Maternal Vitamin B12 Levels During Pregnancy and Their Effects on Maternal Neurocognitive Symptoms: A Systematic Review.

OBJECTIVE: Vitamin B12 deficiency has been linked to neurocognitive symptoms. Vitamin B12 deficiency in pregnancy may be associated with antenatal or postpartum depression along with other neurocognitive symptoms including restless leg syndrome. The objective of this study was to systematically review the literature regarding vitamin B12 deficiency and insufficiency in pregnancy and its effects on maternal neurocognitive symptoms. DATA SOURCES: MEDLINE, Embase, and SCOPUS were searched from inception to October, 2020. STUDY SELECTION: Observational studies and randomized controlled trials of singleton pregnancies involving vitamin B12 deficiency and reporting maternal neurocognitive outcomes were identified. DATA EXTRACTION AND SYNTHESIS: Data were synthesized and are presented narratively. CONCLUSIONS: The 5 studies included in the analysis did not demonstrate a statistically significant link between vitamin B12 deficiency or insufficiency and either restless leg syndrome or depression in pregnancy. To date, evidence is lacking that would support a causal link between suboptimal vitamin B12 serum levels and maternal restless leg syndrome or depression.

Asymptomatic Atypical Hyperplasia and Endometriosis Following Treatment with Tamoxifen: A Case Report and Review of the Literature.

BACKGROUND: Tamoxifen may cause proliferative effects in the endometrium. Patients on tamoxifen have an increased risk for endometriosis, but are not routinely screened for this. CASE: A 49-year-old postmenopausal patient presented for a total laparoscopic hysterectomy and bilateral salpingo-oophorectomy several years after initiating tamoxifen for breast cancer. She had no clinical history to suggest endometriosis, but was found to have extensive pelvic endometriosis intraoperatively with polypoid hyperplasia found on the pathology of the uterine and the ovarian tissue. CONCLUSION: This is the first case reported of an asymptomatic patient on tamoxifen with a new diagnosis of endometriosis along with atypical hyperplasia in the ectopic tissue. The potential for pre-malignant/malignant transformation may alter the treatment course if identified following tamoxifen exposure.

Prevalence of distracted walking with mobile technology: an observational study of Calgary and Edmonton high school students.

OBJECTIVES: Distracted walking poses a safety concern while crossing roads. A 2014 Canadian survey showed that 51% of teenagers were hit or almost hit while crossing the street, many of whom were distracted by mobile technology. An American study demonstrated that 1 in 5 high school students engaged in distracted walking; however, prevalence estimates in Canada have not been described. This study aimed to obtain a prevalence estimate of distracted walking in high school students in Calgary and Edmonton, Alberta, Canada. METHODS: Students were observed crossing the street at 20 high schools following afternoon school dismissal times during September to November 2017. Behaviours included talking on mobile phone, using earbuds, looking down at phone, and engaging in more than one of these behaviours. Also recorded were median household income of surrounding neighbourhood, outside temperature, gender, and crosswalk type. RESULTS: A total of 3553 students were observed, with 666 engaged in distracted walking (18.7%). Females engaged in distracted walking more than males (19.9% vs. 17.6%, respectively). The most prevalent behaviour was using earbuds (66.5%). Males had a lower prevalence of distracted walking compared with females. Distracted walking was more prevalent when the temperature was above 10 °C compared with less than 0 °C and less prevalent at signaled compared with non-signaled intersections. CONCLUSION: This study demonstrates that approximately 1 in 5 high school students in Calgary and Edmonton, Alberta, Canada, engage in distracted walking behaviours while crossing the street. These results may help raise awareness and inform policy to decrease risk of pedestrian injury.

Reducing infection transmission in the playroom: Balancing patient safety and family-centered care.

BACKGROUND: Family-centered care requires that institutions develop strategies to allow sibling visitors to hospitalized children while reducing risks of infectious disease transmission. Most guidelines recommend that siblings not be permitted to visit playrooms. This approach was not seen as consistent with family-centered care in our setting; therefore, in a pilot project we developed an approach for screening siblings with cooperation of families, child life specialists, the care team, and the infection prevention and control service. METHODS: A literature review using CINAHL and PubMed databases (Medical Subject Heading terms: visitors to patients, child, infection, nosocomial, and siblings) from 2004-2014 did not uncover formal established methods for reducing playroom infectious disease exposures. Benchmarking with other Canadian centers revealed a diversity of approaches. Child life, the ward staff, and infection prevention and control at this center collaborated to develop a sibling screening strategy. RESULTS: The collaborative approach led to a process based on a screening form that is introduced to the family during admission. The process requires the cooperation of the admitting nurse, parents, and child life staff. In the first 2 years of the project, approximately 10% of screened siblings had a potentially communicable illness. CONCLUSION: A collaborative multidisciplinary approach based on family center care principles led to a process whereby siblings of hospitalized children can be allowed to visit playrooms, while reducing risk of infectious disease transmission.