BackgroundApproximately 10% of all newborns require resuscitation at birth. Training healthcare providers in standardised formal neonatal resuscitation training (SFNRT) programmes may improve neonatal outcomes. Substantial healthcare resources are expended on SFNRT.ObjectivesTo determine whether SFNRT programmes reduce neonatal mortality and morbidity, improve acquisition and retention of knowledge and skills, or change teamwork and resuscitation behaviour.Search methodsWe searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PREMEDLINE, EMBASE, CINAHL, Web of Science and the Oxford Database of Perinatal Trials, ongoing trials and conference proceedings in April 2014 and updated in March 2015.Selection criteriaRandomised or quasi-randomised trials including cluster-randomised trials, comparing a SFNRT with no SFNRT, additions to SFNRT or types of SFNRT, and reporting at least one of our specified outcomes.Data collection and analysisTwo authors extracted data independently and performed statistical analyses including typical risk ratio (RR), risk difference (RD), mean difference (MD), and number needed to treat for an additional beneficial outcome (NNTB) or an additional harmful outcome (NNTH) (all with 95% confidence intervals (CI)). We analysed cluster-randomised trials using the generic inverse variance and the approximate analysis methods.Main resultsWe identified two community-based and three manikin-based trials that assessed the effect of SFNRT compared with no SFNRT. Very low quality evidence from one study suggested improvement in acquisition of knowledge (RR 5.96, 95% CI 3.60 to 9.87) and skills (RR 170, 95% CI 10.8 to 2711) and retention of knowledge (RR 3.60, 95% CI 2.43 to 5.35) and the other study suggested improvement in resuscitation and behavioural scores.We identified three community-based cluster-randomised trials in developing countries comparing SFNRT with basic resuscitation training (Early Newborn Care). In this setting, there was moderate quality evidence that SFNRT decreased early neonatal mortality (typical RR 0.88, 95% CI 0.78 to 1.00; 3 studies, 66,162 neonates) and when analysed by the approximate analysis method (typical RR 0.85, 95% CI 0.75 to 0.96; RD -0.0044, 95% CI -0.0082 to -0.0006; NNTB 227, 95% CI 122 to 1667). Low quality evidence from one trial showed that SFNRT may decrease 28-day mortality (typical RR 0.55, 95% CI 0.33 to 0.91) but the effect on late neonatal mortality was more uncertain (typical RR 0.47, 95% CI 0.20 to 1.11). None of our a priori defined neonatal morbidities were reported. We did not identify any randomised studies in the developed world.We identified two trials that compared SFNRT with team training to SFNRT. Teamwork training of physician trainees with simulation may increase any teamwork behaviour (assessed by frequency) (MD 2.41, 95% CI 1.72 to 3.11) and decrease resuscitation duration (MD -149.54, 95% CI -214.73 to -84.34) but may lead to little or no difference in Neonatal Resuscitation Program (NRP) scores (MD 1.40, 95% CI -2.02 to 4.82; 98 participants, low quality evidence).We identified two trials that compared SFNRT with booster courses to SFNRT. It is uncertain whether booster courses improve retention of resuscitation knowledge (84 participants, very low quality evidence) but may improve procedural and behavioural skills (40 participants, very low quality evidence).We identified two trials on decision support tools, one on a cognitive aid that did not change resuscitation scores and the other on an electronic decision support tool that improved the frequency of correct decision making on positive pressure ventilation, cardiac compressions and frequency of fraction of inspired oxygen (FiO(2)) adjustments (97 participants, very low quality evidence).Authors' conclusionsSFNRT compared to basic newborn care or basic newborn resuscitation, in developing countries, results in a reduction of early neonatal and 28-day mortality. Randomised trials of SFNRT should report on neonatal morbidity including hypoxic ischaemic encephalopathy and neurodevelopmental outcomes. Innovative educational methods that enhance knowledge and skills and teamwork behaviour should be evaluated.
PURPOSE:To assess the long-term impact of retinopathy of prematurity (ROP) on macular function in pediatric and adult patient cohorts through the analysis of multifocal ERG (mfERG) results. Sectoral analyses were employed to uncover subtle localized findings that ring assessments could mask. METHODS:25 children and 28 adults were recruited into three groups: "ex-ROP" (individuals with a history of ROP), "preterm" (preterm-born without ROP), and "term" (term-born controls). mfERG P1 amplitudes and latencies were evaluated in five concentric rings centered on the fovea, as well as superior, inferior, nasal and temporal quadrants following Patterns 1, 2 and 3 for sectoral analysis. Macular optical coherence tomography (OCT) was performed to measure central retinal thickness and evaluate correlation with mfERG results. RESULTS:Using a sectoral mfERG analysis approach, applied for the first time in this population, we identified functional alterations that were not apparent with traditional global ring averages. In the pediatric cohort, sectoral evaluation revealed a significant reduction in temporal inner retinal responses in both ex-ROP and preterm children, changes that were obscured when relying solely on traditional mfERG ring analysis. Within the ex-ROP pediatric group, laser-treated eyes showed more pronounced dysfunction, with significantly prolonged P1 latencies and increased central retinal thickness compared to untreated eyes. In adults, sectoral analysis again highlighted functional abnormalities: ex-ROP and preterm participants demonstrated significantly decreased P1 amplitudes in multiple localized regions, including Rings 2 and 3. Finally, both pediatric and adult ex-ROP cohorts exhibited greater central retinal thickness than term-born controls, reinforcing the structural-functional relationship captured more sensitively through this refined sectoral method. CONCLUSION:Our study demonstrated that a history of ROP is associated with diminished macular function, as evidenced by mfERG assessments, a finding more pronounced in adults compared to the younger pediatric cohort, possibly suggestive of an age-related degeneration in retinal function.
