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Biomedical subjects

C M O'Connell

Publications and source records attributed to C M O'Connell.

16 recordsLinked to original sources
PubMed2006

Predictors of respiratory depression at birth in the term infant.

OBJECTIVE: To evaluate predictive factors for respiratory depression at birth in infants >/=37 weeks. DESIGN: A population-based cohort study of respiratory depression at birth at term and post-term. SETTING: Nova Scotia, Canada. POPULATION: All 126 604 nonanomalous, singleton deliveries >/=37 weeks in cephalic presentation from 1988-2002. METHODS: An analysis of maternal, antenatal, intrapartum, and neonatal factors associated with respiratory depression at birth >/=37 weeks. MAIN OUTCOME MEASURES: A composite outcome of delay in initiating and maintaining respiration after birth, 5-minute Apgar score </= 3, or neonatal seizures due to hypoxic-ischaemic encephalopathy. RESULTS: The rate of respiratory depression at birth with delay in respiration was 5.2/1000, with Apgar </= 3 1.0/1000 live births, and with neonatal seizures 0.7/1000. A composite of any of the three respiratory depressions at birth criteria showed comparable low rates with spontaneous delivery (4.4/1000) and elective caesarean (4.8/1000). Compared with elective caesarean delivery, vacuum (13.2/1000, relative risk [RR] 3.97, P < 0.001), forceps (8.8/1000, RR 1.84, P= 0.003), failed vacuum (13.3/1000, RR 2.76, P= 0.005), failed forceps (33.3/1000, RR 6.93, P < 0.001), and caesarean in labour (17.0/1000, RR 3.54, P < 0.001) had significantly higher rates of the composite outcome. CONCLUSION: Overall, the rate of respiratory depression at birth in the term infant was low and the serious manifestation of seizures was less than 1 in 1000. There was a significant relationship between operative delivery in labour and respiratory depression at birth.

Asphyxia Neonatorum↗
PubMed2005

Severe obstetric maternal morbidity: a 15-year population-based study.

Using a provincial perinatal database for 15 years, 1988-2002. Cases were identified with one or more of the following markers of severe maternal morbidity: blood transfusion > or = 5 units, emergency hysterectomy, uterine rupture, eclampsia, intensive care (ICU) admission. There were 159,896 mothers delivered of whom 313 (2.0/1000) had 385 markers of severe morbidity (257 had one, 42 had two, 12 had three, and two had four). The following rates of morbidity were recorded: blood transfusion > or = 5 units 119 (0.74/1000); emergency hysterectomy 88 (0.55/1000); uterine rupture 49 (0.31/1000); eclampsia 46 (0.28/1000); ICU 83 (0.52/1000). There was a statistically significant association between multiparity > or = 1, and emergency hysterectomy and uterine rupture; between age > or = 35 years, and emergency hysterectomy, uterine rupture and ICU; and between caesarean delivery and blood transfusion > or = 5 units, emergency hysterectomy, uterine rupture, eclampsia and ICU. The main contributing obstetric complications were haemorrhage (64.7%) and complications of hypertensive disorders (16.8%).

Adult↗
PubMed2003

Maternal morbidity associated with cesarean delivery without labor compared with spontaneous onset of labor at term.

OBJECTIVE: To estimate the maternal morbidity associated with cesarean deliveries performed at term without labor compared with morbidity associated with spontaneous labor. METHODS: A 14-year, population-based, cohort study (1988-2001) using the Nova Scotia Atlee Perinatal Database compared maternal outcomes in nulliparous women at term undergoing spontaneous labor for planned vaginal delivery with singleton, cephalic presentation and nulliparous women delivering by cesarean without labor. RESULTS: From a total of 18,435 pregnancies, which satisfied inclusion and exclusion criteria, 721 were cesarean deliveries without labor. There were no maternal deaths or transfers for intensive care. There was no difference in wound infection, blood transfusion, or intraoperative trauma. Women undergoing cesarean deliveries without labor were more likely to have puerperal febrile morbidity (relative risk [RR] 2.2; 95% confidence interval [CI] 1.1, 4.5; P=.03), but were less likely to have early postpartum hemorrhage (RR 0.6; 95% CI 0.4, 0.9; P=.01) compared with women entering spontaneous labor. Subgroup analyses of maternal outcomes in women delivering by spontaneous and assisted vaginal delivery and cesarean delivery in labor were also performed. The highest morbidity was found in the assisted vaginal delivery and cesarean delivery in labor groups. CONCLUSION: The increased maternal morbidity in elective cesarean delivery compared with spontaneous onset of labor is limited to puerperal febrile morbidity. Maternal morbidity is increased after assisted vaginal delivery and cesarean delivery in labor compared with cesarean delivery without labor.

Adult↗
PubMed2001

Combined vaginal-cesarean delivery of twin pregnancies.

