The Labor Progression Study: The use of oxytocin augmentation during labor following Zhang's guideline and the WHO partograph in a cluster randomized trial.

INTRODUCTION: This study aims to investigate the use of oxytocin augmentation during labor in nulliparous women following Zhang's guideline or the WHO partograph. MATERIAL AND METHODS: This is a secondary analysis of a cluster randomized controlled trial in 14 birth-care units in Norway, randomly assigned to either the intervention group, which followed Zhang's guideline, or to the control group, which followed the WHO partograph, for labor progression. The participants were nulliparous women who had a singleton full-term fetus in a cephalic presentation and spontaneous onset of labor, denoted as group 1 in the Ten Group Classification System. RESULTS: Between December 2014 and January 2017, 7277 participants were included. A total of 3219 women (44%) received augmentation with oxytocin during labor. Oxytocin was used in 1658 (42%) women in the Zhang group compared with 1561 (47%) women in the WHO group. The adjusted relative risk for augmentation with oxytocin was 0.98 (95% CI 0.84-1.15; P = .8) in the Zhang vs WHO group, with an adjusted risk difference of -0.8% (95% CI -7.8 to 6.1). The participants in the Zhang group were less likely to be augmented with oxytocin before reaching 6 cm of cervical dilatation (24%) compared with participants in the WHO group (28%), with an adjusted relative risk of 0.84 (95% CI 0.75-0.94; P = .003). Oxytocin was administered for almost 20 min longer in the Zhang group than in the WHO group, with an adjusted mean difference of 17.9 min (95% CI 2.7-33.1; P = .021). In addition, 19% of the women in the Zhang group and 23% in the WHO group received augmentation with oxytocin without being diagnosed with labor dystocia. CONCLUSIONS: Although no significant difference in the proportion of oxytocin augmentation was observed between the 2 study groups, there were differences in how oxytocin was used. Women in the Zhang group were less likely to receive oxytocin augmentation before 6 cm of cervical dilatation. The duration of augmentation with oxytocin was longer in the Zhang group than in the WHO group.

Single-family room design in the neonatal intensive care unit did not improve growth.

AIM: The aim was to compare growth in very premature infants cared for in a single-family room (SFR) and an open-bay (OB) unit. We recorded duration of parental presence and skin-to-skin contact as proxies for parental involvement in care of their infants. METHODS: We consecutively included infants with gestational ages 28 + 0 through 32 + 0 weeks at two hospitals in Norway, one SFR unit (n = 35) and one OB unit (n = 42). Weight, length, and head circumference were followed from birth to four months after term date. Both units adhered to the same nutritional protocol and methods of recording events. RESULTS: The SFR mothers spent a mean (standard deviation) of 111 (38) hours and the OB mothers 33 (13) hours with their infants during the first week and 21 (5) versus 7 (3) hours per day later. The respective duration of skin-to-skin care was 21 (10) versus 12 (8) hours during the first week and 4.2 (2) versus 3.0 (2) hours per day later. The differences were similar, but less pronounced for the fathers. The growth trajectories did not differ between the groups. CONCLUSION: SFR care was associated with more parental involvement, but not with better growth.

Parent-Infant Closeness, Parents' Participation, and Nursing Support in Single-Family Room and Open Bay NICUs.

This was a prospective survey study, comparing parent-infant closeness, parents' perceptions of nursing support, and participation in medical rounds in single-family room (SFR) and an open bay (OB) neonatal intensive care units. Nurses' assessments of provided support were also measured. In total, 115 parents of 64 preterm infants less than 35 weeks' gestational age and 129 nurses participated. Parents recorded the presence and skin-to-skin care. Parents were sent 9 text message questions in random order. Nurses answered corresponding Internet-based questions. SFR mothers were more present, 20 hours daily (median) versus 7 hours (P < .001), initiated skin-to-skin contact (SSC) at 4 versus 12 hours (P = .03), and preformed SSC 180 min/24 h versus 120 min/24 h for mothers in the OB unit (P = .02). SFR fathers were also more present, 8 versus 4 hours (P < .001), initiated SSC at 3 versus 40 hours (P = .004), and performed SSC 67 min/24 h versus 31 min/24 h (P = .05). SFR parents rated participation in medical rounds and emotional support higher than OB parents. Parental trust was rated higher by nurses in the OB unit (P = .02). SFR facilitated parent-infant closeness, parents' participation in medical rounds, and increased support from nurses.

