Prevalence and risk factors for Salmonella in veal calves at Danish cattle abattoirs.

The study's objectives were to determine herd- and animal-level prevalence and herd-level risk factors for Salmonella in dairy-bred veal calves at slaughter in Denmark. In total, 1296 faecal samples were collected at five cattle abattoirs in Denmark during 2007-2008. The animals came from 71 randomly selected specialized veal-calf producers that delivered more than 100 animals to slaughter per year. Salmonella Dublin bacteria were isolated from 19 samples from 12 herds and Salmonella Typhimurium was isolated from one sample. The apparent prevalence of herds delivering Salmonella-shedding animals to slaughter was 18% (95% CI 9-27). The overall estimated true prevalence of shedding calves at slaughter was 1.3%. Veal-calf herds that purchased animals from herds not classified as low risk in the Danish Salmonella surveillance programme had significantly (P=0.03) higher risk of delivering Salmonella-shedding calves to slaughter. The results emphasize the importance of efforts in the dairy industry to ensure food safety for consumers.

Complementary and alternative medicine in pregnancy: a survey of North Carolina certified nurse-midwives.

OBJECTIVE: To determine the prevalence and types of complementary and alternative medicine therapies used by certified nurse-midwives in North Carolina. METHODS: Surveys were sent to all 120 licensed certified nurse-midwives in North Carolina requesting information concerning their recommendations for use of complementary and alternative medicine for their pregnant or postpartum patients. RESULTS: Eighty-two responses were received (68.3%). Seventy-seven (93.9%) reported recommending complementary and alternative medicine to their pregnant patients in the past year. Forty-seven (57.3%) reported recommending complementary and alternative medicine to more than 10% of patients. The percentage of nurse-midwives who recommended each type of complementary and alternative medicine was as follows: herbal therapy (73.2%), massage therapy (67.1%), chiropractic (57.3%), acupressure (52.4%), mind-body interventions (48.8%), aromatherapy (32.9%), homeopathy (30.5%), spiritual healing (23.2%), acupuncture (19.5%), and bioelectric or magnetic applications (14.6%). The 60 respondents who reported prescribing herbal therapies gave them for the following indications: nausea and vomiting, labor stimulation, perineal discomfort, lactation disorders, postpartum depression, preterm labor, postpartum hemorrhage, labor analgesia, and malpresentation. CONCLUSION: Complementary and alternative medicine, especially herbal therapy, is commonly prescribed to pregnant women by nurse-midwives in North Carolina.

Just a beta....

Traditional implementation of clinical information systems follows a predictable project management process. The selection, development, implementation, and evaluation of the system and the project management aspects of those phases require considerable time and effort. The purpose of this paper is to describe the beta site implementation of a knowledge-based clinical information system in a specialty area of a southeastern hospital that followed a less than traditional approach to implementation. Highlighted are brief descriptions of the hospital's traditional process, the nontraditional process, and key findings from the experience. Preliminary analysis suggests that selection of an implementation process is contextual. Selection of elements from each of these methods may provide a more useful process. The non-traditional process approached the elements of communication, areas of responsibility, training, follow-up and leadership differently. These elements are common to both processes and provide a focal point for future research.

Truth or consequences?

PIP: Women in the US experience high rates of unintended pregnancy compared with women from other countries. It is estimated that nearly 50% of pregnancies are unintended. About 66% of these pregnancies occur in adult women and 30% occur within marriage. In considering this fact, it is reasonable to explore how women's health care providers¿ influence reduces unintended pregnancies. This includes examining how new patients seeking contraceptive care are handled; availability and accessibility of services; patients' decisions regarding family size and spacing; and patients' education. Traditional health education often implies that if a woman has sex without using a method of birth control she will become pregnant. Such does not apply for the majority of the population, and the dissonance between the educational message and the reality leads to questions on fertility, failure, and risking unintended pregnancies. Moreover, advocates should voice out their stance in negotiations undertaken in legislative decisions and insurance contracts.^ieng

Defining and measuring unintended pregnancy: issues and concerns.

