Prenatal care: an update and future trends

Prenatal care gained universal acceptance during this century, but its efficacy and impact has been questioned widely. Many studies have linked inadequate, or lack of, prenatal care with adverse pregnancy outcomes; however others have failed to confirm the association. This article reviews salient aspects of standard prenatal care, and presents future trends in this field.     

Young inner-city children visiting the emergency room (ER) for asthma: risk factors and chronic care behaviors

A longitudinal growth study with monthly measurements during the 1st year of life was conducted by nine paediatricians working in private practice in Zurich. Of 92 children, none was lost to the study and only 32 of 1104 planned visits were missed; the quality of the measurements was comparable to that of a specialised university clinic. Compared to the Zurich Longitudinal Growth Studies, children of this study were considerably heavier and taller. In 92% of the subjects, growth velocity was at least once outside the reference range (3rd 97th percentile). For weight increments, the corresponding proportion was 87%. CONCLUSIONS: The data indicate that current standards for the 1st year of life for the Zurich area might no longer be appropriate and need to be updated. The currently used velocity percentiles based on 3-monthly measurements are not suitable to assess individual height and weight increments calculated from monthly measurements.     

Primary medical care. The cooperative solution to the volume problem

Neisseria gonorrhoeae were isolated from 1,019 (39.8%) of 2,558 male patients examined in a venereal disease clinic. Three specimens per patient were plated on Thayer-Martin medium. One plate was placed in a C02 -enriched environment and incubated immediately. The other two were held at room temperature in a standard atmosphere for 1-4 hours before similar processing. A statistically significant loss of N. gonorrhoeae was found when placement in a candle jar and incubation was delayed 2 or more hours. Morever, the appearance of colonies was delayed and colonial size and number were significantly reduced in specimens held 2 hours or longer before incubation in a candle jar.     

Implementing the SF-12 in an inner-city clinic: the importance of providing help

The size, form and charge of the stabilized water clusters present in the aqueous humour of the mammalian eye influence the facility for aqueous flow through the pupillary ball valve and through the trabecular meshwork. The properties of the clusters can be influenced in many different ways, all of which can influence the anterior and posterior chamber intraocular pressures as well as the uveoscleral outflow.     

Prenatal ultrasonographic assessment of the middle cerebral artery: a review

Published reports, case studies, and articles regarding ultrasonographic morphology, physiology, and pathophysiology of the fetal middle cerebral artery obtained from a MEDLINE search from 1966 through January 1997 were reviewed. Both transabdominal and transvaginal color Doppler ultrasonographic modalities may be used to assess fetal middle cerebral artery flow hemodynamics. Altered middle cerebral artery flow velocities may be noted in various medical conditions that include various behavioral states, term and preterm labor, maternal medications (anesthesia, tocolytics), fetal compromise (growth restriction and hypoxia), twin-twin transfusion syndrome, invasive diagnostic procedures (amniocentesis and fetal blood sampling), fetal anemia and transfusion, in addition to intracranial fetal lesions (congenital anomalies and hemorrhage). In summary, knowledge of Doppler flow velocity of the fetal middle cerebral artery may assist prenatal diagnosis and management of complicated pregnancies.     

Prenatal infant feeding intent and perceived social support for breastfeeding in Manitoba first nations communities: a role for health care providers

In a prospective study of pregnant women (n = 36) in four southern Manitoba First Nations communities to test a breastfeeding decision-making model, maternal perceptions of the impact of referents (individuals and groups which impact a woman's decisions) was measured. A quantitative "referent score" comprised of a measure of the referent's "breastfeeding-supportiveness" and a measure of maternal compliance with the referent. The woman's own mother, the community health nurse, and the physician were perceived as highly supportive of breastfeeding, and as people with whom the woman was most likely to comply. Women also identified the timing of their infant feeding decisions, as reported in the third trimester of pregnancy. Only 22% had decided prior to pregnancy. During the third trimester, 36% did not know their infant feeding choice. Women forced to verbalize a "choice" prior to being informed may make decisions based on the perceived cultural norm, which may be bottle feeding. A neutral attitude by health professionals may be harmful if it prevents informed choice by pregnant or postpartum clients. Prenatal education of the pregnant woman with her own mother, and adolescent school education of the peer group (sisters, close friends and male partner) may need to be incorporated into a community strategy to promote breastfeeding.     

