Prolactinoma and Adenomyosis – More than Meets the Eye: A Case Report

Background/Objective: To report a case of adenomyosis in a woman with hyperprolactinemia which resolved after initiation of dopamine agonist therapy. Case Report: A 35-year-old woman with a history of Graves’ disease was referred for evaluation of hyperthyroidism in March 2020. She was started on methimazole and thyroid function normalized. The patient also had a history of a pituitary microadenoma and was previously treated with cabergoline which was stopped after 12 months as she became pregnant.In July 2020, the patient began to have polymenorrhea. Hyperprolactinemia was thought to be an unlikely cause as it most often causes hypogonadotropic hypogonadism with amenorrhea. A pelvic ultrasound demonstrated a bulky uterus with adenomyosis. Gynecology recommended treating adenomyosis by lowering her prolactin levels. She was started on cabergoline 0.25 mg weekly in October 2021. Within 2 months of initiation of cabergoline, she had resolution of symptoms and radiological resolution of adenomyosis. Discussion: Prolactin has been implicated in the pathogenesis of adenomyosis, endometriosis and leiomyomas suggesting that a decrease in prolactin levels may suppress these lesions. The pathogenesis of adenomyosis has been related to direct prolactin effects in the promotion of gland/cell proliferation and function. Conclusion: We conclude that prolonged elevation in prolactin may result in the development of adenomyosis and subsequent prolonged abnormal uterine bleeding. Dopamine agonists, like cabergoline, inhibit the synthesis and secretion of prolactin from the pituitary gland and may have a role in the management of adenomyosis in patients with hyperprolactinemia

Seizures Related to Hypomagnesemia

Objective: Childhood seizures have various nonneurological etiologies. The patient’s magnesium levels should be measured when evaluating afebrile seizures. The purpose of the current case series is to describe a systematic approach for diagnosing hypomagnesemia using 3 recent patient cases. Methods: This case series describes 3 patients with unprovoked hypomagnesemia-associated seizures. The authors describe the differential diagnosis, pathophysiology, and the workup of hypomagnesemia-associated seizures. Results: Hypomagnesemia contributed to the cause of the seizures in all 3 cases. Various causes of hypomagnesemia were investigated, including genetic etiologies. All 3 patients were maintained at a magnesium level >0.65 mmol/L, which improved or eliminated the seizures. Significance: Magnesium levels should always be measured when trying to determine the etiology of seizures. Hypomagnesemia and afebrile seizures should be treated with the goal of maintaining a magnesium concentration >0.65 mmol/L. Although rare, genetic causes of hypomagnesemia should be considered, once common causes of hypomagnesemia are ruled out

Hepatitis B in pregnancy: a concise review of neonatal vertical transmission and antiviral prophylaxis

Hepatitis B is a chronic viral infection of the liver leading to complications including cirrhosis and hepatocellular carcinoma. The leading cause of acquisition is vertical transmission from an infected mother to the newborn. Despite newborn immunoprophylaxis, vertical transmission may still occur in 1-14%. The aim of this article is to provide a concise review of the mechanisms and risk factors involved in vertical transmission, as well as prophylactic strategies using immunoprophylaxis and antiviral medications. Mechanisms of vertical transmission include intrauterine and perinatal transfer of virus. High HBV viral load and presence of HBeAg increases risk of transmission. Combination vaccine and hepatitis B immunoglobulin given at birth reduces risk of transmission, as does HBIG given to mothers in the third trimester. Three antivirals have been studied in pregnancy: lamivudine, telbivudine, and tenovofir. All have shown significant reduction in viral loads and vertical transmission and have favorable safety profiles. In conclusion, HBV vertical transmission is preventable through use of immunoprophylaxis and antiviral medications. Recommendation for antiviral use in third trimester in mothers whose HBV VL is greater than 1 × 106 copies/mL

Heart Health Begins With Community: Community-Based Research Exploring Innovative Strategies to Support First Nations Heart Health

