BackgroundIn the past fifteen years there has been a wave of closures of small maternity services in Canada and other developed nations which results in the need for rural parturient women to travel to access care. The purpose of our study is to systematically document newborn and maternal outcomes as they relate to distance to travel to access the nearest maternity services with Cesarean section capabililty.MethodsStudy population is all women carrying a singleton pregnancy beyond 20 weeks and delivering between April 1, 2000 and March 31, 2004 and residing outside of the core urban areas of British Columbia. Maternal and newborn data was linked to specific geographic catchments by the B.C. Perinatal Health Program. Catchments were stratified by distance to nearest maternity service with Cesarean section capabililty if greater than 1 hour travel time or level of local service. Hierarchical logistic regression was used to test predictors of adverse newborn and maternal outcomes.Results49,402 cases of women and newborns resident in rural catchments were included. Adjusted odds ratios for perinatal mortality for newborns from catchments greater than 4 hours from services was 3.17 (95% CI 1.45-6.95). Newborns from catchments 2 to 4 hours, and 1 to 2 hours from services generated rates of 179 and 100 NICU 3 days per thousand births respectively compared to 42 days for newborns from catchments served by specialists.ConclusionsDistance matters: rural parturient women who have to travel to access maternity services have increased rates of adverse perinatal outcomes.
A health survey was carried out on all white males in an aluminum smelter in British Columbia. The survey consisted of a medical-occupational questionnaire, spirometry, chest radiography, and environmental monitoring. We have compared the results of a respiratory survey in 713 workers in the office and casting department with no significant exposure to air contaminants (control workers) with those of 797 potroom workers: 495 who spent more than 50% of their working time in the potroom (high exposure) and 302 workers who spent less than 50% of their working time in the potroom (medium exposure). Potroom workers (high) had a significantly greater prevalence of cough and wheeze than did those in the control group, and they had significantly lower mean forced expiratory volume in one second and maximal midexpiratory flow rate than did those in the control group after adjustment had been made for differences in age, height, and smoking habits. Potroom workers (medium) had a slightly greater prevalence of respiratory symptoms and lower lung function than did workers in the control group, but the differences were not significant. We were unable to demonstrate potroom asthma. The levels of total fluoride, gaseous fluoride, particulate fluoride, sulphur dioxide, and total particulates found in the potroom at the time of the study were below the currently accepted threshold limit values, but the levels of benzo-alpha-pyrene were high.
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