Paternity leave uptake and parental post-partum depression: findings from the ELFE cohort study

BACKGROUND

Several countries are expanding their paternity leave policies, which can have positive effects on parental mental health. We examined whether 2 weeks of paid paternity leave are associated with post-partum depression in mothers and fathers at 2 months after the birth of their child.

METHODS

We used data from the Etude Longitudinale Française depuis l'Enfance (ELFE) cohort study. Participating mothers gave birth in 2011 in a representative sample of 320 maternity hospitals in mainland France. Inclusion criteria were single or twin livebirths born after at least 33 weeks' gestation; mother's age at least 18 years; no plans to leave metropolitan France within 3 years. Mothers were interviewed face-to-face shortly after the child's birth. Fathers and mothers were both interviewed by telephone 2 months after the child's birth, reporting whether the father had the right to paternity leave and if yes, if he had taken or intended to take it. We used the Edinburgh Postnatal Depression Scale to assess post-partum depression among fathers and mothers at 2 months. Logistic regression models, using survey-weighted data and adjusted for confounders using inverse probability weights, yielded odds ratios (ORs).

FINDINGS

We included 10 975 fathers and 13 075 mothers with reported information on paternity leave and post-partum depression at 2 months in the statistical analyses. Fathers had a median age of 32·6 years (IQR 36·9-22·6) and mothers had a median age of 30·5 years (34·0-27·1) at the time of the ELFE child's birth. The prevalence of depression in fathers according to paternity leave status was 4·5% among those who used paternity leave, 4·8% among those who intended to use paternity leave, and 5·7% among those who did not use paternity leave. For mothers, the prevalence of post-partum depression was 16·1% among those whose partner used paternity leave, 15·1% among those whose partner intended to use paternity leave, and 15·3% among those whose partner did not use paternity leave. Fathers who took paternity leave had reduced odds of post-partum depression (OR 0·74 [95% CI 0·70-0·78]) as did fathers who intended to take paternity leave (0·76 [0·70-0·82]) compared with fathers who did not take paternity leave. However, we did not find such beneficial effects for mothers whose partners took (1·13 [1·05-1·20]) or intended to take paternity leave (1·02 [0·96-1·08]).

INTERPRETATION

Taking and intending to take 2-weeks' paid paternity leave was associated with a reduced likelihood of reporting post-partum depression in fathers. However, offering 2-weeks' paternity leave might place mothers at a greater risk of post-partum depression, suggesting that optimal length and timing of the leave, among other factors, need further investigation.

FUNDING

The French National Research Agency.

Adolescent cannabis experimentation and unemployment in young to mid-adulthood: Results from the French TEMPO Cohort study

BACKGROUND

France accounts for one of the highest levels of recreational cannabis use, with almost 40% of youth aged 17 reporting having experimented with cannabis. We investigated the impact of early cannabis experimentation (defined as first-time use ≤ 16 years) on future probability of unemployment in young to mid-adulthood using a longitudinal, community sample over the span of 9 years.

METHODS

Data were obtained from the French TEMPO Cohort study, set up in 2009 among young adults aged 22-25 years old. Participants who reported information on age of cannabis experimentation and employment status in at least one study wave (2009, 2011, 2015 and 2018) were included in the statistical analyses (N = 1487, 61.2% female).

RESULTS

In A-IPW-adjusted analyses, early cannabis experimenters (≤ 16 years) had 1.71 (95% CI: 1.46-2.02) times higher odds of experiencing unemployment compared to late cannabis experimenters (> 16 years) and 2.40 (95% CI: 2.00 - 2.88) times higher odds of experiencing unemployment compared to non-experimenters. Late cannabis experimenters experienced 1.39 (95% CI: 1.17-1.68) times higher odds of being unemployed compared to non-experimenters, and early cannabis experimenters experienced 3.84 (95%CI: 2.73-5.42) times higher odds of experiencing long-term unemployment (defined as unemployed at least twice) compared to non-experimenters.

CONCLUSIONS

Participants who ever used cannabis, especially at or before the age of 16, had higher odds of experiencing unemployment, even when accounting for many psychological, academic and family characteristics which preceded cannabis initiation.

