Screening for thyroid disorders during pregnancy: results of a survey in Maine.

OBJECTIVE: Guidelines regarding prenatal screening for thyroid deficiency are conflicting, and current practice in primary care settings is unknown. Our survey sought to determine the: 1) extent of screening in Maine; 2) factors associated with screening; and 3) laboratory cut-off levels used. STUDY DESIGN: In 2004 we surveyed 61 prenatal care practices, representing 246 practitioners and 85% of Maine deliveries. RESULTS: Screening via thyroid-stimulating hormone (TSH) testing was routine in 48% of the practices. Obstetrician practices screened at a significantly higher rate than family practices (56% vs 8%; odds ratio [OR] 15.0, 95% CI 1.9-130.0). Nonsignificant higher rates were found for urban versus rural, and multipractitioner versus solo practices. The lower TSH cut-off levels ranged between 0.1 and 0.5 mU/L among practices; the upper cut-off levels ranged between 3.5 and 5.5 mU/L. CONCLUSION: Prenatal screening for thyroid deficiency varies among practices, reflecting conflicting guidelines. TSH cut-offs are also variable and might benefit from standardization.

Patient and health professional acceptance of integrated serum screening for Down syndrome.

Integrated testing for Down syndrome combines first trimester maternal serum and nuchal translucency (NT) measurements with second trimester maternal serum measurements into a single second trimester Down syndrome risk. A variant of integrated testing, the integrated serum test, requires only the serum measurements and may be more suitable for widespread use in the general pregnancy population. Concern has been voiced that women will find the delay associated with waiting for screening results unacceptable for either fully integrated (including NT measurements) or integrated serum testing. To address this issue, we surveyed 60 women from a population of 8773 women enrolled in an integrated serum screening intervention trial in Maine. The women all had also undergone traditional second trimester screening 1 to 2 years earlier. All 60 women remembered having the integrated serum test, and 59 remembered having a prenatal test in their previous pregnancy. Three-quarters of women did not experience anxiety relating to the wait for final results in the second trimester, and 95% would consider being screened by the integrated serum test in a future pregnancy. Women receiving prenatal care at the primary care level are prepared to wait until the second trimester for more accurate Down syndrome risk estimates on which to base their decision-making.

Longer term health of young and middle-aged adults following unintentional falls at home resulting in hospitalisation.

UNLABELLED: Unintentional falls at home are a common cause of admissions to hospital amongst young and middle-aged adults. This population-based study investigated the longer-term health, physical and psychological outcomes following such injuries, and the predictors of these sequelae. METHOD: Individuals aged 25-60 years admitted to hospital in the Auckland region between July 2005 and June 2006 following an unintentional fall at home were interviewed soon after the injury (baseline) and 15-months following the injury. Information collected at baseline on pre-injury status was analysed in relation to changes in general health and functioning, psychological outcomes, and role limitations at follow-up. RESULTS: Of the 328 participants eligible for study, 251 (77%) completed the follow-up interview. Reductions in general health and overall functioning (compared with pre-injury status) were reported by 25% and 43% of participants, respectively. In multivariate analyses, predictors of specific adverse outcomes at follow-up included increasing age (reduction in functioning), lower limb injuries (reductions in general health and functioning); female gender (psychological sequelae); injury severity score ≥9 (anxiety and depression); and length of hospital stay (fear of falling and post-traumatic stress symptoms). CONCLUSIONS: The significant longer-term reductions in health and levels of functioning reveal the importance of strengthening efforts to prevent falls amongst young and middle-aged adults, and identifying groups at increased risk of longer-term disability who could benefit from targeted interventions.

Integrated serum screening for Down syndrome in primary obstetric practice.

OBJECTIVES: Integrated serum screening for Down syndrome is potentially more effective than current second-trimester screening. We report results of an intervention trial of integrated serum screening that involved 229 primary prenatal care practitioners throughout Maine. METHODS: Women provided a first-trimester serum (for PAPP-A) followed by a second-trimester serum (for AFP, uE3, hCG, and DIA). These five marker measurements were used to calculate a Down syndrome risk in the second trimester. Screen-positive women (risk > or = 1:100) were managed according to standard practice. RESULTS: During 24 months' enrollment, 11 159 women provided a first-trimester sample (61% of women receiving screening services). Nine thousand seven hundred twenty-three women also provided a second-trimester sample; 8773 women satisfied gestational age criteria for testing in both trimesters. Integrated serum screening detected 14 of 16 Down syndrome cases (87%) and 79% after adjustment for trimester-of-ascertainment bias. The initial false-positive rate was 3.2% and was 2.7% when restricted to ultrasound-dated pregnancies. Performance was better than any combination of second-trimester markers. Implementation challenges included initial samples being collected too early and sample matching. CONCLUSIONS: Integrated serum screening for Down syndrome was successfully implemented in primary care settings; screening performance was consistent with predictions. It provides an accessible and acceptable alternative to screening protocols that require nuchal translucency measurements.