Background: Indigenous people have displayed their strength through their holistic practices and spiritual connection to the land. Despite overcoming the impact of discriminatory and disempowering policies within Western institutions, Indigenous people continue to experience a higher risk of cardiovascular disease, compared to the general population. To move toward improving Indigenous health outcomes, researchers need to work in partnership with communities to develop heart health strategies centred on their experienced barriers and sources of healing. We conducted a community-based explorative study in Moosonee, Ontario to explore the local community’s needs and priorities regarding heart health and wellness. Methods: A convenience sample of community members and healthcare professionals were invited to participate in a sharing circle. Qualitative data were analyzed using conventional content analysis and the Indigenous method of two-eyed seeing. Results: Eight community members and 5 healthcare professionals participated in the sharing circle. Four dominant themes were identified: (1) heart health is more than metrics; (2) honouring our traumas; (3) destigmatizing care through relationship building; and (4) innovative solutions start with community. With the history of mistreatment among Indigenous people, strength-based solutions involved rebuilding clinical relationships. To bring care closer to home, digital health tools were widely accepted, but the design of these tools needs to integrate both Western and Indigenous approaches to healing. Conclusions: Indigenous health upholds the physical, emotional, psychological, and spiritual needs of an individual as being of equal importance. To improve community heart health, strategies should start by strengthening broken bonds and bridging multiple worldviews of healing. Résumé: Contexte: Les peuples autochtones tirent une grande force de leurs pratiques holistiques et de leur lien spirituel avec le territoire, et même s’ils ont surmonté les répercussions des politiques discriminatoires et marginalisantes des institutions occidentales, ils présentent encore un risque de maladies cardiovasculaires supérieur à celui de la population générale. Afin d’aider à améliorer la santé cardiovasculaire des Autochtones, les chercheurs doivent travailler avec les communautés pour mettre en place des stratégies qui tiennent compte des obstacles en matière de soins de santé et des méthodes de guérison traditionnelles. Nous avons réalisé une étude exploratoire en milieu communautaire à Moosonee (Ontario) dans le but d’explorer les besoins et les priorités de la communauté locale en matière de santé cardiovasculaire et de bien-être. Méthodologie: Des membres de la communauté et des professionnels de la santé ont été invités à participer à un cercle de partage. Les données qualitatives ont été analysées au moyen d’une analyse classique et de la méthode autochtone dite à double perspective. Résultats: Huit membres de la communauté et cinq professionnels de la santé ont participé au cercle de partage. Quatre principaux thèmes ont été abordés : 1) la santé cardiovasculaire va au-delà de ce qui se mesure; 2) il faut tenir compte des traumatismes; 3) il faut déstigmatiser les soins en nouant des relations et 4) les solutions novatrices doivent reposer sur la participation de la communauté. En raison du passé de maltraitance envers les peuples autochtones, les solutions axées sur les forces devaient permettre de restaurer la confiance envers les soins cliniques. Les outils de santé numérique, bien adaptés aux besoins de la communauté, ont été largement acceptés, mais ils doivent intégrer les méthodes de soins occidentales et autochtones. Conclusions: Selon la vision autochtone, la santé repose en parts égales sur les aspects physiques, émotionnels, psychologiques et spirituels d’une personne. L’amélioration de la santé cardiovasculaire des membres de la communauté passe donc avant tout par des stratégies qui permettent de recréer les liens qui ont été brisés et qui intèrent plusieurs visions thérapeutiques

