Obstetric anal sphincter injury by maternal origin and length of residence: a nationwide cohort study.

OBJECTIVE: To estimate the association between maternal origin and obstetric anal sphincter injury (OASI), and assess if associations differed by length of residence. DESIGN: Population-based cohort study. SETTING: The Medical Birth Registry of Norway. POPULATION: Primiparous women with vaginal livebirth of a singleton cephalic fetus between 2008 and 2017 (n = 188 658). METHODS: Multivariable logistic regression models estimated adjusted odds ratios (aORs) for OASI with 95% CI by maternal region of origin and birthplace. We stratified models on length of residence and paternal birthplace. MAIN OUTCOME MEASURES: OASI. RESULTS: Overall, 6373 cases of OASI were identified (3.4% of total cohort). Women from South Asia were most likely to experience OASI (6.2%; aOR 2.24, 95% CI 1.87-2.69), followed by those from Southeast Asia, East Asia & the Pacific (5.7%; 1.59, 1.37-1.83) and Sub-Saharan Africa (5.2%; 1.85, 1.55-2.20), compared with women originating from Norway. Among women born in the same region, those with short length of residence in Norway (0-4 years), showed the highest odds of OASI. Migrant women across most regions of origin had the lowest risk of OASI if they had a Norwegian partner. CONCLUSIONS: Primiparous women from Asian regions and Sub-Saharan Africa had up to two-fold risk of OASI, compared with women originating from Norway. Migrants with short residence and those with a foreign-born partner had higher risk of OASI, implying that some of the risk differential is due to sociocultural factors. Some migrants, especially new arrivals, may benefit from special attention during labour to reduce morbidity and achieve equitable outcomes. TWEETABLE ABSTRACT: Anal sphincter injury during birth is more common among Asian and Sub-Saharan migrants and particularly among recent arrivals.

Return to work, sexual activity, and other activities after acute myocardial infarction.

OBJECTIVES: (1) To examine the effects of exercise alone and the additional benefit of a teaching-counseling program with exercise when compared with usual medical and nursing care on the rate of return to previous activities, and (2) to describe the rates of return to former activities of daily living after an acute myocardial infarction. DESIGN: Prospective randomized clinical trial. SETTING: Seven Northwestern hospitals. SAMPLE: 258 patients, 70 years of age or younger, with the diagnosis of acute myocardial infarction, admitted to coronary care units of participating hospitals. OUTCOME MEASURES: Return to work, sexual activity, driving, previous maximum level of activity, and activities out of the home. INTERVENTION: Subjects were randomly assigned to control group A, which received usual medical and nursing care; group B1, which received usual care plus exercise; or group B2, usual care plus exercise plus teaching-counseling sessions. Home exercise programs were prescribed for patients in groups B1 and B2. Those in group B2 also participated in the outpatient teaching-counseling program that consisted of eight group sessions pertaining to risk factor reduction and psychosocial adjustment to myocardial infarction. All subjects completed Activity Summary Questionnaires, a 12-item self-report paper and pencil questionnaire about the week's activity, each week, for 12 consecutive weeks, and at week 24 after hospital discharge. RESULTS: There were no significant differences between the three groups. Previously employed patients who returned to work did so by week 24. Patients who returned to their previous maximum level of activity resumed by week 24. Most patients returned to sexual activity, driving, and activities out of the house by week 12. CONCLUSIONS: The rates of return to activities were not significantly different between the three groups. Most patients were active earlier than previously reported. Over 50% of patients returned to sexual activity, driving, and outdoor activities by 3 weeks after acute myocardial infarction. These results are useful for health care professionals who counsel patients about expectations in activity resumption.