Psychosocial Characteristics and Gestational Weight Change among Overweight, African American Pregnant Women

Objectives. To describe psychosocial factors identified as contributors of weight gain in the general population and to examine the relationship between these factors and gestational weight gain among low socioeconomic status, African American, overweight pregnant women. Methods. African American women (n=120) with a pregravid body mass index ≥25 kg/m2 completed measures of eating, sleep, and depressed mood between 14 and 24 weeks of gestation. Weight was tracked. Descriptive statistics, correlations, and linear regression modeling were used to characterize the sample and examine predictors of gestational weight gain. Results. Four percent screened positive for night eating syndrome, with 32% consuming at least 25% of their daily caloric intake after dinner (evening hyperphagia). None met criteria for binge eating disorder; 4% reported occasional binge episodes. Cognitive restraint over eating was low. Participants slept 7.1 (SD=1.9) h per night and reported 4.3 (SD=3.6) awakenings per week; 18% reported some level of depressed mood. Night and binge eating were related to each other, sleep quality, and depressed mood. Eating due to cravings was the only psychosocial variable to predict gestational weight gain. Conclusions. Depressed mood, night eating, and nighttime awakenings were common in this cohort, while cognitive restraint over eating was low. Most psychosocial variables were not predictive of excess gestational weight gain

Evaluation of Fetuses in the Preventive IVIG Therapy for Congenital Heart Block (PITCH) study

The recurrence rate of anti-SSA/Ro associated congenital heart block (CHB) is 17%. Reversal of 3rd degree block has never been achieved. Based on potential reduction of maternal autoantibody titers as well as fetal inflammatory responses, IVIG was evaluated as a preventative therapy for CHB

Inclure les compétences relatives à la collaboration interprofessionnelle dans la supervision : effets d’un programme de formation destiné aux superviseurs

Contexte : Le Réseau de collaboration sur les pratiques interprofessionnelles en santé et services sociaux, Centre d’expertise sur la collaboration interprofessionnelle, en partenariat avec le Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale (Québec, Canada) a développé, expérimenté et évalué un programme de formation destiné aux superviseurs de toutes les disciplines des sciences sociales et de la santé visant à les habiliter à cibler explicitement la CIP dans leurs activités de supervision. Objectifs : Évaluer quels sont les effets du programme de formation « Développer ses compétences pour superviser la collaboration interprofessionnelle » sur la réceptivité des superviseurs de stages et leur sentiment d’auto-efficacité en matière de supervision des compétences relatives à la collaboration interprofessionnelle (CIP). Méthodes : Étude évaluative à l’aide de questionnaires auto-administrés. Ce programme comprenant quatre modules poursuit en milieu de stage le développement des compétences des étudiants de 10 programmes de formation de l’Université Laval. Cinquante-six participants provenant de trois contextes de pratique et d’enseignement distincts ont suivi la formation. Résultats : Parmi les participants, 96,2 % reconnaissent que la formation leur a permis d’améliorer leurs compétences pour superviser la CIP. De plus, le sentiment d’efficacité personnelle envers le soutien des pratiques de CIP s’est accru de façon significative pour l’ensemble des participants. Conclusion : Ces résultats laissent présager que les participants inscriront davantage la CIP comme un volet à superviser auprès de leurs étudiants. Néanmoins, pour la reconnaître comme une dimension incontournable à aborder dans la supervision, il serait pertinent d’assurer une sensibilisation auprès des superviseurs de toutes les disciplines

Vaginal birth after caesarean section versus elective repeat caesarean section: assessment of maternal downstream health outcomes.

OBJECTIVE: To compare the maternal implications of strategies of vaginal birth after caesarean section (VBAC) attempt versus elective repeat caesarean section in women with one previous lower segment caesarean section. DESIGN: Decision model. POPULATION: Women with one prior low transverse caesarean section who are eligible for trial of labour. METHODS: Two decision models were built: the first one applying to women planning only one more pregnancy, the second one applying to women planning two more pregnancies. Probability estimates for VBAC success rate and risks of uterine rupture, placenta praevia, placenta accreta and hysterectomy were extracted from the available literature. MAIN OUTCOME MEASURES: Hysterectomy for uterine rupture, placenta accreta or other indications. RESULTS: In the first model VBAC attempt led to a higher hysterectomy rate (267/100,000) compared with repeat caesarean section (187/100,000). However, in the second model a policy of elective repeat caesarean section led to higher cumulative hysterectomy rate: 1465/100,000 versus 907/100,000 for VBAC. The first model was robust to all but one variable in sensitivity analyses. The second model was robust to all variables in sensitivity analyses. CONCLUSIONS: These results indicate that long term reproductive consequences of multiple caesarean sections should be considered when making policy decisions regarding the risk-benefit ratio of VBAC

The effect of prematurity on vaginal birth after cesarean delivery: success and maternal morbidity.