This article of the past and current measures of unintendedness of pregnancy has been offered in the hope that investigation into this area can be expanded. Current information available from available national surveys is not comparable due to different survey questions, inclusion criteria, and timing of interviews. What are often reported as rates of unintendedness may be rates of unwantedness--a completely different concept. Many studies fail to delineate the distinction between those unintended pregnancies that are indeed unintended versus those that were mistimed. Potentially, these existing data sets could be reanalyzed by using specific inclusion criteria for unintendedness, maternal age, and marital status. This information might be helpful in improving the comparability between the surveys and in assessing trends in unintendedness. In the future, to accurately measure unintendedness of pregnancy, we must use a consistent definition that takes into account the complexities of the issue. Valid and reliable scales that reflect the value of unintendedness from the mother's perspective need to be developed to reflect the potential change in intendedness over time. The adequate measurement of unintendedness of pregnancy is the first step in addressing the Healthy People 2000 goal and measuring progress in addressing the nation's reportedly high rate in the long-term goal of addressing the risk factors of unintended pregnancy.

Pregnant women's perspectives on intendedness of pregnancy.

PIP: This study examined whether intendedness is a valued characteristic of pregnancy and what factors influence women to risk unintended (unwanted or mistimed) pregnancy. Study participants were 24-34 weeks pregnant, White or Black, aged 18-30, and receiving prenatal care from a publicly funded clinic in North Carolina. Information gathered from 8 focus group sessions (14-15 participants each) revealed that: 1) the concept of a planned pregnancy had no meaning to many of the women; 2) religious beliefs helped people accept unintended pregnancy; 3) planning for pregnancy is a stressful concept because of potential disappointment; 4) unprotected intercourse without pregnancy leads to assumptions of infertility; 5) attitudes of male partners, friends, and family members influence women to risk pregnancy; 6) women adapt to unintended pregnancy very readily; 7) there are no uniform situational risks for unintended pregnancy; and 8) unintended pregnancies are more advantageous than not for some women. These results question the assumption that intendedness of pregnancy is preferred among low-income women or that the pregnancies are "subintended." While interventions to increase intendedness focus on access to contraception, study participants reported no barriers to access as a reason for conception. Health educators should consider the ramifications of teaching that pregnancy can result from a single act of unprotected intercourse without also teaching that pregnancy can occur after several acts of unprotected intercourse. These findings suggest hypotheses that should be explored with further research.^ieng

The impact of a preconceptional health promotion program on intendedness of pregnancy.

The objective for this study was to determine whether a brief preconceptional health promotion program for low-income women attending family planning clinics impacts on intendedness of pregnancy. In this prospective study, we examined data on 1378 women presenting for prenatal care at three local health departments. Each of the departments offers a standardized preconceptional health promotion program in its family planning clinics. Comparisons were undertaken for 456 women who had been exposed to the family planning preconception program, 309 women who had attended the family planning clinics but had not been exposed to the program, and 613 women who were unknown to the health department before beginning prenatal care. Women exposed to information on preconceptional health during routine family planning visits, the experimental group, had a 51.8% (p = 0.064) greater likelihood of identifying their pregnancies at intended than a group known to the local health departments' family planning programs but unexposed to the intervention. Furthermore, the experimental group had a 64.2% (p = 0.0009) greater likelihood of intendedness than a comparison group not known to the health departments before the initiation of prenatal care. Our study indicates that an introductory program of preconceptional health promotion which is targeted to women not planning a pregnancy in the immediate future is associated with a higher rate of intendedness in subsequent pregnancies. Expansion of similar preconceptional programs in family planning clinics may prove a useful approach for promoting intendedness of pregnancy in low-income women.

Racial disparity in pregnancy outcomes: analysis of black and white teenage pregnancies.

