The diagnostic experience of polycystic ovary syndrome: A scoping review of patient perspectives.

OBJECTIVE: Polycystic Ovary Syndrome (PCOS) is a common endocrine condition with a complex diagnostic process. The present study aims to understand patient perceptions of the process of PCOS diagnosis, and how challenges during diagnosis can influence patient understanding of PCOS and trust in healthcare providers (HCPs). METHODS: A scoping review framework was followed. Six databases were searched for patient experiences of PCOS diagnosis, between January 2006 - July 2021. Data extraction and thematic analyses were conducted. RESULTS: Of the 338 studies screened, 21 studies fulfilled the inclusion criteria. Patient experiences of the diagnostic process were stratified into three themes: emotional, negotiating, and incomplete. As a result of these experiences, patients begin to perceive their HCPs as lacking knowledge and empathy. CONCLUSION: There are prevailing gaps in how PCOS diagnostic criteria are understood and applied in the clinical setting, leading to a lengthy diagnostic process. Additionally, poor HCP communication negatively affects patient trust in HCPs. PRACTICE IMPLICATIONS: Practicing patient-centered care and empowering patients by addressing their specific information needs are essential to improving the diagnostic experience and care of individuals living with PCOS. These recommendations may also apply to the diagnosis of other complex chronic conditions.

Single-Centre Retrospective Cohort Study of Demographic Characteristics and Perinatal Outcomes in Pregnant Refugee Patients in Toronto, Canada.

Pregnant refugee patients are especially vulnerable to adverse perinatal outcomes. Detailed characterization of this heterogenous population will identify risk factors and thus guide contextualized initiatives for improved patient care. A retrospective cohort study of obstetrical refugee patients at a tertiary-care hospital in Toronto, Ontario. Of 196 pregnant refugees, 48% were fluent English speaking, 57% had poor social support, and 42% lived in a shelter. Eighty-seven percent started prenatal care after the first trimester, which was associated with delivery of a large-for-gestational-age infant (p = 0.043). Sixteen percent experienced family violence, which was associated with poor fetal aggregate outcomes (p = 0.03). There were significantly higher rates of pre-eclampsia and Cesarean sections in refugee versus non-refugee patients (p < 0.05). Pregnant refugees are at risk for psychosocial challenges and experience significantly worse obstetrical outcomes compared with non-refugees. Quality improvement initiatives should focus on access to early prenatal care, stable housing, and support for victims of family violence.

The prevalence and management of diabetes among Vietnamese Americans: A population-based survey of an understudied ethnic group.

OBJECTIVES: Although obesity remains relatively rare among Vietnamese Americans, the prevalence of diabetes has increased in this population. This study aims to: 1. Estimate the prevalence of diabetes among non-obese Vietnamese American adults compared to non-obese non-Hispanic whites (NHW). 2. Identify factors associated with diabetes among non-obese Vietnamese Americans. 3. Examine whether Vietnamese Americans and NHW with diabetes are equally as likely to receive optimal frequency of diabetes care (i.e., hemoglobin A1C monitoring, foot care, eye care). METHODS: We conducted a secondary analysis of non-obese adult Vietnamese Americans using pooled data from the 2007, 2009, 2011 and 2013-2016 waves of the California Health Interview Survey (CHIS). RESULTS: Only 9% of Vietnamese Americans with diabetes are obese. Non-obese Vietnamese Americans have 60% higher adjusted odds of diabetes compared to non-obese NHW. Among non-obese Vietnamese Americans, those who were older, ever smokers and born outside US had a higher prevalence of diabetes. We found both Vietnamese Americans and NHW with diabetes received similar levels of care. DISCUSSION: Non-obese Vietnamese Americans have much higher odds of diabetes than NHW. Health professionals can effectively minimize disparities between Vietnamese Americans and NHW with diabetes through appropriate monitoring of foot care, eye care and A1C levels.

The effect of menopause on metabolic syndrome: cross-sectional results from the Canadian Longitudinal Study on Aging.