Shape information from glucose curves: functional data analysis compared with traditional summary measures.

BACKGROUND: Plasma glucose levels are important measures in medical care and research, and are often obtained from oral glucose tolerance tests (OGTT) with repeated measurements over 2-3 hours. It is common practice to use simple summary measures of OGTT curves. However, different OGTT curves can yield similar summary measures, and information of physiological or clinical interest may be lost. Our mean aim was to extract information inherent in the shape of OGTT glucose curves, compare it with the information from simple summary measures, and explore the clinical usefulness of such information. METHODS: OGTTs with five glucose measurements over two hours were recorded for 974 healthy pregnant women in their first trimester. For each woman, the five measurements were transformed into smooth OGTT glucose curves by functional data analysis (FDA), a collection of statistical methods developed specifically to analyse curve data. The essential modes of temporal variation between OGTT glucose curves were extracted by functional principal component analysis. The resultant functional principal component (FPC) scores were compared with commonly used simple summary measures: fasting and two-hour (2-h) values, area under the curve (AUC) and simple shape index (2-h minus 90-min values, or 90-min minus 60-min values). Clinical usefulness of FDA was explored by regression analyses of glucose tolerance later in pregnancy. RESULTS: Over 99% of the variation between individually fitted curves was expressed in the first three FPCs, interpreted physiologically as "general level" (FPC1), "time to peak" (FPC2) and "oscillations" (FPC3). FPC1 scores correlated strongly with AUC (r=0.999), but less with the other simple summary measures (-0.42≤r≤0.79). FPC2 scores gave shape information not captured by simple summary measures (-0.12≤r≤0.40). FPC2 scores, but not FPC1 nor the simple summary measures, discriminated between women who did and did not develop gestational diabetes later in pregnancy. CONCLUSIONS: FDA of OGTT glucose curves in early pregnancy extracted shape information that was not identified by commonly used simple summary measures. This information discriminated between women with and without gestational diabetes later in pregnancy.

A population-based study of demographical variables and ability to perform activities of daily living in adults with osteogenesis imperfecta.

PURPOSES: To describe demographical variables, and to study functional ability to perform activities of daily life in adults with osteogenesis imperfecta (OI). METHODS: Population-based study. Ninety-seven patients aged 25 years and older, 41 men and 56 women, were included. For the demographical variables, comparison was made to a matched control-group (475 persons) from the Norwegian general population. Structured interviews concerning social conditions, employment and educational issues and clinical examination were performed. The Sunnaas Activities of Daily Living (ADL) Index was used to assess the ability to perform ADL. RESULTS: The prevalence of clinical manifestations according to Sillence was in accordance with other studies. Demographical variables showed that most adults with OI are married and have children. They had a higher educational level than the control group, but the employment rate was significantly lower. However, the rate of employed men was similar in both groups. Adult persons with OI achieved a high score when tested for ADL. CONCLUSIONS: Adults with OI are well educated compared with the general population, and most of them are employed. High scores when tested for ADL indicate that most of them are able to live their lives independently, even though there are some differences according to the severity of the disorder.

Anxiety, depression, and psychological well-being 2 to 5 years poststroke.

OBJECTIVES: We sought to explore psychological well-being and the psychosocial situation in persons with stroke, 2 to 5 years after discharge from a specialized rehabilitation hospital. METHODS: The Hospital Anxiety and Depression Scale; the 30-item General Health Questionnaire; and a questionnaire were mailed to 255 former patients. RESULTS: A total of 64% answered (36% women), and the average age was 58 years. The Hospital Anxiety and Depression Scale identified problems in 47% (anxiety in 36% and depression in 28%) and 30-item General Health Questionnaire in 54%. About half had experienced periods of anxiety, depression, or both since discharge. Most were satisfied with support by family/friends (88%), home ward (68%), and community therapy services (57%). Marital status was as in the general population. CONCLUSIONS: Long after stroke, almost half of the investigated patients with stroke had psychiatric problems according to the questionnaires. This is higher than in the general population but is comparable with some other chronic, somatic populations in Norway.

The Labour Progression Study (LaPS): Duration of labour following Zhang's guideline and the WHO partograph - A cluster randomised trial.

