Maternal obesity and pregnancy outcome.

BACKGROUND: Obesity, a common condition in developed countries, is recognized as a threat to health. OBJECTIVES: To describe the distribution of weight in pregnant women and evaluate the influence of obesity on pregnancy outcome in a high parity northern Israeli population. METHODS: The study included 887 women who gave birth in the Western Galilee Medical Center during the period August to November 1995. The patients were classified as underweight, normal weight, overweight, or obese according to body mass index. Maternal demographic, obstetric, and perinatal variables were compared. A control group of 167 normal weight women were matched with the obese group for maternal age, parity, and gestational age. RESULTS: Obese mothers had a higher incidence of gestational diabetes and pregnancy-induced hypertension compared to normal weight mothers (5.4% vs. 1.8%, and 7.2% vs. 0.6% respectively, P < 0.01), a higher rate of labor induction (20.4% vs. 10.2%, P < 0.01), and a higher cesarean section rate (19.6% vs. 10.8%, P < 0.05). There was also a significant difference in the prevalence of macrosomia in the offspring (16.8% vs. 8.4%, P < 0.05). CONCLUSION: Obese pregnant women are at high risk for complications during delivery and therefore need careful pre-conception and prenatal counseling, as well as perinatal management.

[Hypertension in the community].

Hypertension is a major risk factor for cerebral and coronary disease and its early detection is very important for the family physician. We checked the implications of a hypertension survey in the community (from the age of 10 years) on the attitude of the primary care team. We found that although the medical team was aware of the significance of early detection and treatment of hypertension, according to the "law of halves" half the hypertensives were in treatment and of them half had normal blood pressure. This fact is probably not related to the quality of medical care. High risk groups identified were hypertensive patients who smoked, Jewish men of western origin, and Jewish women of Asian-African origin (who had a high rate of strokes). These groups were targeted for active intervention by the primary care team. This survey is part of planned community-intervention by the primary care team in the field of hypertension.

Possible influence of changes in risk factors on cardiovascular morbidity and mortality in Israel: need for an information system.

Mortality from ischemic heart disease (IHD) and cerebrovascular disease (CVD) has continued to fall in Israel during the period 1978-82. Proportionally, the fall has been 27.5% in males and 34.4% in females for IHD and 37.0 and 40.4% for CVD. There are few data available in Israel that can explain this decline, and it is doubtful whether it is due to any major attempt to change risk factor status. A top priority at this stage would seem to be the development of an information system (including data collection and processing) on a national level that will provide the opportunity for future assessment of the significance of change in such mortality. The need for future major intervention programs should be determined on the basis of such morbidity and mortality data.

Evaluation of a rapid method for diagnosing streptococcal pharyngitis in a rural community clinic.

Group A beta-hemolytic streptococcal pharyngitis is a common ailment whose accurate diagnosis is dependent on laboratory testing. Transport problems common to rural practices, for laboratory testing, could be resolved by a reliable rapid test. Laboratory evaluations of rapid streptococcal tests, performed mostly in research settings, indicate that the tests have acceptable specificity and sensitivity. This paper describes a comparison study of 248 consecutive throat swab specimens using a commercially available agglutination test with routine throat culturing. All agglutination testing was done by the office staff under actual working conditions, in a rural primary care clinic. The cultures were processed in the main regional microbiology laboratory. As a result of transportation delay, swabs were plated either within 6 h from collection or after 6 h. The test sensitivity (72%) and specificity (88%) compared well with that reported in the literature from microbiology laboratories, especially for swabs plated within six hours (80% and 93% respectively). The rapid test is an acceptable alternative to the standard culture technique in the family practice office under normal working conditions, provided that patients with negative results follow up with throat cultures.

Blood pressure and hypertension in an elderly population.

In order to study the epidemiology of hypertension in the elderly and its relationship to other disease situations, a study was performed on 815 institutionalized elderly people indicating a statistically significant decrease of both systolic and diastolic blood pressure with age. There is a difference between the population originating in Europe and America and those from Asia and Africa; in the latter group the blood pressure values were significantly higher, specially in females. The prevalence of hypertension as a disease does not differ between younger and older age groups. The lower prevalence in the population studied (28.1%) when compared to data in the literature which indicates prevalence of about 40%, might be due to the fact that the institution population live under sheltered conditions and close medical follow up. In conclusion hypertension in the elderly serves as a major risk factor for several disease situations thus leading to a better survival for those with lower values of blood pressure.

Long-term follow-up of patients aged 75 years and older admitted to an acute care hospital in Israel.

Certain biomedical and psychosocial factors may be important in predicting short-term and long-term outcomes in elderly inpatients in an acute care hospital. We prospectively studied all patients aged 75 years and older who were admitted to an acute inpatient geriatrics unit between June, 1984 and May, 1985, and we followed them for 5 years. Patients were followed by phone and/or the outpatient ambulatory service; follow-up visits occurred at 4 to 6 weeks following discharge and annually thereafter. After 5 years, 21% of the patients were alive. Apparently, age and gender were the major parameters associated with prognosis. Functional status and nutritional state (body weight, serum albumin) were also important prognostic factors. Of the geriatric syndromes, urinary incontinence seemed to be most strongly associated with a poor outcome, followed by falls and confusion. Iatrogenic conditions apparently had no such association. These findings suggest that certain demographic and clinical factors may be useful prognosticators for elderly hospitalized patients.