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PubMed1988

Effects of labor force participation on women's health: new evidence from a longitudinal study.

Effects of labor force participation on women's health are evaluated in analyses of longitudinal data for a national sample of older middle-aged women. Our findings indicate that labor force participation had beneficial effects on health for unmarried women and for married black women, but, on the average, labor force participation had no significant effect on health for married white women. Analyses by occupational category suggest that labor force participation had beneficial effects on health for some blue collar married women, but, on the average, labor force participation had harmful effects on health for white collar married women. Our findings, taken together with previous evidence, suggest that employment may increase social support, and job-related social support may have particularly beneficial effects on health for unmarried women and for married women whose husbands are not emotionally supportive confidants. Additional results from this study showed no significant difference in the health effects of part-time and full-time employment.

Adult↗

PubMed2006

Minimum oxytocin dose requirement after cesarean delivery for labor arrest.

OBJECTIVE: To estimate the minimum effective intravenous dose of oxytocin required for adequate uterine contraction after cesarean delivery for labor arrest. METHODS: A randomized single-blinded study was undertaken in 30 parturients undergoing cesarean deliveries under epidural anesthesia for labor arrest despite intravenous oxytocin augmentation. Oxytocin was administered as a slow intravenous bolus immediately after delivery of the infant, according to a biased coin up-down sequential allocation scheme. After assisted spontaneous delivery of the placenta, the obstetrician, blinded to the oxytocin dose, assessed uterine contraction as either satisfactory or unsatisfactory. Additional boluses of oxytocin were administered as required, followed by a maintenance infusion. Data were interpreted and analyzed by a logistic regression model at 95% confidence intervals. RESULTS: All patients received oxytocin infusions at a mean +/- standard deviation of 9.8 +/- 6.3 hours before cesarean delivery (maximum infusion dose 10.3 +/- 8.2 mU/min). The minimum effective dose of oxytocin required to produce adequate uterine response in 90% of women (ED90) was estimated to be 2.99 IU (95% confidence interval 2.32-3.67). The estimated blood loss was 1,178 +/- 716 mL. CONCLUSION: Women requiring cesarean delivery for labor arrest after oxytocin augmentation require approximately 3 IU rapid intravenous infusion of oxytocin to achieve effective uterine contraction after delivery. This dose is 9 times more than previously reported after elective cesarean delivery in nonlaboring women at term, suggesting oxytocin receptor desensitization from exogenous oxytocin administration during labor. Therefore, alternative uterotonic agents, rather than additional oxytocin, may achieve superior uterine contraction and control of blood loss during cesarean delivery for labor arrest. LEVEL OF EVIDENCE: I.

Adult↗

PubMed2003

Prevalence of sexually transmitted diseases among Latino immigrant day laborers in an urban setting--San Francisco.

BACKGROUND: Although rural Latino migrant laborers have been identified as a group at-risk for acquiring HIV, few studies have examined transmitted diseases (STDs) in urban, Latino migrant laborers. GOAL: To assess the prevalence of STDs in a sample of urban, migrant day laborers in San Francisco. STUDY DESIGN: A convenience sample of participants in the Day Laborer Project of the San Francisco Department of Public Health was screened for STDs from September 1994 to January 2001. Screening included serologic tests for syphilis and nucleic acid amplification tests for gonorrhea and chlamydia. RESULTS: A total of 292 clients participated in the screening program. All participants were male, Latino, and recent immigrants. Of the 235 persons screened for syphilis, secondary syphilis was diagnosed in one (0.4%) participant. Of the 198 persons screened for gonorrhea and chlamydia, 1 (0.5%) had gonorrhea and 7 (3.5%) had chlamydia. CONCLUSION: Urban Latino migrant day laborers are a population at-risk for infection with STDs. Community-based STD screening programs might be an effective way to detect STDs in this population.

Adult↗

PubMed2004

Pregnant adolescents' preferences for labor pain management.

