Image-scoring system for umbilical and uterine artery pulsed-wave Doppler ultrasound measurement.

OBJECTIVES: To develop an objective image-scoring system for pulsed-wave Doppler measurement of maternal uterine and fetal umbilical arteries, and evaluate how this compares with subjective assessment. METHODS: As an extension to the INTERGROWTH-21st Project, we developed a scoring system based on six predefined criteria for uterine and umbilical artery pulsed-wave Doppler measurements. Objective evaluation using the scoring system was compared with subjective assessment which consisted of classifying an image as simply acceptable or unacceptable. Based on sample size estimation, a total of 120 umbilical and uterine artery Doppler images were selected randomly from the INTERGROWTH-21st image database. Two independent reviewers evaluated all images in a blinded fashion, both subjectively and using the six-point scoring system. Percentage agreement and kappa statistic were compared between the two methods. RESULTS: The overall agreement between reviewers was higher for objective assessment using the scoring system (agreement, 85%; adjusted kappa, 0.70) than for subjective assessment (agreement, 70%; adjusted kappa, 0.47). For the six components of the scoring system, the level of agreement (adjusted kappa) was 0.97 for anatomical site, 0.88 for sweep speed, 0.77 for magnification, 0.68 for velocity scale, 0.68 for image clarity and 0.65 for angle of insonation. CONCLUSION: In quality assessment of umbilical and uterine artery pulsed-wave Doppler measurements, our proposed objective six-point image-scoring system is associated with greater reproducibility than is subjective assessment. We recommend this as the preferred method for quality control, auditing and teaching. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

Feeding practices and risk factors for chronic infant undernutrition among refugees and migrants along the Thailand-Myanmar border: a mixed-methods study.

BACKGROUND: This study aims to provide a comprehensive understanding of maternal risk factors, infant risk factors and maternal infant feeding practices among refugees and migrants along the Thailand-Myanmar border. METHODS: This study employed a mixed-methods approach with two components: (1) cross-sectional survey (n = 390) and (2) focus group discussions (n = 63). Participants were chosen from one of three clinics providing antenatal and delivery services for Karen and Burman refugees and migrants along the border. Participants were pregnant women and mother-infant dyads. RESULTS: Refugee and migrant mothers demonstrated high rates of suboptimal breastfeeding and low rates of minimum dietary diversity and acceptable diet. Multivariable regression models showed infant stunting (AOR: 2.08, 95% CI: 1.12, 3.84, p = 0.020) and underweight (AOR: 2.26, 95% CI: 1.17, 4.36, p = 0.015) to have increased odds among migrants, while each 5 cm increase in maternal height had decreased odds of stunting (AOR: 0.50, 95% CI: 0.38, 0.66, p < 0.001) and underweight (AOR: 0.64, 95% CI: 0.48, 0.85, p = 0.002). In addition, small-for-gestational-age adjusted for length of gestation, infant age and gender increased odds of infant's stunting (AOR: 3.42, 95% CI: 1.88, 6.22, p < 0.001) and underweight (AOR: 4.44, 95% CI: 2.36, 8.34, p < 0.001). Using the Integrated Behavioural Model, focus group discussions explained the cross-sectional findings in characterising attitudes, perceived norms, and personal agency as they relate to maternal nutrition, infant malnutrition, and infant feeding practices. CONCLUSIONS: Inadequate infant feeding practices are widespread in refugee and migrant communities along the Thailand-Myanmar border. Risk factors particular to maternal nutrition and infant birth should be considered for future programming to reduce the burden of chronic malnutrition in infants.

Genetic epidemiology and pathology of raccoon-derived Sarcoptes mites from urban areas of Germany.

