HIV and Drug Use: A Tale of Synergy in Pulmonary Vascular Disease Development.

Over the past two decades, with the advent and adoption of highly active anti-retroviral therapy, HIV-1 infection, a once fatal and acute illness, has transformed into a chronic disease with people living with HIV (PWH) experiencing increased rates of cardio-pulmonary vascular diseases including life-threatening pulmonary hypertension. Moreover, the chronic consequences of tobacco, alcohol, and drug use are increasingly seen in older PWH. Drug use, specifically, can have pathologic effects on the cardiovascular health of these individuals. The "double hit" of drug use and HIV may increase the risk of HIV-associated pulmonary arterial hypertension (HIV-PAH) and potentiate right heart failure in this population. This article explores the epidemiology and pathophysiology of PAH associated with HIV and recreational drug use and describes the proposed mechanisms by which HIV and drug use, together, can cause pulmonary vascular remodeling and cardiopulmonary hemodynamic compromise. In addition to detailing the proposed cellular and signaling pathways involved in the development of PAH, this article proposes areas ripe for future research, including the influence of gut dysbiosis and cellular senescence on the pathobiology of HIV-PAH. © 2023 American Physiological Society. Compr Physiol 13:4659-4683, 2023.

ACROBAT Edge: Safety and Efficacy of Switching Injected SRLs to Oral Paltusotine in Patients With Acromegaly.

CONTEXT: Paltusotine is a once-daily, oral, nonpeptide small-molecule somatostatin receptor type 2 (SST2) agonist in clinical development for treatment of acromegaly. OBJECTIVE: This work aimed to evaluate change in insulin-like growth factor I (IGF-I) levels in patients switched from octreotide long-acting release or lanreotide depot monotherapy to paltusotine. METHODS: A phase 2, open-label, prospective, multicenter, multinational, nonrandomized, single-arm exploratory study was conducted in which dosage uptitrations were performed in a double-blinded manner. At 26 global sites, patients with acromegaly switched to paltusotine from injected somatostatin receptor ligand (SRL)-based therapy. Patients received 13-week treatment with once-daily oral paltusotine (10-40 mg/d). The primary end point was change from baseline to week 13 in IGF-I for patients who switched from long-acting octreotide or lanreotide depot monotherapy to paltusotine (group 1). All patients underwent a 4-week paltusotine washout at end of treatment period (wk 13-17). IGF-I, growth hormone (GH), patient-reported outcome, and safety data were collected. RESULTS: Forty-seven patients enrolled. In group 1 (n = 25), IGF-I and GH showed no significant change between SRL baseline and end of paltusotine treatment at week 13 (median change in IGF-I = -0.03×upper limit of normal [ULN]; P = .6285; GH = -0.05 ng/mL; P = .6285). IGF-I and GH rose significantly in the 4 weeks after withdrawing paltusotine (median change in IGF-I = 0.55×ULN; P < .0001 [median increase 39%]; GH = 0.72 ng/mL; P < .0001 [109.1% increase]). No patients discontinued because of adverse events (AE); no treatment-related serious AEs were reported. CONCLUSION: These results suggest once-daily oral paltusotine was effective in maintaining IGF-I values in patients with acromegaly who switched from injected SRLs. Paltusotine was well tolerated with a safety profile consistent with other SRLs.

Establishing a Cohort and a Biorepository to Identify Biomarkers for Early Detection of Lung Cancer: The Nashville Lung Cancer Screening Trial Cohort.