OBJECTIVES: Data were examined from women surveyed in the Canadian Longitudinal Study on Aging to evaluate whether menopause is an independent risk factor for the development of metabolic syndrome (MetS) or its components, including hypertension, central obesity, dyslipidemia, or elevated glycated hemoglobin. METHODS: We conducted a cross-sectional analysis of women aged 45-85 years old that participated in the baseline data of the Canadian Longitudinal Study on Aging Comprehensive Cohort collected from 2012 to 2015. Modified Poisson regression with robust error variance was used to estimate the crude and adjusted relative risks (aRRs) of MetS in postmenopausal women compared to premenopausal women. RESULTS: Among 12,611 women analyzed, 10,035 (79.6%) had undergone menopause and 2,576 (20.4%) were premenopausal. Postmenopausal women were more likely to meet criteria for MetS compared to premenopausal women (32.6% vs 20.5%, P < 0.001). Using the MetS criteria with a lower waist circumference threshold, the prevalence of MetS was higher at 38.2% among postmenopausal women and 23.2% among premenopausal women (P < 0.001). After adjusting for age, body mass index, and other covariates, the occurrence of menopause was not associated with a significantly higher relative risk of MetS, using the unified criteria for MetS (aRR 1.09 [95% CI: 0.99-1.19]). Women with menopause had a significantly higher relative risk of MetS when using criteria with a lower waist circumference (aRR 1.10 [95% CI: 1.01-1.19]). Menopause was also associated with a higher risk of impaired glucose tolerance (aRR 1.42 [95% CI: 1.26-1.59]), elevated blood pressure (aRR 1.12 [95% CI: 1.03-1.21]), and elevated triglycerides (aRR 1.17 [95% CI: 1.08-1.26]). CONCLUSION: Menopause is associated with an increased risk of MetS, independent of age. Lifestyle interventions targeted at women with MetS are known to prevent type 2 diabetes mellitus and cardiovascular risk. Perimenopause may be an important preventative care opportunity to assess metabolic risk factors and improve health and longevity of Canadian women.

Antenatal corticosteroid administration is associated with decreased growth of the fetal thymus: a prospective cohort study.

OBJECTIVE: To examine the effect of antenatal corticosteroid administration (ACS) on fetal thymus growth in women who received ACS compared with gestational-age-matched controls. STUDY DESIGN: Fetal thymus size and growth were measured in women at risk for preterm delivery who received ACS and compared with a matched cohort of women who were at low risk for preterm delivery and did not receive ACS. Fetal thymus perimeter and diameter were measured by 2-D ultrasound at baseline and every 2 weeks until delivery. RESULTS: After adjusting for confounders, ACS exposure was associated with a significant reduction in thymus perimeter size (-0.70; 95% CI: -1.33, -0.07; P = 0.03). For every additional week of exposure, thymus growth trajectory was significantly decreased in ACS-exposed fetuses (P = 0.04). CONCLUSION: The association between ACS and reduced fetal thymus growth should be further examined to establish the impact of ACS on childhood thymus development and immune programming.

Diabetes and diabetes care among non-obese South Asian Americans: Findings from a population-based study.

AIMS: The aim of this paper is to provide population-based data from California on: (a) the prevalence and the odds of diabetes among non-obese South Asian (SA) Americans compared to non-Hispanic Whites (NHW); (b) to assess the prevalence and odds of optimal medical care including regular eye exams, foot exams, and the monitoring of hemoglobin A1C blood glucose levels; and (c) To identify the factors that are associated with diabetes among SA Americans. METHODS: The combined 2007, 2009, and 2011 waves of the adult California Health Interview Survey (CHIS) was used to analyze a non-obese (BMI<30) sample of 1251 SA and 72,072 NHW. Chi-square and logistic regression analyses were performed using Stata. RESULTS: Non-obese SA had more than twice the odds of diabetes in comparison to NHW (OR = 2.50; 1.66, 3.76), even after adjusting for sociodemographic characteristics. Despite their higher propensity for diabetes, there were no significant ethnic differences in the level of optimal care received by those with diabetes. Among non-obese South Asian Americans, the odds of diabetes were higher for older respondents, those without a post-secondary degree, those who were foreign-born, those who had ever smoked, and those with BMI from 25 to 29.99. CONCLUSIONS: Non-obese SA in California experience a disproportionately higher prevalence of diabetes than their NHW counterparts.

Difference in Visceral Adipose Tissue in Pregnancy and Postpartum and Related Changes in Maternal Insulin Resistance.

