The impact of pregnancy on physical activity level.

Objective: The purpose of this study was to compare women's levels of physical activity during early pregnancy and during the year before pregnancy, and to identify characteristics associated with discontinuing sports and exercise among women previously active during the year before pregnancy.

Methods: Data collected from 1,737 women enrolled in a prospective cohort study and who had no contraindications for exercise were included in this analysis. Measures of physical activity (including household and care-giving activities, active living and sports and exercise activities) during early pregnancy were compared to the year before pregnancy.

The fetuses-at-risk approach: clarification of semantic and conceptual misapprehension.

Background: Although proponents of the fetuses-at-risk approach describe it as a causal model that resolves various conundrums, several areas of semantic and conceptual misapprehension remain. Differences in terminology include use of denominators such as 'ongoing pregnancies' and the need for an ad hoc 'correction factor' in order to calculate gestational age-specific rates. Further, there is conceptual disagreement regarding the proper candidates for neonatal death and related phenomena.

Special considerations for a first seizure in childhood and adolescence.

Children with a first unprovoked seizure almost always present with a convulsive seizure. The differential diagnosis includes many paroxysmal events, especially convulsive syncope but even with a good history; there is often uncertainty that cannot be eliminated by investigations. In general, an EEG and MRI are indicated with other investigations determined on a case-by-case basis.

Socioeconomic status and perinatal outcomes in a setting with universal access to essential health care services.

Background: The health care system in Canada provides essential health services to all women irrespective of socioeconomic status. Our objective was to determine whether perinatal and infant outcomes varied by family income and other socioeconomic factors in this setting.

Methods: We included all 92,914 women who delivered in Nova Scotia between 1988 and 1995 following a singleton pregnancy.

Caffeine as an adjuvant to ibuprofen in treating childhood headaches.

In adults, caffeine has been shown to enhance the effectiveness of most analgesics, including ibuprofen. This double-blind cross-over pilot study evaluated the effect of ibuprofen and caffeine compared with ibuprofen and placebo in 12 children with headaches. Patients completed diaries for both headaches.

Preventable and unpreventable causes of childhood-onset epilepsy plus mental retardation.

Objective: The objective of this study was to determine the causes of childhood epilepsy associated with mental retardation and determine whether these causes are preventable.

Methods: We selected all patients from the Nova Scotia population-based childhood epilepsy cohort (n = 692) who had mental retardation and had epilepsy onset between 1977 and 1985. Causes and family history were determined by chart review and caregiver interview after 18.

Long-term prognosis for symptomatic (secondarily) generalized epilepsies: a population-based study.

Purpose: To describe the long-term outcome of childhood-onset secondarily generalized epilepsies (SGEs).

Methods: Children were identified from the Nova Scotia population-based epilepsy study (n=692). Onset of epilepsy was between 1977 and 1985, and follow-up was mainly in 2003.

Reconciling the high rates of preterm and postterm birth in the United States.

Objective: Preterm and postterm birth rates are substantially higher in the United States than in Canada and other industrialized countries, although relative mortality at preterm compared with term gestation is considerably lower. We attempted to explain these differences based on differences in the method of gestational age estimation.

Methods: We used information on all live births in the United States and Canada for 1995-2002 and on singleton births and perinatal deaths for 1996-1999.

The spiritual experience of high-risk pregnancy.

Objective: To uncover the spiritual beliefs and practices of women experiencing high-risk pregnancies.

Design: Qualitative, naturalistic inquiry via face-to-face, semistructured interviews, with thematic analysis of interview transcripts.

Setting: A prenatal special care unit of a tertiary health centre.

The office management of epilepsy.

Epilepsy in children is mostly diagnosed and treated in an ambulatory office setting. This article reviews the literature and offers opinions about the best practice from the time of diagnosis through to remission and beyond. The diagnosis and assignment of an epilepsy syndrome may be difficult, and even experts disagree in many cases.

Phase 1 first-in-human studies of the reactogenicity and immunogenicity of a recombinant meningococcal NspA vaccine in healthy adults.

Background: Neisserial surface protein A (NspA) is a highly conserved, surface-exposed outer membrane protein of Neisseria meningitidis that has been shown to induce a bactericidal immune response in animals against all pathogenic Neisserial serogroups.

Methods: Healthy 18-50-year-old adults were assigned to receive, in a dose escalating manner, 3 doses of 1 of 5 formulations of an experimental, unfolded, recombinant NspA (rNspA) vaccine or placebo, or 1 dose of commercially available quadravalent (A, C, Y, W-135) meningococcal polysaccharide vaccine (Menomune((R))). Adverse events were collected during the first week post-immunization, prior to the next dose and 1 month after the last dose.

Monitoring for adverse effects of antiepileptic drugs.

Best practices for monitoring the adverse effects of antiepileptic drugs (AEDs) have not been carefully studied. Routine blood and urine studies do not appear to be of value in asymptomatic patients to avoid severe acute reactions. Subtle chronic AED side effects exist but algorithms for their detection and treatment are not well developed.

