Neurodevelopmental outcomes following preterm birth and the association with postmenstrual age at discharge

Objective: To 1) define the prevalence of motor, cognitive, and language delays in preterm infants born < 32 weeks estimated gestational age (EGA) and 2) identify the relationship between the timing of discharge from the NICU and neurodevelopmental outcome in early childhood. Study Design: This retrospective study of 176 preterm infants born < 32 weeks EGA and hospitalized in a level IV NICU captured medical factors, including timing of discharge, from the NICU stay. Standardized developmental testing at 1-2 years corrected age was conducted in the newborn follow-up clinic. Results: At 1-2 years corrected age, the sample had an average cognitive composite score of 91.5 ± 17.4, language composite score of 84.5 ± 17.3, and motor composite score of 88.9 ± 18.4. Lower EGA at birth, necrotizing enterocolitis, patent ductus arteriosus, and oxygen requirement for > 28 days were independently associated with higher postmenstrual age (PMA) at NICU discharge. After controlling for known risk factors, higher PMA at discharge was associated with poorer cognitive outcome [p < 0.001, (-0.16, -0.07), β = -0.35], poorer language outcome [p = 0.049 (-0.10, 0.00), β = -0.15] and poorer motor outcome [p < 0.001, (-0.14, -0.05), β = -0.30]. Conclusion: Poorer cognitive, language, and motor outcomes were associated with longer hospitalization, even after controlling for medical risk factors known to be associated with poorer outcome. This provides further evidence for the potential role of the environment that may be impacting the developmental outcomes of infants hospitalized in the NICU.

Melatonin and Epilepsy

Epilepsy is a chronic neurological disease with recurrent seizures. Its incidence, the social and psychological aspects of epilepsy-associated stigmatization in society, the medical risk of severe seizures, and the challenges in treatment confirm its medical and social significance. The pathogenesis of the diseases is associated with abnormal activity of a population of neurons due to various mechanisms, the most frequent being oxidative stress, glutamate excitotoxicity, and mitochondrial dysfunction. In the last 3-4 decades, the possible connection between epilepsy and melatonin &ndash; a neurohormone secreted by the pineal gland &ndash; has been sought and studied. Various physiological functions of melatonin in humans have been proven &ndash; regulation of circadian rhythms (diurnal, seasonal), sleep and wakefulness, participation in the processes of thermoregulation, tumour growth and aging, sexual activity and reproductive functions. It also has immunomodulatory, cytoprotective and antioxidant activity. The results from the studies with experimental models with animals conducted so far in search of a correlation between melatonin and epileptogenesis are mainly in support of the hypothesis of its anticonvulsant effect. The studies with humans are diverse in design, with a smaller number of participants, and the results are not always in explicit support of this hypothesis. The correlation between melatonin concentration and the course of the disease in patients with epilepsy has been discussed. The possibility of adding melatonin to anti-epileptic therapy has also been studied recently.

Influenza risk groups in Norway by education and employment status

Aims: This study aimed to estimate the size of the risk group for severe influenza and to describe the social patterning of the influenza risk group in Norway, defined as everyone ⩾65 years of age and individuals of any age with certain chronic conditions (medical risk group). Methods: Study data came from a nationally representative survey among 10,923 individuals aged 16–79 years. The medical risk group was defined as individuals reporting one or more relevant chronic conditions. The associations between educational attainment, employment status, age and risk of belonging to the medical risk group were studied with logistic regression. Results: Nearly a fifth (19.0%) of respondents reported at least one chronic condition, while 29.4% belonged to the influenza risk group due to either age or chronic conditions. Being older, having a low educational level (comparing compulsory education to higher education, odds ratio (OR)=1.4, 95% confidence interval (CI) 1.2–1.8 among women, and OR=1.3, 95% CI 1.1–1.7 among men) and a weaker connection to working life (comparing disability pension to working full-time, OR=6.8, 95% CI 5.3–8.7 among women, and OR=6.5, 95% CI 4.9–8.5 among men) was associated with a higher risk of belonging to the medical risk group for severe influenza. Conclusions: This study indicates that the prevalence of medical risk factors for severe influenza is disproportionally distributed across the socio-economic spectrum in Norway. These results should influence both public funding decisions regarding influenza vaccination and communication strategies towards the public and health professionals.

Scuba diving-related fatalities in New Zealand, 2007 to 2016

Introduction: New Zealand (NZ) diving-related fatalities have been reported since the 1960s. The aim is to identify contributing risk factors, including medical, and to inform appropriate preventative strategies. Methods: NZ scuba diving fatalities from 2007 to 2016 were searched from multiple sources – the National Coronial Information System (NCIS); the NZ Chief Coroner’s office; Water Safety NZ Drownbase™ and the NZ Police National Dive Squad records. For inclusion, a victim must have been wearing a scuba set (which may include a rebreather). A key word search of the NCIS was made and the results matched to the other databases. An Excel® database was created and a chain of events analysis (CEA) conducted. Results: Forty-eight scuba diving fatalities were identified, 40 men and eight women, average age 47 years (range 17−68), 20 of Māori ethnicity. Thirty-five were classified as overweight (14) or obese (21). Pre-existing medical risk factors were identified, either pre dive or at autopsy, in 37 divers, the commonest being ischaemic heart disease (IHD, 20), left ventricular hypertrophy (LVH, 18) and hypertension (seven). IHD, LVH and obesity were variously associated with each other. The likely commonest disabling conditions, identified in 32 cases, were asphyxia (15), cardiac (nine) and pulmonary barotrauma/cerebral arterial gas embolism (five). Multiple environmental and diving practice breaches and poor planning were identified in the CEA, similar to those seen in other studies. Thirty-eight divers had not released their weight belt. Information on resuscitation was limited. Conclusions: Obesity and cardiovascular disease were common and Māori appear to be over-represented, both as previously reported.