OBJECTIVE: To investigate labour duration in different phases of labour when adhering to Zhang's guideline for labour progression compared with the WHO partograph. DESIGN: A secondary analysis of a cluster randomised controlled trial. SETTING: Fourteen Norwegian birth care units, each with more than 500 deliveries per year constituted the clusters. PARTICIPANTS: A total of 7277 nulliparous women with singleton foetus in a cephalic presentation and spontaneous onset of labour at term were included. INTERVENTION: Seven clusters were randomised to the intervention group that adhered to Zhang's guideline (n = 3972) and seven to the control group that adhered to the WHO partograph (n = 3305) for labour progression. MEASUREMENTS: The duration of labour from the first registration of cervical dilatation (≥ 4 cm) to the delivery of the baby and the duration of the first and second stages of labour; the time-to-event analysis was used to compare the duration of labour between the two groups after adjusting for baseline covariates. FINDINGS: The adjusted median duration of labour was 7.0 h in the Zhang group, compared with 6.2 h in the WHO group; the median difference was 0.84 h with 95% confidence interval [CI] (0.2-1.5). The adjusted median duration of the first stage was 5.6 h in the Zhang group compared with 4.9 h in the WHO group; the median difference was 0.66 h with 95% CI (0.1-1.2). The corresponding adjusted median duration of the second stage was 88 and 77 min; the median difference was 0.18 h with 95% CI (0.1-0.3). KEY CONCLUSIONS: The women who adhered to Zhang's guideline had longer overall duration and duration of the first and second stages of labour than women who adhered to the WHO partograph. IMPLICATIONS FOR PRACTICE: Understanding the variations in the duration of labour is of great importance, and the results offer useful insights into the different labour progression guidelines, which can inform clinical practice.

Birth complications, overweight, and physical inactivity.

OBJECTIVE: Maternal lifestyle factors are potential predictors of pregnancy complications. We examined relations between modifiable factors and delivery complications. DESIGN: Prospective cohort. SETTING: University hospital antenatal clinic, Oslo, Norway. SAMPLE: A cohort of 553 women followed through pregnancy and delivery. MAIN OUTCOME MEASURES: Pre-specified birth complications: cesarean section (CS), operative vaginal deliveries (VDs), third and fourth degree of perineal lacerations and hemorrhage (> or =1,000 ml). METHODS: Univariate and multiple logistic regression analyses were performed. Besides high birthweight (> or =4,200 g), modifiable predictors (high body mass index (BMI), fasting glucose and physical inactivity) and non-modifiable predictors (parity, maternal age, gestational age, and gender) were considered. RESULTS: Significant predictors for induction of labor were parity (odds ratio (OR): 2.1; 95% CI 1.3-3.5), maternal age (OR: 2.0; 1.2-3.4), gestational age (OR: 1.9; 1.1-3.1), and BMI > or =30 (OR: 4.2; 2.2-7.8, p<0.01). High birthweight and high BMI were overrepresented among CSs. Emergency CS was associated with birthweight (OR: 3.7; 1.7-8.1), parity (OR: 3.5; 1.7-7.2), maternal age (OR: 2.6; 1.3-5.3), and induction of labor (OR: 4.8; 2.6-9.1). After excluding CS, operative VD was associated with parity (OR: 8.7; 3.8-20) and gender (OR: 2.2; 1.2-14.1). Perineal laceration was associated with pre-gestational physical inactivity (OR: 6.1; 1.6-22.9) and operative VD (OR: 5.1; 1.5-17.6). Hemorrhage was associated with high birthweight (OR: 4.2; 1.2-4.7) and BMI > or =30 (OR: 4.6; 1.2-17.7). CONCLUSIONS: Pre-gestational physical inactivity increased the risk of perineal lacerations and male infants were associated with higher risk of vaginal operative delivery.

Effect of a cholesterol-lowering diet during pregnancy on maternal and fetal Doppler velocimetry: the CARRDIP study.

OBJECTIVE: The purpose of this study was to evaluate the effect of a low-cholesterol low-saturated fat diet on Doppler indices in the fetus and mother. STUDY DESIGN: Two hundred ninety nonsmoking white women, aged 21-38 years, without previous pregnancy complications and carrying a single fetus were assigned randomly to continue their usual diet (control subjects; n = 149) or to adopt a low-cholesterol low-saturated fat diet (intervention group; n = 141) from gestational week 17-20 to birth. Doppler velocimetry of the umbilical artery and both uterine arteries were assessed at gestational weeks 24, 30, and 36. RESULTS: The physiologic gestational decrease in umbilical artery pulsatility index (PI) from week 24-30 was more pronounced in the intervention group, compared with the control group, with median values (interquartile range) of -0.17 (-0.29, -0.06) and -0.11 (-0.25, 0.01), respectively (P = .048). Assignment to the intervention diet did not influence the changes in mean PI value of the 2 uterine arteries (P = .3). The change in umbilical artery PI and mean PI value of the uterine arteries between weeks 24 and 36 were not significantly different between the 2 groups (P = 1.0 and .2 respectively). CONCLUSION: Our study shows that a cholesterol-lowering diet during pregnancy may modify fetoplacental circulation in mid pregnancy.

Audits can improve neurosurgical practice--illustrated by endoscopic third ventriculostomy.

OBJECTIVE: A single-center, retrospective study was performed to evaluate the effect of audit on the patient selection for endoscopic third ventriculostomy (ETV). MATERIALS AND METHODS: Between 01.01.99 and 07.31.01, 134 patients underwent ETV (group 1). During this period, there was no consensus within the neurosurgical community as to patient selection criteria for ETV. A review of our clinical practice in August 2001 demonstrated significantly lower ETV success rates for patients <6 months of age, patients with communicating hydrocephalus (HC) and for patients with prior shunt surgery. Thus, stricter patient selection criteria were established. Between 08.01.01 and 12.31.02, 54 patients were operated (group 2). The two groups were compared with respect to age, type of HC, previous shunt surgeries and ETV success rates. The primary outcome event was ETV malfunction, defined as symptoms and/or signs of increased intracranial pressure leading to repeat ETV or shunt implantation. Follow-up was done through outpatient clinics and telephone interviews. Average follow-up time was 12 months (range 0-44 months). No patient was lost to follow-up. RESULTS: The overall 1-year ETV success rate in group 2 (65%) was significantly higher than in group 1 (53%) (p < 0.04). Group 2 had a significantly higher proportion of patients >6 months of age (p = 0.013) and with obstructive HC (p = 0.001). CONCLUSION: Patient selection criteria critically affect the overall ETV success rate. An audit of our results led to a significant change in clinical practice, thereby improving the ETV success rates and patient care.

Risk factors for pressure sores in adult patients with myelomeningocele--a questionnaire-based study.

BACKGROUND: Myelomeningocele (MMC) is a part of a complex neural tube defect and a disorder of the cerebrospinal fluid system. Pressure sores are a frequent complication for patients with MMC. Little is known about the risk factors for pressure sores in adults with MMC. The aim of this study was to investigate an association between the presence of pressure sores and other patient characteristics, in order to develop an improved strategy for the management of sores. METHODS: A structured questionnaire regarding sores, medical condition, function and living factors was designed and sent to the 193 patients with MMC registered in the year 2003 at TRS, a National Centre for Rare Disorders in Norway. RESULTS: Out of 193 total, 87 patients participated and 71 patients (82%) reported sores; 26 (30%) at the time of the interview and 45 (52%) during the last 5 years. Sores were mostly localized on toes and feet and occurred exclusively in regions with reduced or missing sensibility. A significant association was found between sores and memory deficit (p = 0.02), Arnold Chiari malformation (p = 0.02) and a record of previous sores (p = 0.004). Sores were not significantly associated with hydrocephalus, syringomyelia, nutrition, body mass index, smoking, physical activity, employment or living together with other persons. Some patients (18, 21%) reported skin inspection by others and the remainder relied on self-inspection. CONCLUSION: Patients with sensory deficit, memory problems, and Arnold Chiari malformation had a higher risk of having pressure sores. This patient group needs improved skin inspection routines and sore treatment.

Computed tomography of alveolar bone grafts 20 years after repair of unilateral cleft lip and palate.

The aim of this study was to estimate the clinical condition and amount of remaining grafted bone 20 years after final repair of unilateral cleft lip and palate. Eighteen consecutive patients had computed tomograms (CT) and clinical examination 20 years or more after secondary bone grafting which had been done at ages of 7-11 years. The images were obtained with a spiral CT with 1 mm collimation, and reconstructed as three-dimensional volumes with reformatted cut planes. The area of grafted bone was measured in a plane perpendicular to the curved axis of the alveolar arch and compared with the area corresponding section through the non-cleft side. The clinical examination showed satisfactory results in all. CT indicated a mean cross sectional area of 97 mm2 on the cleft side compared with 157 mm2 on the non-cleft side. The bone mass was significantly less on the grafted cleft side (p < 0.001), but the functional results were satisfactory.