OBJECTIVE: To measure the difference between first-trimester and postpartum visceral adipose tissue (VAT), the agreement of this difference with change in body mass index, and whether a difference in VAT is associated with insulin resistance or glucose mishandling. METHODS: Prospective study of 93 women with singleton pregnancies without a history of diabetes. Visceral adipose tissue depth was sonographically assessed at 11 to 14 weeks and at 6 to 12 weeks postpartum. Metabolic measures, sampled at 24 to 28 weeks and 6 to 12 weeks postpartum, included homeostatic model assessment of insulin resistance, insulin sensitivity index composite, and area under the 75-g oral glucose tolerance test curve. RESULTS: First-trimester VAT depth explained only 37% (95% confidence interval [CI], 22-52) of the variation in postpartum VAT depth. There was limited agreement between the net change in postpartum minus first-trimester VAT depth and that same net change for body mass index (Cohen's kappa, 0.26; 95% CI, 0.05-0.47). Those with a net gain in VAT depth demonstrated poorer insulin sensitivity index postpartum than women with a net regression in VAT depth-a difference of -2.0 (95% CI, -3.3 to -0.69). CONCLUSION: Sonographic assessment of postpartum VAT is feasible and may provide insight to metabolic changes between pregnancy and postpartum, beyond body mass index.

Is anemia an independent risk factor for postpartum depression in women who have a cesarean section? - A prospective observational study.

BACKGROUND: The symptoms of anemia and depression are very similar suggesting that there may be an association between the two entities. The aim of this study is to assess whether postpartum anemia (PPA) is an independent risk factor for de novo postpartum depression (PPD)in women undergoing elective cesarean section. METHODS: Women after an uncomplicated term cesarean section were recruited and their hemoglobin and iron status were measured on day 3-5 post section and again at 6 weeks. Postpartum depression was screened using the Edinburgh Postnatal Depression Scale (EPDS) and functional capacity was assessed with the RAND 12-item Health survey. RESULTS: One hundred and three women completed the study. The incidence of probable postpartum depression (PPD) as defined by EPDS score ≥ 10 was 17% at 6 weeks. There was no difference in hemoglobin or iron status in women who had PPD compared to those without (OR-0.69; 95% CI-0.15-2.49). Similarly, there was no significant association between low hemoglobin and maternal functional status (OR -1.03; 95% CI-0.34 - 2.94). CONCLUSIONS: Neither anemia or low iron stores were found to be an independent risk factors for postpartum depression or decreased postpartum functional capacity in women who undergo an elective cesarean section.

Access to Prenatal Care for Pregnant Refugee Women in Toronto, Ontario, Canada: An Audit Study.

We assessed whether eligible refugee claimants faced barriers to accessing prenatal care in the context of changes to Canadian health care policy that generated multiple categories of refugee health care eligibility. METHODS: Prenatal care providers in Toronto were contacted twice using standardized scripts to book appointments for a pregnant non-refugee and refugee claimant, both eligible for prenatal care. PRIMARY OUTCOME: unequivocal offer of appointment. Secondary outcome: reasons for refusal of prenatal care. RESULTS: There was a statistically significantly lower rate of offering prenatal care (34%) to refugee claimants compared with non-refugees (95%) (p < .001). Lack of knowledge, confusion about policies, time-consuming administrative requirements, and slow reimbursement processes were cited as reasons for refusal of care. CONCLUSIONS: Our results highlighted barriers to accessing prenatal care for refugee women. There are important future policy implications when considering the numerous changes to refugee health care policy in the last five years.

Circulating B-type natriuretic peptide in women with and without recent gestational diabetes: The impact of current glucose intolerance.

CONTEXT: Circulating B-type natriuretic peptide, as measured by the N-terminal fragment of its prohormone (NT-proBNP), is inversely associated with incident type 2 diabetes (T2DM) but positively related to future cardiovascular disease (CVD). Recognizing that gestational diabetes (GDM) identifies women at future risk for both T2DM and CVD, we sought to determine whether gestational glucose tolerance relates to NT-proBNP in the years after delivery. DESIGN/PATIENTS/MEASUREMENTS: Three hundred and forty women underwent a glucose challenge test (GCT) and an oral glucose tolerance test (OGTT) in pregnancy, yielding 4 gestational glucose tolerance groups: GDM (n = 105); gestational impaired glucose tolerance (n = 59); abnormal GCT with a normal OGTT (n = 98); and normal GCT with normal OGTT (n = 75). At 3-year postpartum, they underwent cardiometabolic characterization (including measurement of estimated glomerular filtration rate (eGFR), adiponectin and NT-proBNP) and repeated the OGTT, revealing 69 women with glucose intolerance (prediabetes/diabetes). RESULTS: At 3-year postpartum, serum NT-proBNP did not differ between the 4 original gestational glucose tolerance groups (P = .44), but instead progressively decreased across current glucose tolerance strata, from normal to prediabetes to diabetes (P = .006). Indeed, on logistic regression analysis, NT-proBNP emerged as a negative predictor of prediabetes/diabetes (OR = 0.903, 95% CI 0.825-0.988, P = .026). On multiple linear regression analyses of NT-proBNP, the significant association with current glucose intolerance was ultimately attenuated in a fully adjusted model, revealing two independent determinants of NT-proBNP: eGFR (t = -2.71, P = .007) and adiponectin (t = 2.44, P = .015). CONCLUSION: Serum NT-proBNP relates to current glucose intolerance, rather than preceding gestational dysglycaemia. Thus, the diabetic (rather than vascular) risk implications of NT-proBNP predominate in young women.

