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PubMed1997

Finding common ground: how public health can work with organized labor to protect workers from environmental tobacco smoke. National Association for Public Health Policy.

Tobacco is not and does not have to be a high priority for all segments of organized labor, but public health advocates should continue to promote the issue and find segments which are open to collaborative efforts to protect workers' health. Even in those unions representing workers for whom smoking and ETS pose a lower health risk relative to other workplace toxins, smoking policy remains a strategic issue for at least two reasons. First, supporting efforts to control ETS exposure sure is an issue of service to non-smoking union members, and like-wise, bargaining for smoking cessation programs is a service to members who smoke. Second, it is in the union's interest to engage with management through collective bargaining to develop smoking policies, rather than to allow management to unilaterally propose and/or implement policies. To remain a strong voice in the worksite, labor needs to defend its unions and members from misdirected and overzealous actions. Within the context of the diversity of opinions from within labor and public health, this policy statement aims to identify our common ground and recommend ways to collaborate in protecting worker health. Specifically, we recommend that the public health community take the following actions: I) assist unions with smoking cessation services that meet the needs of labor, 2) support labor's efforts to negotiate smoking policies within the context of collective bargaining, 3) include labor in tobacco control coalitions, 4) advocate for regulatory initiatives that include ETS as part of an overall indoor air quality strategy, 5) focus attention on preventing smoking among children of union members, and 6) develop strategies with labor to benefit from savings that employers achieve under smoking restrictions or bans. Smoking and exposure to second-hand smoke represent a threat to the health of workers. Given that the public health and labor movements have a mutual interest in protecting worker health, it makes sense for these two groups to join together on tobacco control policy-making in the worksite.

Adult↗
PubMed1983

Insulin and glucose requirements during the first stage of labor in insulin-dependent diabetic women.

Studies utilizing glucose-controlled insulin infusion systems were undertaken to more accurately define the glucose and insulin requirements during the first stage of labor induced by oxytocin in 12 insulin-dependent diabetic women in whom normoglycemia had been maintained before delivery. Insulin requirements decreased to zero during active stage 1 labor, while the glucose infusion rate necessary to maintain a blood glucose level of 70 to 90 mg/dl (or 3.9 to 5.0 mmol/liter) was constant at 2.55 mg/kg per minute. The findings were confirmed in 40 additional studies of oxytocin-induced labor. Studies of six women undergoing spontaneous labor and one nonpregnant woman receiving oxytocin confirmed that the decrement in the insulin requirement during stage 1 labor was not influenced by oxytocin infusion. The changes occurred regardless of whether epidural anesthesia was employed. Insulin requirements returned during the second stage of labor. Active stage 1 labor in diabetic women thus appears to be associated with a predictable decrease in the need for insulin and a constant glucose requirement.

Blood Glucose↗
PubMed2006

Continuous monitoring of cervical dilatation and fetal head station during labor.

An ultrasound-based computerized system was developed for monitoring cervix dilatation and fetal head station during labor. The system was designed to provide continuous and accurate assessment of the progression of labor. The computerized labor-monitor (CLM) was tested in the laboratory and was studied in over 95 women during labor. The laboratory test showed that the mean error of measurement is 0.1 mm with standard deviation of 1.14 mm. In the clinical experiments, safety of the various system components was demonstrated and partograms were compared to manual measurements. The systematic error of the fetal head station measurement is estimated as 10-20%, depending on patient's anatomy. In addition, the clinical tests indicated that measurements of the changes of both cervix dilatation and fetal head station are feasible. The CLM is expected to change patient management in the labor room. It will enable timely recognition of abnormal labor patterns such as dysfunctional and precipitous labor. Continuous accurate data will allow earlier diagnosis and intervention that is very likely to improve both mother's and baby's clinical outcome.

Adult↗
PubMed1998

Influence of acupuncture on duration of labor.