The raccoon, Procyon lotor (Carnivora: Procyonidae), is an invasive species that is spreading throughout Europe, in which Germany represents its core area. Here, raccoons mostly live in rural regions, but some urban populations are already established, such as in the city of Kassel, or are starting to build up, such as in Berlin. The objective of this study was to investigate Sarcoptes (Sarcoptiformes: Sarcoptidae) infections in racoons in these two urban areas and to identify the putative origin of the parasite. Parasite morphology, and gross and histopathological examinations of diseased skin tissue were consistent with Sarcoptes scabiei infection. Using nine microsatellite markers, we genotyped individual mites from five raccoons and compared them with Sarcoptes mites derived from fox, wild boar and Northern chamois, originating from Italy and Switzerland. The raccoon-derived mites clustered together with the fox samples and were clearly differentiated from those of the wild boar and chamois samples, which suggests a fox origin for the raccoon mange infection. These results are evidence of the cross-transmission of S. scabiei among wild carnivores. Although our results cannot elucidate whether raccoons became infected by frequent interaction with endemically or epidemically infected foxes or whether these cases resulted from occasional contacts among these animal species, they do nevertheless show that pathogens can be shared among urban populations of native and invasive carnivores.

[Socio-demographic status of elderly and senile age people died from alcohol-attributable states in Arkhangelsk].

To determine the characteristics of the socio-demographic status of elderly and senile age people died of alcohol-attributable states in Arkhangelsk, data from the medical certificate of death was analyzed. Data of death for persons who died in the city of Arkhangelsk in the period from 1 July 2011 to 30 June 2012 (one year) were copied out. The vast majority of alcohol conditioned deaths among men occurs in middle (working) age, 1/3 of women--over the age of 60 years. The alcohol-attributable mortality revealed the transformation of the structure of women over the age of 60 years compared with the mature age. Gender and age significantly affect the probability of death from alcohol only attribute states after 60 years. The results of the study indicate a different impact on the character of the individual sociodemographic factors on the probability of death from alcohol-attributable states in elderly and senile age.

[Alcohol-related mortality in the assessments of hospital unit physicians and pathologists: analysis of accounting medical documents].

AIM: To make a comparative analysis of the data available in the accounting medical documents drawn up at a multidisciplinary hospital on the level and structure of alcohol-related mortality (ARM) and to evaluate the efficiency of its accounting. MATERIALS AND METHODS: Accounting medical documents, such as 453 inpatient cards (Form 003/y), 453 postmortem protocols (cards) (Form 013/H-80), and 453 death certificates (Form 106/y-08), were chosen as the basis for the study. The data of the final clinical and postmortem diagnoses in the patients who had died at hospital and their primary cause of death were comparatively analyzed. RESULTS: According to Form 003/y, ARM was 5.5%; the detection rate of alcohol-related disease (ARD) was 11% (95% confidence interval (CI), 8.3 to 14.3%); according to Form 013/H-80, ARM was 7.1% (95% CI, 4.9 to 9.8%) and the detection rate of ARD was 12.6% (95% CI, 9.7 to 16%). The consistency of the diagnoses of ARD as a main cause of death, made by hospital unit physicians and pathologists, is estimated as the mean--the Cohen's kappa coefficient (kappa) is 0.570) (p < 0.001). CONCLUSION: The results of the investigation suggest that there are 3 types of ARM, which differ in its level and structure: ARM in the assessments of hospital unit physicians; that in the assessments of pathologists, and that according to the death certificates drawn up. The consistency index for the diagnosis of ARD as a main cause of death indicates that the hospital unit physicians only determine the etiology of alcohol-related cause of death, without identifying it specifically.

[On the problem of registration of mortality associated with alcohol consumption among the population in the forensic medical practice].

The objective of the present study was the comparative analysis of the data obtained from the available medical documentation with a view to estimating the effectiveness of taking into account the mortality associated with alcohol consumption. The data subjected to the analysis included the age and the gender of the deceased subjects, complete forensic medical diagnoses from 1607 expert reports and acts of forensic medical expertise of the corpses (form 171/y), and information about the cause of death (item 19) from the relevant medical death certificates (form 106y/08). The mortality associated with alcohol consumption estimated based on the expert reports and acts of forensic medical expertise of the corpses (form 171/y) amounted to 6.7% (95% CI: 5.5- 8.1%); the occurrence of pathology attributable to alcohol consumption was estimated at 7.2% (95% CI: 5.9-8.5%) of the total number of deaths. It was shown that forensic medical experts do not employ in the full measure the diagnostic potential of the International Classification of Diseases (ICD-10) when having to deal with the mortality associated with alcohol consumption. The results of the study confirm the qualitative transformation of the alcohol attributable mortality structure associated with the transfer of information from the expert reports and acts of forensic medical expertise of the corpses (form 171/y) to the medical death certificates (form 106/y-08).