Cross-sectional therapeutic programs--an example of a cooperative health care system. A review with comments]

There is no tradition for sharing the responsibility for episodes of care between the primary and secondary sectors in the Danish health care system. Concurrently with increased international experience with shared care programmes, there is also a growing interest in Denmark in cooperation between the sectors. Based on literature research, shared care programmes are presented as a method of ensuring continuity and quality in treatment of chronic diseases. Experiences in the areas of diabetes, asthma, rheumatoid arthritis, and cancer are described. It is concluded that the Danish health care system is well prepared for the implementation of shared care programmes; there are only few sources of payment in the system, and an extensive continuing medical education system ensures that general practitioners can participate in relevant education. The implementation of shared care programmes in Denmark should be followed by scientific evaluation and documentation of the quality of the treatment programmes.     

Prenatal diagnosis of cardiac osteoma: a case report

Primary benign intracardiac tumours in the infant period are rare. We report a case of a cardiac osteoma detected at 17 weeks of gestation. Ultrasonographically, it appeared as a calcified mass with a sharp margin and was associated with hypoplastic right ventricle. The gross and histological findings are presented.     

Coworker ability and effort as determinants of individual effort on a collective task.

Research on social compensation has documented that individuals may actually work harder collectively than individually under some conditions in order to compensate for the expected poor performance of other group members. The present study examined the joint effects of both coworker ability and coworker effort expectations on collective task performance. Participants (N?=?112) worked either coactively or collectively on an idea-generation task with a coworker who was believed to be either high or low on both effort and ability at the task. When group members were paired with a partner who they believed would exert low effort, they (a) compensated when the partner had low ability and (b) loafed when the partner had high ability. Implications of these findings for group research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prenatal diagnosis: methods--indications--risks

The demands made on prenatal care in terms of fetal anomaly recognition and full and early counseling have become more and more sophisticated over the last few years. Today, a range of non-invasive and invasive procedures are now available for the detection of fetal anomalies, genetic disorders and e.g. infection. The most important of the former are ultrasound and triple test (determination of alpha feto-protein, HCG and unconjugated estriol), while amniocentesis remains the major invasive measure. The indications, the information they provide, and possible risks of these procedures are discussed.     

Opportunities not missed--systematic influenza and pneumococcal immunization in a public inner-city emergency department

OBJECTIVE: To demonstrate the feasibility of systematic influenza and pneumococcal vaccination in a busy Emergency Department (ED). SETTING: A public, inner-city hospital with an annual adult ED census of 120,000. 93% of patients are people of color. 78% deny having either government or private insurance. Only 28% of patients report having a primary care provider. Only 15% present with complaints requiring immediate evaluation by a physician. METHODS: Two uncontrolled demonstration projects were conducted during two periods, from 10/21/96 through 12/2/96, (during the influenza immunization season) and from 5/27/97 to 7/26/97. During project one, nurses were given standing orders that all non-urgent patients meeting CDC recommended criteria were to be offered immunization against influenza and/or pneumococcus at triage. The date of immunization was entered into unused fields in the computerized patient registration system, making it available system-wide, to all providers having access to billing system terminals. From 11/4 through 11/18, an extra 'immunization nurse' was assigned to test for improvement in immunization figures. A time/motion study of the time required for each immunization was conducted using a convenience sample of eight nurses over all three shifts. During project two, responsibility for carrying out standing orders for immunization was transferred to the patient's nurses in the treatment area, and all high-risk patients were made eligible for immunization. An immunization card was issued to the patient at the time of each immunization. A monetary incentive to nurses was used to encourage completion of tracking forms. Computer record-keeping was continued. RESULTS: Both projects required intense supervision to ensure performance. Despite initial resistance, and extreme variation in individual performance, many nurses and physicians became supportive of ED immunization during the two projects. During project one, 2631 patients were screened, and 789 high-risk patients were identified. 1238 patients were immunized against influenza and 374 against pneumococcus. Immunizations per shift per nurse varied from 0 to 24. Median time for immunization was 4 min (range 2-10). The addition of an extra nurse at triage did not improve performance. During period two, 1907 patients were screened, 1532 high-risk patients were identified, and 1179 patients were immunized against pneumococcus. CONCLUSION: Systematic ED immunization of high-risk adults is feasible even in a busy public ED setting.     

Prenatal care in Pelotas, Rio Grande do Sul, Brazil, 1993]

The urinary excretion of 2-hydroxyphenylacetic acid (2HPAA) was studied in human volunteers after oral and parenteral doses of coumarin. The presence of 2HPAA in the urine was confirmed by gas chromatography mass spectroscopy (GC MS). Mass spectra of reference material and samples are presented. The determination of 2HPAA was carried out by GC with flame-ionization detection. Prior to analysis samples were extracted into ethyl ether and the analytes were derivatized with trimethlyphenylammonium hydroxide. A calibration range from 0.3 to 150 micrograms ml-1 was established using 3-hydroxyphenyl acetic acid (3HPAA) as an internal standard. On average less than 10% of the coumarin administered were excreted into the urine in the form of 2HPAA.