Poor birth outcomes are associated with illicit drug use during pregnancy. While prenatal cigarette exposure has similar effects, cessation of illicit drug use during pregnancy is often prioritized over cessation of smoking. The study goal was to examine the impact of pregnancy tobacco use, relative to use of illicit drugs, on birth outcomes. Women were recruited at entry to prenatal care, with background and substance use information collected during pregnancy. Urine drug screens were performed during pregnancy, and the final sample (n = 265) was restricted to infants who also had biologic drug testing at delivery. Participants were classified by pregnancy drug use: no drugs/no cigarettes, no drugs/cigarette use, illicit drugs/no cigarettes, and illicit drugs/cigarette use. Groups differed significantly on infant birthweight, but not gestational age at delivery after control for confounders including background and medical factors. Among women who smoked, the adjusted mean birthweight gain was 163 g for those not using hard illicit drugs, while marijuana use had no effect on birth weight beyond the effect of smoking cigarettes. Women who used hard illicit drugs and did not smoke had an adjusted mean birthweight gain of 317 g over smokers. Finally, women who refrained from hard illicit drugs and smoking had a birthweight gain of 352 g. Among substance using pregnant women, smoking cessation may have a greater impact on birthweight than eliminating illicit drug use. Intervention efforts should stress that smoking cessation is at least as important to improving pregnancy outcomes as abstaining from illicit drug use.

Swallowing impairments co-occur with chronic obstructive pulmonary disease (COPD) leading to aspiration, disease exacerbations, and malnutrition. This pilot survey study aimed to identify current clinical practice patterns for swallowing evaluation and treatment in persons with COPD. A 35-question Qualtrics survey was deployed to medical speech-language pathology (SLP) social media sites and professional boards; flyers were distributed at a professional conference. Forty-eight SLPs completed the study. SLPs routinely include a clinical swallow examination (96%), videofluoroscopic swallowing study (79%), adjunctive respiratory measures (respiratory rate [83%], and pulse oximetry [67%], respiratory–swallow pattern [77%]) but less frequently include fiberoptic endoscopic evaluation of swallowing (23%). Self-reported advanced clinical experience and expert respiratory analysis skills were associated with adjunctive respiratory measure (respiratory rate, pulse oximetry) inclusion during assessment. Compensatory strategy training (77%) is a preferred treatment for dysphagia in COPD; however, respiratory–swallow pattern training and expiratory muscle strength training are increasing in use. SLPs self-report a comprehensive, individualized patient-centered care approach with inclusion of adjunctive respiratory-focused methods in dysphagia evaluation and treatment practice in persons with COPD. Advances in the identification of the integral role of respiratory function in swallowing integrity may be translating to clinical practice methods for dysphagia management in persons with COPD.

SUMMARY The gastric secretory response to insulin is mediated predominantly by the vagus. The associated hypoglycaemia stress response is mediated by the sympathetic nervous system.Inhibition of the sympathetic response by simultaneous alpha and beta receptor blockade was studied in five healthy young adults.No appreciable modification of gastric secretory output resulted.Insulin-induced hypoglycaemia leads to vagally mediated stimulation of gastric secretion (Hollander, 1946). Insulin-induced hypoglycaemia also produces a stress response mediated by the sympathetic nervous system (Cannon, McIver, and Bliss, 1924; von Euler and Luft, 1952;Duner, 1954;Cantu, Wise, Goldfien, Gullixson, Fischer, and Ganong, 1963). Adrenaline and l-noradrenaline reduce basal and stimulated gastric secretion (Baronofsky and Wangensteen, 1945; Forrest and Code, 1954;Leonsins and Waddell, 1958; Nicoloff, Peter, Stone, and Wangensteen, 1964; Haigh, Moffitt, and Steedman, 1967). It appears therefore that the effects on secretion of the parasympathetic and sympathetic nervous systems are mutually antagonistic. This study was undertaken to determine whether inhibition of the sympathetic component leads to a rise in human secretion during insulin-induced hypoglycaemia. In order to achieve adequate inhibition of this sympathetic component it is necessary to block specifically both alpha and beta sympathetic receptors (Ahlquist, 1948) simultaneously, and this was done. Methods and MaterialsFive healthy informed volunteers between the ages of 20 and 26 years each underwent two studies in random order. The initervals between studies were seven, 12, 14, 38, and 54 days. An electrocardiogram was performed on all subjects before the experiments to exclude the presence of any cardiac conduction defects.Received for publication 25 January 1972. CONTROL INSULIN STUDYAfter a 12-hour fast from nine o'clock the previous evening a 14FG gastric tube was passed into the stomach and the opaque tube tip fluoroscopically positioned so that it lay in the most dependent part of the stomach with the subject lying on his lefthand side.Following four 15-minute basal collections of gastric secretion, aspiration being performed continuously by hand, an intravenous infusion of 0 9% saline was set up and continued for the remainder of the experiment. The total volume infused did not exceed 1 litre.Thirty minutes after beginning this infusion, the stomach was aspirated and the specimen discarded. Crystalline insulin', 0.15 units per kilogram body weight, was then injected intravenously as a bolus, and eight further 15-minute gastric samples were obtained.Blood sugar levels were measured before and after the basal collection, immediately before giving the insulin, and afterwards, at 15, 30, 45, 75, and 105 minutes. Blood pressure and pulse rate were recorded at 15-minute intervals throughout, and more often when indicated. INSULIN STUDY WITH SYMPATHETIC BLOCKADEA similar procedure to that described above was followed with the exception that the infusion contained p...