OBJECTIVES: The purpose of this study was to examine the obstetric anesthesia method used, based on the patient's age. Confounding variables analyzed were the effect on labor pain management choices of parity, race, prenatal care participation, insurance status, and length of labor. METHODS: This was a case control study from the Medical University of South Carolina (MUSC). The primary outcome measured was regional anesthesia (RA) use in labor. The exposure groups were based on the patient's age. All women aged 11 years and older who delivered vaginally from 1996 to 2001 were included; 7,583 patients met inclusion criteria. Results were analyzed using chi2 statistic, univariate analysis, ANOVA, and logistic regression. RESULTS: We found that primiparous adolescents used RA less than primiparous women over age 20. This association is not found in multiparous teens. Patients with shorter labors, black women, those without prenatal care, and older patients lacking private insurance declined RA more often. CONCLUSIONS: RA is the most utilized form of obstetric pain management in the last decade. In primiparous adolescents, declining RA cannot be explained by length of labor, race, insurance status, or prenatal care participation.

Adolescent↗

PubMed1981

Female labor force participation, status integration and suicide, 1950-1969.

Using Census data covering the 29 year period starting in 1950 this study tests the hypothesis that (1)#female labor force participation may result in more married women committing suicide due to the strain of household and outside working responsibilities and the (2) female labor force participation may also be associated with higher rates of male suicide due to the fact that it represents apparent failure of the husband as sole breadwinner (Stack, 1978). Results show that during the 1950's male suicide was not associated with growth in the female labor force, but female suicide was. During the 1960s male suicide was negatively associated with female labor force participation, but the opposite was true for females. It is argued that working women represented a weakening of norms concerning sex roles. Apparently as more and more women entered the labor force, role conflict did ensue, but contrary to the above hypothesis it only increased female suicide potential. These results are discussed in terms of different normative sex role contexts of the 1950s and the 1960s.

Employment↗

PubMed2004

Self-Administration of cocaine-opioid combinations by rhesus monkeys: evaluation of the role of mu receptor efficacy using labor supply analysis.

Cocaine and heroin often are abused by self-administering the drugs in combination as a "speedball". We evaluated the extent to which intrinsic efficacy at the mu-opioid receptor influences combined cocaine-opioid self-administration and used the behavioral economic model termed "labor supply" to quantitatively evaluate the reinforcing effects of cocaine-opioid combinations. Rhesus monkeys (n = 8) were trained under a progressive-ratio schedule of i.v. cocaine injection in which the response requirement increased during the experimental session and the initial response requirement was varied. Combination of cocaine with heroin enhanced self-administration compared with the drugs individually, with ineffective doses of both drugs maintaining self-administration when combined. These effects also were observed with the high-efficacy mu agonist alfentanil and low-efficacy agonist nalbuphine. Using the labor supply economic model, combinations of heroin, alfentanil, or nalbuphine with relatively low doses of cocaine were found to increase the number of injections per session ("income") and total responses per session ("labor"). Combination of a relatively high dose of cocaine with either heroin or alfentanil, but not nalbuphine, also resulted in only a small reduction in income concomitant with increased labor, suggesting that heroin and alfentanil made cocaine consumption more resistant to increasing response costs, or more "inelastic." Collectively, these findings suggest that speedball self-administration may occur even with relatively low levels of intrinsic efficacy at mu-opioid receptors and that an inelastic relationship between drug consumption and labor may contribute to the persistence of speedball abuse.

Alfentanil↗

PubMed2003

Minimum analgesic doses of fentanyl and sufentanil for epidural analgesia in the first stage of labor.

UNLABELLED: In this study, we sought to determine the minimum analgesic doses and relative potencies of fentanyl and sufentanil when they are used as the sole epidural analgesic during the first stage of labor. Nulliparous parturients (n = 66) in spontaneous labor at term gestation and requesting epidural analgesia were enrolled into this prospective, double-blinded, randomized, sequential-allocation study. Each woman received fentanyl or sufentanil diluted with 0.9% wt/vol saline to a volume of 10 mL. The initial dose was arbitrarily chosen to be 125 microg for fentanyl and 25 microg for sufentanil, with subsequent doses being determined by the response of the previous patient (testing interval, 5 microg for fentanyl and 1 microg for sufentanil). Efficacy was accepted if the visual analog score decreased to < or =10 mm on a 100-mm scale within 30 min. The minimum analgesic dose or median effective dose was 21.1 microg (95% confidence interval [CI], 20.2-21.9 microg) for sufentanil and 124.2 microg (95% CI, 118.1-130.6 microg) for fentanyl (P < 0.0001). The sufentanil/fentanyl potency ratio was 5.9 (95% CI, 5.6-6.3). In conclusion, we have established the equivalent doses and relative potencies of fentanyl and sufentanil for epidural analgesia in the first stage of labor. IMPLICATIONS: This study determined the minimum analgesic doses of fentanyl and sufentanil for epidural anesthesia in the first stage of labor. The sufentanil/fentanyl potency ratio was 5.9. This ratio may be used to establish the equivalent doses for fentanyl and sufentanil for epidural analgesia in labor.

