Opioids for Cesarean delivery under general anesthesia and neonatal outcome: a historical cohort study.

PURPOSE: The lack of evidence-based recommendations for Cesarean delivery under general anesthesia can lead to practice variability and morbidity, particularly concerning the use of opioids. The goal of this study was to describe the practice for Cesarean delivery performed under general anesthesia and identify predictive factors for opioid use at anesthesia induction and the need for neonatal resuscitation. METHODS: We conducted a single-center historical cohort study. We included all adult parturients who underwent Cesarean delivery under general anesthesia between 1 January 2012 and 31 December 2016. We excluded patients who received general anesthesia after delivery or with known intrauterine fetal demise. We collected data on anesthetic medication use, maternal comorbidities, neonatal resuscitation, and anesthetic complications. We used logistic regression models to identify predictors of opioid use at anesthesia induction and predictors of neonatal resuscitation. RESULTS: Two hundred and three patients were included. Propofol was the main induction agent (n = 195), 201 patients received neuromuscular blockers, and 67 received opioids. No maternal factors, including hypertensive disorders of pregnancy (odds ratio [OR], 1.94; 95% confidence interval [CI], 0.96 to 3.95; P = 0.06), were predictors of opioid use at induction of anesthesia. No statistical differences were detected between opioid administration groups, except for Cesarean indication, with preeclampsia being the main contributor. Low gestational age (OR, 0.75; 95% CI, 0.65 to 0.87; P = 0.002) was the only predictor of neonatal resuscitation. CONCLUSION: Hypertensive disorders of pregnancy were not predictors of opioid use and opioid use was not a predictor of neonatal resuscitation. This suggests opioids could be used for maternal indications.

RéSUMé: OBJECTIF: L'absence de recommandations fondées sur des données probantes pour les accouchements par césarienne sous anesthésie générale peut entraîner une variabilité de la pratique et une morbidité, en particulier en ce qui concerne l'utilisation d'opioïdes. L'objectif de cette étude était de décrire la pratique pour les accouchements par césarienne réalisés sous anesthésie générale ainsi que d'identifier les facteurs prédictifs d'une utilisation d'opioïdes lors de l'induction de l'anesthésie et la nécessité d'une réanimation néonatale. MéTHODE: Nous avons mené une étude de cohorte historique monocentrique. Nous avons inclus toutes les parturientes adultes qui ont accouché par césarienne sous anesthésie générale entre le 1er janvier 2012 et le 31 décembre 2016. Nous avons exclu les patientes ayant reçu une anesthésie générale après l'accouchement ou ayant subi une mort fœtale intra-utérine connue. Nous avons recueilli des données sur l'utilisation de médicaments anesthésiques, les comorbidités maternelles, la réanimation néonatale et les complications anesthésiques. Nous avons utilisé des modèles de régression logistique pour identifier les prédicteurs d'une utilisation d'opioïdes lors de l'induction de l'anesthésie et les prédicteurs de réanimation néonatale. RéSULTATS: Deux cent trois patientes ont été incluses. Le propofol était le principal agent d'induction (n = 195), 201 patientes ont reçu des bloqueurs neuromusculaires et 67 ont reçu des opioïdes. Aucun facteur maternel, y compris les troubles hypertensifs de la grossesse (rapport de cotes [RC], 1,94; intervalle de confiance [IC] à 95 %, 0,96 à 3,95; P = 0,06), n'était un prédicteur d'utilisation d'opioïdes au moment de l'induction de l'anesthésie. Aucune différence statistique n'a été détectée entre les groupes d'administration d'opioïdes, à l'exception de l'indication de césarienne, la prééclampsie étant le principal contributeur. Un âge gestationnel bas (RC, 0,75; IC 95 %, 0,65 à 0,87; P = 0,002) était le seul prédicteur de réanimation néonatale. CONCLUSION: Les troubles hypertensifs de la grossesse n'étaient pas des prédicteurs de l'utilisation d'opioïdes et l'utilisation d'opioïdes n'était pas un prédicteur de réanimation néonatale. Cela suggère que les opioïdes pourraient être utilisés pour des indications maternelles.

Measurement invariance of the Personality Inventory for DSM-5 across sex.