Text messages for influenza vaccination among pregnant women: A randomized controlled trial.

OBJECTIVE: To evaluate if text message reminders increase the likelihood of receiving the influenza vaccine among pregnant women. METHODS: Pregnant women were randomized to either receive or not receive weekly text messages. Women were told the messages would be about health-related behavior in pregnancy. Those randomized to the intervention group received two messages weekly for four consecutive weeks reinforcing that the influenza vaccine is recommended for all pregnant women and safe during pregnancy and breastfeeding. Women were contacted six weeks postpartum to determine if they had received the vaccine. Sample size calculation determined that 108 women were required in both groups to see a 75% increase in vaccination rates over baseline in the text message group compared to the control group. RESULTS: Recruitment began November 4, 2013, and 317 women were randomized. The mean gestational age at recruitment was 22weeks. There were 40/129 (31%) women in the text message group and 41/152 (27%) women in the control group who received the vaccine (p=0.51). Significant predictors of vaccine acceptance were being married compared to single (95% vs. 67%, p<0.001), having higher household income (55% vs. 39%, p=0.03) and having received the vaccine before (77% vs. 36%, p<0.001). Among women receiving text messages, the majority were satisfied, with only 15/129 (12%) reporting that they did not like receiving the messages, and 24/129 (19%) stating that the information in the messages was not helpful. CONCLUSION: Weekly text messages reinforcing the recommendation for and safety of the influenza vaccine in pregnancy did not increase the likelihood of actually receiving the vaccine among pregnant women. Overall vaccination rates were low, highlighting the need for patient education and innovative techniques to improve vaccine acceptance. Registered with ClinicalTrials.gov at http://www.clinicaltrials.gov, registration number NCT 02428738.

Preeclampsia and Preterm Birth Associated With Visceral Adiposity in Early Pregnancy.

OBJECTIVE: To determine if an increasing amount of visceral adipose tissue, measured by ultrasound in early pregnancy, is associated with a higher risk of preeclampsia and preterm birth (PTB). METHODS: We completed a prospective cohort study of 463 pregnant women. Maternal visceral adiposity tissue (VAT) depth was measured by ultrasound at 11 to 14 weeks' gestation. Relative risks (RR) were adjusted for age, parity, chronic hypertension, pre-pregnancy BMI, and use of acetylsalicylic acid. RESULTS: The rate of preeclampsia was much higher at quintile (Q) 5 of VAT depth (9.8%) than at Q1 to Q4 (1.6%) but not significantly so in the adjusted model (RR 3.39, 95% CI 0.86 to 13.39). The adjusted RR of PTB was significantly elevated at Q5 VAT depth (6.53, 95% CI 1.47 to 6.53), as was preeclampsia with PTB (16.91, 95% CI 1.24 to 231.07). CONCLUSION: Higher amounts of VAT in pregnancy may play a direct role in the pathogenesis of preeclampsia, including early onset preeclampsia necessitating preterm delivery.

Canadian women's attitudes toward noninvasive prenatal testing of fetal DNA in maternal plasma (.).

OBJECTIVE: To determine the perceptions and attitudes of Canadian women to Noninvasive Prenatal Testing of fetal DNA. STUDY DESIGN: A designed questionnaire was administered to women attending the outpatient antenatal clinic at a tertiary urban hospital. Attitudes to current and new prenatal screening modalities were assessed using a five-point Likert scale. Bowker's test of symmetry was used to compare individual responses regarding the two screening modalities. Changes in women's responses pre- and post-delivery were also compared. RESULTS: One hundred and twenty-nine women were enrolled in this study. 88% of women state that they would perform prenatal screening via fetal DNA in the maternal plasma if available. When compared to conventional screening, significantly less women believe that the NIPT should be available upon request for non-medical traits (36.4% versus 60.4%, p < 0.001). When compared to their answer before delivery, more women agreed that screening with fetal DNA in maternal plasma could be used in a negative way to select for desired non-medical traits such as gender. CONCLUSIONS: The use of fetal DNA in the maternal plasma is widely accepted in our Canadian population as a future method of noninvasive prenatal screening despite recognition of certain ethical concerns. This information can be used when implementing new genetic screening programs.