A Survey of Immunization Practices in Patients With Congenital Heart Disease

Background: Congenital heart disease, the most common congenital anomaly, often presents in neonates. Because of perceived risks, health care providers may consider deferring immunizations in this population. We sought to understand the perceived risk of immunizations in those providing health care to children with particular heart conditions. Methods: A survey, which included 6 hypothetical scenarios assessing immunization recommendations, was distributed internationally to relevant health care providers, and responses were compared between the different scenarios. Results: Majority of responses (n = 142) were from paediatric cardiologists (n = 98; 69%) and nurse practitioners (n = 27; 19%) located in the United States (n = 77; 54%) or Canada (n = 53; 37%) working in academic teaching hospitals (n = 133; 93.7%). Most favoured vaccinations (n = 107; 75.4%) and less likely to proceed with the first immunization in infants with structural heart disease compared with channelopathy (risk ratio: 0.80, confidence interval: 0.73-0.87; P < 0.001). Only 40% would proceed with immunization as normal in an infant with manifest Brugada type I electrocardiogram. Special precautions after the immunization included longer duration of observation (19%) and administering prophylactic antipyretic medication (92%). Conclusions: Respondents were 20% more likely to defer immunizations in the presence of treatable structural heart disease as compared with channelopathy despite the lack of evidence supporting deferring immunizations in children with structural heart disease. Most were cautious in their response to the scenario involving Brugada syndrome, indicating awareness of the risk of haemodynamic instability in the event of a fever. The majority of respondents still strongly recommend immunizations in this population as the benefits outweigh the potential for adverse events. Résumé: Contexte: La cardiopathie congénitale – l’anomalie congénitale la plus courante – est souvent observée chez les nouveau-nés. En raison des risques perçus, les dispensateurs de soins de santé peuvent parfois envisager de reporter la vaccination chez ces patients. Notre but était de comprendre le risque perçu à l'égard de la vaccination par les dispensateurs de soins de santé traitant des enfants atteints de certaines cardiopathies. Méthodologie: Un sondage comprenant six scénarios hypothétiques visant à évaluer les recommandations de vaccination a été distribué à des dispensateurs de soins de santé pertinents dans différents pays, et leurs réponses pour les différents scénarios ont été comparées. Résultats: La majorité des répondants (n = 142) étaient des cardiologues pédiatriques (n = 98; 69 %) ou des infirmières praticiennes (n = 27; 19 %) des États-Unis (n = 77; 54 %) ou du Canada (n = 53; 37 %) travaillant dans des hôpitaux universitaires (n = 133; 93,7 %). La plupart d’entre eux étaient en faveur de la vaccination (n = 107; 75,4 %), bien que moins enclins à administrer un premier vaccin à des nourrissons présentant une cardiopathie structurelle comparativement à une canalopathie (rapport des risques : 0,80, intervalle de confiance : 0,73-0,87; p < 0,001). Or, seulement 40 % d’entre eux vaccineraient de façon normale un nourrisson présentant un syndrome de Brugada de type 1 à l’ECG. Les précautions particulières prises après la vaccination comprenaient une période d’observation plus longue (19 %) et l’administration d’un antipyrétique à des fins prophylactiques (92 %). Conclusions: À la lumière des réponses obtenues, la probabilité de report de la vaccination était 20 % plus élevée en présence d’une cardiopathie structurelle traitable comparativement à une canalopathie, malgré le manque de données probantes justifiant ce report chez les enfants atteints d’une cardiopathie structurelle. La plupart des répondants ont répondu de façon prudente au scénario du syndrome de Brugada en évoquant un risque d’instabilité hémodynamique en cas de fièvre. La majorité d’entre eux recommandent quand même fortement la vaccination chez ces patients, car les bienfaits escomptés l’emportent sur les risques d’effets indésirables

The Development of a Chest-Pain Protocol for Women Presenting to the Emergency Department