OBJECTIVE: To estimate the incidence and factors associated with combined vaginal-cesarean delivery in twin pregnancies. METHODS: We studied all twin births weighing 500 g or more during a 20-year period (1980-1999) at a tertiary care center. Major anomalies, monoamniotic and conjoined twins, and antepartum fetal deaths were excluded. RESULTS: During this 20-year period, 105,987 women delivered, of whom 1565 (1.5%) had twins. Of these, 1151 twin sets fulfilled the study criteria. The mode of delivery was vaginal in 653 (56.8%), cesarean in 448 (38.9%), and vaginal-cesarean in 50 (4.3%). During the 20 years there was a statistically significant increase in combined vaginal-cesarean and elective cesarean deliveries, with a decrease in vaginal deliveries. Parity, gestational age, and birth weight discordance (>25%) were not associated with combined delivery. Compared with vaginal delivery, the nonvertex second twin was associated with a twofold higher risk of cesarean delivery (relative risk [RR] 2.3; 95% confidence interval [CI] 1.3, 3.8; P =.002); and an interdelivery interval of over 60 minutes with an eightfold higher risk (RR 8.2; CI 4.6,14.6; P <.001). Vaginal-cesarean delivery had a 22-fold higher use of general anesthesia compared with vaginal delivery (RR 21.8; CI 5.4, 88.5; P <.001). CONCLUSION: There has been a significant increase in combined vaginal-cesarean and elective cesarean deliveries among twin gestations, with a decrease in vaginal births. Vaginal-cesarean delivery is associated with nonvertex second twin and a prolonged interdelivery interval.

Adult↗
PubMed2000

Identification and characterization of promoters regulating tuf expression in Chlamydia trachomatis serovar F.

Gene expression in the obligate intracellular bacterium Chlamydia trachomatis ranges from nil in the infectious EB form to high in the dividing RB form. Little is known about the mechanisms of gene regulation in chlamydiae and only a few promoter sequences have been characterized. The purpose of our study was to examine the expression of a cluster of genes that are required for translation in C. trachomatis serovar F: infA (encoding Initiation Factor 1), tRNA(Thr), tuf (encoding Elongation Factor Tu), and tRNA(Trp). Primer extension analysis indicated that tuf is expressed in three different mRNAs. Putative promoter sequences for these transcripts were defined as P1 (upstream of tRNA(Thr)), P2 (within infA) and P3 (upstream of infA). Quantitative RT-PCR analysis revealed that P1 transcripts were most abundant at 16 h postinfection (pi), whereas P2 transcripts predominated at 24 h pi. P3 was active at all times pi; however, transcription terminated upstream of tuf at early times pi and continued through tuf at later times. P1 and P3 were active in Escherichia coli, as assessed by CAT expression in promoter-fusion vectors and a chlamydial in vitro transcription system. Site-specific mutagenesis confirmed the importance of the -35 and -10 hexamers in the P1 and P3 promoters. P2 was weakly active in E. coli and inactive in the in vitro transcription system, indicating either that the P2 transcript is processed from a longer transcript or that P2 expression requires a sigma or transcription factor which is not present in E. coli or the in vitro transcription system. Our data suggest that multiple processes play a role in the regulation of tuf gene expression during the developmental cycle.

Amino Acid Sequence↗
PubMed1999

Prostheses for persons with lower-limb amputations: an extra joint increases range of motion.

This report describes two cases in which the addition of an extra joint enhanced range of motion and improved function in persons with unilateral lower-limb amputation. Both individuals had significant disability in the workplace and at home before this modification. In the first case, an individual with a hemipelvectomy had inadequate hip-joint flexion for maneuvering during photo shoots. In the second case, the individual's transfemoral prosthesis provided insufficient knee flexion for kneeling and working in tight spaces. In each case, a manual-locking, single-axis knee joint was added adjacent to the joint with the limited range of motion. In both cases, the addition of the second joint provided the increased flexibility needed. The first person's hip-flexion range improved from 125 degrees to 190 degrees, and the second person's knee-flexion range improved from 140 degrees to 170 degrees. In repeated follow-up, both patients remained highly satisfied with the intervention. The addition of an extra joint is an option that should be considered when inadequate range interferes with function.

Activities of Daily Living↗
PubMed1995

Conflicts of practice confronting second line nurse managers in an accident and emergency department. Part I.

In recent times in Australia, there has been a proliferation of nursing career structures which aim to address the historical neglect of a career path for clinical nurses. Among these developments has been the formulation of a new and exciting nursing role, that of the second line nurse manager. This role was designed to give experienced nurses who traditionally worked 'in charge' formal recognition of their knowledge and skill, and sought to construct a role that encompassed both clinical and managerial responsibilities. However, the reality of these nurses' practice is fraught with problems and difficulties as they attempt to negotiate a new and uncharted domain. This paper recounts an action research study conducted by a group of second line nurse managers in an Accident and Emergency department, who sought to explore the dimensions of their practice. The study identifies problems with combining clinical and managerial responsibilities in the one role, within a context marked by a high level of unpredictability, and a culture which values clinical practice over other forms of nursing practice. The paper concludes with a number of recommendations to overcome these problems.

Conflict, Psychological↗
PubMed1995

Conflicts of practice confronting second line nurse managers in an accident and emergency department. Part 2.

