Objective We set out to ascertain the relationship between insulin resistance, fitness, and brain structure and function in adolescents. Design and Methods We studied 79 obese and 51 non-obese participants who were recruited from the community, all without type 2 diabetes mellitus. All participants received medical, endocrine, neuropsychological, and MRI evaluations as well as a 6-minute walk test that was used to estimate fitness (maximal oxygen consumption). Results Obese adolescents had significantly thinner orbitofrontal cortices and performed significantly worse on Visual Working Memory tasks and the Digit Vigilance task. Insulin sensitivity and maximal oxygen consumption (VO2 max) were both highly correlated with central obesity and orbitofrontal cortical thickness, although insulin sensitivity was the stronger predictor for orbitofrontal cortical thickness. We also found that VO2 max was the only significant physiological variable related to visual working memory. Conclusions This is the first study to report positive associations between insulin resistance, VO2 max, and frontal lobe brain integrity in adolescents. Given the importance of brain health for learning and school performance, we conclude that schools should also emphasize physical fitness in order to maintain structural and functional brain integrity and facilitate academic achievement.

Objective Nutrition during pregnancy is an important modifiable determinant of fetal growth and development. This pilot study aimed to characterize the association between fetal anthropometry, fetal brain development, and maternal diet among women in Ecuador using portable ultrasound in resource‐limited clinics, including measurements of brain structures not typically imaged in this setting. Methods Pregnant women (n = 47) from four resource‐limited health centers were surveyed on demographic, socioeconomic, morbidity, and dietary information. Maternal height, weight, and blood pressure were taken. A sonographer took 15 images per participant, including those standardly assessed during the fetal survey and additional brain structures identified as potentially responsive to maternal nutrition, but not part of the standard fetal survey. Results Mean percentiles for all standard fetal survey measurements generated from WHO Fetal Growth Curves fell below 50%, and negative mean Z scores were found for biparietal diameter (−0.95 ± 1.11) and femur length (−0.22 ± 1.10). Generalized linear modeling adjusting for gestational age and other covariates showed frequency of seafood consumption was positively associated with fetal biparietal diameter Z score (P = 0.005), beans and legumes positively associated with femur length (P = 0.006), and a negative association was found for soda consumption and fetal head circumference (P = 0.013). Conclusions This pilot study demonstrated the feasibility of capturing images of nutrition‐relevant fetal brain structures not part of the standard fetal survey in resource‐limited settings using portable ultrasound. Our study revealed associations between anthropometry, brain structure size, and maternal diet demonstrating potential for prenatal nutrition research using ultrasound in the field.

OBJECTIVE: To determine modifiable risk factors associated with surgical site infection (SSI) and postpartum endometritis. We hypothesized that inappropriate surgical antibiotic prophylaxis would be a risk factor for both types of infections. METHODS: This was a single-center case-control study of SSI and endometritis after cesarean delivery over a two-year period from 2016 to 2017. Cases were identified by ICD-10 diagnosis codes, infection control surveillance, and electronic medical records search, and were subsequently confirmed by chart review. Three controls were randomly selected for each case from all cesareans ±48 hours from case delivery. Demographic, pregnancy and delivery characteristics were abstracted. Separate multivariable logistic regression models were used to assess factors associated with SSI and endometritis. Postpartum outcomes, including length of stay and readmission, were also compared. RESULTS: We identified 141 cases of SSI and endometritis for an overall postpartum infection rate of 4.0% among all cesarean deliveries. In adjusted analysis, factors associated with both SSI and endometritis were intrapartum delivery, classical or other (non-low-transverse) uterine incision, and blood transfusion. Factors associated with SSI only included inadequate antibiotic prophylaxis, public insurance, hypertensive disorder of pregnancy and non-chlorhexidine abdominal preparation; factors only associated with endometritis included beta-lactam allergy, anticoagulation therapy, and chorioamnionitis. Among cases, 34% of those with SSI and 25% of those with endometritis did not receive adequate antibiotic prophylaxis, compared to 12.9% and 13.5% in control groups, respectively. Failure to receive appropriate antibiotic prophylaxis was associated with increased risk of SSI (aOR 4.4, 95% CI 1.3-15.6), but not endometritis (aOR 0.9, 95% CI 0.4-2.0). CONCLUSION: Inadequate surgical antibiotic prophylaxis was associated with an increased risk of SSI, but not postpartum endometritis, highlighting the different mechanisms of these infections and importance of prioritizing adequate surgical prophylaxis. Additional potentially modifiable factors which emerged included blood transfusion and chlorhexidine skin preparation.

INTRODUCTION: Surveillance for surgical site infections (SSI) following cesarean can be challenging. We sought to identify cases of SSI over two years and describe our methods of case ascertainment. METHODS: We queried our hospital's data warehouse for cesareans deliveries from 2016-2017 among women >18 years of age. Three methods for case finding were used: i) ICD-10 diagnoses codes, ii) reporting complications in postoperative notes, and iii) infection control surveillance activities. For ICD-10 codes, we sought endometritis following delivery and infection of obstetrical surgical wound, infection following procedure, cellulitis, and/or peritoneal abscess. We included endometritis as an organ/space SSI by CDC definitions. Chart review was performed for all cases identified by any of the 3 methods to confirm SSI diagnosis as per CDC criteria. RESULTS: Among 3,507 cesareans, ICD-10 codes identified 76 confirmed cases of endometritis and 31 SSI. The positive predictive value for endometritis was 88.0% (95% CI 80.2-93.1) and for SSI codes, 53.5% (95% CI 43.0-63.6). Adding puerperal sepsis produced one additional SSI case, and searching the postoperative note yielded another 26 cases of endometritis and one wound infection. Six SSI were identified by infection control not identified by other methods. In total, we identified 141 SSI, including 98 endometritis-only cases. The incidence of all SSI, endometritis, and SSI excluding endometritis was 4.02%, 2.79%, and 1.23%. CONCLUSION: Improved ascertainment methods are needed to inform and assess performance improvement efforts for cesarean SSI. Reliance on diagnosis codes may miss a significant number of cases and is poorly predictive of SSI other than endometritis.

INTRODUCTION: Surgical site infections (SSI) are common complications following cesarean delivery. As part of a performance improvement project, we recognized the need to differentiate infections based on severity and thus sought to characterize the most severe cases of SSI. METHODS: We performed a retrospective review of women ≥18 years or older who delivered by cesarean in 2016 and 2017 at a Women's Hospital. Using a combination of ICD-10 diagnosis codes, the electronic medical record, and infection control surveillance, we identified cases and confirmed all diagnoses by chart review using CDC definitions for SSI. We defined severe SSI as cases requiring additional treatment (change in antibiotics or additional procedure), readmission, CT imaging, ICU admission, or length of stay ≥7 days. We compared maternal demographics and clinical characteristics between severe and non-severe cases using the Student t-test and Fischer exact test as appropriate. RESULTS: Among 3,507 cesarean deliveries, 141 met criteria for SSI. Of these, there were 53 cases of severe SSI. Women with severe SSI were older (31.9 vs. 30.2 years, p=0.01), had lower gestational ages at delivery (35.8 vs. 37.6 weeks, p<0.01), were more likely to have diabetes (26.4% vs. 10.2%, p=0.02) and less likely to have endometritis only (50.9% vs. 81.8%, p<0.01). There was no difference between groups in BMI, prior cesarean, hypertension, GBS status, length of labor or rupture of membranes, or emergent/urgent deliveries. CONCLUSION: In our cohort, severe SSI was associated with older age, diabetes, and earlier deliveries. Further research is needed to identify modifiable risk factors and guide prevention strategies.