Introduction: There has been an international movement towards dimensional models of personality disorders (PDs) in the last decades, which culminated in the publication of the Alternative Model of Personality Disorders (AMPD) in the Emerging Measures and Models section of the DSM-5. This model was accompanied by a APA-sanctioned Personality Inventory for DSM-5 (PID-5) for the assessment of the AMPD pathological personality traits. One major issue with the assessment of personality disorders pertains to sex differences, and measurement invariance across sex in assessment instruments for PDs is necessary in order to ensure non-biased evaluations and to make valid comparisons between men and women. This study aimed to provide more information on measurement invariance across sex for the PID-5, using both the original scoring approach provided by the authors of the instrument and the scoring approach suggested by the APA in the published version of the PID-5. Methods: This study was conducted with a sample of 2273 participants from the general Québec (Canada) adult population aged 18 to 90 years (M = 46.59; SD = 16.32; 51.8% women). Results: The original scoring approach model showed good fit to data after freeing paths between certain traits and reached strict invariance. The APA scoring approach also showed good fit to data and reached strict invariance, but needed an adjustment (path freed between Emotional lability and Impulsivity in men) to reach scalar invariance. Discussion: In line with previous research, the PID-5 is invariant across sex and the five-factor structure adjusts well to data. The APA scoring approach appears to attenuate the cross-loading problem observed with the original scoring approach. In light of these results, we recommend using the APA scoring approach to derive domain scores.

Prevalence of the alternative model of personality disorders diagnoses in populational and at-risk samples, gender and age groups comparisons, and normative data for the LPFS-SR and PID-5.

The Alternative Model of Personality Disorders (AMPD), introduced in Section III of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013), was proposed as a new operationalization of personality disorders (PDs) aiming to overcome the several limitations of the traditional symptom-based model (Waugh et al., 2017; Zimmerman et al., 2019). In the AMPD, PDs are defined by two-dimensional criteria (the level of personality functioning and maladaptive personality traits), but as a hybrid model, it also allows for categorical assessment of PDs (i.e., "hybrid types") to facilitate continuity with clinical practice. The present study aimed to provide normative data for two widely used instruments assessing Criterion A (Level of Personality Functioning Scale-Self-Report; Morey, 2017) and B (Personality Inventory for DSM-5; Krueger et al., 2012) in a large populational French-Canadian sample. Regarding the categorical assessment, Gamache et al. (2022) recently tested scoring approaches for extracting the PD hybrid types from dimensional measures of the AMPD. In the present study, these approaches were used to estimate prevalence rates for these PD hybrid types in two samples. In the populational sample, results showed that prevalence rates varied from 0.2% (antisocial PDs) to 3.0% (trait-specified PDs), with an overall prevalence of 5.9% to 6.1% for any PD hybrid type. Prevalence was higher in men than in women in the populational sample, but the contrary was observed in the at-risk sample. Prevalence was higher in younger adults than in middle-aged and older adults. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec.

BACKGROUND: Since 2002, an epidemic of Clostridium difficile-associated-diarrhea (CDAD) associated with a high case-fatality rate has involved >30 hospitals in the province of Quebec, Canada. In 2003, a total of 55% of patients with CDAD at our hospital had received fluoroquinolones in the preceding 2 months. It has been suggested that massive use of proton pump inhibitors might have facilitated this epidemic. METHODS: To delineate the risk of CDAD associated with specific classes of antibiotics and whether this is modulated by concomitant use of proton pump inhibitors and other drugs altering gastric acidity or gastrointestinal motility, we conducted a retrospective cohort study of patients hospitalized in a teaching hospital in Sherbrooke, Canada, during the period of January 2003 through June 2004. We obtained data on 7421 episodes of care corresponding to 5619 individuals. Patients were observed until they either developed CDAD or died or for 60 days after discharge from the hospital. Adjusted hazard ratios (AHRs) were calculated using Cox regression. RESULTS: CDAD occurred in 293 patients. Fluoroquinolones were the antibiotics most strongly associated with CDAD (AHR, 3.44; 95% confidence interval [CI], 2.65-4.47). Almost one-fourth of all inpatients received quinolones, for which the population-attributable fraction of CDAD was 35.9%. All 3 generations of cephalosporins, macrolides, clindamycin, and intravenous beta-lactam/beta-lactamase inhibitors were intermediate-risk antibiotics, with similar AHRs (1.56-1.89). Proton pump inhibitors (AHR, 1.00, 95% CI, 0.79-1.28) were not associated with CDAD. CONCLUSIONS: Administration of fluoroquinolones emerged as the most important risk factor for CDAD in Quebec during an epidemic caused by a hypervirulent strain of C. difficile.