Clinical utility of point-of-care glucose testing in the assessment of gestational diabetes: Prospective cohort study.

OBJECTIVE: To assess the clinical utility of point-of-care (POC) capillary blood glucose (CBG) testing in the assessment of gestational diabetes mellitus (GDM) during oral glucose tolerance test (OGTT). DESIGN: Prospective cohort study. SETTING: Antenatal clinics at King's College Hospital. POPULATION: Women screened for GDM between March and June 2020. METHODS: The CBG was measured using the POC StatStrip® test and the venous plasma glucose (VPG) was measured by Roche analyser (Cobas 8000 c702). GDM was diagnosed based on the 2015 National Institute for Health and Clinical Excellence (NICE) Clinical Guideline criteria. The two methods were compared statistically using Analyse-It 5.40.2. MAIN OUTCOME MEASURES: Diagnostic sensitivity, specificity, positive and negative predictive values (PPV and NPV) for the POC StatStrip® test, compared with VPG measured by reference laboratory method. RESULTS: A total of 230 women were included. The number and percentage of women with glucose concentrations above the GDM threshold using the POC StatStrip® test versus laboratory VPG measurement was 15 (6.5%) versus eight (3.4%) at fasting and 105 (45.6%) versus 72 (31.1%) at 2 h, respectively. The sensitivity and specificity values (and 95% CIs) for the POC StatStrip® test were 88% (52%-99%) and 97% (93%-98%) at fasting and 97% (91%-99%) and 79% (71%-84%) at 2 h, respectively. However, the specificity and the NPV for the POC StatStrip® test for concentrations of ≤5.0 mmol/L at fasting or <7.5 mmol/L at 2 h were 100%, and the sensitivity and the PPV for concentrations of >9.5 mmol/L at 2 h were 100%. CONCLUSIONS: In our cohort the POC measurement of CBG cannot entirely replace the laboratory method for the OGTT; however, it can be used to rule out/rule in GDM for glucose concentrations of ≤5.0 mmol/L at fasting or <7.5/>9.5 mmol/L at 2 h.

Improving quality of diabetes care by integrating psychological and social care for poorly controlled diabetes: 3 Dimensions of Care for Diabetes.

OBJECTIVE: Many people with persistent suboptimal diabetes control also have psychiatric morbidity and social problems which interfere with their ability to self-manage their diabetes. Current models of care in the UK do not integrate these different dimensions of care or address inequalities between physical and mental health. 3DFD (3 Dimensions of Care For Diabetes) integrated medical, psychological, and social care in diabetes for patients with persistent suboptimal glycemic control (HbA1c > 75 mmol/mol) despite guideline-based routine diabetes care, to improve glycemic control, reduce psychological distress, and improve social functioning. METHODS: The service delivered interventions including brief psychological therapies, mental health assessments, psychotropic medications, and social support, enhanced by patient-led case conferences aiming to optimize diabetes care. 3DFD measured changes in HbA1c, psychological functioning, quality of life, rates of unscheduled care, and levels of engagement with routine diabetes care at baseline and at 12 months. CONCLUSION: At 12-month follow-up, 3DFD patients achieved significant reductions in HbA1c of 15 mmol/mol, International Federation of Clinical Chemistry (1.4% Diabetes Control and Complications Trial) and improvements in depression scores and patient satisfaction. This model of care demonstrates that integrated care can improve diabetes outcomes in people with psychological and social comorbidities.

Evaluation of methods for the laboratory diagnosis of malaria in Guyana

When 297 blood samples taken from patients attending a fever clinic in Georgetowm Public Hospital were examined microscopically, after thick and thin blood films had been stained with Giemsa, one hundred and forty-two (47.8 per cent ) were microscopically positive for malaria. After processing the patients' serum samples by the Indirect Fluourescent Antibody (IFA) technique, specific IgG and IgM antibodies were detected in 239 (81.3 per cent ) and 179 (60.1 per cent ), respectively, of the sera. Based on the microscopical findings, the IFAT gave positive and negative values of 54.4 per cent and 81.8 per cent (IgG), and 57.5 per cent and 67.8 per cent (IgM), suggesting that the IgM would be more useful than the IgG in the diagnosis of current malaria. An odds ratio analysis showed that the presence of symptoms, IgG or IgM antibodies, as well as visits to endemic regions, could be good indicators of current malaria. Age and occupation are not. The microscopical method will continue to be the gold standard - the best available criterion for the validation of our tests - for our diagnosis of acute malaria.

