This study was undertaken to investigate the incidence and associations of placental villitis of unknown origin or etiology (VUE). Five hundred nine placentas from women delivered of small- for- gestational- age infan...This study was undertaken to investigate the incidence and associations of placental villitis of unknown origin or etiology (VUE). Five hundred nine placentas from women delivered of small- for- gestational- age infants (SGAP) and 529 placentas from women delivering infants with birth weights appropriate for gestational age (AGAP) were examined prospectively for VUE as part of a population- based case control study of SGA infants at term. VUE was found in 17.3% of SGAP and 11.7% of AGAP and was an independent risk factor for SGA (adjusted odds ratio 2.35, 95% CI 1.55- 3.56). Villitis in conjunction with maternal hypertension increased the risk of SGA substantially (adjusted odds ratio 17.7, 95% CI 3.6- 86.9). A study of a wide range of pregnancy- related factors found no significant associations with VUE in AGAP. In contrast, VUE in SGAP had significant associations after multivariate analysis with maternal body mass index, multigravidity, ethnicity, and 1 index of maternal infection. VUE is an independent risk factor for SGA at term. Maternal factors influence this association, possibly by modifying a systemic effect on fetal growth of villous inflammation at commonly occurring defects in the maternal- fetal immune barrier.展开更多
Aims: To evaluate the effect of the implementation of an asthma clinical path way on asthma in children in general practice. Methods: A randomized, controlled trial involving 270 general practitioners. One group of ge...Aims: To evaluate the effect of the implementation of an asthma clinical path way on asthma in children in general practice. Methods: A randomized, controlled trial involving 270 general practitioners. One group of general practitioners i mplemented the asthma clinical pathway for children (intervention group)- and t he control group continued with their usual asthma medical care management. The main outcome measures were admissions to hospital for asthma and attendance at t he Children’s Emergency Department. Compliance with the guidelines was assesse d by examining asthma drug prescriptions. Results: Admissions to hospital for as thma dropped 40% in the intervention group, by 33% in the control group and by 22% in general practitioners not participating in the trial. The difference s between the intervention and control and between the intervention and non- pa rticipating general practitioners were not statistically significant. The decrea se in attendance at the Children’s Emergency Department decreased by 25% , 30 % and 19% , respectively, but this was not statistically signifi- cant. Ther e was a significant decrease in prescriptions for oral relievers, dry powder rel ievers in the under 6s, mast cell stabilizers and methylxanthines in both contro l and intervention groups. However, only for oral relievers was there a signific ant difference between the intervention group and control, with the decrease lar ger in the intervention group (p < 0.001). Conclusions: Admissions to hospital f or asthma decreased, as did attendance at the Children’s Emergency Department. Prescriptions for asthma medication changed in the direction anticipated with c ompliance with the asthma clinical pathway. However, we found no evidence within the study that implementation of the asthma clinical pathway by general practit ioners resulted in lower morbidity than those general practitioners who did not implement the pathway. Possible explanations are that these general practitioner s were already providing care according to the recommendations of the pathway, o r that there was contamination of the control group by the intervention, or that the guidelines, although based on currently accepted recommendations, are ineff ective.展开更多
Background: Mortality from SIDS has declined since the recommendation that infants are not placed prone to sleep. SIDS mortality is higher in infants born preterm than those born at term. Aim: To determine if risk fac...Background: Mortality from SIDS has declined since the recommendation that infants are not placed prone to sleep. SIDS mortality is higher in infants born preterm than those born at term. Aim: To determine if risk factors for SIDS are any different for preterm and term infants. Methods: Mortality data over time were used to determine whether the reduction in SIDS mortality rates had occurred equally in term and preterm infants. Data from two New Zealand studies (a case-control study and a case-cohort study)were used to determine if any differences existed in risk factors for SIDS between term and preterm infants before and after the SIDS prevention campaign. Results: SIDS mortality appears to have decreased by similar proportions in term and preterm infants. Risk factors for SIDS were similar in preterm and term infants, except for parity where there was a significant interaction. Increasing parity was a risk factor for SIDS in term infants but not preterm infants. Conclusion: SIDS rates have decreased at comparable rates in term and preterm infants, but preterm birth still remains a risk factor for SIDS. The magnitude of the odds ratios associated with modifiable risk factors were similar for both groups. There may however be a difference in risk associated with parity between term and preterm infants. The messages for risk factors for SIDS are applicable to mothers of preterm as well as term infants.展开更多