The aim of this case control study was to evaluate the thus far controversially discussed influence of acupuncture (AP) on the duration of labor. Fifty-seven women with AP treatment (group A) were included in our study after spontaneous vaginal full-term delivery. The control group included 63 women (group B). Median duration of the first stage of labor was 196 min in group A and 321 min in group B (Wilcoxon 2-sample test, p < 0.0001). Median duration of the second stage of labor was 57 min in group A and 57 min in group B (Wilcoxon 2-sample test, p = 0.82). Thirty women had a premature rupture of the membranes (PROM), in group A 66.7% and in group B 33.3% (chi2 test, p = 0.02). Women without AP (group B) received significantly more often oxytocin during the first stage of labor compared with group A women (85 and 15%, respectively, chi2 test, p = 0.01) as well as during the second stage of labor (72 and 28%, respectively, chi2 test, p = 0.03). Our study suggests that AP treatment is a recommendable form of childbirth preparation due to its positive effect on the duration of labor, namely by shortening the first stage of labor.

Acupuncture Analgesia↗
PubMed1989

Relationship of admissions for false labor to perinatal outcome.

While false labor is a common clinical problem, little information exists for correlating hospital visits (for false labor) with the subsequent labor course or perinatal outcome. We evaluated the obstetric and perinatal outcomes in 112 consecutive patients with one or more hospital visits for false labor and compared them with those in matched controls. The only statistically significant difference was the incidence of oxytocin induction following premature rupture of the membranes in the false-labor group (16 vs. 6, chi 2 = 5.05, P less than .05). This study suggests that a previous false-labor admission does not increase the risk of a labor abnormality or suboptimum perinatal outcome.

Delivery, Obstetric↗
PubMed1985

Fetal breathing movements and the diagnosis of labor: a prospective analysis of 100 cases.

One hundred patients self-admitted to the hospital with a diagnosis of labor, were observed for up to 45 minutes with real-time ultrasonography to determine if the presence or absence of fetal breathing movements was helpful in separating false labor from true labor. Fetal breathing movements were not detected in 31 patients, and 30 of these delivered spontaneously within 48 hours; fetal breathing movements were present in 69 cases, and pregnancy continued for at least 48 hours in 56; of the remaining 13, labor occurred spontaneously within 48 hours in eight, whereas five had labor induced. Assessment of the cervix by Bishop score after ultrasound further improved diagnostic precision; none of 13 patients with a score greater than 9 exhibited fetal breathing movements, and all delivered within 48 hours. Gestational age did not influence outcome; 25 patients were preterm, and all 22 in whom fetal breathing movements were present continued for more than 48 hours. The results suggest that the absence of fetal breathing movements differentiates true labor from false labor.

Cervix Uteri↗
PubMed1977

[Dilatation of the os uteri in various types of amniotic rupture and in induction of labor (author's transl)].

Basing on the "partial dilatation" ("Teileröffnungszeiten" (W. Wolf), ie the time in which the os uteri opens from a certain size to its full potential, the process of openning of the os uteri was compared between various types of rupture of the amnion and in programmed induction of labor. Both in the case of primiparas and pluriparas, opening is fastest after early rupture of the amnion, followed by premature amniotic opening and opening at induction of labor. Opening is slowest in the case of timely rupture of the amnion. However, the differences in the opening process between induction of labor and premature amniotic rupture on the one hand, and between induction of labor and timely amniotic rupture on the other, are not significant. The differences in opening following spontaneous onset of labor are attributed to the individual varying circumstances relating to the mechanism of birth. In regard to the temporal course of birth, neither the mother nor the child is subjected to an increased stress of labor resulting from induction of labor.

Female↗
PubMed1982

[The observation of the maternal hemodynamics during labor and cesarean section (author's transl)].