Visceral Adiposity in the First Half of Pregnancy in Association with Glucose, Lipid and Insulin Profiles in Later Pregnancy: A Cohort Study.

Background Obesity is the most common risk factor in pregnancy but few studies have assessed the association of between visceral adiposity (VAT) depth in early to mild pregnancy and insulin resistance (IR), dysglycemia and dyslipidemia in later pregnancy. Objective To assess the association between VAT depth in early to mid pregnancy and IR [homeostatic model assessment of IR (HOMA-IR)], dysglycemia and dyslipidemia in later pregnancy. Methods We completed a prospective cohort study of 344 pregnant women at a single large hospital in Recife, Brazil. VAT depth was measured by ultrasound at 15-20 weeks gestation. Serum glucose, insulin and lipids were evaluated at 32-37 weeks gestation. Results In contrast to pre-pregnancy body mass index (BMI), VAT depth at 15-20 weeks was generally inferior in explaining the variation in the biochemical measures at 32-37 weeks gestation. This was the case for fasting HOMA-IR (adjusted r(2): 0.21 vs. 0.11, respectively), fasting insulin (adjusted r(2): 0.27 vs. 0.09, respectively), and lipids. Only for fasting glucose was the opposite true, but marginally (adjusted r(2) 0.03 vs. 0.06, respectively). Conclusion VAT depth measured in the first half of pregnancy is not better than pre-pregnancy BMI in predicting IR and related biochemical measures in later pregnancy.

Non-Alcoholic Fatty Liver Disease in Early Pregnancy Predicts Dysglycemia in Mid-Pregnancy: Prospective Study.

OBJECTIVES: Non-alcoholic fatty liver disease (NAFLD) is mediated by insulin resistance, as is gestational diabetes mellitus (GDM). NAFLD has not been studied in relation to GDM. The objective of this study was to assess the association between first-trimester sonographic findings of NAFLD, and both dysglycemia and GDM in mid-pregnancy. METHODS: We followed a prospective cohort design at a large obstetrics clinic in Toronto, Ontario with 476 women enrolled in early pregnancy. NAFLD was assessed by ultrasound at 11-14 weeks gestation, and standardized images were independently scored by two ultrasonographers for the presence of hepatorenal contrast (one finding) and/or blurring of the intrahepatic vessels (one finding), relative to neither being present. Logistic regression analysis was used to generate odds ratios (ORs) and 95% confidence interval (CI) for the relation between 0, 1, or 2 sonographic findings of NAFLD and the composite outcome of impaired fasting glucose, impaired glucose tolerance, or GDM at 24-28 weeks gestation, determined by a fasting 75-g oral glucose tolerance test. ORs were adjusted (aOR) for maternal age, ethnicity, first-degree relative with type 2 DM, body mass index (BMI) at 11-14 weeks gestation, and change in BMI from 11-14 to 24-28 weeks gestation. RESULTS: Fifty out of 476 women (10.5%) developed the composite outcome. The presence of 1 (aOR 2.0, 95% CI: 1.0-4.1) or 2 (aOR 2.9, 95% CI: 1.0-18.4) sonographic features of NAFLD predicted the composite outcome. Limiting the analysis to ≥1 feature vs. none, the aOR was 2.2 (95% CI: 1.1-4.3). CONCLUSIONS: Sonographic assessment of NAFLD is a semiquantitative measure, with limited ability to detect small amounts of hepatic steatosis, or to distinguish various stages of NAFLD. First-trimester sonographic evidence of NAFLD predicts dysglycemia in mid-pregnancy.

First-Trimester Maternal Abdominal Adiposity Predicts Dysglycemia and Gestational Diabetes Mellitus in Midpregnancy.

OBJECTIVE: This study assessed the association between first-trimester abdominal adiposity and dysglycemia and gestational diabetes mellitus (GDM) in midpregnancy. RESEARCH DESIGN AND METHODS: In a prospective cohort of 485 women, we measured subcutaneous (SAT), visceral (VAT), and total (TAT) adipose tissue depth, using ultrasound at 11-14 weeks' gestation. Logistic regression analysis assessed the relation between quartiles of SAT, VAT, or TAT depth and the composite outcome of impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or GDM, based on a 75-g oral glucose tolerance test at 24-28 weeks. RESULTS: Adjusting for maternal age, ethnicity, family history of diabetes, and BMI, quartile 4 versus quartile 1 VAT (adjusted odds ratio [aOR] 3.1, 95% CI 1.1-9.5) and TAT (aOR 2.7, 95% CI 1.1-7.8) were significantly associated with the composite outcome, but SAT was not (aOR 1.8, 95% CI 0.70-4.8). The same was seen for GDM alone. CONCLUSIONS: Elevated first-trimester VAT and TAT depth independently predicted the risk of dysglycemia later in pregnancy.