Cardiovascular disease (CVD) is the leading cause of death in women worldwide, and of premature death in women in Canada. Despite improvements in cardiovascular care over the past 15-20 years, acute coronary syndrome (ACS) and CVD mortality continue to increase among women in Canada. Chest pain is a common symptom leading to emergency department visits for both men and women. However, women with ACS experience worse outcomes. compared with those of men, due to misdiagnosis or lack of diagnosis resulting in delayed care and underuse of guideline-directed medical therapies. CVD mortality rates are highest in Indigenous and racialized women and those with a disproportionately high number of adverse social determinants of health. CVD remains underrecognized, underdiagnosed, undertreated, and underresearched in women. Moreover, a lack of awareness of unique symptoms, clinical presentations, and sex-and-gender specific CVD risk factors, by healthcare professionals, leads to outcome disparities. In response to this knowledge gap, in acute recognition and management of chest-pain syndromes in women, the Canadian Women’s Heart Health Alliance performed a needs assessment and review of CVD risk factors and ACS pathophysiology, through a sex and gender lens, and then developed a unique chest-pain assessment protocol utilizing modified dynamic programming algorithmic methodology. The resulting algorithmic protocol is presented. The output is intended as a quick reference algorithm that could be posted in emergency departments and other acute-care settings. Next steps include protocol implementation evaluation and impact assessment on CVD outcomes in women. Résumé: Les maladies cardiovasculaires (MCV) sont la principale cause de décès chez les femmes dans le monde et de décès prématuré chez les femmes au Canada. Malgré les progrès réalisés dans le domaine des soins cardiovasculaires au cours des 15 à 20 dernières années, les taux de syndrome coronarien aigu (SCA) et de mortalité due aux MCV continuent d’augmenter chez les femmes au Canada. La douleur thoracique est un symptôme fréquent qui pousse les hommes et les femmes à se rendre aux urgences. Toutefois, les femmes atteintes d’un SCA présentent de moins bons résultats cliniques que les hommes, en raison d’erreurs de diagnostic ou d’une absence de diagnostic causant des retards dans les soins prodigués et une sous-utilisation des traitements médicaux préconisés dans les lignes directrices. Les taux de mortalité liée aux MCV sont les plus élevés chez les femmes autochtones et les femmes racialisées ainsi que chez celles qui présentent un nombre particulièrement élevé de déterminants sociaux de la santé défavorables. Les MCV continuent d’être sous-estimées, sous-diagnostiquées et sous-traitées chez les femmes et ne sont pas suffisamment étudiées dans cette population. De plus, la méconnaissance par les professionnels de la santé des symptômes, des tableaux cliniques et des facteurs de risque de MCV selon le sexe et le genre entraînent des disparités dans les résultats cliniques. Pour combler ces lacunes dans les connaissances en matière de reconnaissance et de prise en charge des symptômes de douleur thoracique chez les femmes, l’Alliance canadienne de la santé cardiaque des femmes a réalisé une évaluation des besoins et un examen des facteurs de risque de MCV et de la physiopathologie du SCA en tenant compte des particularités liées au sexe et au genre, et a ensuite élaboré un protocole unique d’évaluation de la douleur thoracique faisant appel à une méthodologie algorithmique par programmation dynamique modifiée. Nous présentons le protocole algorithmique qui en est issu. Ce résultat se veut un algorithme de référence rapide pouvant être diffusé dans les services d’urgences et les autres services de soins de courte durée. Les prochaines étapes de notre travail seront d’évaluer la mise en œuvre du protocole et son incidence sur les issues cardiovasculaires chez les femmes

A nosocomial outbreak of community-associated methicillin-resistant Staphylococcus aureus among healthy newborns and postpartum mothers