Spontaneous firing patterns in the medial geniculate nucleus in a guinea pig model of tinnitus

The mechanism of tinnitus, the perception of sound in the absence of acoustic stimulation, remains as yet unknown. It has been proposed that tinnitus is caused by altered spontaneous activity in the auditory pathway following cochlear damage in combination with inadequate gating at the level of the auditory thalamus, the medial geniculate nucleus (MGN). To investigate this further we made electrophysiological recordings in MGN of guinea pigs (n = 9) with and without tinnitus after acoustic trauma (continuous loud tone at 10 kHz, 124 dB SPL for 2 h). Parameters of interest were spontaneous tonic and burst firing. After acoustic trauma, 5 out of 9 guinea pigs developed signs of tinnitus as determined by the gap prepulse inhibition of acoustic startle. Spontaneous firing rates were significantly increased in the tinnitus animals as compared to the non-tinnitus animals and this change was specific to pure-tone responsive MGN neurons. However, burst firing parameters, including number of bursts per minute, burst duration, number of spikes in each burst, and percentage of spikes occurring in a burst, were not different between tinnitus and non-tinnitus animals. In addition, our data showed a strong dependence of spontaneous firing rates with heart rate, which implies that monitoring physiological status in animals is pertinent to obtaining reliable data when recording at higher levels of the auditory pathway. Our results suggest that increases in the tonic spontaneous fining rate of pure-tone responsive MGN neurons but not changes in burst firing parameters, are a robust neural signature of tinnitus in anaesthetised animals.

The impact of COVID-19 on emergency general surgery admissions and operative volumes: A single centre experience

Introduction

The COVID-19 pandemic has placed a significant strain on healthcare resources and utilisation globally. The appearance of the disease in the Republic of Ireland resulted in a broad postponement of scheduled and routine surgical care. The influence of the novel coronavirus, and the associated imposition of public health measures such as school closures and social distancing, on the burden of emergency surgical disease is less clear.

Aim

The aim of this study was to examine the impact of COVID-19 on the number of patients presenting to our institution with emergent surgical illnesses or requiring emergency general surgical procedures.

Methods

All patients attending our service between March 1st 2020 and April 30th 2020 were identified retrospectively by examining electronic handover and electronic discharge summaries, and data were collected relating to demographics, presenting illness, critical care utilisation, length of stay, operative or endoscopic procedure performed, and in-hospital mortality. Similar data were collected March 1st to April 30th 2019, 2018, and 2017 respectively to allow direct comparison.

Results

151 patients were admitted during the study period, compared to a total of 788 during the proceeding three years (mean 2.49 admissions per night versus 4.35 per night, 42.8% reduction, p < 0.001). Median age of admitted patients was 51.8 years, compared to 50.3 years formerly (p = 0.35). 53 emergency procedures were performed, compared to a median of 70 over the same period in the previous years (mean 0.87 per day versus 1.16 per day, 25.4% reduction, p = 0.05).

Conclusion

A significant overall reduction in the number of patients being admitted to our unit and requiring emergency surgical procedures during March and April 2020 was seen, in line with patterns reported internationally.

Prophylactic negative wound therapy in laparotomy wounds (PROPEL trial): randomized controlled trial

BACKGROUND

Superficial surgical site infections are a common post-operative complication. They also place a considerable financial burden on healthcare. The use of prophylactic negative pressure wound therapy has been advocated to reduce wound infection rates. However, there is debate around its routine use. The purpose of this trial is to determine if prophylactic negative pressure wound therapy reduces post-operative wound complications in patients undergoing laparotomy.

METHODS/DESIGN

This multi-centre randomised controlled trial will compare standard surgical dressings (control) to two competing negative pressure wound therapy dressings (Prevena™ and PICO™). All patients will be over 18 years, who are undergoing an emergency or elective laparotomy. It is intended to enrol a total of 271 patients for the trial.

DISCUSSION

The PROPEL trial is a multi-centre randomised controlled trial of patients undergoing laparotomy. The comparison of standard treatment to two commercially available NPWT will help provide consensus on the routine management of laparotomy wounds.

TRIAL REGISTRATION

This study is registered with ClinicalTrials.gov (NCT number NCT03871023).

Benign subcutaneous emphysema: A case report with bite

INTRODUCTION

Subcutaneous emphysema is the presence of air/gas within the subcutaneous tissue plane. Though there are numerous causative factors, benign subcutaneous emphysema is rare.