Ethanol extraction preparation of American ginseng (Panax quinquefolius L) and Korean red ginseng (Panax ginseng C.A. Meyer): differential effects on postprandial insulinemia in healthy individuals.

ETHNOPHARMACOLOGICAL RELEVANCE: Ginsenosides are the proposed bioactive constituent of ginseng, especially for the attenuation of postprandial glycemia (PPG). The efficacious proportion of total and specific ginsenosides, remains unknown. Alcohol extraction of whole ginseng root can be used to selectively manipulate the ginsenoside profile with increasing alcohol concentrations producing high yields of total ginsenosides and varying their individual proportions. AIM OF THE STUDY: We aimed to compare the acute efficacy of different ethanol-extraction preparations of American ginseng (AG) and Korean red ginseng (KRG), with their whole-root origins, on PPG and insulin parameters in healthy adults. MATERIALS AND METHODS: Following an overnight fast, 13 healthy individuals (Gender: 5M:8F, with mean ± SD, age: 28.9 ± 9.2 years, BMI: 26.3 ± 2.7 kg/m(2) and fasting plasma glucose: 4.21 ± 0.04 mmol/L) randomly received 3g of each of the following 10 different ginseng treatments on separate visits: whole root KRG and AG; 30%, 50% or 70% ethanol extracts of KRG and AG and 2 cornstarch placebos. Treatments were consumed 40 min prior to a 50 g oral glucose challenge test with capillary blood samples collected at baseline, 15, 30, 45, 60, 90 and 120 min. Insulin samples were collected at 0, 30, 60 and 120 min. RESULTS: There was no difference in attenuation of PPG among the tested ginseng preparations. Measures of Insulin Sensitivity Index (ISI) showed increased insulin sensitivity (IS) with KRG-30% and AG-50% extracts compared to placebo (p<0.05). CONCLUSIONS: The insulin sensitizing effects of KRG-30% and AG-50% extracts suggest that other root parts, including other ginsenosides not typically measured, may influence PPG and insulin parameters. There is potential for AG and KRG extracts to modulate IS, an independent predictor of type 2 diabetes.

Acceptability, predictors and attitudes of Canadian women in labour toward point-of-care HIV testing at a single labour and delivery unit.

OBJECTIVE: To assess attitudes and opinions surrounding point-of-care HIV testing among Canadian women, and to determine predictors for acceptance of testing. METHODS: A survey assessing acceptability and attitudes toward rapid HIV testing was distributed on the labour and delivery unit in an academic hospital (St Michael's Hospital) in Toronto, Ontario, in 2011. Information collected included demographic data, health and pregnancy history, willingness to undergo rapid HIV testing while in labour and barriers to testing. RESULTS: Responses in 92 completed questionnaires were analyzed. The mean age of respondents was 32 years and all were HIV negative. Twelve percent of patients reported having at least one risk factor for HIV transmission. The study showed that only 59% of women were willing to be tested at the time of survey completion, and these women stated that they would accept saliva, urine or serum testing. If found to be positive, 96% would accept antiretroviral treatment and 94% would formula feed their infants. Of the 41% who were not willing to be tested, their reasons for refusal included "don't want to know" (39%) and being in "too much labour pain" (29%). Regardless of willingness to be tested, the most frequently cited barriers to testing were social stigma (64%) and reaction from partners (69%). CONCLUSIONS: Canadian women in labour were willing to undergo rapid HIV testing via urine, saliva or serum. If found to be positive, women were willing to undergo treatment and to formula feed to prevent mother-to-child transmission of HIV.

