Background Postpartum depression (PPD) can result in negative personal and child developmental outcomes. Only a few large population based studies of PPD have used clinical diagnoses of depression and no study has examined how a maternal depression history interacts with known risk factors. The objective of the study was to examine the impact of a depression history on PPD and pre- and perinatal risk factors. Method Nationwide prospective cohort study of all women with live singleton births in Sweden from 1997 through 2008. Relative risk of clinical depression within the first year postpartum and two-sided 95% confidence intervals. Results The relative risk of PPD in women with a history of depression was estimated at 21.03 (confidence interval: 19.72–22.42), compared to those without. Among all women, PPD risk increased with advanced age (1.25[1.13–1.37]) and with gestational diabetes (1.70[1.36–2.13]). Among women with a history of depression, pre-gestational diabetes (1.49[1.01–2.21]) and mild preterm delivery also increased risk (1.20[1.06–1.36]). Among women with no depression history, young age (2.14 [1.79–2.57]), those undergoing instrument assisted (1.23[1.09–1.38]) or cesarean (1.64[1.07–2.50]) delivery and moderate preterm delivery increased risk (1.36[1.05–1.75]). Rates of PPD decreased considerably after the first postpartum month (relative risk = 0.27). Conclusion In the largest population based study to date, the risk of PPD was more than 20 times higher for women with a depression history, compared to women without. Gestational diabetes was independently associated with a modestly increased PPD risk. Maternal depression history also had a modifying effect on pre- and perinatal PPD risk factors.

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Background. Protease inhibitor (PI)–based combination antiretroviral therapy (cART) is administered during pregnancy to prevent perinatal human immunodeficiency virus (HIV) transmission. However, PI use has been associated with adverse birth outcomes, including preterm delivery and small-for-gestational-age (SGA) births. The mechanisms underlying these outcomes are unknown. We hypothesized that PIs contribute to these adverse events by altering progesterone levels.Methods. PI effects on trophoblast progesterone production were assessed in vitro. A mouse pregnancy model was used to assess the impact of PI-based cART on pregnancy outcomes and progesterone levels in vivo. Progesterone levels were assessed in plasma specimens from 27 HIV-infected and 17 HIV-uninfected pregnant women.Results. PIs (ritonavir, lopinavir, and atazanavir) but not nucleoside reverse transcriptase inhibitors (NRTIs) or nonnucleoside reverse transcriptase inhibitors reduced trophoblast progesterone production in vitro. In pregnant mice, PI-based cART but not dual-NRTI therapy was associated with significantly lower progesterone levels that directly correlated with fetal weight. Progesterone supplementation resulted in a significant improvement in fetal weight. We observed lower progesterone levels and smaller infants in HIV-infected women receiving PI-based cART, compared with the control group. In HIV-infected women, progesterone levels correlated significantly with birth weight percentile.Conclusions. Our data suggest that PI use in pregnancy may lead to lower progesterone levels that could contribute to adverse birth outcomes.

Ontario Ministry of Health and Long-term Care, Academic Medical Organization of Southwestern Ontario, Schulich School of Medicine and Dentistry, Western University, and Lawson Health Research Institute.

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ising rates of antimicrobial resistance are an emerging public health crisis. 1,2 Antibiotic use is associated with antimicrobial resistance at both the patient and population level. 3-5 The largest modifiable driver of resistance is antibiotic use. In addition, antibiotics have important adverse effects, including up to a 30% risk of allergic reactions and gastrointestinal symptoms, including diarrhea associated with Clostridium difficile. 6-9 Existing evidence suggests there is a considerable amount of inappropriate antibiotic use in ambulatory settings, where 92% of antibiotics are prescribed in Canada. 10 In the United States, it is estimated that 30%-50% of antibiotics prescribed outside of hospitals are unnecessary. 11,12 In the United Kingdom, overprescribing of antibiotics for respiratory infections is common, particularly for acute bronchitis, sinusitis and acute otitis media in children. 13,14 Furthermore, an Ontario study identified that 46% of older adults with a presumed viral respiratory infection filled an antibiotic prescription. 15 However, the degree of unnecessary antibiotic use in Canadian primary care settings is not well defined. The US National Action Plan for Combatting Antibioticresistant Bacteria has set a goal to reduce inappropriate antibiotic prescribing by 50% by 2020. 16 The UK's 5-year plan is to reduce overall human antibiotic use by 15% by 2024. 17 Canada has yet to articulate a similar plan to reduce overall antibiotic use in humans, partly because, to date, reasonable targets

This study quantified the influence of visual attention therapy on the reading comprehension of Grade 6 children with moderate reading disabilities (RD) in the absence of specific reading remediation. Thirty students with below-average reading scores were identified using standardized reading comprehension tests. Fifteen children were placed randomly in the experimental group and 15 in the control group. The Attention Battery of the Cognitive Assessment System was administered to all participants. The experimental group received 12 one-hour sessions of individually monitored, computer-based attention therapy programs; the control group received no therapy during their 12-week period. Each group was retested on attention and reading comprehension measures. In order to stimulate selective and sustained visual attention, the vision therapy stressed various aspects of arousal, activation, and vigilance. At the completion of attention therapy, the mean standard attention and reading comprehension scores of the experimental group had improved significantly. The control group, however, showed no significant improvement in reading comprehension scores after 12 weeks. Although uncertainties still exist, this investigation supports the notion that visual attention is malleable and that attention therapy has a significant effect on reading comprehension in this often neglected population.