Activity levels among adolescents with migraine.

Data was analyzed from the nationally representative Canadian Community Health Survey. A total of 17,549 adolescents reported whether they had "migraine headaches" (response rate 99.9%) and in what exercise activities they participated.

Immunogenicity and protective efficacy of a recombinant filamentous haemagglutinin from Bordetella pertussis.

Bordetella pertussis is the causative agent of whooping cough, a major childhood pathogen; acellular vaccines consisting of purified B. pertussis antigens such as filamentous haemagglutinin (FHA) are commonly used to prevent pertussis. Despite the importance of FHA in B.

Interchangeability of two diphtheria and tetanus toxoids, acellular pertussis, inactivated poliovirus, Haemophilus influenzae type b conjugate vaccines as a fourth dose in 15-20-month-old toddlers.

Background: Since 1998, all children in Canada have been immunized with a pentavalent diphtheria and tetanus toxoids, acellular pertussis, inactivated poliovirus, Haemophilus influenzae type b conjugate vaccine (DTaP-IPV-Hib) produced by one manufacturer (Pentacel). Recently, another DTaP-IPV-Hib (Infanrix-IPV-Hib) became available. Data on the interchangeability of these products was lacking.

Socioeconomic status and receipt of obstetric services in Canada.

Objective: To examine differences in labor induction and cesarean delivery rates by socioeconomic status in Nova Scotia, Canada.

Methods: We studied all women in Nova Scotia who delivered between 1988 and 1995 after a singleton pregnancy. Information was obtained from the Nova Scotia Atlee Perinatal Database and the federal income tax (T1) Family Files maintained by the Small Area and Administrative Data Division of Statistics Canada (n = 76,440).

Sudden unexpected death in people with epilepsy: a pediatric perspective.

The possibility of sudden unexpected death in people with epilepsy (SUDEP) is very frightening for parents of a child with epilepsy. The mechanism for SUDEP is unclear but is probably most commonly related to postictal respiratory insufficiency. Occasionally the cause is a cardiac arrhythmia induced by a seizure.

Defining urinary tract infection in the critically ill child.

Objective: To define urinary tract infections in critically ill children in the intensive care unit setting for the purpose of surveillance of infection, enrollment of children in sepsis trials, and for trials of therapy and prevention.

Design: Summary of the literature with review and consensus by experts in the field.

Results: A variety of definitions, only some of which have been validated for use in children, were identified.

Surfactant use outside the tertiary care centre.

Early administration of surfactant to preterm babies with respiratory distress syndrome saves lives and decreases morbidity such as pneumothorax. Surfactant administration shortly after birth to intubated babies less than 30 weeks gestation decreases pulmonary air leak, chronic lung disease and mortality. Some preterm babies may be born in hospitals with a transport team hours away.

Incidence-based measures of birth, growth restriction, and death can free perinatal epidemiology from erroneous concepts of risk.

Background: Traditional perinatal epidemiology appears to embrace fallacious concepts of risk. The use of incorrect denominators for perinatal rates is commonplace both for straightforward indices such as the gestational age-specific labor induction rate and also for the more conceptually challenging indices such as the gestational age-specific neonatal mortality rate. As a consequence, perinatology is beset by several conondrums including the paradox of intersecting perinatal mortality curves.

Erb's palsy - Who is to blame and what will happen?

Erb's palsy is initially frightening. The infant's arm hangs limply from the shoulder with flexion of the wrist and fingers due to weakness of muscles innervated by cervical roots C5 and C6. Risk factors are macrosomia (large baby) and shoulder dystocia.

Optimal management of phenylketonuria: a centralized expert team is more successful than a decentralized model of care.

Objective: To compare phenylketonuria (PKU) management by a centralized, expert team in the Province of Nova Scotia (NS) with the decentralized approach in New Brunswick (NB).

Study Design: Retrospective chart review documented frequency of outpatient visits, phenylalanine (Phe) concentration, and medical formula use. Structured telephone interviews with the 8 regional NB dietitians (NB-D) documented their knowledge and support in PKU management.

Effects of insulin-like growth factor-type 1 on weight gain and hepatic glycogen during early development in a surfactant/virus mouse model of acute liver failure: correlation with mortality.

Acute liver failure (ALF) was reproduced in young mice exposed daily for 12 days to the industrial surfactant, Toximul 3409F (Tox), and infected on postnatal day (P) 14 with sublethal doses of mouse-adapted human influenza B (Lee) virus (FluB). Combined Tox + FluB treatment potentiated mortality due to non-necrotic ALF. This study tested the hypothesis that mortality would decline if the known losses in energy production due to compromised fatty-acid beta-oxidation were compensated by pharmacological manipulation of hepatic glycogen stores.

What is new in paediatric epilepsy?

There are many recent advances in the understanding and management of epilepsy in children. Epidemiological data support the requirement for two or more unprovoked seizures for the diagnosis. New epilepsy syndromes abound as magnetic resonance imaging has uncovered new causative brain malformations with important implications for counseling and treatment.