BACKGROUND: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has increasingly been isolated from individuals with no predisposing risk factors; however, such strains have rarely been linked to outbreaks in the hospital setting. The present study describes the investigation of an outbreak of CA-MRSA that occurred in the maternal-newborn unit of a large community teaching hospital in Toronto, Ontario. METHODS: Screening and clinical specimens collected from mothers and newborns delivered during the outbreak period, as well as from staff on the affected unit, were submitted for microbiological testing. Computerized delivery logs and nursing notes were reviewed, and a case control study was conducted. RESULTS: Analysis by pulsed-field gel electrophoresis revealed 38 babies and seven mothers with MRSA colonization and/or infection by the same unique strain (Canadian MRSA-10-related) from September to December 2004. Isolates were characterized as having the staphylococcal chromosome cassette mec type IVa and were positive for the Panton-Valentine leukocidin gene. No one health care worker was associated with all cases; however, mothers and newborns exposed to one particular nurse (Nurse A) were almost 23 times (odds ratio 22.7, 95% CI 3.3 to 195.9) more likely to acquire MRSA than those with no such contact. MRSA was successfully isolated from Nurse A and from an environmental swab of a telephone recently used by Nurse A; both isolates matched the pulsed-field gel electrophoresis pattern of the outbreak strain. CONCLUSION: The first nosocomial outbreak of CA-MRSA among healthy newborns and postpartum mothers in Canada is described. Effective control of sustained MRSA transmission within an institution may require prompt identification, treatment and monitoring of colonized and/or infected staff. Key Words: Community-acquired MRSA; Panton-Valentine leukocidin; SCCmec type IV Éclosion nosocomiale de staphylocoque doré méthicillinorésistant associé à la communauté chez des nouveau-nés et des nouvelles accouchées en bonne santé HISTORIQUE : Un staphylocoque doré méthicillinorésistant associé à la communauté (ou CA-MRSA pour community-associated methicillinresistant Staphylococcus aureus) est isolé de plus en plus souvent chez des individus ne présentant aucun facteur de risque prédisposant. Toutefois, ce type de souches a rarement été associé à une éclosion en milieu hospitalier. La présente étude décrit l&apos;enquête entourant une éclosion de CA MRSA survenue dans une unité d&apos;obstétrique/néonatalogie d&apos;un grand hôpital universitaire communautaire de Toronto, Ontario. MÉTHODES : Les spécimens de dépistage et cliniques recueillis chez des mères ayant accouché durant la période de l&apos;éclosion et leur nouveau-né, de même que chez le personnel de l&apos;unité affecté ont été soumis à des analyses microbiologiques. Les compte rendus informatisés des accouchements et les notes des infirmières ont été passés en revue et une étude cas-témoins a été réalisée. RÉSULTATS : L&apos;analyse par électrophorèse sur gel en champ pulsé a révélé que 38 bébés et sept mères ont présenté une colonisation et/ou une infection à la même souche de MRSA (liée au MRSA-10 canadien) entre septembre et décembre 2004. Les isolats se sont révélés dotés d&apos;une cassette chromosomique mec du staphylocoque de type IVa et ils étaient positifs à l&apos;endroit du gène de la leucocidine de Panton-Valentine. Aucun travailleur de la santé n&apos;a été associé à lui seul à tous ces cas; par contre, les mères et les nouveau-nés exposés à une infirmière en particulier (infirmière A) étaient près de 23 fois (rapport des cotes 22,7, IC à 95 %, 3,3 à 195,9) plus susceptibles de contracter le MRSA que ceux qui n&apos;avaient pas été en contact avec elle. Le MRSA a été isolé avec succès chez l&apos;infirmière A et dans un prélèvement provenant de la surface d&apos;un téléphone récemment utilisé par l&apos;infirmière A. Les deux isolats correspondaient à l&apos;isolat de la souche associée à l&apos;éclosion identifiée par l&apos;électrophorèse sur gel en champ pulsé. CONCLUSION : La première éclosion nosocomiale de CA-MRSA chez des nouveau-nés et des nouvelles accouchées en bonne santé au Canada est décrite ici. La lutte efficace contre la transmission soutenue du MRSA dans un établissement peut nécessiter une identification, un traitement et une surveillance rapides du personnel colonisé et/ou infecté. T he transmission of methicillin-resistant Staphylococcus aureus (MRSA) in the health care setting has been frequently documented among high-risk populations. In pediatric patients, risk factors for MRSA colonization or infection include prior hospitalization, premature birth or low birth weight, chronic underlying diseases, prolonged or recurrent exposure to antibiotics, and invasive or surgical procedures (1,2). Newborns, especially those born prematurely and those requiring specialized care, are thus highly susceptible to infection with this organism; for this reason, outbreaks of MRSA have routinely been reported in neonatal intensive care units (NICUs) (3-6). In recent years, however, MRSA has emerged as a source of skin and soft tissue infections in the community, and has increasingly been isolated from children and adults with no predisposing risk factors. Evidence suggests that these communityassociated strains of MRSA (CA-MRSA) are genetically distinct from those associated with the health care setting and demonstrate different antibiotic susceptibilities (7-9). Transmission of CA-MRSA has been described in several community settings, such as child care centres (10), military bases (11), prisons (12,13) and school sports teams (14). Adding complexity to the epidemiology of MRSA, several reports have now documented the transmission of CA-MRSA in the hospital setting among patients with and without traditional risk factors for MRSA acquisition (15-22). However, nosocomial outbreaks of CA-MRSA have rarely involved healthy newborns and postpartum women (23-25). In October 2004, an outbreak of CA-MRSA was identified among healthy discharged neonates and their mothers at a large community teaching hospital in Toronto, Ontario. Those affected had no known predisposing risk factors, and most were hospitalized for less than 24 h. The present article describes the investigation to determine the scope and source of this outbreak. METHODS Setting Integrating four services on one floor, the maternal-newborn unit includes fetal assessment, labour and delivery, and postpartum and neonatal intensive care (24-bed level II NICU). Over 5000 deliveries are performed annually by family physicians, obstetricians and midwives, with assistance from the labour and delivery unit nursing staff. Following delivery, mothers are admitted to the postpartum unit; newborns are also admitted unless they require care in the NICU. Barring complications, both may be discharged home within 24 h to 72 h, depending on the method of delivery (eg, vaginal or caesarean). Case finding Mothers and babies: On October 13, 2004, the Infection Prevention