The pregnancies of black women are complicated by adverse outcomes such as prematurity and low birth weight at twice the rate of complications in pregnancies of white women. Although the cause of this racial disparity is unknown, it is most likely multifactorial. The disparity in outcomes has been found in many studies despite implementation of controls for the factors of age, socioeconomic status, and access to health care. We hypothesized that the increased incidence of adverse outcomes may be strongly affected by adequacy of prenatal care. We investigated the effects of comprehensive prenatal care delivered at the University of North Carolina-Chapel Hill Teenage Obstetric Clinic. The gestational age at the onset of prenatal care and the mean number of prenatal visits were the same for black and white teenagers. Among 183 teenagers we found no significant difference between black and white pregnancies for the outcomes of premature labor, premature delivery, fetal death, neonatal mortality, or hypertensive diseases. The mean gestational age at delivery was 38.3 weeks and 39.1 weeks for black and white women, respectively. The mean birth weight was 3126 gm and 3272 gm for black and white women, respectively. There was a trend (p < 0.09) toward more low birth weight infants in white women: 7% for black infants and 12% for white infants. We believe that comprehensive prenatal care significantly lessens the racial disparity in pregnancy outcomes between black and white adolescent women.

Preconception care: a means of prevention.

Preconceptional health promotion should provide a prevention framework for interactions with all women of childbearing potential. Preconceptional counselling is properly directed by specialists in the field of obstetrics and gynaecology, but a multispecialty effort may be needed to achieve adequate information for decision-making. Preconceptional health care offers an important opportunity for physicians involved in women's health to expand a primary care and a primary prevention focus. The obstetrician or gynaecologist is not only involved in acute diagnosis and treatment plans but also in disease prevention, risk and behaviour modification and counselling, which are integral parts of primary prevention and co-ordinated women's health care.

Group B streptococci: results of a protocol of antepartum screening and intrapartum treatment.

OBJECTIVE: Our purpose was to evaluate and report the results of a protocol for the identification and treatment of all group B streptococcal carriers. STUDY DESIGN: In 1991 we instituted a protocol of antepartum cultures for group B streptococci on all pregnant women who attended clinics at the University of North Carolina Hospitals. Cultures were obtained from the lower third of the vagina and rectum at 24 to 28 weeks' gestation. Women with positive cultures were treated with intravenous antibiotics in labor. Women with signs of chorioamnionitis (through intrapartum assessment) were also treated in labor, regardless of carrier status. RESULTS: During the first 2 years of this protocol 1681 women were delivered. Forty percent of the women were from the private practice, 32% were black, and 62% were married. The group B streptococcal carriage rate was 14%. During the period of evaluation there were no infants infected with group B streptococci and no adverse reactions or complications among women who were treated with antibiotics. CONCLUSION: We found antepartum screening and intrapartum chemoprophylaxis of all group B streptococcal carriers to be an acceptable and effective protocol for reducing perinatal group B streptococcal infections.

Opinions and approaches to continuing education among obstetrician/gynecologists.

This national survey of Fellows of The American College of Obstetricians and Gynecologists found that obstetrician/gynecologists are actively involved in continuing medical education activities and appear satisfied with the resources available, yet desire additional opportunities for lifelong learning. Traditional resources (eg, journals, seminars) are used much more extensively than newer, electronic resources (eg, video cassettes, cable television), probably as a result of unfamiliarity with these latter methods and limited access to them. However, the majority of Fellows want increased exposure to these newer educational programs. Relevance of content, caliber of faculty, and potential for professional growth were important factors in choosing continuing medical education programs. Strong interest was expressed in individualized learning programs designed in collaboration with university faculty. These findings are of value in producing future educational programs for practitioners in obstetrics and gynecology.

Preconceptional health promotion: a health education opportunity for all women.