Registration of livebirths, stillbirths and neonatal deaths in a cohort study of Jamaican mothers (1986) - abstract

Registration of vital events provides essential information for monitoring the health status of a country and planning for health and other social services. This study aimed to determine the extent of under-registration of livebirths, stillbirths and neonatal deaths among a cohort of mothers delivering island-wide in September and October, 1986 and determine the case ascertainment rate of the Jamaican Perinatal Morbidity and Mortality Survey. Lists by parish of delivery of all mothers interviewed in the study were matched to registration documents for livebirths, stillbirths and neonatal deaths filed in the Registrar General's Department for infants delivered in September and October, 1986 and registered between September, 1986 and October, 1987. Whlie 91 percent of all identified livebirths were registered, only 9 per cent of the stillbirths and 6.5 percent of the neonatal deaths were registered one year after the event had occurred. When the infants died in the neonatal period, the birth tended not to be registered; only 47 percent of these births were registered compared to 92 percent of those surviving the neonatal period. The Perinatal Study managed to interview 94 percent of mothers of liveborn infants during the study period. While livebirth registrations are fairly complete, the level of registration of stillbirths and neonatal deaths is unacceptable and gives an inaccurate impression of the state of the nation and the health services (AU)

An assessment of the extent of registration of stillbirths and neonatal deaths in Jamaica

A study was done between February and May, 1988 to determine the completeness of registration of stillbirths and neonatal deaths in Jamaica. Registrations were matched with data on events identified in the Jamaica Perinatal Mortality and Morbidity Study, 1986-1987. The results indicated very low levels of registration - 6 percent of stillbirths and 11 percent of neonatal deaths. This was the trend irrespective of where the event took place or who was in attendance at the birth. However, there was a significantly higher level of registration of stillbirths that occurred in private hospitals (5 percent). Neonatal deaths which occurred at home were more likely to be registered (22 percent) than those in hospital (12 percent). The low level of registration is attributable mainly to insufficient knowledge on the part of the public as well as health workers of the importance of vital statistics and registration. A public education programme and training for health workers and registrars were recommended as actions likely to bring about significant improvements in the vital registration system. (AU)

Political economy of health care in Jamaica an historical analysis 1962-1983

Examines the approaches and policies of successive governments to health care from 1962 to 1983, and the effects of these policies within the constraints of social and economic factors. Contends that developmental policies in Jamaica failed to acknowledge the important contribution of health to development. Presents an historical review of the development of health care in colonial Jamaica with the responsibility for health care passing from the hands of planters to charitable institutions and later to government institutions. Discusses the first independence five year plan in which priority was given to increasing hospital capacity but little attention paid to primary health care. Contends that expenditure on health care was only six percent of total government expenditure despite the buoyancy in economic expansion. Attributes the slow progress in some areas to government's tendency of equating health care with expensive hospital services. Discusses the 1978 to 1982 Five Year Plan with its slogan that health care is a fundamental right. Comments on the programmes stress on more effective use of existing workers and the redefinition of roles and extensive inservice training and on the improvement in nutrition and the increased number of health centres. Points to the neglect in maintaining existing infrastructure and to the attrition among the health personnel. Comments on the adverse effects of structural adjustment policies of the 1980s on health and on recent policies which seem to reflect a departure from those of 1978-1982. Concludes that, in the short run, present policies will impact negatively on health, which in turn will affect the human resources and inhabit the country's growth potential. (AU)

Political economy of health care in Jamaica an historical analysis 1962-1983

Examines the approaches and policies of successive governments to health care from 1962 to 1983, and the effects of these policies within the constraints of social and economic factors. Contends that developmental policies in Jamaica failed to acknowledge the important contribution of health to development. Presents an historical review of the development of health care in colonial Jamaica with the responsibility for health care passing from the hands of planters to charitable institutions and later to government institutions. Discusses the first independence five year plan in which priority was given to increasing hospital capacity but little attention paid to primary health care. Contends that expenditure on health care was only six percent of total government expenditure despite the buoyancy in economic expansion. Attributes the slow progress in some areas to government's tendency of equating health care with expensive hospital services. Discusses the 1978 to 1982 Five Year Plan with its slogan that health care is a fundamental right. Comments on the programmes stress on more effective use of existing workers and the redefinition of roles and extensive inservice training and on the improvement in nutrition and the increased number of health centres. Points to the neglect in maintaining existing infrastructure and to the attrition among the health personnel. Comments on the adverse effects of structural adjustment policies of the 1980s on health and on recent policies which seem to reflect a departure from those of 1978-1982. Concludes that, in the short run, present policies will impact negatively on health, which in turn will affect the human resources and inhabit the country's growth potential.