demographic information were obtained from nullipara and multipara women aged 20-46 yrs at 35-37 weeks pregnant (358 Maori and 717 non-Maori), and women in the general population (381 Maori and 577 non-Maori). RESULTS: After controlling for ethnicity, age, socio-economic status, and employment status, pregnant women average 30 min less TST than women in the general population. The distribution of TST was also greater in pregnant women, who were 3 times more likely to be short sleepers (≤6 h) and 1.9 times more likely to be long sleepers (>9 h). In addition, pregnant women were 1.8 times more likely to report excessive daytime sleepiness (EDS). Pregnant women >30 years of age experienced greater age-related declines in TST. Identifying as Maori, being unemployed, and working at night increased the likelihood of reporting abnormal sleep duration across all women population in this study. EDS also more likely occurred among Maori women and women who worked at night. CONCLUSIONS: Pregnancy increases the prevalence of abnormal sleep duration and EDS, which are also higher among Maori than non-Maori women and those who do night work. Health professionals responsible for the care of pregnant women need to be well-educated about the importance of sleep and discuss sleep issues with the women they care for.