Rationale: A prospective longitudinal cohort of individuals at high risk of developing lung cancer was established to build a biorepository of carefully annotated biological specimens and low-dose computed tomography (LDCT) chest images for derivation and validation of candidate biomarkers for early detection of lung cancer.Objectives: The goal of this study is to characterize individuals with high risk for lung cancer, accumulating valuable biospecimens and LDCT chest scans longitudinally over 5 years.Methods: Participants 55-80 years of age with a 5-year estimated risk of developing lung cancer >1.5% were recruited and enrolled from clinics at the Vanderbilt University Medical Center, Veteran Affairs Medical Center, and Meharry Medical Center. Individual demographic characteristics were assessed via questionnaire at baseline. Participants underwent an LDCT scan, spirometry, sputum cytology, and research bronchoscopy at the time of enrollment. Participants will be followed yearly for 5 years. Positive LDCT scans are followed-up according to standard of care. The clinical, imaging, and biospecimen data are collected prospectively and stored in a biorepository. Participants are offered smoking cessation counseling at each study visit.Results: A total of 480 participants were enrolled at study baseline and consented to sharing their data and biospecimens for research. Participants are followed with yearly clinic visits to collect imaging data and biospecimens. To date, a total of 19 cancers (13 adenocarcinomas, four squamous cell carcinomas, one large cell neuroendocrine, and one small-cell lung cancer) have been identified.Conclusions: We established a unique prospective cohort of individuals at high risk for lung cancer, enrolled at three institutions, for whom full clinical data, well-annotated LDCT scans, and biospecimens are being collected longitudinally. This repository will allow for the derivation and independent validation of clinical, imaging, and molecular biomarkers of risk for diagnosis of lung cancer.Clinical trial registered with ClinicalTrials.gov (NCT01475500).

Data for training and testing radiation detection algorithms in an urban environment.

The detection, identification, and localization of illicit nuclear materials in urban environments is of utmost importance for national security. Most often, the process of performing these operations consists of a team of trained individuals equipped with radiation detection devices that have built-in algorithms to alert the user to the presence nuclear material and, if possible, to identify the type of nuclear material present. To encourage the development of new detection, radioisotope identification, and source localization algorithms, a dataset consisting of realistic Monte Carlo-simulated radiation detection data from a 2 in. × 4 in. × 16 in. NaI(Tl) scintillation detector moving through a simulated urban environment based on Knoxville, Tennessee, was developed and made public in the form of a Topcoder competition. The methodology used to create this dataset has been verified using experimental data collected at the Fort Indiantown Gap National Guard facility. Realistic signals from special nuclear material and industrial and medical sources are included in the data for developing and testing algorithms in a dynamic real-world background.

ERp29 as a regulator of Insulin biosynthesis.

The environment within the Endoplasmic Reticulum (ER) influences Insulin biogenesis. In particular, ER stress may contribute to the development of Type 2 Diabetes (T2D) and Cystic Fibrosis Related Diabetes (CFRD), where evidence of impaired Insulin processing, including elevated secreted Proinsulin/Insulin ratios, are observed. Our group has established the role of a novel ER chaperone ERp29 (ER protein of 29 kDa) in the biogenesis of the Epithelial Sodium Channel, ENaC. The biogenesis of Insulin and ENaC share may key features, including their potential association with COP II machinery, their cleavage into a more active form in the Golgi or later compartments, and their ability to bypass such cleavage and remain in a less active form. Given these similarities we hypothesized that ERp29 is a critical factor in promoting the efficient conversion of Proinsulin to Insulin. Here, we confirmed that Proinsulin associates with the COP II vesicle cargo recognition component, Sec24D. When Sec24D expression was decreased, we observed a corresponding decrease in whole cell Proinsulin levels. In addition, we found that Sec24D associates with ERp29 in co-precipitation experiments and that ERp29 associates with Proinsulin in co-precipitation experiments. When ERp29 was overexpressed, a corresponding increase in whole cell Proinsulin levels was observed, while depletion of ERp29 decreased whole cell Proinsulin levels. Together, these data suggest a potential role for ERp29 in regulating Insulin biosynthesis, perhaps in promoting the exit of Proinsulin from the ER via Sec24D/COPII vesicles.

Surgical management of medically-refractory hyperinsulinism.