Adult↗

PubMed2026

Effect of Local Anesthetic Solution at Different Temperatures for Epidural Labor Analgesia on Intrapartum Fever: A Randomized Clinical Trial.

BACKGROUND: Whether heating local anesthetic solutions to core body temperature (37°C) for epidural labor analgesia reduces intrapartum fever incidence remains undefined in the current literature. METHODS: This double-blind randomized controlled trial (RCT) enrolled 220 nulliparous parturients (18-35 years, American Society of Anesthesiologists [ASA] physical status II, term singleton pregnancy). Participants were randomized to receive epidural labor analgesia with 0.075% ropivacaine + 0.5 µg/mL sufentanil at 37°C (warmed group) or 22°C (room-temperature group). Epidurals were placed at L3-L4 with a test dose of 3 mL of 1.5% lidocaine at room temperature, followed by programmed bolus epidural analgesia (initial 10 mL, 10 mL/h) and patient-controlled epidural analgesia (PCEA) 5 mL (30-minute lockout). Tympanic temperature was measured every 30 minutes from epidural initiation to delivery, defining intrapartum fever as ≥38°C. The primary outcome was fever incidence, on which the power analysis was based, and also maximum temperature and shivering. Secondary outcomes comprised analgesia onset, block level, labor durations, neonatal Apgar scores, umbilical cord blood pH and BE, and maternal adverse events. RESULTS: A total of 220 parturients were included (warmed group, n = 110; room-temperature group, n = 110). The warmed group had a lower intrapartum fever incidence (15.5% [17/110] vs 30.9% [34/110], relative risk [RR] 0.5 [95% confidence interval {CI}, 0.298-0.840]; P = .007); however, the reduction of 49.8% did not reach the preset clinically meaningful difference of 60% reduction proposed in the power analysis. The maximum body temperature was also lower in the warmed group: median (interquartile range [IQR]) 37.4 (IQR, 37.2-37.7) °C vs 37.6 (IQR, 37.3-38.0) °C, median difference -0.2 (95% CI, -0.3 to -0.1) °C ( P = .006). Shivering incidence was not different between groups (10.9% [12/110] vs 14.5% [16/110]; P = .418). No statistically significant differences were observed between groups in any of the secondary outcomes assessed, including block characteristics, local anesthetic consumption, labor duration, neonatal outcomes, and maternal adverse events. CONCLUSION: Although we found a 50% reduction in the incidence of temperature rise using warmed (37°C) local anesthetics for epidural labor analgesia, this did not reach our preset threshold of 60% reduction.

Humans↗

PubMed1986

Intramuscular pethidine (meperidine) during labor associated with metabolic acidosis in the newborn.

Analyses of fetal heart rate (FHR) variability, visual evaluation of FHR decelerations, and respiratory gas analyses of the umbilical vein were performed in 27 labors, where one dose (50 or 75 mg) of intramuscular pethidine was used for pain relief, in 47 labors with one paracervical blockade (6 ml 0.5% marcaine) and in a control group of 135 labors without any pain relief. Umbilical vein pH, standard bicarbonate and base excess were lowest in the pethidine group and highest in the PCB group. The duration of labor was shortest in the control group, but there was no difference in the duration of labor of the two anesthesized groups. Intramuscular pethidine seems to associate with umbilical metabolic acidosis and PCB should be preferred to it, when an obstetrician is available.

Acidosis↗

PubMed1995

[Studies on factors influencing the attack of subarachnoid hemorrhage during labor].

