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Endoscopic Positioning of Last Ventricular Catheter Using Seldinger Approach: Explanation associated with Approach and Case Collection.
Rural counties have the highest infant mortality rates across the United States when compared with rates in more urban counties. We use a social-ecological framework to explain infant mortality disparities across the rural-urban continuum.

We created a cohort of all births in the United States linked to infant death records for 2014 to 2016. Records were linked to county-level data from the Area Health Resources File and the American Community Survey and classified using the National Center for Health Statistics Urban-Rural Classification Scheme. Using multilevel generalized linear models, we investigated the association of infant mortality with county urban-rural classification, considering county health system resources and measures of socioeconomic advantage, net of individual-level characteristics, and controlling for US region and county centroid.

Infant mortality rates were highest in noncore (odds ratio [OR] = 1.32, 95% confidence interval [CI] 1.26-1.39) and micropolitan counties (OR = 1.26, 95% CI 1.20-1.32) when compared with large metropolitan fringe counties, controlling for geospatial measures. Inclusion of county health system characteristics did little to attenuate the greater odds of infant mortality in rural counties. Instead, a composite measure of county-level socioeconomic advantage was highly protective (adjusted OR = 0.84; 95% CI 0.82-0.86) and eliminated any difference between the micropolitan and noncore counties and the large metropolitan fringe counties.

Higher infant mortality rates in rural counties are best explained by their greater socioeconomic disadvantage than more-limited access to health care or the greater prevalence of mothers' individual health risks.
Higher infant mortality rates in rural counties are best explained by their greater socioeconomic disadvantage than more-limited access to health care or the greater prevalence of mothers' individual health risks.Pediatricians play a crucial role in optimizing the prevention of perinatal transmission of HIV infection. Pediatricians provide antiretroviral prophylaxis to infants born to women with HIV type 1 (HIV) infection during pregnancy and to those whose mother's status was first identified during labor or delivery. Infants whose mothers have an undetermined HIV status should be tested for HIV infection within the boundaries of state laws and receive presumptive HIV therapy if the results are positive. Cinchocaine solubility dmso Pediatricians promote avoidance of postnatal HIV transmission by advising mothers with HIV not to breastfeed. Pediatricians test the infant exposed to HIV for determination of HIV infection and monitor possible short- and long-term toxicity from antiretroviral exposure. Finally, pediatricians support families living with HIV by providing counseling to parents or caregivers as an important component of care.
The Canadian National Advisory Committee on Immunization recommends universal vaccination against pertussis in pregnancy. We assessed the cost-effectiveness of vaccination with tetanus-diphtheria-acellular pertussis (Tdap) vaccine in pregnancy in Canada.

We conducted a cost-utility analysis comparing a vaccination program to no program corresponding with the 2017 Canadian guideline for economic evaluation from the Canadian Agency for Drugs and Technologies in Health. We developed 2 models - part decision tree, part Markov model - to estimate the long-term cost and quality-adjusted life-years (QALYs) for pregnant women and their infants. We obtained epidemiologic data from 2006 to 2015, and derived costs and utility values from relevant sources. Results were reported in 2019 Canadian dollars. We obtained expected values through probabilistic analysis, with methodologic and structural uncertainty assessed through scenario analyses. The analysis adopted an acquisition price of Tdap vaccine of $12.50, with sc$14.03 or less. Province- and territory-specific analyses should be done to inform local decision-making.
Improving rural health is often identified as a priority area for research and policy in Canada. We examined how findings on HIV outcomes (virologic suppression) can vary depending on the definition of rurality used.

We performed retrospective cohort analyses using the Comparative Outcomes and Service Utilization Trends study population-based cohort of adults (age ≥ 19 yr) living with HIV in British Columbia between Apr. 1, 2012, and Mar. 31, 2013. We performed univariate logistic regression analyses using the following geographic variables to predict HIV virologic suppression rurality defined by forward sortation area, by Statistical Area Classification and by health authority. We mapped suppression using geographic information systems.

Virologic suppression was observed in 5605 (65.2%) of 8598 participants. In univariate analysis, rurality defined by Statistical Area Classification (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.65-0.82), but not by forward sortation area, was associated with lower odds of suppression. When we examined suppression by health authority, Northern Health had the lowest odds of suppression (OR 0.46, 95% CI 0.36-0.58 compared to Vancouver Coastal Health). Geographic information systems mapping showed poorer suppression in northern areas.

Health outcome findings can vary depending on the definition of the geographic variable. When including geographic variables, researchers should carefully consider variable definitions and whether other classification systems, such as north-south, are more appropriate than rurality for their analysis.
Health outcome findings can vary depending on the definition of the geographic variable. When including geographic variables, researchers should carefully consider variable definitions and whether other classification systems, such as north-south, are more appropriate than rurality for their analysis.
Genetic testing in families with hereditary cancer enables identification of people most likely to benefit from intensive screening and preventive measures; however, the uptake of testing in relatives (known as cascade carrier testing) for hereditary colorectal cancer syndromes has been shown to be low. Our objective was to report rates of familial testing for hereditary colorectal cancer syndromes in a publicly funded hereditary cancer clinic in Canada.

A cross-sectional retrospective database review was used to determine testing uptake between 1997 and 2016 for families served by the provincial Hereditary Cancer Program for British Columbia and Yukon. Analyses were conducted for genes associated with syndromes with an increased risk for colorectal cancer, including Lynch syndrome (
,
,
,
and
) and familial adenomatous polyposis (
), and for additional moderate- to high-penetrance genes (
,
,
,
,
and
). Descriptive statistics were used and all analyses were 2-tailed.

The study cohort included 245 index patients, with carrier testing performed in 382 relatives.
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