BACKGROUND: Congenital hyperinsulinism (CHI) and insulinomas are the most common causes of medically-refractory pediatric hyperinsulinism. METHODS: Children with CHI or insulinoma treated from 1/1/2014-1/1/2019 at an academic center were retrospectively analyzed. Primary outcome was persistent intravenous dextrose requirement at discharge. RESULTS: Eleven patients were identified: six with diffuse-type CHI, three with focal-type CHI, two with insulinoma. Median age at diagnosis was 20 days (1 day-16 years). Preoperative functional imaging (18F-Fluoro-l-DOPA PET-CT scan) accurately localized 66% of focal-type CHI lesions. All patients with focal-type CHI and insulinoma were cured by local resection. All patients with diffuse-type CHI underwent near-total pancreatectomy (NTP): four patients were cured of hyperinsulinism, of which 2 developed insulin-dependent diabetes, while two patients were palliated to home enteral glucose infusion. CONCLUSIONS: Localized resection cures children with focal, insulin-secreting lesions. NTP may cure diffuse-type CHI; potential complications include diabetes, exocrine insufficiency, and persistent hypoglycemia from residual hypersecreting pancreatic tissue. SUMMARY: Congenital hyperinsulinism (CHI) and insulinomas are the most common causes of medically-refractory pediatric hyperinsulinism, causing potential complications including permanent brain injury. 18F-Fluoro-l-DOPA PET-CT scan can be used to localize focal insulin-secretion lesions preoperatively. Focal-type CHI and insulinoma are cured by localized resection. Diffuse-type CHI requires near-total pancreatectomy for cure, but complications include diabetes, exocrine insufficiency, or persistent hypoglycemia from residual foci of hypersecreting pancreatic tissue.

The Pursuit of Noninvasive Diagnosis of Lung Cancer.

The noninvasive diagnosis of lung cancer remains a formidable challenge. Although tissue diagnosis will remain the gold standard for the foreseeable future, questions pertaining to the risks and costs associated with invasive diagnostic procedures are of prime relevance. This review addresses new modalities for improving the noninvasive evaluation of suspicious lung nodules. Ultimately, the goal is to translate early diagnosis into early treatment. We discuss how biomarkers could assist in distinguishing benign from malignant nodules and aggressive from indolent tumors. The field of biomarkers is rapidly expanding and progressing, and efforts are well underway to apply molecular diagnostics to address the shortcomings of current lung cancer diagnostic tools.

Sexually Transmitted Pathogens, Depression, and Other Manifestations Associated with Premenstrual Syndrome.

This study investigated whether sexually transmitted infections and lifestyle variables are associated with premenstrual syndrome (PMS) as well as particular manifestations commonly associated with PMS. Data were gathered from medical records of 500 regularly cycling women. The following infectious agents were investigated: human papillomavirus, Chlamydia trachomatis, Neisseria gonorrheae, Gardnerella vaginalis, Candida albicans, and Trichomonas vaginalis. Bivariate tests and multivariate logistic regressions were used to evaluate whether these pathogens were associated with headache, pain, nausea, and depression. Chlamydia trachomatis was significantly associated with premenstrual syndrome (PMS) and two common manifestations of PMS: depression and pain. Trichomonas vaginalis was significantly correlated with headache and Gardnerella vaginalis with nausea. None of the illness manifestations was significantly associated with the tested lifestyle variables: dietary calcium supplementation, alcohol and drug use, exercise, and smoking. These associations provide a basis for assessment of infectious causation of PMS and several manifestations of illness that are commonly associated with PMS.

The feasibility and effectiveness of emergency department based hypertension screening: a systematic review.