Efforts to prevent perinatal mortality and morbidity are traditionally directed at the pregnant woman. It is during the prenatal period that the mother's health status is closely monitored; her exposure to substances known to be harmful to the fetus is assessed, and intensive patient education on behaviors likely to benefit the unborn child is offered. Unfortunately, the initiation of prenatal care may already be too late to prevent spontaneous abortions, congenital anomalies, and some causes of low birthweight. Until routine prepregnancy care is available to all women of childbearing age, many opportunities for the primary prevention of poor reproductive outcomes will be lost. This paper describes the rationale for prepregnancy or preconceptional counseling and the specific purposes it should serve. A model program providing such services is described, and findings for a low socioeconomic population involved in the model program are given.

PIP: Efforts to prevent perinatal mortality and morbidity are traditionally directed a the pregnant woman. It is during the prenatal period that the mother's health status is closely monitored; her exposure to substances known to be harmful to the fetus is assessed, and intensive patient education on behaviors likely to benefit the unborn child is offered. Unfortunately, the initiation of prenatal care may already be too late to prevent spontaneous abortions, congenital anomalies, and some causes of low birthweight. Until routine prepregnancy care is available to all women of childbearing age, many opportunities for the primary prevention of poor reproductive outcomes will be lost. This paper describes the rationale for prepregnancy or preconceptional counseling and the specific purpose it should serve. A model program providing such services is described, and findings for a low socioeconomic population involved in the model program are given. (Author's).

Preconceptional health promotion: a focus for obstetric care.

Women contemplating pregnancy generally dream of a healthy infant yet are unaware of the critical significance of the weeks of organogenesis that precede entry into prenatal care. Programs of preconceptional health promotion provide women with information on the potential relatedness of prepregnancy lifestyle choices, health status, and pregnancy outcomes. We review the significance of this relationship and offer a framework for exploring preconceptional issues with women contemplating pregnancy.

Elevated second trimester maternal serum alpha-fetoprotein and cytomegalovirus infection.

A case is presented of intrauterine cytomegalovirus infection. Initially, the infection was most probably manifested by elevated second trimester maternal serum alpha-fetoprotein levels. Placental involvement by the infectious agent may have produced the elevations in maternal serum. Alpha-fetoprotein elevation unrelated to fetal anatomic abnormalities, twins, or incorrect dates may represent a potential marker of placental pathology.

Relationships between public and private providers of health care.

Fifteen local health departments that were identified as notable for their involvement in rendering personal health care were intensively studied along with their communities. Interviews with local medical care leaders and practitioners provided much of the study data. Three patterns characterized the relationships between the health departments and private providers in the communities. In one pattern, there were dual or parallel systems of care, both public and private, which were self-contained, with little planned linkage between them. In another pattern, the public and private sectors were interactive, relying on each other in deliberate ways for the exchange of services. In a third pattern, termed accommodative, the private and public sectors, although maintaining service separation, planned with each other for the establishment of complementary programs that would be responsive to community needs. Provision of health services of high repute was associated with all three of these patterns. Although tensions were not absent between public and private providers in the study communities, a climate of mutual support and good will appeared to characterize their relationships. In none of the health departments selected as outstanding, was an atmosphere of conflict with the private medical community reported.

Role of local health departments in the delivery of ambulatory care.

Many people (40 per cent) receive each year some personal health service provided by local health departments. A substantial number of poor children (50 per cent) look to public agencies including health departments for all or part of their medical care. A number of departments including those represented in this study come close to serving as the guarantor of basic medical care for entire constituent populations, reaching those people who are not reached by other provider systems. Health departments over the past decade have increased their involvement as providers of medical care, in part assisted by such federal initiatives as WIC, and Medicaid. Health departments have institutionalized many of the innovations generated by federal demonstration projects of the 1960s, and continue a tradition as centers of important innovation in styles and continuity of health care. The health departments studied are notable in many respects, not the least of which is their constructive relationship with private providers. Some health departments appear to function at high levels of effectiveness in a dual fashion alongside private provider systems. Other departments interact or accommodate with private providers in ways that appear beneficial to the populations they serve. It would appear that both public and private provider systems are essential, and that they need not compete; they can provide mutual reinforcement for achieving universal and equitable health services in the public interest.