and Control program (North York General Hospital, Toronto, Ontario) became aware of six babies with laboratoryconfirmed MRSA infection who had been born at the hospital between September 30 and October 7, 2004, and were routinely discharged. All mothers who delivered during this time were contacted and advised to bring their newborns into the hospital to be screened for MRSA colonization or infection. Each infant was assessed by a physician and had screening specimens collected from three sites (eg, nasal, rectal and umbilical). When three additional infants and two mothers who had delivered after October 7 were identified as having been infected or colonized with MRSA, the screening clinics were expanded to include all mothers and babies delivered at the hospital between September 29 and October 22, 2004. As a result of ongoing media reports of the outbreak, several mothers and babies who had delivered before September 29 selfreported to the hospital. All mothers who gave birth between September 1 and September 28, 2004, were subsequently sent a letter advising them to seek medical attention if they had reason to suspect staphylococcal infection in themselves or their newborns. Additional case finding efforts included enhanced surveillance for skin and soft tissue infections in neonates admitted to the inpatient pediatric unit and weekly screening of babies admitted to the NICU. Infection control professionals and physicians at other local hospitals, as well as pediatricians in the community, were alerted to monitor for infants with symptoms consistent with staphylococcal infections, and to report such cases to the hospital. Because the source of the outbreak was not definitively established at the end of October 2004, a sentinel surveillance system was implemented. Selected obstetricians and pediatricians affiliated with the hospital were asked to obtain screening specimens from all the newborns seen in their offices (usually three to four days postdischarge). This enhanced surveillance by sentinel physicians was discontinued on November 15, 2004, in favour of routine laboratory-based surveillance. Cases were defined initially as any mother or baby with delivery between September 29 and October 22, 2004, with a positive MRSA culture matching the outbreak strain (as determined by pulsed-field gel electrophoresis [PFGE]) isolated from either a screening specimen (colonized case) or a clinical specimen (infected case). This definition was later expanded to encompass both phases of the outbreak from September 1 to December 31, 2004. Secondary cases were defined as any mother or baby who either shared a room with an infected or colonized case or was admitted into a room previously occupied by a case within the previous 12 h. Staff: After the initial cases were identified, the medical charts of the MRSA-positive newborns and their mothers were reviewed for staff contacts. Occupational Health was notified, and health care workers who had direct contact with the infected patients were screened. As additional cases were discovered, screening was recommended for all staff on the maternal-newborn unit and included the collection of both nasal and rectal swabs. Any employee with symptoms consistent with staphylococcal infection was assessed by Occupational Health, tested for culture, prescribed antibiotic treatment, and advised to remain off work until the infection resolved. Laboratory testing All screening and clinical specimens collected from mothers, newborn infants and hospital staff were submitted for microbiological testing to the Shared Hospital Laboratory in Scarborough, Ontario. All specimens were processed according to standard microbiological methodology. MRSA isolates were forwarded to a tertiary care hospital laboratory for fingerprinting using Sma-I digested PFGE. Representative isolates were tested for the PantonValentine leukocidin (PVL) and staphylococcal protein A (spa) genes, as well as for staphylococcal chromosome cassette mec (SCCmec) typing. samples were collected because all units had undergone enhanced environmental cleaning the previous day. Risk factor assessment Computerized delivery logs, which were obtained for all births recorded during the study period, provided information on the mother&apos;s gestational age, date and time of birth, the infant&apos;s sex and birth weight, type of delivery, method of membrane rupture, use and type of anaesthesia, and the names of all health care workers in attendance at delivery. Computerized nursing notes for each of the mothers documented details on all nursing and/or medical interventions (eg, positioning, administration of fluids, medications, etc) experienced during their stay in the labour and delivery unit. Finally, paper-based medical charts were retrieved from the postpartum unit for all confirmed MRSA cases, and inpatient medical records were obtained for the mothers of all infected or colonized babies. An epidemic curve was generated for mothers and babies with MRSA colonization and infection by date of delivery. A spot map was also plotted with the patients&apos; postpartum room assignments. Statistical tests of significance were performed for all risk factor variables (eg, χ 2 test for categorical variables and Student&apos;s t test for continuous variables). Case control study A case-control study was conducted to identify potential risk factors associated with the acquisition of MRSA infection or colonization. All of the mother and baby pairs who went through delivery between September 29 and October 11, 2004, and were screened for MRSA were considered eligible. Cases were defined as any mother and baby pairs in which at least one person met the case definition for MRSA infection or colonization. Individuals meeting the definition of a secondary case were excluded from the analysis, as were those whose PFGE pattern results were either unavailable or not related to the outbreak strain. All of the noncases (eg, both the mother and baby were screened as negative for MRSA) were included as controls. The main exposure of interest was hypothesized to be direct contact with an infected or colonized health care worker. For each of the cases and controls, computerized delivery logs and nursing notes were reviewed, and the names of all health care workers with documented contact with the patient were extracted. Odds ratios (ORs) and 95% CIs were calculated for each health care worker based on three levels of exposure: presence at delivery only, documented contact in the nursing notes only (eg, provided nursing care in the labour and delivery unit), and both the presence at delivery and documentation in the nursing notes. Additional variables of interest included mother&apos;s gestational age, date and time of birth, the infant&apos;s sex and birth weight, type of delivery, method of membrane rupture, and the use and type of anaesthesia. Statistical tests of significance were performed for all risk factor variables (eg, χ 2 test for categorical variables, Student&apos;s t test for continuous variables and 95% CIs)