OBJECTIVE: We sought to compare vaginal birth after cesarean (VBAC) success and uterine rupture rates between preterm and term gestations in women with a history of one prior cesarean delivery. Our hypothesis was that preterm women undergoing VBAC were more likely to be successful and have a lower rate of complications than term women undergoing VBAC. METHODS: We reviewed medical records of women with a history of a cesarean delivery who either attempted a VBAC or underwent a repeat cesarean delivery from 1995 through 2000 in 17 community and university hospitals. We collected information on demographics, medical and obstetric history, complications, and outcome of the index pregnancy. The primary analysis was limited to women with singleton gestations and one prior cesarean delivery. Statistical analysis consisted of bivariate and multivariable techniques. RESULTS: Among the 20,156 patients with one prior cesarean delivery, 12,463 (61%) attempted a VBAC. Mean gestational ages for the term and preterm women were 39.2 weeks and 33.9 weeks of gestation, respectively. The VBAC success rates for the term and preterm groups were 74% and 82%, respectively (P \u3c .001). Multivariable analysis showed that the VBAC success was higher (adjusted odds ratio 1.54, 95% confidence interval 1.27-1.86) in preterm gestations. A decreased risk of rupture among preterm gestations was suggested in these results (adjusted odds ratio 0.28, 95% confidence interval 0.07-1.17; P = .08). CONCLUSION: Preterm patients undergoing a VBAC have higher success rates when compared with term patients undergoing a VBAC. Preterm patients undergoing VBAC may have lower uterine rupture rates

Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation.

OBJECTIVE: To compare rates of vaginal birth after cesarean (VBAC) failure and major complications in women attempting VBAC before and after the estimated date of delivery (EDD) METHODS: This was a 5-year retrospective cohort study in 17 university and community hospitals of women with at least 1 prior cesarean delivery. Women who attempted VBAC before the EDD were compared with those at or beyond 40 weeks of gestation. Logistic regression analyses were performed to assess the relationship between delivery beyond the EDD and VBAC failure or complication rate. RESULTS: A total of 11,587 women in the cohort attempted VBAC. Women past 40 weeks of gestation were more likely to have a failed VBAC. After controlling for confounders, the increased risk of a failed VBAC beyond 40 weeks remained significant (31.3% compared with 22.2%, odds ratio 1.36, 95% confidence interval 1.24-1.50). The risk of uterine rupture (1.1% compared with 1.0%) or overall morbidity (2.7% compared with 2.1%) was not significantly increased in the women attempting VBAC beyond the EDD. When the cohort was defined as 41 weeks or more of gestation, the risk of a failed VBAC was again significantly increased (35.4% compared with 24.3%, odds ratio 1.35, 95% confidence interval 1.20-1.53), but the risk of uterine rupture or overall morbidity was not increased. CONCLUSION: Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased

Transmission et héritages de la littérature québécoise

La cohésion de la littérature québécoise semble aujourd'hui aller de soi. Il s'agit pourtant d'un tissage mouvant et continuel de liens avec le passé. Ce livre en fait la démonstration selon trois perspectives contrastées mais complémentaires. Dans une première partie, on s'intéresse à des phénomènes tels que la fabrication de l'histoire littéraire, l'inclusion ou non des œuvres de langue anglaise ou des francophonies canadiennes. La deuxième partie examine l'oubli sélectif de certaines œuvres, comme les textes du XIXe siècle, ceux d'auteurs dits mineurs ou encore de genres moins canoniques, comme le théâtre. La dernière partie présente les cas particuliers d'héritages littéraires représentés dans les œuvres elles-mêmes sous la forme de jeux intertextuels, de mises en scène d'auteurs et de lecteurs ou de problèmes d'herméneutique littéraire. Ces trois perspectives font ainsi ressortir les figures, les lieux de mémoire ou les récits qui accompagnent nécessairement la littérature québécoise