文摘This study was undertaken to investigate the incidence and associations of placental villitis of unknown origin or etiology (VUE). Five hundred nine placentas from women delivered of small- for- gestational- age infants (SGAP) and 529 placentas from women delivering infants with birth weights appropriate for gestational age (AGAP) were examined prospectively for VUE as part of a population- based case control study of SGA infants at term. VUE was found in 17.3% of SGAP and 11.7% of AGAP and was an independent risk factor for SGA (adjusted odds ratio 2.35, 95% CI 1.55- 3.56). Villitis in conjunction with maternal hypertension increased the risk of SGA substantially (adjusted odds ratio 17.7, 95% CI 3.6- 86.9). A study of a wide range of pregnancy- related factors found no significant associations with VUE in AGAP. In contrast, VUE in SGAP had significant associations after multivariate analysis with maternal body mass index, multigravidity, ethnicity, and 1 index of maternal infection. VUE is an independent risk factor for SGA at term. Maternal factors influence this association, possibly by modifying a systemic effect on fetal growth of villous inflammation at commonly occurring defects in the maternal- fetal immune barrier.
文摘Aims: To evaluate the effect of the implementation of an asthma clinical path way on asthma in children in general practice. Methods: A randomized, controlled trial involving 270 general practitioners. One group of general practitioners i mplemented the asthma clinical pathway for children (intervention group)- and t he control group continued with their usual asthma medical care management. The main outcome measures were admissions to hospital for asthma and attendance at t he Children’s Emergency Department. Compliance with the guidelines was assesse d by examining asthma drug prescriptions. Results: Admissions to hospital for as thma dropped 40% in the intervention group, by 33% in the control group and by 22% in general practitioners not participating in the trial. The difference s between the intervention and control and between the intervention and non- pa rticipating general practitioners were not statistically significant. The decrea se in attendance at the Children’s Emergency Department decreased by 25% , 30 % and 19% , respectively, but this was not statistically signifi- cant. Ther e was a significant decrease in prescriptions for oral relievers, dry powder rel ievers in the under 6s, mast cell stabilizers and methylxanthines in both contro l and intervention groups. However, only for oral relievers was there a signific ant difference between the intervention group and control, with the decrease lar ger in the intervention group (p < 0.001). Conclusions: Admissions to hospital f or asthma decreased, as did attendance at the Children’s Emergency Department. Prescriptions for asthma medication changed in the direction anticipated with c ompliance with the asthma clinical pathway. However, we found no evidence within the study that implementation of the asthma clinical pathway by general practit ioners resulted in lower morbidity than those general practitioners who did not implement the pathway. Possible explanations are that these general practitioner s were already providing care according to the recommendations of the pathway, o r that there was contamination of the control group by the intervention, or that the guidelines, although based on currently accepted recommendations, are ineff ective.
文摘Background: Mortality from SIDS has declined since the recommendation that infants are not placed prone to sleep. SIDS mortality is higher in infants born preterm than those born at term. Aim: To determine if risk factors for SIDS are any different for preterm and term infants. Methods: Mortality data over time were used to determine whether the reduction in SIDS mortality rates had occurred equally in term and preterm infants. Data from two New Zealand studies (a case-control study and a case-cohort study)were used to determine if any differences existed in risk factors for SIDS between term and preterm infants before and after the SIDS prevention campaign. Results: SIDS mortality appears to have decreased by similar proportions in term and preterm infants. Risk factors for SIDS were similar in preterm and term infants, except for parity where there was a significant interaction. Increasing parity was a risk factor for SIDS in term infants but not preterm infants. Conclusion: SIDS rates have decreased at comparable rates in term and preterm infants, but preterm birth still remains a risk factor for SIDS. The magnitude of the odds ratios associated with modifiable risk factors were similar for both groups. There may however be a difference in risk associated with parity between term and preterm infants. The messages for risk factors for SIDS are applicable to mothers of preterm as well as term infants.