The Canadian Women’s Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 7: Sex, Gender, and the Social Determinants of Health

Women vs men have major differences in terms of risk-factor profiles, social and environmental factors, clinical presentation, diagnosis, and treatment of cardiovascular disease. Women are more likely than men to experience health issues that are complex and multifactorial, often relating to disparities in access to care, risk-factor prevalence, sex-based biological differences, gender-related factors, and sociocultural factors. Furthermore, awareness of the intersectional nature and relationship of sociocultural determinants of health, including sex and gender factors, that influence access to care and health outcomes for women with cardiovascular disease remains elusive. This review summarizes literature that reports on under-recognized sex- and gender-related risk factors that intersect with psychosocial, economic, and cultural factors in the diagnosis, treatment, and outcomes of women’s cardiovascular health. Résumé: Les profils de facteurs de risque, les facteurs sociaux et environnementaux, le tableau clinique, le diagnostic et le traitement des maladies cardiovasculaires montrent des différences importantes entre les femmes et les hommes. Il est plus probable que les femmes expérimentent des problèmes de santé complexes et multifactoriels, qui sont souvent en relation avec les disparités dans l’accès aux soins, la prévalence des facteurs de risque, les différences biologiques entre les sexes, les facteurs liés au genre et les facteurs socioculturels. De plus, la sensibilisation à la nature et à la relation intersectionnelles des déterminants socioculturels de santé, notamment les facteurs liés au sexe et au genre, qui influencent l’accès aux soins et les résultats cliniques des femmes atteintes d’une maladie cardiovasculaire demeure insaisissable. La présente revue résume la littérature qui porte sur les facteurs de risque liés au sexe et au genre peu reconnus qui se recoupent aux facteurs psychosociaux, économiques et culturels dans le diagnostic, le traitement et les résultats cliniques en lien avec la santé cardiovasculaire des femmes