In recent times in Australia, there has been a proliferation of nursing career structures which aim to address the historical neglect of a career path for clinical nurses. Among these developments has been the formulation of a new and exciting nursing role, that of the second line nurse manager. This role was designed to give experienced nurses who traditionally worked 'in charge' formal recognition of their knowledge and skill, and sought to construct a role that encompassed both clinical and managerial responsibilities. However, the reality of these nurses' practice is fraught with problems and difficulties as they attempt to negotiate a new and uncharted domain. This paper recounts an action research study conducted by a group of second line nurse managers in an Accident and Emergency department, who sought to explore the dimensions of their practice. The study identifies problems with combining clinical and managerial responsibilities in the one role, within a context marked by a high level of unpredictability, and a culture which values clinical practice over other forms of nursing practice. The paper concludes with a number of recommendations to overcome these problems.

Conflict, Psychological↗
PubMed1992

60- and 72-month follow-up of children prenatally exposed to marijuana, cigarettes, and alcohol: cognitive and language assessment.

Cognitive and receptive language development were examined in 135 60-month-old and 137 72-month-old children for whom prenatal exposure to marijuana, cigarettes, and alcohol had been ascertained. Discriminant Function analysis revealed an association between prenatal cigarette exposure and lower cognitive and receptive language scores at 60 and 72 months. This paralleled and extended observations made with this sample at annual assessments at 12 to 48 months of age. Unlike observations made at 48 months, prenatal exposure to marijuana was not associated with the cognitive and verbal outcomes. Relatively low levels of maternal alcohol consumption did not have significant relationships with the outcome variables. The importance of assessing subtle components rather than global cognitive and language skills to detect potential behavioral teratogenic effects of the drugs being examined is discussed.

Alcohol Drinking↗
PubMed1987

The validity of smoking self-reports by adolescents: a reexamination of the bogus pipeline procedure.

Cigarette smoking was measured in a naive tenth grade population under conditions expected to influence the student's willingness to admit smoking. All students were tested for smoking both by questionnaire and by expired-air carbon monoxide assessment. The carbon monoxide data were used to test the equivalence of the study groups and to partition the sample into smokers and nonsmokers. Of the smokers those who were advised in advance of the biological test were twice as likely to admit cigarette use in the past week compared to those who were advised of the testing procedure only after they had completed their questionnaire. A live explanation and demonstration of the biological testing procedure proved as effective as a videotaped message. These data support earlier reports of the 'bogus pipeline' effect. Several methodological issues are discussed which may explain previous failures to replicate this finding.

Adolescent↗
PubMedDate not supplied

A comparison of the effects of prenatal exposure to tobacco, alcohol, cannabis and caffeine on birth size and subsequent growth.

Maternal use of cigarettes, alcohol, cannabis, and caffeine was established for four time periods; prepregnancy, first trimester, third trimester and average use over pregnancy. The relationship between such usage and growth parameters of offspring followed up from birth to 12 and 24 months of age were examined. Of the soft drugs used, nicotine had the most pronounced effect. After adjustment for other relevant variables, nicotine use prior to and during pregnancy was negatively related to weight and head circumference at birth. Furthermore, third trimester nicotine use was a stronger predictor of decreased weight and head circumference at birth than was first trimester use. The results obtained are consistent with ponderal index (PI) literature suggesting a recovery of growth retardation in infants with a lowered PI. Average consumption of greater than one ounce of absolute alcohol per day was negatively related to birth weight and length. Neither cannabis nor caffeine use had a significant negative effect on any growth parameter.

Adult↗
PubMedDate not supplied

Prenatal exposure to cannabis: a preliminary report of postnatal consequences in school-age children.

Aspects of neurobehavioural development were examined in 28 school-age children born to regular cannabis users and 28 control children matched on prenatal drug history. Measures which discriminated between the study groups and on which the children of cannabis users scored more poorly included parental ratings of behaviour problems, visual-perceptual tasks, language comprehension, and distractibility. For a measure of visual memory and a measure of language comprehension, mother's age at the child's birth potentiated the effect of cannabis use to produce lowered scores for children of young, cannabis-using mothers relative to children of young, nonusing mothers. After controlling for the influence of mother's age at delivery, mother's personality and home environment, the relationship between prenatal cannabis exposure and the discriminating variables was no longer statistically significant. Path analysis demonstrated the way in which home environment conditions, particularly high levels of aggression, could magnify effects of prenatal exposure to cannabis on postnatal outcomes.

Adult↗
PubMedDate not supplied

An investigation of prenatal cannabis exposure and minor physical anomalies in a low risk population.

The offspring of 25 cannabis using women and the offspring of 25 matched controls were examined for the presence of a number of minor physical anomalies (MPA's). None of the anomalies noted occurred more frequently among the offspring of cannabis users. The number of anomalies present in an individual was not correlated with any of the maternal variables of cannabis, nicotine, or alcohol use or with maternal nutritional status during the first trimester. Children with "high" anomaly scores (i.e., more than three anomalies) had not experienced more fetal distress or neonatal difficulty than had children with low anomaly scores. Although a pattern of anomalies was not detected among the offspring of cannabis users, two anomalies, true ocular hypertelorism and severe epicanthus, were found only among children of heavy users of cannabis.

Abnormalities, Drug-Induced↗