Prenatal care: the patient's perspective. A qualitative study.

OBJECTIVES: To investigate the subjective experiences and perceptions of the prenatal care system for women following a prenatal diagnosis and to assess the factors related to dissatisfaction with medical treatment. METHODS: Data derived from a follow-up investigation in fifty women following a prenatal diagnosis is presented. Women were asked to give written comments concerning their feelings and experiences during their time at the prenatal care unit. A qualitative content analysis was performed in order to examine the patients' perceptions and expectations of the prenatal care management and to seek potential associations of certain attitudes with socio-demographic, clinical, or psychological characteristics. Womens' comments were coded within established categories including 'satisfaction', 'dissatisfaction' and 'communicated emotionality'. RESULTS: A high proportion of women were found to be dissatisfied with the physicians' attitudes (42%), the amount of information provided (46%), and medical staffs' attitudes (30%). One criticism, in particular, concerned a lack of communication skills in doctors and medical staff members. Forty-eight percent of our study population mentioned that they had benefited from psychological support. 'Nullipara' was the only variable associated with dissatisfaction with the received prenatal care. CONCLUSIONS: The results of the study suggest that the high degree of discontent found in prenatal care patients could at least in some part be alleviated by implementation of communication training and supervision services for prenatal care workers. Moreover, nullipara may constitute a particular vulnerable subgroup that may need special attention and support. However, given the qualitative nature of our study, our results warrant replication in further empirically based research.

Interactions of 1 alpha,25-dihydroxyvitamin D3 with IL-12 and IL-4 on cytokine expression of human T lymphocytes.

BACKGROUND: 1 alpha,25-Dihydroxyvitamin D3 (1 alpha,25[OH](2)D(3)) exerts its effects on the immune system, particularly through suppression of T helper/cytotoxic cell 1 (T(H)/T(C)1)-mediated reactions, although direct actions of 1 alpha,25(OH)(2)D(3) on human T lymphocytes have not yet been studied in detail. OBJECTIVE: We evaluated the effect of 1 alpha,25(OH)(2)D(3) on basal and cytokine-driven T-cell functions at the single-cell level. METHODS: We used 4-color flow cytometry for simultaneous detection of intracellular cytokines in CD4(+) and CD8(+) human PBMCs that had been cultured in the presence of 1 alpha,25(OH)(2)D(3) singly or in combination with either IL-12 or IL-4. According to the exploratory nature of these investigations, the Bonferroni correction was not applied for data analysis and presentation. RESULTS: 1 alpha,25(OH)(2)D(3) had little effect on T(H)/T(C)1 cytokines but significantly inhibited IL-12-induced IFN-gamma production. Constitutive synthesis of T(H)/T(C)2-related cytokines was also only modestly affected by 1 alpha,25(OH)(2)D(3) alone. When T(H)/T(C)2 differentiation was induced by IL-4, 1 alpha,25(OH)(2)D(3) significantly expanded the percentages of IL-4(+) and IL-13(+) cells. However, the predominant effect of 1 alpha,25(OH)(2)D(3) on T lymphocytes, particularly in the presence of IL-4, was the induction of separate CD4(+) and CD8(+) subpopulations with almost exclusive expression of IL-6. This might be an important facet of the immunomodulatory action of 1 alpha,25(OH)(2)D(3) because IL-6 might act in parallel with 1 alpha,25(OH)(2)D(3) in modulation of T(H)/T(C) effector cell functions. CONCLUSIONS: Our data imply that the specific actions of 1 alpha,25(OH)(2)D(3) on cytokine-stimulated T-cell functions could play a role in the prevention of T(H)/T(C)1-related autoimmune diseases but also predispose toward T(H)/T(C)2-mediated allergic reactions.