Background and objectives:Obstetric and gynaecological care profoundly affects individuals' health and well-being. However, many international studies reveal negative and even dehumanizing experiences of this type of healthcare. This study documents recent experiences of obstetric and gynaecological care in Québec. We examine patient-healthcare provider interactions, respect for patient rights, whether patient needs are met, and how these factors impact satisfaction with the treatment provided and trust in the healthcare system. Methods:The PAROLES project is based on a self-report questionnaire posted online from July 2023 to January 2024. The sample comprises 1490 respondents who reported 1599 recent experiences of obstetric and gynaecological care. Descriptive analyses and linear regressions were performed. Results:Generally, patient-healthcare provider interactions were perceived positively, but some significant shortcomings were revealed in terms of unmet needs for shared decision-making and disrespected rights. Although patients were relatively satisfied with their care, there was considerable distrust in the healthcare system. Meeting needs in terms of shared decision-making and respecting rights were associated with overall satisfaction and trust in the healthcare system. Conclusion:The results uncover substantial inadequacies in obstetric and gynaecological care in Québec. To optimize patient-healthcare provider interactions and better meet patient needs, there must be greater respect for patients' rights.
BACKGROUND Parental smoking is a leading source of secondhand smoke exposure for children, increasing risks of respiratory illness and future smoking. Cessation treatment delivery for parents remains rare in pediatrics. This study evaluates the population-level impact of an automated tobacco treatment system integrated into the electronic health record (EHR) in pediatric primary care.METHODS We conducted a retrospective observational study of parents whose children received care at 12 pediatric practices in a cluster-randomized trial (June 2021-August 2024). Six practices implemented an automated EHR-linked parent tobacco treatment system (screening, motivational messaging, automatic treatment connection including nicotine replacement therapy, SmokefreeTXT, and quitline referral through a previsit questionnaire); 6 implemented screening only. This analysis included all parents who completed questionnaires during routine care, excluding parents enrolled in the trial. We analyzed self-reported cessation rates among parents who reported smoking during the study period.RESULTS Among 55 567 parents with follow-up data (49 595 mothers; 5972 fathers), smoking rates were 4.3% vs 5.5% for mothers and 6.5% vs 8.3% for fathers receiving care with vs without the system. Among mothers who reported smoking during the study, cessation rates were significantly higher for those receiving care with the system (37.4% vs 33.5%, P = .044), representing a 3.9% improvement. Among fathers who smoked, there was no difference in cessation rates (29.6% vs 29.6%).CONCLUSIONS An automated tobacco treatment system was associated with significantly increased maternal smoking cessation in pediatric settings while showing no effect for fathers. This scalable approach could enhance pediatric preventive care by reducing household tobacco use.
Gasoline (petrol) stations emit benzene and other volatile organic compounds (VOCs) into ambient air, potentially increasing childhood cancer risk, though epidemiological evidence remains limited. We investigated whether residential proximity to gasoline stations at birth was associated with childhood cancer incidence. We conducted a population-based cohort study of 824,414 newborns in Quebec, Canada. We constructed three exposure metrics at the birth residence: A) number of gasoline stations within 250 m; B) distance to the nearest gasoline station; C) sum of inverse distances to all gasoline stations within 500 m categorized as quartiles. Associations with any cancer, any leukemia, and acute lymphoblastic leukemia (ALL) were estimated using Cox models adjusted for potential confounders. Higher childhood cancer risks were suggested when at least one gasoline station was within 250 m of the residence, with risk increasing as the distance to the nearest station decreased. For newborns residing within 100 m of a gasoline station, adjusted hazard ratios (HRs) were 1.14 (95 % CI: 0.80-1.63) for any cancer, 1.35 (0.74-2.47) for leukemia and 1.27 (0.63-2.59) for ALL, compared to those with no station within 500 m. When excluding Montreal where gasoline stations must control vapor emissions, HRs were 1.42 (0.93-2.18) for any cancer and 1.55 (0.72-3.30) for leukemias. For exposure metric C, the HR for the highest exposure quartile compared to those unexposed was 1.34 (1.01-1.77) for leukemia and 1.34 (0.97-1.84) for ALL. Residential proximity to gasoline stations may increase the risk of childhood cancer, particularly leukemia, supporting measures to limit VOC emissions.