The echocardiographic observation of the maternal hemodynamics was performed in 12 normal parturient women during labor and 10 patients during cesarean section. In the first stage of labor, the increase of cardiac output volume (CO) was observed during contraction as compared with that between contraction. And this increase of CO was due to the increase of heart rate (HR) t 4-5cm dilatation of cervix, and the increase of stroke volume (SV) at 7-8cm dilatation of cervix. In the second stage of labor, the increase of HR and mean velocity of circumferential fiber shortening (mVcf), and the decrease of ejection time, end-diastolic volume, SV, CO and ejection fraction (EF) were observed during contraction with expulsive efforts as compared with those in late pregnancy. These changes suggest that the severe hypovolemic stress is imposed, which may be caused by a decrease of venous return. The increase of HR and the decrease of SV, CO, EF, mVcf and LAD were observed 15 minutes after the epidural anesthesia as compared with those in late pregnancy, and these changes also suggest that the hypovolemic stress is imposed, which may depend on a decrease of venous return. The increase of CO was observed 3 and 5 minutes after delivery in labor and cesarean section as compared with those in late pregnancy. This increase of CO was due to the increase of HR and SV in labor, and the increase of HR in cesarean section. Consequently, the changes of maternal hemodynamics during labor imply to be greater than those during cesarean section, and this may depend on such factors as pains, expulsive efforts and cyclic blood volume redistribution during labor.

Adult↗
PubMed1975

Computer diagnosis of labor progression.

Abnormal labor has been suspected of being inherently delectorious to the fetus. In order to explore this problem, clinical factors, labor progress, and fetal monitoring parameters were compared in matched groups of high-risk patients whose fetuses were in theoccipitoposterior (0P) and occipitoanterior postions. The OP group showed significant excesses of dysfunctional labor aptterns, uterine contraction pattern abnormalities, and late and variabl fetal heart rate decelerations not accounted for by theuse of oxytocin or the presence of cord problems. In OP labor, lower Apgar scores were associated withasignificant excess of preceding fetal heart rate decelerations independant of operative delivery. This study suggests that neonatal depression in OP laboris related to intrapartum factors preceding delivery and provides direct support for theconcept that abnormal labor may adversely affect the fetus. The OP position is an indication for close fetomaternal supervision during labor.

Adolescent↗
PubMed1991

Labor force participation among persons with musculoskeletal conditions, 1970-1987. National estimates derived from a series of cross-sections.

In the present study, we estimated the labor force participation rate among persons with musculoskeletal conditions in 1987, compared this rate with that experienced by persons with other chronic conditions or with none, and estimated the change in labor force participation rates among persons with musculoskeletal conditions for the period 1970-1987. Rates were estimated from 18 years of National Health Interview Survey data, and the sampling weights from this survey were used to obtain population estimates. To ensure statistically stable estimates, we averaged the rates over 6 years of data. In 1987, 42.9% of all working-age persons with musculoskeletal conditions were out of the labor force, this study's definition of work disability. Overall labor force participation rates among persons with musculoskeletal conditions declined from 71% to 56% between 1976-1981 and 1982-1987, 22% in relative terms. Much of this decline was concentrated among men, especially men 55-64 years of age. However, women 55-64 years of age with musculoskeletal conditions also experienced declining labor force participation rates. Labor force participation patterns among persons with musculoskeletal conditions fit more general labor market trends, with gains among younger women more than offset by declines among older men and women. However, these trends appear to be more accentuated among persons with musculoskeletal conditions, suggesting that enforcement of the employment provisions of the Americans with Disabilities Act of 1990 place special emphasis on labor force participation among such persons.

Adult↗
PubMed1985

Female labor force participation and female mortality in Wisconsin 1974-1978.

The following research question is addressed in the study: what effect will the entrance of women into the labor force have on female mortality rates for all causes of death combined as well as specific causes relating to occupational stress, behavioral factors and physical hazards associated with occupation? This question is examined through comparisons of age, marital status and occupation-specific death rates for all causes of death combined and for selected causes of death. Death certificates provided by the Wisconsin Bureau of Health Statistics for the years 1974-1978 and population data provided by the 1976 Survey of Income and Education were used to construct death rates. The death rates of the white civilian female population of Wisconsin 16-64 years of age were examined using exploratory data analysis techniques (schematic plots and median polish) and standard errors. In general, the death rates of women in the labor force are substantially lower than those of housewives. These results may indicate that the role of housewife exposes women to health hazards. In addition, the results of this study may suggest some selectivity of healthy women into the labor force or a protective effect of labor force participation. In a limited number of instances, labor force participants' mortality rates exceed those of housewives. In the 60-64 year old population, white-collar workers, specifically, sales workers, managers and professionals, experience significantly higher death rates than housewives. In addition, specific groups of labor force participants experience significantly higher death rates than housewives for accidental deaths (i.e. laborers 16-44 and 45-54), deaths due to heart disease (i.e. laborers 45-54 and sales workers 60-64) and deaths due to malignant neoplasms (i.e. white-collar workers 60-64 years of age). The possibility that these instances indicate the direction of future mortality trends should be considered.