PURPOSE: Hypertension is a highly prevalent risk factor for cardiovascular disease, and its early identification and management results in reductions in morbidity and mortality. Our objectives were to: (1) determine the extent to which the emergency department (ED) has been used to screen patients for undiagnosed hypertension; (2) estimate the incidence of undiagnosed hypertension in the ED population; (3) identify and describe the programs for ED hypertension screening; and (4) determine the feasibility of ED-based hypertension screening programs and the requirements for further study. DATA SOURCES: An online search of databases (i.e., OVID Search, CINAHL, Scopus, Web of Science), unpublished sources (i.e., ProQuest Dissertation & Theses and Papers First), and grey literature (i.e., OpenSIGLE and the New York Academy of Grey Literature) was conducted. A manual search of the reference lists of relevant studies was also completed. CONCLUSION: Hypertension screening in the ED is feasible. Individuals with elevated blood pressure (BP) in the ED should be referred for follow-up. Further study is needed to develop an ED screening tool that is predictive of persistently elevated BP in undiagnosed individuals. IMPLICATIONS FOR PRACTICE: Nurse practitioners in the ED should identify patients with elevated BP, provide hypertension education, and ensure appropriate intervention and referral.

Functional outcomes after neonatal open cardiac surgery: comparison of survivors of the Norwood staged procedure and the arterial switch operation.

BACKGROUND: Improvements in long-term survival of children undergoing the Norwood staged procedure and the arterial switch operation have resulted in the need to prepare these at-risk children for each stage of their developmental trajectory, including school readiness. This study describes and compares functional outcomes following the Norwood staged procedure and arterial switch operations. METHODS: This prospective inception cohort study comprised a sample of 73 children (71% boys) who had the Norwood staged procedure (n = 28) or the arterial switch operation (n = 45) at the age of 6 weeks or younger at the Stollery Children's Hospital, Edmonton, Alberta, between 2002 and 2005. We excluded children who had chromosomal abnormalities or cerebral palsy. When children were 18-24 months of age, parents completed the Adaptive Behavioral Assessment System II. Standard scores for the domains are mean 100, standard deviation (15); skill area scaled scores, 10 (3). Student's t-test with Bonferonni correction was used to compare groups. RESULTS: This population has greater than four times the number of children delayed on the General Adaptive Composite than the normative group. Functional outcomes were similar in the two groups other than those of home living (Norwood: 8.8 (2.8) compared with arterial switch: 11.2 (3.1), t = 3.389, p = 0.001) and self-care (Norwood: 5.9 (3.5) versus arterial switch: 8.1 (2.6), t = 3.140, p = 0.002). CONCLUSION: These survivors are at increased risk for delayed functional abilities. Self-care, necessary for independence and confidence as children reach school age, was particularly low in the Norwood group. Reasons for low self-care abilities require further study.

Genetic ablation of luteinizing hormone receptor improves the amyloid pathology in a mouse model of Alzheimer disease.

Amyloid-beta peptide (Abeta) plays an essential pathophysiologic role in Alzheimer disease, and elevation of luteinizing hormone (LH) levels during aging has been implicated in its pathogenesis. To assess the effect of LH receptor deficiency on Abeta accumulation, we generated a bigenic mouse model, APPsw(+)/Lhr(-/-), which expresses human amyloid precursor protein (APPsw) in the background of LH receptor (Lhr) knockout. Genetic ablation of Lhr resulted in a significant decrease in the number of Abeta plaques and protein content in the hippocampus and cerebral cortex in both male and female mice. Accordingly, several Abeta deposition-related neuropathologic features and functionally relevant molecules were markedly improved, including decreased astrogliosis, reductions of elevated phosphorylated tau, c-fos, alpha7-nicotinic acetylcholine receptor, and restoration of the altered neuropeptide Y receptors Y1 and Y2. Diminution of Abeta accumulation in the absence of LH receptor supports the contention that dysregulation of LH may impact the pathogenesis of Alzheimer disease. The APPsw(+)/Lhr(-/-) mouse may be a useful tool for advancing understanding of the role of LH-mediated events in Alzheimer disease and a model in which to test therapeutic interventions.

Midline location of tumour is a risk factor for postoperative vomiting in children requiring posterior fossa tumour resection.

