Is there an association between sonographically determined occipito-transverse position in the second stage of labor and operative delivery?

OBJECTIVE: To evaluate if ultrasound-determined occipito-transverse position early in the second stage of labor is associated with operative delivery. DESIGN: Retrospective review of two prospective cohort studies. SETTING: An Australian tertiary referral hospital. POPULATION: Women with term, cephalic singleton pregnancies. METHODS: Retrospective analysis of data from two prospective studies. Logistic regression was undertaken to assess the independent contribution of the occipito-transverse position to operative delivery. MAIN OUTCOME MEASURE: Operative delivery (cesarean section, forceps or vacuum extraction). RESULTS: Among 422 women included, the occipito-transverse position was present in 80, occipito-anterior in 303 and the occipito-posterior in 39. Compared with occipito-anterior, the adjusted odds ratio for operative delivery was 2.1 (95% confidence interval 1.2-3.8, p = 0.02) for the occipito-transverse position, and 7.4 (95% confidence interval 3.2-17) for the occipito-posterior position. Factors that independently predicted operative delivery were nulliparity, abnormal second stage cardiotocography, maternal place of birth and epidural analgesia. The length of second stage of labor was longer for the occipito-transverse group than for the occipito-anterior group (median 2 h 7 min vs. 1 h 36 min, p = 0.003). CONCLUSION: The occipito-transverse position early in the second stage of labor was associated with an increased operative delivery rate.

Quantitative analysis of students' reasons for nonsuiting and support of policy change at one urban middle school.

PURPOSE: Physical activity participation in physical education is compromised when students nonsuit. We investigated: (a) reasons for nonsuiting/support of policy change and whether they differed by gender, ethnicity, or grade; and (b) the likelihood of nonsuiting based on the same demographics. METHOD: Participants (N = 627) were 6th and 7th graders attending 1 urban middle school located in San Diego, CA. Students completed a questionnaire composed of 4 demographic items, level of agreement with 15 reasons for nonsuiting, and level of support of 6 proposed policy changes. Exploratory and confirmatory factor analyses were used to classify reasons for nonsuiting items and policy change items. Demographic differences among resultant factor scores and individual items were analyzed using t tests. Associations between factors/items and nonsuit frequency and demographics were analyzed using multinomial logistic regression. RESULTS: Girls, Latinos, and 7th graders were more likely habitual nonsuits (> or = 4 nonsuits) compared with their respective counterparts. Statistically significant factor scores (reasons for nonsuiting; emotional excuses, utilitarian excuses) were higher among habitual nonsuits but were not different based on gender, grade, and ethnicity. Seventh graders and girls had statistically significantly higher policy change factor scores compared with their respective counterparts. CONCLUSION: Acting on student input toward reformulating suiting-out policy as well as addressing emotional excuse reasons, which are primarily under teacher control, may result in lower incidence of habitual nonsuiting.

Survey of pain among veterans in Western New York.

Recent emphasis on pain and its impact on the health and well-being of individuals evoked the interest of health care providers about services needed for effective and efficient pain management. This study was undertaken to examine the feasibility of using a mailed survey to determine the prevalence, nature, and extent of pain being experienced by Western New York Veterans. The specific aims were to (1) determine the feasibility of using a mailed survey to obtain information about pain in a population of Veterans; (2) estimate the extent of pain in the sample; and (3) describe the nature and impact of the pain experienced by the respondents. A comprehensive survey was prepared by modifying preexisting, widely used pain-assessment tools to describe a Veteran group's pain experience. It was mailed to a randomly selected sample of 150 Veterans registered at a primary care clinic at the Western New York Veterans Administration Health System. A 76% response rate (n=114) was obtained. Respondents declared a wide variety of health problems, and 71% reported having pain. The average number of body parts affected was 4.4 of a possible 11. The average intensity of pain was moderate; 35% reported constant pain, and 85% reported the pain to be occurring for years. Seventy-nine respondents described their pain to be interfering with their life and well-being. Medication was the primary treatment approach and was reported as ineffective by 48%. Veterans' satisfaction with specific aspects of pain treatment was mixed.