Accidents, Occupational↗
PubMed2006

Labor dystocia and its association with interpregnancy interval.

OBJECTIVE: The purpose of this study was to evaluate the prevalence of labor dystocia and its association with interpregnancy interval. STUDY DESIGN: We linked the birth data for Michigan infants who were born from 1994 to 2002 with the hospital discharge data. The International Classification of Diseases (9th revision, clinical modifications, ICD-9-CM) codes that indicate labor dystocia were identified by a physician panel and classified as functional and mechanical dystocia. We estimated the prevalence of labor dystocia and used stratified and logistic regression analyses to evaluate labor dystocia in relation to interpregnancy interval, controlling for other reproductive risk factors. RESULTS: Overall, 20.8% of the births involved labor dystocia (11.1% functional; 12.5% mechanical). Both functional and mechanical dystocia were more prevalent in first births than in subsequent births; mechanical dystocia was more prevalent in multiple births than in singleton births. In singleton births to multiparous mothers, labor dystocia was associated with the interpregnancy interval in a dose-response fashion. Compared with an interpregnancy interval of <2 years, the adjusted odds ratios that was associated with interpregnancy intervals of 2 to 3, 4 to 5, 6 to 7, 8 to 9, and 10+ years were 1.06 (95% CI, 1.04-1.08), 1.15 (95% CI, 1.12-1.17), 1.25 (95% CI, 1.21-1.29), 1.31 (95% CI, 1.26-1.37), and 1.50 (95% CI, 1.45-1.56), respectively, when we controlled for other reproductive risk factors. Functional dystocia was associated more strongly with interpregnancy interval than mechanical dystocia. CONCLUSION: Labor dystocia is common. In singleton births to multiparous mothers, labor dystocia increased with interpregnancy interval.

Adolescent↗
PubMed2000

An association between severe labor pain and cesarean delivery.

UNLABELLED: The relationship between epidural analgesia and cesarean delivery remains controversial. Several studies have documented an association, although others have not. This inconsistency may result from an association between severe labor pain and dystocia. We hypothesized that dystocia causes severe labor pain, such that more epidural medication is required to maintain comfort. We examined the relationship between labor outcome and severe pain, defined by the number of supplemental epidural boluses. We retrospectively reviewed the anesthesia records of 4493 parturients who received small-dose labor epidural analgesia. An independent association was found between operative delivery and maternal age, body mass index, nulliparity, fetal weight, induction of labor, and the number of boluses required during labor. By using multivariate analysis, the odds ratio of cesarean delivery among women who required at least three boluses was 2.3 compared with those who required two boluses or less. No association was found between the concentration of bupivacaine in the epidural infusion and operative delivery. Because women with cesarean deliveries appeared to have more pain, degree of labor pain may be a confounding factor in studies examining epidural analgesia and outcome. IMPLICATIONS: This is a retrospective observational study demonstrating an association between labor pain and cesarean delivery. Our results provide an alternative explanation of why epidural analgesia is associated with cesarean delivery.

Adult↗
PubMed2000

Analgesia for labor pain: a cost model.

