Outcomes of macrosomic infants in a nurse-midwifery service.

The purpose of this study was to compare outcomes of term infants of average birth weight with outcomes of large infants in a nurse-midwifery service. A retrospective study design was used. Data were retrieved from a computer data base that contained information from a data form routinely completed for all births. Subjects were women cared for by the nurse-midwives including those for whom the birth was conducted by a physician. The final n study population was 2,228; 322 (14.5%) of the infants weighed 4,000 g or more. Women who delivered large infants had a significantly higher prepregnant body mass index and pregnancy weight gain. Shoulder dystocia occurred more often in large infants; however, newborn intensive care unit admission rates did not differ between the average birth weight and the large infants. Apgar scores at 1 and 5 minutes were significantly lower for infants weighing > or = 4,500 g compared to those with birth weights of 2,500-3,999 g and those 4,000-4,449 g; however, these differences were not clinically significant. A trend for fewer occurrences of shoulder dystocia in the side-lying birth position was observed. Logistic regression predicting poor Apgar scores (< 7) showed parity as a protective factor and increased gestational age and higher maternal body mass index as predictive of low Apgar scores. Large infants had birth outcomes comparable to those reported by others in the medical literature, suggesting that nurse-midwifery management, including consultation with physician colleagues, can be appropriate and safe.

The American Social Health Association celebrates 80 years of fighting sexually transmitted diseases.

The American Social Health Association (ASHA) can look back on 80 years of service as the only national nongovernmental organization devoted exclusively to prevention of sexually transmitted diseases (STDs). The valuable contributions made by physicians since the agency's founding in 1914 are noted and gratefully acknowledged. To commemorate its 80th anniversary, ASHA recently published a history that discusses the movements leading to ASHA's founding, the organization's work with the military during the World Wars, the changing face of STD control once penicillin became widely available in the 1940s, and the response to newly identified infections in recent decades. It also lists ASHA's founders, board presidents, executive directors, and recipients of the William Freeman Snow Award for outstanding contributions in the field of sexually transmitted diseases. The history was written by Kay Flaminio and David Klaassen of the ASHA Archive. This article summarizing ASHA's history was written especially for the Journal by Sam A. Nixon and Kay Flaminio. Nixon, a long-time member of the Southern Medical Association, recently retired as an associate network medical director of BlueCross BlueShield of Texas. He has maintained an interest in STD prevention and the work of the ASHA for many years, currently serving as the vice chair of ASHA's board of directors. Kay Flaminio is a member of the staff of ASHA.

Vulvovaginitis: the role of patient compliance in treatment success.

Vulvovaginitis caused by Candida organisms accounts for a large number of annual office visits to physicians, often for recurrent infection. Despite the availability of many effective antifungal preparations, treatment failures continue to occur because of poor compliance with therapy. Several factors may foster noncompliance. Those involving the patient include denial of illness, misconceptions regarding the nature of the infection or its treatment, a misunderstanding of symptomatic relief versus microbiologic cure, dislike of the dosage form, nonsupport of the sexual consort, or intolerance of side effects. The cost of treatment, inconvenient dosage form, and prolonged duration of therapy may also contribute to noncompliance. This article offers suggestions for optimizing compliance and successful treatment. Two perceived means to this end are improved patient education and the use of short-term therapy in convenient dosage form.