OBJECTIF: Évaluer les attitudes et les opinions des femmes canadiennes au sujet du dépistage du VIH au point de service et en déterminer les prédicteurs d'acceptation. MÉTHODOLOGIE: En 2011, un sondage sur l'acceptabilité et les attitudes entourant un test de dépistage rapide du VIH a été distribué à l'unité de travail et d'accouchement d'un hôpital universitaire (St Michael's Hospital) de Toronto, en Ontario. Les chercheurs y ont colligé des données démographiques, les antécédents de santé et de grossesse, la volonté de subir un test de dépistage rapide du VIH pendant le travail et les obstacles à ce test. RÉSULTATS: Les chercheurs ont analysé les réponses des 92 questionnaires remplis. Les répondantes, toutes séronégatives au VIH, avaient un âge moyen de 32 ans. Parmi elles, 12 % ont déclaré présenter au moins un facteur de risque de transmission du VIH. Seulement 59 % étaient prêtes à subir le test au moment de remplir le sondage. Elles ont indiqué qu'elles accepteraient un test par la salive, l'urine ou le sérum. Si les résultats étaient positifs, 96 % accepteraient un traitement antirétroviral et 94 % nourriraient leur nourrisson à l'aide de préparations lactées. Parmi les 41 % qui n'étaient pas prêtes à subir le test, les raisons du refus incluaient « je ne veux pas le savoir ¼ (39 %) et « trop de douleur causée par l'accouchement ¼ (29 %). Quelle que soit la volonté de subir le test, les obstacles les plus cités étaient l'opprobre social (64 %) et la réaction des partenaires (69 %). CONCLUSIONS: Les femmes canadiennes en travail étaient prêtes à subir un dépistage rapide du VIH par l'urine, la salive ou le sérum. S'il était positif, les femmes étaient prêtes à se faire traiter et à nourrir leur nourrisson à l'aide de préparations lactées pour éviter de transmettre le VIH à leur enfant.

Abdominal adiposity and insulin resistance in early pregnancy.

BACKGROUND: High pre-pregnancy body mass index is a known risk factor for gestational diabetes mellitus, but the contribution of abdominal adiposity to insulin resistance (IR) in pregnancy is not well understood. We assessed the association between abdominal adiposity in early pregnancy and IR. METHODS: We completed a prospective cohort study of 79 pregnant women. Visceral adipose tissue (VAT) depth was measured by ultrasonography at 11 to 14 weeks' gestation, at the time of routine fetal nuchal translucency assessment. A two-hour 75 g oral glucose tolerance test was subsequently completed at 16 to 22 weeks' gestation and IR was estimated by the homeostatic model assessment of insulin resistance (HOMA-IR) as well as by the insulin sensitivity index. RESULTS: After adjusting for maternal age, parity, ethnicity, and pre-pregnancy BMI, VAT depth explained 42% of the variance in HOMA-IR, which was slightly better than the variance in the multivariable model examining HOMA-IR and pre-pregnancy BMI (40%). For the insulin sensitivity index, the model variance values were 36% and 32%, respectively. CONCLUSION: Measurement of maternal adipose tissue depth at the time of routine first-trimester ultrasonography may provide additional information about maternal IR, beyond pre-pregnancy BMI.

Contexte : Bien que la présence d'un indice de masse corporelle prégrossesse élevé soit un facteur de risque connu pour ce qui est du diabète sucré gestationnel, l'apport de l'adiposité abdominale à l'insulinorésistance (IR) pendant la grossesse n'est pas bien compris. Nous avons évalué l'association entre l'adiposité abdominale aux débuts de la grossesse et l'IR. Méthodes : Nous avons mené une étude de cohorte prospective auprès de 79 femmes enceintes. La profondeur du tissu adipeux viscéral (TAV) a été mesurée par échographie à 11-14 semaines de gestation, dans le cadre de l'évaluation systématique de la clarté nucale fœtale. Une épreuve d'hyperglycémie provoquée par voie orale (deux heures, 75 g) a par la suite été menée à 16-22 semaines de gestation et l'IR a été estimée au moyen du modèle homéostatique d'évaluation de l'insulinorésistance (HOMA-IR), ainsi qu'au moyen de l'indice de sensibilité à l'insuline. Résultats : À la suite de la neutralisation des effets de l'âge maternel, de la parité, de l'ethnicité et de l'IMC prégrossesse, la profondeur du TAV a permis d'expliquer 42 % de la variance constatée dans le cadre du HOMA-IR, ce qui était légèrement mieux qu'en ce qui concerne la variance constatée dans le cadre du modèle multivarié faisant appel au HOMA-IR et à l'IMC prégrossesse (40 %). Pour ce qui est de l'indice de sensibilité à l'insuline, les valeurs quant à la variance pour chacun des modèles ont été de 36 % et de 32 %, respectivement. Conclusion : La mesure de la profondeur du tissu adipeux maternel, au moment de la tenue systématique de l'échographie au cours du premier trimestre, pourrait fournir des renseignements supplémentaires au sujet de l'IR maternelle, au-delà de ce qu'indique l'IMC prégrossesse.