BACKGROUND: Epidural analgesia and intravenous analgesia with opioids are two techniques for the relief of labor pain. The goal of this study was to develop a cost-identification model to quantify the costs (from society's perspective) of epidural analgesia compared with intravenous analgesia for labor pain. Because there is no valid method to assign a dollar value to differing levels of analgesia, the cost of each technique can be compared with the analgesic benefit (patient pain scores) of each technique. METHODS: The authors created a cost model for epidural and intravenous analgesia by reviewing the literature to determine the rates of associated clinical outcomes (benefit of each technique to produce analgesia) and complications (e.g., postdural puncture headache). The authors then analyzed data from their institution's cost-accounting system to determine the hospital cost for parturients admitted for delivery, estimated the cost of each complication, and performed a sensitivity analysis to evaluate the cost impact of changing key variables. A secondary analysis was performed assuming that the cost of nursing was fixed (did not change depending on the number of nursing interventions). RESULTS: If the cesarean section rate equals 20% for both intravenous and epidural analgesia, the additional expected cost per patient to society of epidural analgesia of labor pain ranges from $259 (assuming nursing costs in the labor and delivery suite do not vary with the number of nursing interventions) to $338 (assuming nursing costs do increase as the number of interventions increases) relative to the expected cost of intravenous analgesia for labor pain. This cost difference results from increased professional costs and complication costs associated with epidural analgesia. CONCLUSIONS: Epidural analgesia is more costly than intravenous analgesia. How the cost of the anesthesiologist and nursing care is calculated affects how much more costly epidural analgesia is relative to intravenous analgesia. Published studies have determined that epidural analgesia provides relief of labor pain superior to intravenous analgesia, quantified in one study as 40 mm better on a 100-mm scale during the first stage of labor and 29 mm better during the second stage of labor. Patients, physicians, and society need to weigh the value of improved pain relief from epidural analgesia versus the increased cost of epidural analgesia.

Adult↗
PubMed2003

Local anesthetic requirements are greater in dystocia than in normal labor.

BACKGROUND: Dystocia is characterized by abnormal progress of labor and is a common contemporary indication for cesarean delivery in the United States. There has been considerable controversy as to whether epidural analgesia causes dysfunctional labor leading to cesarean delivery for dystocia. The minimum local analgesic concentration (MLAC) is a clinical model used to determine the relative potencies of local anesthetics in the first stage of labor. In this article, the authors report a prospective study determining the MLAC of bupivacaine in early labor of parturients who eventually delivered either vaginally or via cesarean section. METHODS: An up-down sequential allocation technique was used to determine the MLAC of bupivacaine in 57 nulliparous parturients assigned to either vaginal delivery or cesarean section arms. In addition, patients were assigned to groups receiving or not receiving intravenous oxytocin at the time of epidural placement. Only patients who delivered by the assigned delivery mode were included in the MLAC analyses. RESULTS: Parturients who later delivered vaginally had 25% and 31% lower MLAC values (0.078% and 0.085% wt/vol bupivacaine, receiving or not receiving intravenous oxytocin, respectively) than those who later delivered by cesarean section (0.102% and 0.106% wt/vol bupivacaine, receiving or not receiving intravenous oxytocin, respectively). CONCLUSIONS: These data suggest that an increased local anesthetic requirement for epidural labor analgesia is associated with more intense pain related to dystocia. Women in early, clinically normal labor but who later develop dystocia require more local anesthetic and, by inference, are experiencing more severe pain than women who deliver vaginally. This association should be considered when studying the relation between the method of labor analgesia and the course of labor.

Adult↗
PubMed2004

Background infusion is not beneficial during labor patient-controlled analgesia with 0.1% ropivacaine plus 0.5 microg/ml sufentanil.