We analyzed factors affecting attacks of subarachnoid hemorrhage (SAH) retrospectively in 411 patients and studied the relation of the attacks with labor. The onset time of SAH has two peaks of the time: one is 7:00 a.m. and the other is between 16:00 and 17:00 in the afternoon. The attacks of SAH during labor were observed in 15.1% of all the patients. It was noted that 66.7% of all the attacks were observed at the time with certain external stress such as working, sporting, sexual intercourse, etc. The number of patients who suffered from attacks during labor with history of hypertension and insomnia were not significantly different compared with those suffered from attacks during other activities, but 40-59 aged men those who have a history of smoking were significantly more in number compared with those that suffered attacks during other activities. Transient increase of blood pressure due to external stress is suggested as an initiative factor of the bleeding during working. Reactivity of the individuals against physical and mental stress (external stress) might be considered to be the major problem, although it remains not to be unexplained whether labor itself participates in the onset of SAH. Regarding the prevention of SAH during labor, new methods of medical examination and health control is required.

Adult↗

PubMed2002

How International Monetary Fund and World Bank policies undermine labor power and rights.

Based on reviews of hundreds of loan and project documents from the International Monetary Fund (IMF) and World Bank, this article provides detailed evidentiary support for critics who have long claimed that the international financial institutions require Third World countries to adopt policies that harm the interests of working people. After reviewing loan documents between the IMF and World Bank and 26 countries, the authors show that the institutions' loan conditionalities include a variety of provisions that undermine labor rights, labor power, and tens of millions of workers' standard of living. These include downsizing of the civil service and privatization of government-owned enterprises; promotion of labor flexibility: the notion that firms should be able to hire and fire workers, or change terms and conditions of work, with minimal regulatory restrictions; mandated wage rate reductions, minimum-wage reductions or containment, and spreading the wage gap between government employees and managers; and pension reforms, including privatization, that cut social security benefits. These labor-related policies take place in the context of broader IMF and World Bank structural adjustment packages that emphasize trade liberalization, with macroeconomic policies that further advance corporate interests at the expense of labor.

Civil Rights↗

PubMed1992

Geographic classification of hospitals: alternative labor market areas.

Medicare hospital payments are adjusted to reflect variation in hospital wages across geographic areas by grouping hospitals into labor market areas. By only recognizing the average wage in an area, Medicare encourages hospitals to contain costs. Labor market area definitions have recently received renewed attention because of their impact on hospital payments. Alternative labor market areas were evaluated using several criteria, including ability to explain wage variation and impact on payment equity. Rural labor market areas can be improved using county population size; however, further research on urban labor market areas is needed.

Catchment Area, Health↗

PubMed1994

Combating pharmacist shortage through labor certification.

Several solutions, ranging from increased technician duties to salary raises, automation, and increasing job satisfaction, have been presented in the literature as methods of assuaging the pharmacist shortage. Although a significant portion of pharmacy graduates from American pharmacy colleges are foreign nationals, no marketing strategies have been elucidated in the retention and recruitment of foreign nationals through labor certification. Labor certifications are generally approved by the Secretary of Labor if the following factors have been verified: 1) there are not sufficient United States workers who are able, willing, qualified, and available for employment; and 2) the employment of the foreign national will not adversely affect the wages and working conditions of U.S. workers similarly employed. When properly understood, the labor certification process is a test of the job market where foreigners, by virtue of their skills and qualifications, attain certification which subsequently leads to permanent residency (green card). The objective of this report is to elucidate the tedious yet effective method of retaining American-educated foreign nationals through labor certification.

Documentation↗

PubMed1996

Human resource departments and hospital labor strategies.

Recently hospitals have increased their use of external labor sources, contracting many traditional functions such as pharmacy and emergency to outside labor providers. Use of external labor sources often means that traditional human resource functions such as screening, hiring, and training are performed by the external labor provider, potentially reducing the value of the HR function. Using financial and staffing data gathered by the California Statewide Health Planning and Development Office during the period 1976 to 1989, this study explores the relationship between the size of HR functions and the utilization of contingent labor.

California↗

PubMed2000

Stratified rates of cesarean sections and spontaneous vaginal deliveries. Data from five labor wards in Denmark--1996.