The impact of ethnicity on awareness and knowledge of and attitudes towards the human papillomavirus and vaccine among adult women.

OBJECTIVE: To determine whether ethnicity affects awareness, knowledge, and attitudes regarding the human papillomavirus (HPV) and the HPV vaccine. METHODS: English speaking women (n = 172) aged 18 and older were recruited from an outpatient gynaecology clinic to complete a self-administered cross-sectional questionnaire that gathered information about (1) virus awareness and knowledge, (2) vaccine awareness and knowledge, (3) attitudes towards the vaccine and (4) participant demographics. Subjects received a virus knowledge score (0 to 6), a vaccine knowledge score (0 to 10) and an attitudes score (8 to 40), with a higher score indicating more positive attitudes towards the vaccine. RESULTS: Virus and vaccine awareness was significantly higher in Caucasian respondents than in non-Caucasian respondents: 93% versus 69% (P < 0.001) and 94% versus 64%, (P < 0.001), respectively. In a multivariate logistic regression model, the Caucasian ethnic group, higher education status, and greater number of years in Canada each emerged as independent predictors of vaccine awareness. Both virus and vaccine knowledge scores were significantly higher in Caucasian than non-Caucasian women: 4.6 versus 3.89 (P = 0.001) and 7.2 versus 6.4, (P = 0.042), respectively. Caucasian women had significantly higher (more positive) attitudes towards the vaccine than non-Caucasians (31.4 vs. 29.2, P = 0.021). Higher HPV vaccine knowledge was positively associated with an interest in vaccination (r(2) = 0.26, P < 0.01) and a more positive vaccine attitudes score (r(2) = 0.40, P < 0.001). CONCLUSION: Virus and vaccine awareness were both higher in Caucasian women than in non-Caucasian women. Improving HPV vaccination knowledge has the potential to improve attitudes and vaccine uptake.

Objectif : Déterminer si l'ethnicité affecte la sensibilisation au virus du papillome humain (VPH) et au vaccin anti-VPH, ainsi que les connaissances et les attitudes à leur égard. Méthodes : La participation de femmes d'expression anglaise (n = 172) de 18 ans ou plus a été sollicitée au sein d'une clinique externe de gynécologie; nous leur avons demandé de remplir un questionnaire transversal autoadministré visant la collecte de données au sujet (1) de la sensibilisation au virus et des connaissances à cet égard; (2) de la sensibilisation au vaccin et des connaissances à cet égard; (3) des attitudes envers le vaccin; et (4) des caractéristiques démographiques des participantes. Celles-ci se sont vu attribuer un score sur les connaissances au sujet du virus (de 0 à 6), un score sur les connaissances au sujet du vaccin (de 0 à 10) et un score sur les attitudes (de 8 à 40), l'obtention d'un score accru indiquant des attitudes plus positives à l'égard du vaccin. Résultats : La sensibilisation au virus et au vaccin était considérablement plus élevée chez les répondantes de race blanche que chez les répondantes d'autres origines ethniques : 93 % vs 69 % (P < 0,001) et 94 % vs 64 %, (P < 0,001), respectivement. Dans le cadre d'un modèle de régression logistique multivariée, le groupe ethnique de race blanche, un niveau de scolarité supérieur et un nombre supérieur d'années passées au Canada ont tous constitué des facteurs prédictifs indépendants de la sensibilisation au vaccin. Les scores sur les connaissances au sujet du virus et du vaccin ont tous deux été considérablement plus élevés chez les répondantes de race blanche que chez les répondantes d'autres origines ethniques : 4,6 vs 3,89 (P = 0,001) et 7,2 vs 6,4, (P = 0,042), respectivement. Les répondantes de race blanche ont obtenu des scores sur les attitudes considérablement plus élevés (attitudes plus positives) en ce qui concerne le vaccin que les répondantes d'autres origines ethniques (31,4 vs 29,2, P = 0,021). Le fait de disposer de plus vastes connaissances au sujet du vaccin anti-VPH a été positivement associé au fait de s'intéresser à la vaccination (r2 = 0,26, P < 0,01) et à l'obtention d'un score sur les attitudes à l'égard du vaccin plus positif (r2 = 0,40, P < 0,001). Conclusion : La sensibilisation au virus et au vaccin était plus élevée chez les répondantes de race blanche que chez les répondantes d'autres origines ethniques. L'amélioration des connaissances au sujet de la vaccination anti-VPH a le potentiel d'entraîner l'amélioration des attitudes et de la mesure dans laquelle le vaccin est utilisé.