BACKGROUND: Although patient-controlled epidural analgesia (PCEA) during labor has been extensively studied in recent clinical trials, the role of a background infusion associated with self-administered boluses is still debated. The authors designed a study to assess whether the use of PCEA with or without background infusion could improve the comfort of parturients and their satisfaction during labor and delivery without affecting the total consumption of local anesthetics. METHODS: One hundred thirty-three laboring parturients requesting epidural analgesia administered via PCEA with a solution of 0.1% ropivacaine plus 0.5 microg/ml sufentanil were randomly assigned to four groups, according to the rate of background infusion used (0, 3, 6, and 9 ml/h). Local anesthetic requirements, maternal satisfaction, verbal pain scores, incidence of side effects, and outcome of labor were compared among groups. RESULTS: Patient demographics, labor characteristics, side effects, and Apgar scores were similar in each group. No significant differences were observed between groups in verbal pain scores during labor, number of supplemental boluses, or maternal satisfaction. A significantly greater overall total drug consumption with a 6-ml/h or a 9-ml/h background infusion (74 and 78 ml, respectively) was observed in comparison with PCEA without a background infusion (55 ml). A similar relation was observed for hourly use during both the first and the second stage of labor. CONCLUSION: The results of this study suggest that the use of a background infusion with PCEA during labor leads to a greater consumption of anesthetic solution without improving comfort and satisfaction of parturients. Moreover, not using a background infusion does not provide an increased incidence of supplemental boluses (which might cause problems in a busy unit) and allows for a substantial reduction in the cost of analgesia.

Adult↗
PubMed1997

Risk differences in fatal occupational injuries among construction laborers in the United States, 1980-1992.

Over 3700 occupational fatalities among all US construction laborers 16 years of age and older during 1980-1992 were analyzed from death certificates to identify differences in mortality rates, higher risk groups, and leading causes of death to be targeted for prevention and monitored over time. Female laborers had an average fatality rate (17.4 deaths/100,000 workers) similar to that for all male construction workers (17.3 deaths/100,000 workers), and ten times higher than for all female construction workers. On average, nonwhite laborers had 27% greater mortality than white laborers. Women were at a higher risk (10.8 deaths/100,000 workers) for motor vehicle injury than were men (6.1 deaths/100,000 workers). The smallest percentage annual decline in cause-specific mortality rates was from motor vehicle for construction laborers (0.1%) and all construction workers (1.4%). Environmental-related fatality rates for laborers rose an average of 0.8% annually. The average years of potential life lost (to age 65) ranged from 27.4 years from explosion to 34.3 years from electrocution. Prevention measures aimed at addressing the highest risk areas, along with research needs, are discussed. With over a quarter of construction fatalities occurring among laborers, occupational injury research on laborers should become a priority.

Adolescent↗
PubMed2003

Labor costs incurred by anesthesiology groups because of operating rooms not being allocated and cases not being scheduled to maximize operating room efficiency.

UNLABELLED: Determination of operating room (OR) block allocation and case scheduling is often not based on maximizing OR efficiency, but rather on tradition and surgeon convenience. As a result, anesthesiology groups often incur additional labor costs. When negotiating financial support, heads of anesthesiology departments are often challenged to justify the subsidy necessary to offset these additional labor costs. In this study, we describe a method for calculating a statistically sound estimate of the excess labor costs incurred by an anesthesiology group because of inefficient OR allocation and case scheduling. OR information system and anesthesia staffing data for 1 yr were obtained from two university hospitals. Optimal OR allocation for each surgical service was determined by maximizing the efficiency of use of the OR staff. Hourly costs were converted to dollar amounts by using the nationwide median compensation for academic and private-practice anesthesia providers. Differences between actual costs and the optimal OR allocation were determined. For Hospital A, estimated annual excess labor costs were $1.6 million (95% confidence interval, $1.5-$1.7 million) and $2.0 million ($1.89-$2.05 million) when academic and private-practice compensation, respectively, was calculated. For Hospital B, excess labor costs were $1.0 million ($1.08-$1.17 million) and $1.4 million ($1.32-1.43 million) for academic and private-practice compensation, respectively. This study demonstrates a methodology for an anesthesiology group to estimate its excess labor costs. The group can then use these estimates when negotiating for subsidies with its hospital, medical school, or multispecialty medical group. IMPLICATIONS: We describe a new application for a previously reported statistical method to calculate operating room (OR) allocations to maximize OR efficiency. When optimal OR allocations and case scheduling are not implemented, the resulting increase in labor costs can be used in negotiations as a statistically sound estimate for the increased labor cost to the anesthesiology department.

Anesthesiology↗