Seasonal variation in maternal and umbilical cord 25(OH) vitamin D and their associations with neonatal adiposity.

DESIGN: Neonatal body fat is an important indicator of foetal energy supply and growth with potential importance for long-term health. In this study, we wanted to explore seasonal variation of 25-hydroxy-vitamin D (25(OH)D) in maternal and umbilical cord plasma (UCP) to examine whether maternal and foetal 25(OH)D levels were associated with maternal BMI and neonatal fat mass (FM), and to explore the relationship among maternal and neonatal 25(OH)D levels, maternal glucose/insulin levels and UCP C-peptide. METHODS: An observational, prospective study of determinants of foetal growth and birth weight in healthy pregnant women. Total body composition in 202 newborns was measured by dual-energy X-ray absorptiometry. Circulating levels of biomarkers were assessed in mothers at gestational weeks 14-16 and 30-32 and UCP. RESULTS: The mean 25(OH)D concentration in UCP was significantly lower than in maternal circulation (31 vs 45 nmol/l, P<0.001). Maternal and UCP 25(OH)D levels varied significantly with season. No significant association between maternal BMI (weeks 14-16) and UCP 25(OH)D concentration was found. We found a strong positive association between maternal 25(OH)D and UCP 25(OH)D (P<0.001). There was no significant linear association between maternal BMI (weeks 14-16) and maternal 25(OH)D. We found no association between maternal 25(OH)D levels and glucose/insulin levels, nor with maternal or UCP 25(OH)D on UCP C-peptide levels. Finally, neonatal total body FM was positively associated with UCP 25(OH)D, P=0.02. CONCLUSIONS: We demonstrated seasonal variation in maternal and neonatal 25(OH)D levels at northern latitudes. UCP, but not maternal, 25(OH)D was a significant predictor of neonatal total FM. Maternal BMI and metabolic parameters such as glucose, insulin and UCP C-peptide levels were not associated with 25(OH)D in mothers or offspring.

Shape information in repeated glucose curves during pregnancy provided significant physiological information for neonatal outcomes.

OBJECTIVE: To use multilevel functional principal component analysis to exploit the information inherent in the shape of longitudinally sampled glucose curves during pregnancy, and to analyse the impact of glucose curve characteristics on neonatal birth weight, percentage fat and cord blood C-peptide. STUDY DESIGN AND SETTING: A cohort study of healthy, pregnant women (n = 884). They underwent two oral glucose tolerance tests (gestational weeks 14-16 and 30-32), which gave two glucose curves per woman. RESULTS: Glucose values were higher, and peaked later in third trimester than in early pregnancy. The curve characteristic "general glucose level" accounted for 91% of the variation across visits, and 72% within visits. The curve characteristics "timing of postprandial peak", and "oscillating glucose levels" accounted for a larger part of the variation within visits (15% and 8%), than across visits (7% and <2%). A late postprandial peak during pregnancy, and high general glucose levels in third trimester had significant, positive effects on birth weight (p<0.05). Generally high glucose levels during pregnancy had a significant, positive impact on neonatal percentage fat (p = 0.04). High general glucose level in third trimester had a significant, positive impact on cord blood C-peptide (p = 0.004). CONCLUSION: Shape information in entire OGTT curves provides significant physiological information of importance for several outcomes, and may contribute to the understanding of the metabolic changes during pregnancy.

Dual-energy X-ray absorptiometry is a valid method to estimate visceral adipose tissue in adult patients with Prader-Willi syndrome during treatment with growth hormone.