Psychological Aspects of Hair Disorders: Consideration for Dermatologists, Cosmetologists, Aesthetic, and Plastic Surgeons

Hair loss disorders may cause considerable distress to patients. Although many do not pose a significant medical risk, the sociocultural importance of hair is substantial. Often the extent of hair loss does not correlate to the impact on psychosocial function, thus necessitating an individualized approach. Hair loss disorders are interrelated with mental health and at times exert significant psychological percussions, and therefore, providers should address both medical and psychological aspects of treatment. This review contains a discussion of the impact on quality of life of common hair loss disorders and the psychological approaches that providers may utilize to improve care. The incorporation of psychodermatology and psychotrichology in dermatology and psychiatry residency programs is of vital importance. Dermatology and psychiatry liaison clinics may prove useful in the treatment of these patients.

Rotavirus Vaccine Safety and Effectiveness in Infants With High-Risk Medical Conditions

OBJECTIVES Rotavirus vaccination has 87% to 100% effectiveness against severe rotavirus acute gastroenteritis (AGE) in healthy infants in high-income countries. Little is known whether infants with medical risk conditions (MRCs) are equally protected and if the vaccine is equally well tolerated. We conducted a quasi-experimental prospective multicenter before-after cohort study to assess the vaccine effectiveness (VE) and safety profile of the human rotavirus vaccine (HRV) among MRC infants that required prolonged or frequent postnatal care. METHODS The Netherlands has no national rotavirus immunization program, but HRV was implemented in routine care for MRC infants in 13 Dutch hospitals. Participants in the before and after cohort, HRV unvaccinated and vaccinated, respectively, were followed for occurrence of (rotavirus) AGE. VE of at least 1 dose was estimated by using time-to-event analysis for severe rotavirus AGE. Vaccine-related serious adverse event (AEs) after HRV were retrieved systematically from medical charts. Solicited AEs after vaccinations were prospectively collected and compared between vaccination time points with or without HRV. RESULTS In total, 1482 high-risk infants with MRC were enrolled, including 631 in the before and 851 in the after cohorts; 1302 infants were premature (88.3%), 447 were small for gestational age (30.2%), and 251 had at least 1 congenital disorder (17.0%). VE against severe rotavirus AGE was 30% (95% confidence interval [CI]: −36% to 65%). Overall, the observed number of rotavirus hospitalizations was low and not significantly different between the cohorts (2 and 2, respectively). The rate of vaccine-related serious AE was 0.24 per 100 vaccine doses. The adjusted risk ratio for any AE after HRV vaccination compared with other routine vaccinations was 1.09 (95% CI: 1.05 to 1.12) for concomitant administration and 0.91 (95% CI: 0.81 to 0.99) for single HRV administration. Gastrointestinal AEs were 10% more frequent after HRV. CONCLUSIONS In contrast to previous findings among healthy term infants, in routine use, HRV offered limited protection to vulnerable medical risk infants. HRV is generally well tolerated in this group in single administration, but when coadministered with routine vaccines, it is associated with higher risk of (mostly gastrointestinal) AE. Our study highlights the importance of studying vaccine performance in subgroups of medically vulnerable infants.

Maternal-Child Health Outcomes from Pre- to Post-Implementation of a Trauma-Informed Care Initiative in the Prenatal Care Setting: A Retrospective Study

Background: There has been an increase in use of trauma-informed care (TIC) approaches, which can include screening for maternal Adverse Childhood Experiences (ACEs) during prenatal care. However, there is a paucity of research showing that TIC approaches are associated with improvements in maternal or offspring health outcomes. Using retrospective file review, the current study evaluated whether differences in pregnancy health and infant birth outcomes were observed from before to after the implementation of a TIC approach in a low-risk maternity clinic, serving women of low medical risk. Methods: Demographic and health data were extracted from the medical records of 601 women (n = 338 TIC care, n = 263 pre-TIC initiative) who received prenatal care at a low-risk maternity clinic. Cumulative risk scores for maternal pregnancy health and infant birth outcomes were completed by health professionals. Results: Using independent chi-squared tests, the proportion of women without pregnancy health risks did not differ for women from before to after the implementation of TIC, χ2 (2, 601) = 3.75, p = 0.15. Infants of mothers who received TIC were less likely to have a health risk at birth, χ2 (2, 519) = 6.17, p = 0.046. Conclusion: A TIC approach conveyed modest benefits for infant outcomes, but not maternal health in pregnancy. Future research examining other potential benefits of TIC approaches are needed including among women of high socio-demographic and medical risk.