Children requiring posterior fossa brain tumour surgery form a unique and significant neuro-oncology population. Postoperative vomiting (POV) is a problem for these children. Also, severe vomiting that is refractory to treatment has been seen clinically in these children, but it is not well described in the literature. A subgroup of children requiring surgery for posterior fossa brain tumours (n=153) from a larger six-year retrospective chart audit (n=249) at two Canadian children's hospitals were reviewed for the presence of no, mild, moderate, and severe POV. Inter-rater reliability was established at 94% following a blinded process of comparing POV severity rankings between two data collector/researchers. Discrepancies were resolved through discussion in order to establish a consensus severity score. Findings from multivariable logistic regression analyses indicated that when age and intraoperative use of ondansetron were controlled for, the location of a tumour in a midline location had no overall effect (adjusted OR=1.37, 95% confidence interval: 0.64-2.96, p=0.43), but greater odds of severe vomiting (adjusted OR=7.08, 95% confidence interval: 2.56-19.64, p<0.001). These results support theories of modulation of vomiting by the medullary midline and clinical observations that children with midline posterior fossa tumours are at greater risk for severe refractory vomiting. The development of clinical practice guidelines and further research to study the effectiveness of novel, multimodal antiemetic therapies are required for this patient population.

Children's vomiting following posterior fossa surgery: A retrospective study.

BACKGROUND: Nausea and vomiting is a problem for children after neurosurgery and those requiring posterior fossa procedures appear to have a high incidence. This clinical observation has not been quantified nor have risk factors unique to this group of children been elucidated. METHODS: A six year retrospective chart audit at two Canadian children's hospitals was conducted. The incidence of nausea and vomiting was extracted. Hierarchical multivariable logistic regression was used to quantify risk and protective factors at 120 hours after surgery and early vs. late vomiting. RESULTS: The incidence of vomiting over a ten day postoperative period was 76.7%. Documented vomiting ranged from single events to greater than 20 over the same period. In the final multivariable model: adolescents (age 12 to <17) were less likely to vomit by 120 hours after surgery than other age groups; those who received desflurane, when compared to all other volatile anesthetics, were more likely to vomit, yet the use of ondansetron with desflurane decre kelihood. Children who had intraoperative ondansetron were more likely to vomit in the final multivariable model (perhaps because of its use, in the clinical judgment of the anesthesiologist, for children considered at risk). Children who started vomiting in the first 24 hours were more likely to be school age (groups 4 to <7 and 7 to <12) and receive desflurane. Nausea was not well documented and was therefore not analyzed. CONCLUSION: The incidence of vomiting in children after posterior fossa surgery is sufficient to consider all children requiring these procedures to be at high risk for POV. Nausea requires better assessment and documentation.

Abdominal wall endometrioma following cesarean delivery: a case report.

BACKGROUND: Rarely, endometriosis occurs in an abdominal wall scar after a cesarean delivery. CASE: This case report summarizes the presentation, diagnosis and treatment of a woman with an abdominal wall endometrioma within a cesarean delivery skin incision scar. CONCLUSION: An abdominal wall endometrioma needs to be considered in the differential diagnosis of any woman of reproductive age presenting with a painful abdominal wall mass and a history of uterine surgery via an abdominal incision.

What are the risk factors for nausea and vomiting after neurosurgery? A systematic review.

In their practice of post-operative neurosurgical care, nurses frequently encounter the problem of post-operative nausea and vomiting (PONV). Knowledge of risk factors for PONV can help nurses to identify groups of patients who may encounter PONV and develop related therapeutic guidelines. The purpose of this systematic review was to identify and summarize risk factor research for PONV after neurosurgical procedures. Of 272 papers identified through a systematic search, 13 studies met the criteria for this review. These studies varied considerably in their outcome measurements, risk factors studied, and target populations. The timeframe of observation (for prospective studies) or chart review (for retrospective studies) ranged from one hour after surgery to the entire length of the hospital stay. For these reasons, it was difficult to compare results among the studies. Overall, the methodological quality of the studies was fair, with few studies controlling for confounders and many with limited explanations of how the risk factors and/or outcomes were measured. Despite these limitations, many authors looked at unique risk factors for neurosurgical patients such as location of surgery (i.e., infratentorial versus supratentorial), awake versus general anesthesia, and use of fat grafting for cerebral spinal fluid leak in transsphenoidal procedures. The findings may challenge traditional thinking about risk factors for PONV and guide future studies.

