Prevalence and predictors for postpartum sleep disorders: a nationwide analysis.

OBJECTIVE: To describe the prevalence and predictors of postpartum sleep disorders. DESIGN: A retrospective cohort study. SETTING: Postpartum. POPULATION: Commercially insured women delivering in California (USA) between 2011 and 2014. METHODS: Using the Optum Clinformatics Datamart Database. MAIN OUTCOME MEASURES: Prevalence of a postpartum sleep disorder diagnosis with and without a depression diagnosis up to 12 months following hospital discharge for inpatient delivery. We also identified predictors of a postpartum sleep disorder diagnosis using multivariable logistic regression. RESULTS: We identified 3535 (1.9%) women with a postpartum sleep disorder diagnosis. The prevalence of sleep disorder diagnoses was insomnia (1.3%), sleep apnea (0.25%), and other sleep disorder (0.25%). The odds of a postpartum sleep disorder were highest among women with a history of drug abuse (adjusted odds ratio (aOR): 2.70, 95% confidence interval (CI): 1.79-4.09); a stillbirth delivery (aOR: 2.15, 95% CI: 1.53-3.01); and chronic hypertension (aOR: 1.82; 95% CI: 1.57-2.11). A comorbid diagnosis of a postpartum sleep disorder and depression occurred in 1182 women (0.6%). These women accounted for 33.4% of all women with a postpartum sleep disorder. The strongest predictors of a comorbid diagnosis were a history of drug abuse (aOR: 4.13; 95% CI: 2.37-7.21) and a stillbirth delivery (aOR: 2.93; 95% CI: 1.74-4.92). CONCLUSIONS: Postpartum sleep disorders are underdiagnosed conditions, with only 2% of postpartum women in this cohort receiving a sleep diagnosis using International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes. Insomnia was the most common disorder and one-third of women diagnosed with a postpartum sleep disorder had a co-morbid diagnosis of depression. Future studies are needed to improve the screening and diagnostic accuracy of postpartum sleep disorders.

Impact of antiretroviral dosing frequency and pill burden on adherence among newly diagnosed, antiretroviral-naive HIV patients.

There are few data on the impact of antiretroviral therapy (ART) regimen factors on adherence in ART-naïve HIV patients on contemporary once- or twice-daily regimens. Ninety-nine newly diagnosed patients in a prospective observational cohort study completed a visual analogue scale to assess their ART adherence. Adherence by type of ART and dosing frequency were compared by Brown-Mood median tests. Participants taking once-daily regimens had higher adherence (n = 70, 99.5%) compared with participants taking twice-daily regimens (n = 29, 94%; P = 0.01). Adherence of participants taking the fixed dose combination efavirenz-emtricitabine-tenofovir (n = 34, 100%) compared with those taking once-daily regimens of two or more pills was no different (n = 36, 99.3%; P = 0.34). Among a cohort of newly diagnosed ART-naïve patients, once-daily dosing of ART resulted in higher adherence than twice-daily dosing. Pill burden among once-daily regimens did not predict adherence, suggesting that factors other than pill burden should drive regimen selection.

A combined-method psychometric analysis recommended modification of the multidimensional health locus of control scales.

OBJECTIVE: The Multidimensional Health Locus of Control (MHLC) scales are widely used to measure beliefs about determinants of persons' health. We evaluated the scales over the largest-ever disease-specific sample of subjects using a combined-method psychometric approach. STUDY DESIGN AND SETTING: We performed a secondary analysis of data from 1,206 subjects from three osteoarthritis studies, using Rasch analysis and confirmatory factor analysis simultaneously. Differential item functioning (DIF) by gender and data source, scale dimensionality, and item fit were examined. The Rasch model fit the data if Rasch residual principal components analysis (PCA) corroborated three distinct dimensions and item fit statistics fell between 0.80 and 1.20. The confirmatory factor (CFA) model fit the data if factor loadings exceeded 0.50 for all items. RESULTS: DIF by gender or data source was not materially evident for any items. PCA supported existence of three dimensions in the data. Both Rasch and CFA models fit the data for 16 items; two items were detected as misperforming. When these items were removed, fit of both models improved. CONCLUSION: Results of this large-sample evaluation of the MHLC scales corroborated earlier findings that removal of certain items improves the scales. The combined Rasch-CFA approach provided better insight to scale performance problems than either method alone provided.

Effect of intrapartum use of oxytocin on estimated blood loss and hematocrit change at vaginal delivery.

We hypothesized that exogenous oxytocin given for labor induction or augmentation results in a greater blood loss at vaginal delivery compared with spontaneous labor. Second, we theorized that duration of exposure, and maximum or final dosage of oxytocin, would be positively correlated with blood loss. We retrospectively studied records of 111 women undergoing labor induction or augmentation by oxytocin infusion along with those of 76 women who had spontaneous labor. The outcomes evaluated included clinically estimated blood loss (EBL), and a change of hematocrit from admission to postpartum. These were further compared to duration and dosage of oxytocin infused. A combination of chi-square and analysis of variance were used to compare the study group with the controls. Regression analysis was used to evaluate possible relationships within the study group. The demographics of the study group who received oxytocin were similar to those of the control group, with the exception of the percent who received an epidural (77% versus 29%, p < 0.0001) and length of labor (381 versus 277 min, p < 0.001). There was no demonstrated relationship between oxytocin use and EBL or hematocrit change. Within the study group of 111 patients, there was a statistically significant increase in EBL (p < 0.01) and hematocrit change (p < 0.0003) with increasing maximum dose of oxytocin. In addition, hematocrit change was greater with an increase in both duration (p < 0.001) and final dose of oxytocin (p < 0.0003). No relationship was demonstrated between exogenous oxytocin administration and increased blood loss, in a group of patients matched for variables other than spontaneous or oxytocin exposed labors. However, among those patients who received oxytocin, there was a correlation between amount of oxytocin exposure and blood loss. The initial hypothesis compared means between the two groups; however, the latter hypothesis sought to correlate increased exposure to oxytocin with increasing blood loss as measured by duration, maximum, and final dose.

Absolute two-photon cross section of Rb measured by differential absorption.

We applied a simple, sensitive differential absorption technique to measure the two-photon cross section for the 5(2)S((1/2))(F(g) = 2) ? 5(2)D(5/2)(F(e) = 4) hyperfine transition in (85)Rb [sigma((2)) = (1.2 +/- 0.5) x 10(-18) cm(4)/W]. The detection circuit permitted straightforward measurements close to the shot-noise limit. Detailed quantitative analysis of the measurements shows excellent agreement with theory.

Simple diffuser for production of laser speckle.

A passive optical element that is a simple, inexpensive, and effective way for producing laser speckle is described. The optical element, a random phase plate, was developed in our laboratory. The statistics of the speckle pattern it produces were measured and are discussed in this paper. The phase plate was used to produce a speckled beam using a 5-mW cw He-Ne laser with a Gaussian beam profile and using a pulsed Nd:YAG laser with a nonuniform intensity profile for which the mean intensity was 10(9) W/cm(2).