The role of nocturnal delivery and delivery during the holiday period in Finland on obstetric anal sphincter rupture rates- a population based observational study

<p>Abstract</p> <p>Background</p> <p>Obstetric anal sphincter rupture (OASR) is a serious complication of delivery, which frequently results in faecal incontinence despite primary repair and has serious implications for women's health. The objective of this study was to assess whether human factors, workload and staffing at night, at weekends and during holidays has an effect on the increasing OASR rates among all singleton vaginal deliveries (n = 514,741) having occurred between 1997 and 2007 in Finland. Women (n = 2,849) with OASR were compared in terms of possible risk factors to women without OASR using stepwise logistic regression analysis.</p> <p>Findings</p> <p>In Finland, the increase in OASR rate is striking, from 0.2% in 1997 to 0.9% in 2007. OASR rates varied from 0.49% to 0.58% (≤ 0.001) according to the time of day, and were lowest at night. After adjustment for patient-mix and the use of interventions, the risk of OASR was 11% lower (95% CI 3-18%) at night and 15% lower (95% CI 3-26%) in July - the main holiday month. Only 14% of the increased OASR risk during the day time (8-23.59) was attributable to vacuum assistance and birth weight, whereas the holiday period had no effect.</p> <p>Conclusions</p> <p>Decreased OASR rates at night and in July suggest that human factors such as decreased alertness due to fatigue or hospitals' administrative factors such as workload and staffing did not increase the rates of OASR.</p

Study-related exhaustion : First-year students’ use of self-regulation of learning and peer learning and perceived value of peer support

This study examines the profiles of self-regulation of learning, peer learning and peer support among students. The study investigates whether the profiles differ in terms of reported study-related exhaustion. Students completed a questionnaire regarding their use of self-regulation of learning and peer learning and perceived peer support and study-related exhaustion. Four different student profiles were found. The profiles differed in terms of self-reported study-related exhaustion. Self-regulated students with a low level of peer learning and low perceived value of peer support reported the lowest levels of study-related exhaustion, whereas students with self-regulation problems, a high level of peer learning and high perceived value of peer support reported the highest levels of study-related exhaustion. The results showed that problems in self-regulation were positively related to self-reported study-related exhaustion. Identifying different student profiles helps to recognise students who may need more support in studying.Peer reviewe

Busy day effect on intrapartum adverse maternal outcomes – A population-based study of 601 247 singleton deliveries

BackgroundThis was a retrospective population-based study, utilizing the data of 601 247 singleton hospital deliveries collected from the Finnish Medical Birth Register (MBR) in 2006-2016. The aim of this study was to analyse the busy day effect on intrapartum adverse maternal outcomes.MethodsTo implement the study design, daily delivery frequencies and ranges (min-max) for each delivery unit (n=26) were stratified to the daily delivery volume distributions by the delivery unit's annual delivery volume and profile: Category (C)1= 3000 and C5 the profile of university hospitals. To study the busy day effect, the quiet, optimal and busy days were defined by calculating the number of days (%) with the lowest and highest daily delivery frequencies and summed to the nearest 10% in each hospital category. Optimal days were determined by calculating approximately 80% of deliveries occurring between the lowest 10%, and highest 10% in each hospital category. Crude and adjusted odd ratios (ORs) with 99% confidence intervals (CIs) were used to analyze the busy day effect on adverse maternal outcomes, blood transfusions, manual removal of the placenta and obstetric anal sphincter injuries, separately in each hospital category.ResultsThe busy day effect was associated with the 28% (99% CI 8-52%) and 25% (99% CI 11-40%) increased need for blood transfusions in C2 and university hospitals (C5), respectively, whereas 22% (99% CI 10-31%) less blood transfusions were needed at university hospitals during quiet days. In C3 hospitals, 83% (99% CI 65-92%) less blood transfusions were needed during busy days. Obstetric and anal sphincter injury rates declined during quiet days by 22% (99% CI 3-38%) only in university hospitals.ConclusionsThe findings of this study identify no specific pattern to the busy day effect for adverse maternal outcomes defined as manual removal of the placenta or obstetric and anal sphincter injuries. However, both quiet and busy days seem to be associated with increased or decreased need for blood transfusions in different sized delivery units. Findings also suggest that quiet days are associated with a decreased number of obstetric and anal sphincter injuries.Peer reviewe

Daily patient flow unevenness in different sized delivery hospitals - An 11-year register study of 610 227 deliveries

Peer reviewe

Effects of Fermented Lingonberry Juice Mouthwash on Salivary Parameters-A One-Year Prospective Human Intervention Study

A one-year prospective human intervention study was performed to examine the effects of fermented lingonberry juice (FLJ), used as a mouthwash for six months, on salivary parameters. A total of 25 adult participants used 10 mL of FLJ as mouthwash 30 s daily for 6 months in addition to their normal oral homecare routines. Standard oral examinations and gathering of samples were performed at the beginning of the study and after six months and one year. Resting and stimulated saliva secretion rates, resting saliva pH, and stimulated saliva buffering capacity were determined. A questionnaire of participants' subjective sensations of mouth dryness was also recorded at each timepoint. Fermented lingonberry juice mouthwash had positive effect to all five salivary parameters and were, according to the omnibus test, statistically significant during the study period. Analysis of the subjective dry mouth sensation questionnaires revealed that symptoms of xerostomia decreased due to the use of FLJ. This study revealed that the once-a-day use of FLJ mouthwash had a beneficial, increasing effect on salivary flow rates, buffering capacity, and salivary pH. FLJ thus can be safely used as an adjunctive and beneficial therapy in oral homecare, protecting teeth and oral mucosa, including periodontium, and also relieving dry mouth symptoms.Peer reviewe

Effects of Fermented Lingonberry Juice Mouthwash on Salivary Parameters—A One-Year Prospective Human Intervention Study

A one-year prospective human intervention study was performed to examine the effects of fermented lingonberry juice (FLJ), used as a mouthwash for six months, on salivary parameters. A total of 25 adult participants used 10 mL of FLJ as mouthwash 30 s daily for 6 months in addition to their normal oral homecare routines. Standard oral examinations and gathering of samples were performed at the beginning of the study and after six months and one year. Resting and stimulated saliva secretion rates, resting saliva pH, and stimulated saliva buffering capacity were determined. A questionnaire of participants’ subjective sensations of mouth dryness was also recorded at each timepoint. Fermented lingonberry juice mouthwash had positive effect to all five salivary parameters and were, according to the omnibus test, statistically significant during the study period. Analysis of the subjective dry mouth sensation questionnaires revealed that symptoms of xerostomia decreased due to the use of FLJ. This study revealed that the once-a-day use of FLJ mouthwash had a beneficial, increasing effect on salivary flow rates, buffering capacity, and salivary pH. FLJ thus can be safely used as an adjunctive and beneficial therapy in oral homecare, protecting teeth and oral mucosa, including periodontium, and also relieving dry mouth symptoms