CASE REPORT

We report a very rare case of benign subcutaneous emphysema following an insect bite on the forearm of a 48-year old man. The puncture area was erythematous and the emphysema extended to the whole arm, axilla and superior mediastinum. Despite, conservative management, the patient had residual discomfort and erythema around the puncture site. Surgical debridement resulted in resolution of symptoms.

DISCUSSION

Subcutaneous emphysema affecting an isolated limb is extremely rare. It is vital to differentiate it from life-threatening soft-tissue infections secondary to a gas-forming organism. Immunodeficiency states are key factors in the development and the outcomes of patients with subcutaneous emphysema. Medical management successfully resolves symptoms in the majority of cases. However, surgical debridement of the puncture site and surrounding fibrotic tissue has been advocated for those with persistent symptoms.

CONCLUSION

This case highlights a rare cause of benign subcutaneous emphysema, highlighting key issues surrounding its management for a successful outcome.

Identification of hydrolysable tannins in the reaction zone of Eucalyptus nitens wood by high performance liquid chromatography--electrospray ionisation mass spectrometry

The first detailed analysis of the phenolic constituents of the reaction zones (tissue of antimicrobial defence) from the sapwood of a Eucalyptus spp. is presented. Plantation-grown Eucalyptus nitens trees with stem decay resulting from pruning wounds were sampled and extracts were prepared from healthy sapwood and from reaction zone tissue. Analysis by HPLC with ESI-MS revealed that a diverse range of hydrolysable tannins are present in both healthy sapwood and in reaction zone extracts, including over 30 gallotannins, ellagitannins and phenols. Eight tannins were unequivocally identified, including the gallotannins tri-O-galloyl-beta-D-glucose, tetra-O-galloyl-beta-D-glucose and penta-O-galloyl-beta-D-glucose, and the ellagitannins pedunculagin, tellimagrandin I, casuarinin, casuarictin and tellimagrandin II. The phenols gallic acid, ellagic acid and catechin were also identified. The ellagitannins (particularly pedunculagin) are considerably more abundant in the reaction zone than in the healthy sapwood and may contribute to the effectiveness of the reaction zone as an antimicrobial barrier.

Changes in regional renal blood flow after unilateral nephrectomy using the techniques of autoradiography and microautoradiography

PURPOSE

To determine alterations in regional renal blood flow following unilateral nephrectomy using an autoradiographic technique. The role of prostaglandins and the sympathetic nervous system in the mediation of these changes was assessed.

MATERIALS AND METHODS

C-14 iodoantipyrine was used as a tracer to measure intrarenal blood flow in anaesthetised rats at multiple time points following nephrectomy. Autoradiographs were produced from tissue sections. C-14 concentrations were measured from standards thus allowing blood flow values to be calculated.

RESULTS

Base line values for cortical and medullary blood flow were 806 +/- 63 and 373 +/- 39 ml./100 gm./min. (mean +/- SEM) respectively. At 2 hours post nephrectomy blood flow to both the cortex and medulla increased significantly (1152 +/- 54 and 594 +/- 37; p < 0.05). Blood flow had returned to control levels by 24 hours and was maintained at 5 days post-nephrectomy. Multiple discrete regions of high blood flow within the cortex were observed. Microautoradiography defined the morphological location of these discrete regions of higher blood flow as periglomerular vasculature. Diclofenac administration did not inhibit the augmentation in cortical blood flow post-nephrectomy, while medullary blood flow fell below base line values at both 30 minutes and 2 hours following nephrectomy. Sympathetic denervation did not affect the changes in cortical blood flow seen following nephrectomy, but did ameliorate the changes in medullary blood flow.

CONCLUSIONS

Significant, transient changes in regional renal blood flow occur in the residual kidney following unilateral nephrectomy. The interaction between vasoactive mediators and the autonomic nervous system which produces changes in cortical blood flow is complex. It is evident, however, that medullary blood flow is dependent on local prostaglandin production and is also influenced by sympathetic nervous supply.

Changes in regional renal blood flow after unilateral nephrectomy using the techniques of autoradiography and microautoradiography

PURPOSE

To determine alterations in regional renal blood flow following unilateral nephrectomy using an autoradiographic technique. The role of prostaglandins and the sympathetic nervous system in the mediation of these changes was assessed.