CONTEXT: Visceral adipose tissue (VAT) is established as a risk factor for type 2 diabetes and cardiovascular disease, but the radiation exposure and cost of computed tomography (CT) measurements limits its daily clinical use. OBJECTIVE: The main objective of this study was to compare the degree of agreement between VAT measurements by a new dual-energy X-ray absorptiometry (DXA) application and one of the standard methods, CT, in a population of patients with Prader-Willi syndrome (PWS) before and after GH treatment. Furthermore, we tested whether VAT estimations by these two methods are equivalent in assessing the metabolic risk in this population. DESIGN AND PATIENTS: Data from the Norwegian population of a multicenter study in adults with genetically proven PWS were used. Subjects with complete anthropometry, biochemical, and imagistic measurements at all study visits (baseline and after 12 and 24 months of GH treatment) (n = 14, six men) were included. VAT was quantified both using CT scans (GE Lightspeed 16 Pro) of the abdomen at L2-L3 level and a total body DXA scan (GE Healthcare Lunar Prodigy). RESULTS: VAT DXA was strongly associated with VAT CT at baseline (r = 0.97) and after 12 (r = 0.90) and 24 months (r = 0.89) of GH treatment (all P < .001). We found moderate to strong positive correlations between VAT by both methods, and blood pressure, weight, body mass index, waist circumference, glucose metabolism, and other fat depots (arms, legs, android, trunk, total body) but no association with age, gender, blood lipids, and IGF-I. Adiponectin was negatively associated with the amount of VAT. At baseline, the highest correlation with homeostasis model assessment of insulin resistance (HOMA-IR) was found for VAT DXA (r = 0.76, P = .001) and VAT CT (r = 0.75, P = .002), respectively. CONCLUSION: VAT can be accurately estimated by DXA, in patients with PWS, and might contribute to the assessment of the metabolic risk.

Umbilical cord levels of sclerostin, placental weight, and birth weight are predictors of total bone mineral content in neonates.

CONTEXT: During pregnancy, changes occur in the maternal calcium homeostasis to fulfill fetal demand. We hypothesized that the fibroblast growth factor 23 (FGF23) system and Wnt signaling pathway are important for normal skeletal development in the offspring. AIMS: Circulating α-klotho, FGF23, sclerostin, and 25-hydroxyvitamin D (25(OH)D) at the fetal and maternal sides of the placenta were measured to investigate associations with newborn bone mass independent of maternal BMI, calcium and phosphate levels, placental weight, and birth weight. METHODS: In a prospective cohort of healthy pregnant women, the total body bone mineral content (BMC) in 202 newborns was measured by dual-energy X-ray absorptiometry. Maternal circulating levels of the biomarkers were measured at gestational weeks 30-32 and in umbilical cord plasma (UCP) at birth. RESULTS: Mean α-klotho and sclerostin concentrations in the UCP were significantly higher than maternal levels (3004 vs 1077  pg/ml; P<0.001 and 629 vs 346  pg/ml; P<0.001 respectively), and mean 25(OH)D was lower (31 vs 45  nmol/l; P<0.001). The UCP and maternal FGF23 levels were similar. No significant effects of maternal biomarkers on BMC were found in regression analyses. Among UCP biomarkers, only UCP sclerostin was significantly associated with BMC in univariate analyses, and the effect remained significant after adjustment for birth weight and other confounders. CONCLUSIONS: We found that UCP sclerostin levels, birth weight, and placental weight were significant predictors of neonatal BMC but found no evidence for a main role of maternal levels of α-klotho, FGF23, sclerostin, or 25(OH)D nor of UCP levels of α-klotho, FGF23, or 25(OH)D.

Increased risk of macrosomia among overweight women with high gestational rise in fasting glucose.

OBJECTIVES: Maternal overweight is a risk factor for gestational diabetes (GDM) and for newborn macrosomia. Among women without GDM, it is not well understood why some women with high body mass index (BMI) give birth to macrosomic newborns while others do not. We wanted to explore the effect of BMI and fasting plasma glucose (FPG), fasting plasma insulin (FPI) and insulin resistance (HOMA-IR) on the risk of newborn macrosomia. METHODS: A cohort of 553 Caucasian women was followed throughout pregnancy. The dependent variable was high birth weight (>or=4200 g). Independent variables included gestational age, intake of macronutrients and energy, maternal BMI, weight gain, FPG, FPI and HOMA-IR. RESULTS: FPG in late pregnancy (30-32 weeks) remained a significant determinant of newborn macrosomia in multiple regression analysis (OR: 1.9, 95% CI: [1.1, 3.4]), whereas FPI and HOMA-IR did not. The women in the highest BMI quartile (>or=27 kg/m(2)) who gave birth to macrosomic newborns had higher increase in FPG and HOMA-IR from early to late pregnancy. Among women in this BMI category, the risk for delivering a macrosomic infant was higher among those with an increase in FPG above 0.60 mmol/l (upper quartile) (OR = 4.5, 95% CI: [1.7, 12.5]). CONCLUSION: Fasting plasma glucose at week 30-32, but not fasting plasma insulin or insulin resistance, is a determinant of newborn macrosomia. Overweight women with high increase in fasting plasma glucose from early to late pregnancy had a 4.5-fold increase in risk of newborn macrosomia compared to the remaining group with high BMI.

Severity of injury does not have any impact on posttraumatic stress symptoms in severely injured patients.

BACKGROUND: Due to improved surgical techniques and more efficient decision making in treating severely injured patients, survival rates have increased over the years. This study was initiated to evaluate the incidence and identify risk factors for developing posttraumatic stress symptoms, using both extensive trauma-related data and data assessing the psychological trauma, in a population of severely injured patients. PATIENTS AND METHODS: 79 patients admitted to the Department of Multitrauma and Spinal Cord Injury at Sunnaas Rehabilitation Hospital from 2003 to 2005, prospectively completed semistructured psychological interviews and questionnaires, such as Impact of Event Scale-Revised. In addition, extensive injury-related data, such as injury severity score (ISS), new injury severity score (NISS), and probability of survival (PS) were collected. RESULTS: 39% had multiple trauma, 34% had multiple injuries including spinal cord injuries, and 27% had isolated spinal cord injuries. Mean NISS was 31.5 (S.D. 13.7). 6% met diagnostic criteria for posttraumatic stress disorder (PTSD) and 9% met the criteria for subsyndromal PTSD. Injury-related data did not influence the prevalence of posttraumatic stress symptoms, however, some psychosocial variables did have a significant impact. CONCLUSIONS: We found a low incidence of PTSD and subsyndromal PTSD. No significant differences were found between the patients suffering from posttraumatic stress symptoms and the non-symptoms group in relation to injury-related data such as ISS/NISS, PS, or multiple trauma versus spinal cord injury. The most evident risk factors for developing posttraumatic stress symptoms were symptoms of anxiety, female gender and negative attitudes toward emotional expression.

Local hospital perspective on a nationwide outbreak of Pseudomonas aeruginosa infection in Norway.

OBJECTIVE: To implement a system for monitoring of rare events based on statistical process control charts. DESIGN: Statistical process control plotting by g chart of clinical microbiology laboratory data. SETTING: Primary and secondary care Norwegian hospital with a 9-bed intensive care unit. RESULTS: During the winter of 2001-2002 in Norway, there was a national monoclonal nosocomial outbreak of Pseudomonas aeruginosa infection mainly affecting patients in intensive care units. In the present work, we demonstrate how the use of SPC at one of the affected hospitals would have detected this outbreak several weeks before the alert from the Norwegian National Public Health Institute (NIPH). By plotting the monthly incidence rate of P. aeruginosa infection (with a c chart), we found that the hospital would have been alerted in February; by plotting the number of days between events (with a g chart), we found that the hospital would have detected a process already out of control in early January 2002. Not until 9 weeks later (ie, mid-March) did the NIPH declare the P. aeruginosa outbreak to be national, and a commercially produced mouth swab contaminated during the manufacturing process was found to be the source. CONCLUSION: The plotting of rare events, such as an outbreak of nosocomial infection, with a g chart may be used for early detection of a process out of control.

Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort.

BACKGROUND AND AIMS: Mucosal healing (MH) in inflammatory bowel disease may be an important sign of efficacy of treatment and a prognostic marker of long-term disease. The aim of the study was to examine both the possible predictors of mucosal healing and the impact of healing on subsequent course of disease. METHODS: In 740 incident patients diagnosed with ulcerative colitis (UC) or Crohn's disease (CD) between 1990 and 1994 (before biologic therapy was available), demographics and symptoms were recorded. Clinical and endoscopic evaluations were done at baseline before treatment and repeated after 1 and 5 years in 495 patients. RESULTS: In UC patients, education longer than 12 years and extensive disease at diagnosis were significant predictors of MH after 1 year (adjusted P = .004 and P = .02, respectively). MH was significantly associated with a low risk of future colectomy (P = .02). In patients with CD, fever at diagnosis and medical treatment without steroids were significant predictors for MH (adjusted P = .03 and P = .01, respectively). MH was significantly associated with less inflammation after 5 years (P = .02), decreased future steroid treatment (P = .02). CONCLUSIONS: Several factors predicted subsequent MH. Education as predictor may implicate the importance of coping, compliance, or lifestyle. MH after 1 year of treatment is predictive of reduced subsequent disease activity and decreased need for active treatment. The present results give further strength to the use of mucosal healing as a clinical indicator and treatment goal in inflammatory bowel disease.