The use of low-dose warfarin as prophylaxis for central venous catheter thrombosis in patients with cancer: a meta-analysis.

PURPOSE/OBJECTIVES: To determine whether the use of low-dose warfarin could reduce the incidence of thrombosis in patients with cancer who have a central venous catheter (CVC). DATA SOURCES: MEDLINE, CINAHL, CANCERLIT, EMBASE, and the Cochrane Library. DATA SYNTHESIS: Meta-analysis of four studies (N = 1,236 patients) revealed that 6.4% of warfarin-treated patients experienced a thrombotic event compared with 7.5% in the control (no treatment) group. The risk difference for thrombus formation was not significant (2.0%, confidence interval = -9.0% to 5.0%). CONCLUSIONS: The administration of warfarin did not reduce the incidence of symptomatic or asymptomatic CVC-associated thrombosis in patients with cancer. IMPLICATIONS FOR NURSING: Using research findings to inform clinical nursing practice is important in caring for patients and providing optimal and improved patient outcomes. Prophylactic use of low-dose warfarin may not prevent thrombus formation and is associated with potentially adverse patient outcomes.

What do women know about the risks of delayed childbearing?

BACKGROUND: Women aged 35 and older account for an increasing proportion of births and are at increased risk of pregnancy complications and poor infant outcomes. The objectives of the study were: 1) to determine what women know about delayed childbearing, including pregnancy complications and outcomes associated with low birthweight (LBW, < 2500 grams), preterm delivery (< 37 weeks) and multiple birth, and 2) to assess the characteristics of women with limited knowledge of risks. METHODS: A computer-assisted telephone interview survey was conducted with 1,044 randomly selected women who delivered their first live-born infant, between July 2002 and September 2003, in two urban centres, Calgary and Edmonton, in Alberta, Canada. RESULTS: The proportion of women aware of specific childbearing risks associated with advanced maternal age were as follows: conception difficulties (85.3%), multiple birth (24.0%), caesarean section (18.8%), preterm delivery (21.8%), and LBW (11.2%). Knowledge of specific developmental and health-related risks of suboptimal infant outcomes ranged between 18.0% and 46.5%. Logistic regression revealed that limited knowledge of maternal age-related pregnancy risks were associated with unplanned pregnancy (OR, 1.48; 95% CI, 1.03-2.14), smoking (OR, 1.83; 95% CI, 1.29-2.60) and non-use of fertility treatment (OR, 2.15; 95% CI, 1.44-3.19). Characteristics associated with limited knowledge of the risks associated with suboptimal birth outcomes were: age 35-39 years (OR, 2.98; 95% CI, 1.35-6.58), less than post-graduate education (< or = high school OR, 2.14; 95% CI, 1.20-3.82), and not currently enrolled as a student (OR, 1.75; 95% CI, 1.02-3.00). CONCLUSIONS: Many women are generally unaware of the potential consequences of delayed childbearing. There are missed opportunities in preconception counselling and education, which should be addressed to allow for more informed decision-making about family planning.

Do women change their drinking behaviors while trying to conceive? An opportunity for preconception counseling.

BACKGROUND: Prenatal alcohol exposure is a leading cause of preventable mental retardation and developmental disabilities, including fetal alcohol syndrome. Current medical guidelines recommend that no alcohol should be consumed over the period of conception and throughout pregnancy. Although the majority of women reduce alcohol consumption when they realize they are pregnant, this recognition may not occur until well into the first trimester, potentially impacting embryonic development. OBJECTIVES: To describe and assess changes in patterns of women's alcohol use between the preconception, pre-pregnancy recognition and post-pregnancy recognition time periods. Secondly, to describe characteristics of women consuming any alcohol and those binge drinking during pre- and post-pregnancy recognition periods. METHODS: Computer assisted telephone interviews were conducted with 1042 women who had recently delivered a baby in urban Alberta, Canada. Differences in consumption patterns between time periods were analyzed using analysis of variance and Chi-square tests. Characteristics of those drinking both before and after pregnancy recognition were analyzed using logistic regression. RESULTS: Eighty percent of women reported alcohol consumption pre-conceptually, 50% pre-pregnancy recognition and 18% post-pregnancy recognition. Binge drinking was reported by 32%, 11% and 0% for preconception, pre-pregnancy recognition and post-pregnancy recognition periods, respectively. Alcohol consumption patterns (i.e., the mean number of drinks per drinking day and week) did not differ significantly between preconception and pre-pregnancy recognition periods but did significantly drop after pregnancy recognition (p<0.001). Alcohol use during the period of pre-pregnancy recognition was higher among those not planning a pregnancy, not using assisted reproductive technology, of higher income, without a history of miscarriage, who were Caucasian, and who used tobacco. Binge drinking was higher among women not planning a pregnancy, those who used tobacco, and those with low self-esteem. Women continuing to drink small amounts of alcohol after pregnancy recognition were more likely to be between the ages of 30-39 years, be Caucasian and use tobacco. CONCLUSION: Preconception and "well-women" counseling strategies would be improved by increasing the emphasis on the risks of alcohol use during periods when pregnancy can occur.

Do maternal characteristics and past pregnancy experiences predict preterm delivery among women aged 20 to 34?

OBJECTIVE: To identify key demographic, lifestyle, and medical indicators for preterm births in women aged 20 to 34. METHODS: A population-based, case-control study consisting of 987 women aged 20 to 34, who delivered a liveborn singleton infant at <37 weeks' gestation in Alberta between May 1999 and August 2000. Controls delivered liveborn infant(s) at > or =37 weeks' gestation. Information was obtained from computer-assisted telephone interviews, and the provincial Physician Notice of Stillbirth/Birth database. Analysis included bivariate and logistic regression techniques. RESULTS: Logistic regression modelling indicated that significant risk factors for preterm delivery included poor past pregnancy outcome (odds ratio [OR] 6.4), poor emotional health (OR 1.8), more than 3 years or less than 1 year between pregnancies (OR 1.4 and 1.9, respectively), polyhydramnios and oligohydramnios (OR 4.1), bleeding at greater than 20 weeks' gestation (OR 10.4), malpresentation (OR 2.9), gestational hyper- tension (OR 2.2), and gestational hypertension with proteinuria (OR 4.4). Women who had fewer than 10 prenatal visits, regardless of attending prenatal classes, were at highest risk of preterm delivery (OR 6.7). CONCLUSIONS: In this population of women aged 20 to 34 years, few prenatal visits, poor emotional health prior to pregnancy, and conditions of the current pregnancy were strongly associated with preterm singleton birth.

Where and to what extent is prevention of low birth weight possible?

Law birth weight (LBW), due to shortened gestation and/or inadequate fetal growth. is the major determinant of infant mortality and morbidity. Despite improvements in infant mortality, them has been no reduction in LBW rates. The authors examined the relationship between 33 maternal characteristics and the increased risks of preterm (PT) delivery or small-for-gestational-age (SGA) births in 76,444 Alberta women 1994-1997. PT was associated with preexisting medical conditions, obstetrical history, and pregnancy complications. Modifiable factors such as advanced maternal age contributed only 11% to the overall PT risk. SGA births were associated with several modifiable factors, including low prepregnancy weight, maternal age, smoking, drinking, and drug dependency. These contributed to 29% and 31% of PTand term SGA births. Smoking remains an important target for intervention, having contributed to 8% of PT births and about 24% of SGA births. SGA appears to be more amenable to prevention than PT delivery.