MATERIALS AND METHODS

C-14 iodoantipyrine was used as a tracer to measure intrarenal blood flow in anaesthetised rats at multiple time points following nephrectomy. Autoradiographs were produced from tissue sections. C-14 concentrations were measured from standards thus allowing blood flow values to be calculated.

RESULTS

Base line values for cortical and medullary blood flow were 806 +/- 63 and 373 +/- 39 ml./100 gm./min. (mean +/- SEM) respectively. At 2 hours post nephrectomy blood flow to both the cortex and medulla increased significantly (1152 +/- 54 and 594 +/- 37; p < 0.05). Blood flow had returned to control levels by 24 hours and was maintained at 5 days post-nephrectomy. Multiple discrete regions of high blood flow within the cortex were observed. Microautoradiography defined the morphological location of these discrete regions of higher blood flow as periglomerular vasculature. Diclofenac administration did not inhibit the augmentation in cortical blood flow post-nephrectomy, while medullary blood flow fell below base line values at both 30 minutes and 2 hours following nephrectomy. Sympathetic denervation did not affect the changes in cortical blood flow seen following nephrectomy, but did ameliorate the changes in medullary blood flow.

CONCLUSIONS

Significant, transient changes in regional renal blood flow occur in the residual kidney following unilateral nephrectomy. The interaction between vasoactive mediators and the autonomic nervous system which produces changes in cortical blood flow is complex. It is evident, however, that medullary blood flow is dependent on local prostaglandin production and is also influenced by sympathetic nervous supply.

Plasma levels of amino acids correlate with motor fluctuations in parkinsonism

Seven patients with Parkinson's disease who experienced severe motor fluctuations in response to levodopa were studied in detail with relation to the effect of dietary protein on their motor function. The levodopa dose for each patient was not changed during the period of study, and no other antiparkinsonian drugs were used. Regular and high-protein diets resulted in a marked elevation in the plasma concentrations of large neutral amino acids (LNAAs) that are known to compete with levodopa for transport across the blood-brain barrier. Despite elevated plasma levodopa levels, all patients with elevated LNAA levels experienced parkinsonian symptoms. When the amino acid level dropped while plasma levodopa levels were elevated, patients experienced relief of these symptoms. On a low-protein diet, LNAA levels remained low and all patients were consistently dyskinetic throughout the day, even though the mean plasma levodopa levels were somewhat lower than when the patients consumed a high-protein diet. A redistribution diet that is virtually protein free until supper and then unrestricted until bedtime is tolerated by patients because this simple manipulation permits near-normal daytime motor function.

Dietary method for reducing fluctuations in Parkinson's disease

Motor fluctuations and non-response to carbidopa-levodopa (Sinemet) therapy are major problems in the long-term management of Parkinson's disease. Levodopa manipulation, addition of adjuvants, and drug holidays are often unsuccessful. Others have shown that the clinical state of stabilized Parkinsonians can be reversed with intravenous administration of large neutral amino acids. Reasoning that dietary protein might precipitate motor oscillations and non-response, a low-protein daytime diet (7 g) was offered to fifteen patients. Eighty-six percent of this sample demonstrated immediate sensitivity to Sinemet. While on a low-protein diet, patients' clinical function was predominantly choreatic. Eight patients required a 10-60 percent reduction in their daily levodopa dose in order to minimize this choreatic tendency. Discontinuation of adjuvants did not compromise motor independence. Conversely, while on a high-protein diet (160 g), patients were predominantly immobile with markedly elevated plasma amino acid and levodopa levels. Consequently, elimination of dietary protein from breakfast and lunch can offer an effective and easily modified method for the amelioration of motor fluctuations and non-response to Sinemet in Parkinson's disease during working hours.

Technicium as a radiolabel in the assessment of in vivo human Fc clearance

99m-Tc was used as a radiolabel to study in vivo human clearance of IgG sensitized erythrocytes. Stannous chloride pretreatment at different doses and varying amounts of 99m-Tc were studied with respect to radiolabelling efficiency and elution. Mean in vivo clearance rates in systemic lupus erythematosus patients were significantly prolonged compared to controls. Using as little as 200 microCi of 99m-Tc per patient, in vivo human immune clearance can be determined with a minimal radiation biohazard. With this method, serial immune determinations can be performed within very short time frames, allowing for monitoring effects of immunomodulatory therapy as well as variations in disease activity.