How Do Women Prepare for Pregnancy? Preconception Experiences of Women Attending Antenatal Services and Views of Health Professionals

Main objective

To determine the extent to which women plan and prepare for pregnancy.

Methods

Cross-sectional questionnaire survey of pregnant women attending three maternity services in London about knowledge and uptake of preconception care; including a robust measure of pregnancy planning, and phone interviews with a range of health care professionals.

Main results

We recruited 1173/1288 (90%) women, median age of 32 years. 73% had clearly planned their pregnancy, 24% were ambivalent and only 3% of pregnancies were unplanned. 51% of all women and 63% of those with a planned pregnancy took folic acid before pregnancy. 21% of all women reported smoking and 61% reported drinking alcohol in the 3 months before pregnancy; 48% of smokers and 41% of drinkers reduced or stopped before pregnancy. The 51% of all women who reported advice from a health professional before becoming pregnant were more likely to adopt healthier behaviours before pregnancy [adjusted odds ratios for greatest health professional input compared with none were 2.34 (95% confidence interval 1.54–3.54) for taking folic acid and 2.18 (95% CI 1.42–3.36) for adopting a healthier diet before pregnancy]. Interviews with 20 health professionals indicated low awareness of preconception health issues, missed opportunities and confusion about responsibility for delivery of preconception care.

Significance of the findings

Despite a high level of pregnancy planning, awareness of preconception health among women and health professionals is low, and responsibility for providing preconception care is unclear. However, many women are motivated to adopt healthier behaviours in the preconception period, as indicated by halving of reported smoking rates in this study. The link between health professional input and healthy behaviour change before pregnancy is a new finding that should invigorate strategies to improve awareness and uptake of pre-pregnancy health care, and bring wider benefits for public health.     

The Spatial Distribution of Hepatitis C Virus Infections and Associated Determinants—An Application of a Geographically Weighted Poisson Regression for Evidence-Based Screening Interventions in Hotspots

Background

Hepatitis C Virus (HCV) infections are a major cause for liver diseases. A large proportion of these infections remain hidden to care due to its mostly asymptomatic nature. Population-based screening and screening targeted on behavioural risk groups had not proven to be effective in revealing these hidden infections. Therefore, more practically applicable approaches to target screenings are necessary. Geographic Information Systems (GIS) and spatial epidemiological methods may provide a more feasible basis for screening interventions through the identification of hotspots as well as demographic and socio-economic determinants.

Methods

Analysed data included all HCV tests (n = 23,800) performed in the southern area of the Netherlands between 2002–2008. HCV positivity was defined as a positive immunoblot or polymerase chain reaction test. Population data were matched to the geocoded HCV test data. The spatial scan statistic was applied to detect areas with elevated HCV risk. We applied global regression models to determine associations between population-based determinants and HCV risk. Geographically weighted Poisson regression models were then constructed to determine local differences of the association between HCV risk and population-based determinants.

Results

HCV prevalence varied geographically and clustered in urban areas. The main population at risk were middle-aged males, non-western immigrants and divorced persons. