Peripartum factors predicting the need for increased doses of postpartum rhesus immune globulin.

OBJECTIVE: To evaluate the need for increased doses of postpartum rhesus immune globulin in a woman at risk for rhesus alloimmunization. METHODS: Using data from the Nova Scotia Atlee Perinatal Database (NSAPD) and the Rh Program of Nova Scotia Database, Rh negative women delivering infants with a birth weight greater than 500 grams and gestational age greater than 20 weeks at the IWK Health Centre from 1998 to 2007 were identified. Within this population, Rh(D) negative women who received both antepartum and postpartum anti-D prophylaxis were identified. Logistic regression was used to estimate peripartum predictive factors for elevated postpartum Kleihauer and the need for administration of additional rhesus immune globulin. RESULTS: The NSAPD and Rh Program Database identified 4323 Rh negative women who received both antepartum and postpartum prophylaxis from 1998 and 2007. Following logistic regression, a postpartum Kleihauer value of > 0.2% was found to be predicted by multiparity (OR 1.47; 95% CI 1.03 to 2.08), multiple gestation (OR 3.03; 95% CI 1.61 to 5.70), antepartum risks for fetomaternal hemorrhage (OR 63.6; 95% CI 30.2 to 134), and Caesarean section (OR 2.03; 95% CI 1.42 to 2.91). A postpartum Kleihauer value of > 0.5% was found to be predicted by antepartum risks for fetomaternal hemorrhage (OR 29.1; 95% CI 12.9 to 65.5), and Caesarean section (OR 2.01; 95% CI 1.18 to 3.42). CONCLUSION: While there are recognized events that increase the risk for Rh(D) alloimmunization, multiparity, multiple gestation, and Caesarean section should be additional factors for consideration, especially with rising rates of CS. Adequate postpartum prophylaxis may be optimized by conducting routine screening for fetomaternal hemorrhage, especially when lower doses of Rh(D) immune globulin are administered.

Determinants of prostate cancer stage in northern New England: USA Franco-American contextual effects.

Despite screening for prostate cancer, mortality in the United States remains substantial. In northern New England, we know little about either determinants of stage at diagnosis--an important predictor of survival--or health outcomes for Franco-Americans, the region's largest ethnic minority. The objective of this investigation was to identify predictors of late prostate cancer stage in a rural, predominantly white state with a large Franco-American population. The Maine Cancer Registry provided incident cases from 1995 to 1998. We modeled individual-level variables (age, sex, race, French ethnicity by surname, and payer) and contextual/town-level variables (socioeconomic measures, population density, Franco ancestry proportion, distance to health care, and weather severity) with multiple logistic regression for late stage. We found that age categories 50-64, 65-74, and 75-84 years--but not 40-49 years--(versus 85+) were protective for late stage, as was residence in higher snowfall areas. Diagnosis in the earlier years of the study, particularly for French-surnamed men, and residence in a high-Franco area conferred greater risk for late disease. However, in a two-way interaction, residence in towns with high Franco ancestry proportion protected French-surnamed men (OR=0.09, type 3 p<0.0593). Using an established framework for social network theory we explore the potential reasons for this interaction, including: high social cohesion, a wide range of strong ties of long duration, and frequent contact, which might have facilitated access to resources as well as social support and normative influences toward health care seeking. The absence of an association of cancer stage with socioeconomic variables may stem from the mixed sociodemographic profiles in rural and urban regions of Maine. We feel that further research should therefore refine these and other contextual measures to elucidate effects on preventable morbidity and mortality; expand our knowledge of Franco-American health outcomes and social networks; and evaluate the utility of assigning French ethnicity by surname.

Cancer of the colorectum in Maine, 1995-1998: determinants of stage at diagnosis in a rural state.

CONTEXT: Despite screening for colorectal cancer, mortality in the United States remains substantial. In northern New England, little is known about predictors of stage at diagnosis, an important determinant of survival and mortality. PURPOSE: The objective of this study was to identify predictors of late stage at diagnosis for colorectal cancer in a rural state with a predominantly white population and a large Franco-American minority. METHODS: Incident cases from 1995-1998 were obtained from the Maine Cancer Registry. Individual-level variables (age, sex, race, French ethnicity by surname, and payer) and contextual/town-level variables (socioeconomic status, population density, Franco ancestry proportion, distance to health care, and weather) were modeled with multiple logistic regression for late stage. FINDINGS: Increasing distance to primary care provider was associated with late stage for colorectal cancer. Compared to patients aged > or =85 years, those aged 65-84 years were less likely to be diagnosed late, while those aged 35-49 years were more likely--although not significantly--to have late stage at diagnosis. Associations were not found with socioeconomic variables. CONCLUSIONS: The finding regarding distance to primary care may be consistent with studies showing that rurality and distance to care predict reduced utilization of health care services and worse health outcomes. The finding regarding age has implications for the education of younger high-risk patients and their physicians. The absence of positive findings with regard to socioeconomic variables may stem from the uniquely mixed sociodemographic profiles in rural and urban regions of Maine. Further research should refine these and other contextual measures to elucidate effects on rural health and should further evaluate the utility of assigning French ethnicity by surname in order to identify health disparities.

Toward a biaxial model of "bipolar" affective disorders: spectrum phenotypes as the products of neuroelectrical and neurochemical alterations.

Based upon a synthesis of findings related to affective illness, a pathophysiologic hypothesis and possible nosology are proposed. The authors reviewed recent (2001-2004) phenomenologic, diagnostic and treatment literature for pathophysiologic implications and selectively reviewed genetic, neuroimaging, neurochemical and neuropathological studies (1966-2004) that might inform the hypothesized model. Modern DSM nosology of affective illness is based upon the accumulation of observations in the purely descriptive tradition and has little pathophysiologic basis. A new perspective, that of the bipolar spectrum, deriving from clinical, theoretical and epidemiologic considerations, appears more promising for building bridges with the emerging neurobiology of bipolar disorder. Research seeking associations between structural alterations (molecular, cellular and system-level) and behavioral-level pathophysiologic processes has provided many clues, but no population-wide, major genetic loci have been identified. Three general hypotheses have emerged in the literature implicating: 1) presynaptic electrical signaling, an early suggestion which has received less recent consideration, 2) neurotransmitter-receptor systems (first messenger) and 3) post-receptor neurochemical signaling systems (second-- and third messenger). The current 'biaxial' hypothesis proposes: 1) affective regulation may be understood in terms of two primary functional spectra: mood range and mood tonicity, 2) these spectra, in turn, are determined by neurochemical capacity and neuroelectrical modulation-and their functional interaction, and 3) proposed cellular pathophysiology suggests primary molecular loci, that may predict phenomenologic patterns and treatment responsiveness.

Sclerotherapy basics.

Sclerotherapy involves the injection of a fluid into blood vessels to eradicate them. A thorough understanding of the basics of sclerotherapy are important when beginning sclerotherapy procedures in practice. This article reviews the essential information of sclerosants, treatment of small vessel disease, and patient management.

Fine structure of the triturating devices in pumps of the food Aphelocheirus and typical naucoridae (heteroptera).

The cibarial food pumps of aquatic Heteroptera contain specialized epipharyngeal triturating devices. In the Naucoridae, striated bands and transverse plates triturate particles against the underlying hypopharynx. Anterior to them lie a pair of oblique folds which play an accessory role. The gross morphology of these devices is very similar in representatives of five genera of typical Naucoridae (Ambrysus, Pelocoris, Limnocoris, Cataractocoris, Cryphocricos) and differs from that of the atypical genus Aphelocheirus. The scanning electron microscope reveals additional differences between Aphelocheirus and the typical genera as well as variations, among the latter, which are not visible with the stereoscopic microscope. The oblique folds of the typical Naucoridae are well developed and contain processes for trapping particles; in three genera the region posterior to the folds is also modified. In Aphelocheirus only the latter region appears to trap particles, and the oblique folds are smooth and weakly developed. The striated bands of all genera bear ventral ridges arranged into transverse zones with precise patterns. The fourzoned bands of Aphelocheirus have a very different pattern than the two-zoned bands of the other genera. Among the latter, Cryphocricos has a simpler pattern of ridges than the other typical Naucoridae. The ventral surfaces of the transverse plates are highly modified in Aphelocheirus and less so in the other genera; those of Cryphocricos differ from those of the other Naucoridae. The fine structure of the cibarial epipharynx supports the views of some systematists that (1) Aphelocheirus should be placed in the monogeneric Family Aphelocheiridae rather than in the Naucoridae, (2) Cryphocricos represents a different subfamily than the other four typical Naucoridae, and (3) Cataractocoris belongs in the same subfamily as Ambrysus rather than with Cfyphocricos.

Fine structure of the triturating devices in the food pump of Notonecta (Heteroptera: Notonectidae).

The cibarial food pump of heteropteran insects conveys fluid food from the piercing stylets to the pharynx. In aquatic Heteroptera the pump also grinds and filters particulate matter in the food stream. The pump's sclerotized triturating devices differ from one family to the next and are often quite elaborate: because of their small size they are best studied by means of the scanning electron microscope. In Notonecta the main triturating devices occur on the transverse plates of the epipharyngeal roof of the pump. They consist of a complex anterior zone with raised nodes and bifurcating longitudinal ridges, and a simpler posterior zone with small nodules. Additional triturating surfaces occur on the hypopharyngeal floor of the pump. The oblique folds of the epipharynx, which lie anterior to the transverse plates, play only an accessory role. The fine structure of the grinding surfaces on the transverse plates of Gelastocoris (Gelastocoridae), Ambrysus (Naucoridae), and Aphelocheirus (Aphelocheiridae) is here briefly described and compared with that of Notonecta.