BACKGROUND: A fundamental point when auditing labor management is to ensure present and stratified process data. METHOD: Stratification of deliveries into ten mutually exclusive groups enabled comparisons of rates of cesarean sections and rates of spontaneous vaginal deliveries between labor wards. RESULTS: Data from five labor wards in Denmark in 1996 were included in the study comprising a total of 11,287 women. The overall cesarean section rates were between 13.2 and 15.2% which was not a significant difference, whereas cesarean section rates in several of the ten groups and the rates of spontaneous vaginal delivery in group 1 and 3 were significantly different between the labor wards. DISCUSSION: The method presented here is simple and can be used as an integrated part of the daily work and quality assurance. We advocate that stratification of the delivering women into ten groups should take place in every labor ward with focus on both the cesarean section rate and the rate of spontaneous vaginal delivery. Stratification provides data for periodical evaluation of the outcome within a department and for comparison between departments with different populations and policy.

Cesarean Section↗

PubMed2000

Epidural PCA with bupivacaine 0.125%, sufentanil 0.75 microgram and epinephrine 1/800.000 for labor analgesia: is a background infusion beneficial?

Eighty term parturients requesting epidural analgesia for labor pain treatment were randomly assigned to receive bupivacaine 0.125%, sufentanil 0.75 microgram/ml and epinephrine 1/800.000 by PCA modality with or without a basal rate of 3 ml/hr. A loading of 10 ml using the same mixture was administered while the PCA-demand dose consisted of 3 ml (lock out time 12 minutes). Total consumption, duration of labor, pain scores during the first and second stage of labor, maternal satisfaction and side-effects did not differ among both groups. Only when short labours were considered total consumption was lower in those treated with the demand modality only but they tended to experience more pain during the second stage. We conclude that for shortlasting labors, a low dose epidural PCA regimen results in a dose-sparing effect when compared to PCEA combined with a background infuson. For longer-lasting labors no differences between the two modalities could be observed.

Adult↗

PubMed2001

Mode of delivery following labor epidural analgesia: influence of ropivacaine and bupivacaine.

Epidural analgesia is a popular and effective method for pain relief during labor. Bupivacaine is a commonly used local anesthetic for labor epidural analgesia. Ropivacaine is an amino acid local anesthetic that is structurally related to bupivacaine with a similar potency and duration, but ropivacaine has less cardiac toxicity than bupivacaine and produces less motor blockade. These properties make ropivacaine a desirable local anesthetic agent for obstetrical analgesia. The purpose of the present study was to compare the cesarean section and instrumental delivery rates for patients receiving labor epidural analgesia using bupivacaine and ropivacaine. The medical records of 500 consecutive patients receiving bupivacaine for labor epidural analgesia were reviewed. After a 3-month familiarization period for ropivacaine, the records of 500 consecutive patients receiving ropivacaine for labor epidural analgesia similarly were reviewed. The groups did not differ demographically. The instrumental delivery rate was 14.2% for the bupivacaine group and 9.8% for the ropivacaine group. The cesarean section rate was 14% for the bupivacaine group and 10.2% for the ropivacaine group. At our facility, the use of ropivacaine decreased both cesarean section and instrumental delivery rates when compared with bupivacaine in the population studied.

Adult↗

PubMed2002

Obstructed labor at a district hospital.

A retrospective analysis of all deliveries that occurred at Jimma hospital, south western Ethiopia from September 1990 to May 1999 was conducted to determine the incidence, maternal and perinatal outcome, sociodemographic and clinical characteristics of mothers with obstructed labor. Seven percent (945/13,425) of the deliveries were complicated with obstructed labor with an overall increasing trend noted during the study period. Sixty seven percent of the cases were primigravida and grand multiparous mothers. Fourteen percent of obstructed labor occurred among teenage pregnant mothers. Forty four percent of the cases had no antenatal care while 35.1% had antenatal care. Cephalopelvic disproportion (CPD) was responsible for 80.6% of the cases, malpresentations accounting for the remainder, shoulder presentation being the commonest (11.5%). Fifty eight percent of the CPD cases were among the primigravida but para two to four mothers were not immune accounting for 25.7% of the cases, the rest being grand multipara, (15%). Fifty seven percent of the ruptured uterus cases were para two to four mothers while primigravids accounted for 7.2%. Maternal mortality was 9.1% while 62.1% of the perinates died with only 12.5% of the neonates having normal first minute apgar scores. Obstructed labor was the commonest cause of maternal and perinatal mortality at the hospital during the study period responsible for 45.5% and 37.4% of the deaths respectively. Any attempt to reduce maternal mortality at the hospital must comprehensively address the issue of obstructed labor, identify risk groups of mothers for this peripartum complication and design preventive strategies.

Adolescent↗