[The mortality because of conditions related to alcohol consumption].

The article presents the systematization of data concerning alcohol-depended mortality as a occurrence with complicated structure. It is established that grouping of alcohol-depended mortality on isolated components is conditioned by different nature of unhealthy consumption of alcohol in the development of alcohol-depended conditions as a conditional and/or supporting factor. Among other causation factors article points out the input of pattern of alcohol consumption into the value of risk of development of alcohol-attributive conditions and two-way impact of unhealthy alcohol consumption at the risk of development of particular alcohol-attributive conditions.

[The Arkhangelsk society of physicians--one of the first public medical organizations in Russia].

The Arkhangelsk society of physicians was officially opened in 1863. The purposes and tasks of the organization were the following: to one another with mutual education, information about important cases and news; to follow the development of medical sciences by means of journals and books subscription; to study sanitary hygienic conditions in Arkhangelskaya gubernia. The society supported in Arkhangelsk the organization of the feldsher midwife and veterinary schools (1876); the organization of the congress of physicians of Arkhangelskaya guberina (1907); the organization of spearheads to lecture the population (1911); the organization of public group "The drop of milk" $ participated in the Red Cross actions "White flower" and "Yellow flower". The activities of society played an important role in the consolidation of physicians of Arkhangelskaya guberina, promoted the enhancement of their professional qualification and the development of health care in Russian North.

[The public health of Arkhangelskaya gubernia in late XIX-early XX century].

The main indicators of public health in Arkhangelskaya gubernia in late XIX-early XX centuries are discussed. Among these indicators the article deals with population number, gender structure, economic activity, birth rate and mortality. The family and cultural traditions in Pomor North are analyzed. The major characteristics of state and structure of public health system functioning during this period are given.

[The social hygienic aspects of disability and mortality in the Archangelskaya oblast].

The article analyses the indicators of disability and mortality in Archangelskaya Oblast. The medical sociological study of the disabled patients of able-bodied age was organized based on the characteristics of working activities and labor potentials to establish the prospective of involvement of this population category into the social economic development of the region. The emphasis is made upon the specific of population mortality in Archangelskaya oblast due to the external causes impact as a priority trend in enhancing the regional policy of medical demographic development.

[Health-related quality of life in patients with chronic kidney disease]. / Qualita' della vita nei nefropatici.

Assessment of quality of life in patients with different degrees of chronic kidney disease is an important issue because of its impact on clinical decisions and financial resource management in the health-care system. The aim of this study was to assess whether a generic instrument like the SF-36 questionnaire is able to discriminate three different populations of patients with different degrees of renal disease (pre-ESRD, ESRD, TxR). Five hundred sixty-three patients from 12 Italian nephrology units completed the SF-36 scales by themselves. The results from these samples were compared with those from the general population. Univariate analysis and multivariate regression were used. The generic SF-36 questionnaire proved to be a powerful instrument to discriminate populations with different degrees of chronic renal failure. The quality of life of patients on dialysis is significantly worse than that of the normal population and other patients with less severe renal function impairment.

[Social problems of transition society and health of populations of the North of the European Russia]. / Sotsial'nye problemy perekhodnogo obshchestva i zdorov'e naselenii Evropeiskogo Severa Rossii.

Dramatic changes in Russian economic life led to worse health state of population, higher children's mortality. Unfavorable influence of environmental pollution on health state is also seen in Northern regions. Governmental institutions should participate in creation of system for health care and preservation.

[Conceptual approaches to the organization of medico-social care of children]. / Kontseptual'nye podkhody k organizatsii mediko-sotsial'noi pomoshchi detiam.

Social economic crisis and decreased level of life tell on the health status of children. As primary health centers, pediatric outpatient clinics play the main role in the formation of healthy life style and rendering medicosocial care. However the existing system of organization of prophylactic care in pediatric outpatient clinics does not meet modern requirements, and problems of infant health care cannot be considered as purely medical. A draft program of restructuring local pediatric services is offered with consideration for modern social and economic problems.

[Specificity of the suicidal behavior in the Arkhangelsk Region]. / Osobennosti proiavleniia suitsidal'nogo povedeniia v Arkhangel'skoi oblasti.

The paper deals with a high suicide rate in the European North. Data for the rural and urban population categories are compared. Specific features of suicide attempts and of completed suicides are accentuated for the gender and sex aspects. A set of system-making factors, which are responsible for shaping the suicidal behavior in Russia's European North, is defined; social-and-hygienic portraits of self-murders are compiled. The main trends are outlined in the field of suicidal prevention.

[Subjective evaluation of health status and motivation for improving it in able-bodied urban population of the European North of Russia]. / Sub"ektivnaia otsenka zdorov'ia i motivatsiia na ego ukreplenie trudoposobnogo gorodskogo naseleniia Evropeiiskogo Severa Rossii.

The study was made of the awareness of capable urban population of the Arkhangelsk region about own health condition, health care system, health promotion and disease prevention. Motivation for healthy life style appeared extremely low. Subjective opinion of personal health is a valuable information of its objective condition. That is why it must be taken into consideration in objective examination of the individual.

[Habitual abortion as a high risk factor for the formation of perinatal pathology and disorders of psychomotor development in children]. / Privychnoe nevynashivanie kak faktor vysokogo riska formirovaniia perinatal'noi patologii i narusheniia psikhomotornogo razvitiia detei.

With the aim to analyse the patterns and incidence of perinatal abnormalities, the history of pregnancy and the course of labour were studied in 400 recurrent spontaneous abortion cases. The course of the early neonatal period of these mothers' newborns was investigated and the follow-up history of 50 infants of this group was analysed. The findings indicated a high (62.8 per cent) incidence of perinatal damage in the studied group. The early neonatal period in the newborns was characterized by maladaptation and increased vulnerability followed by impairment of the mental and physical development.

[Subependimal hemorrhages in neonates: echographic characteristics and psychoneurological outcome]. / Subépendimal'nye krovoizliiania u novorozhdennykh: ékhograficheskaia kharakteristika i psikhonevrologicheskie iskhody.

The examination of 1712 neonates by using an ultrasound method provided the findings of the incidence and echographic pattern of subependymal hemorrhages (SEH). A long-term follow-up of 32 newborns with SEH detected at birth by dynamic brain echography indicated that the mental and motor development in 30 of them was normal, whereas 2 babies had mild specific growth retardation unrelated to SEH. EEG abnormalities were found in 9 of 20 examined children. It was suggested that SEH failed to affect the mental and nervous development in infants, regardless of the extent and site of an injury.

[Bimodal long-latency evoked potentials in normal newborns with different gestational ages and in leukoencephalopathy]. / Bimodal'nye dlinnolatentnye vyzvannye potentsialy u novorozhdennykh razlichnogo gestatsionnogo vozrasta v norme i pri leikoéntsefalopatii.

Bimodal visual somatosensory long-latent evoked potentials (LEP) and automatic analysis were employed to examine 110 healthy neonates of different gestation age. The data were obtained about maturation of that type of evoked bioelectric activity of the brain. Nonspecific changes in LEP revealed in 34 neonates with impairment of the white matter of the cerebral hemispheres pointed to the gravity of the pathological process, corresponded with the intensity of brain echogram abnormalities and disease outcomes. LEP were shown to be labile in premature neonates suffering from leukoencephalopathy.

[The clinical significance of cysts of the vascular plexuses in the cerebral ventricles of newborn infants]. / Klinicheskoe znachenie kist sosudistykh spletenii zheludochkov golovnogo mozga u novorozhdennykh.

The incidence of cysts of cerebral ventricular vascular plexuses (CVP), estimated with the use of echography in 2671 newborns, has made up 4.16% in full-term babies and 3.67% in preterm ones. Analysis of 40 CVP cases has shown that asphyxia and marked mechanical effects on fetal head and neck at birth and intrauterine herpetic infection may be conducive to the development of this condition. Psychomotor development of these children in the first 3 years of life was normal and only if CVP were combined with other diseases inducing stable brain injuries, neurologic disorders were present.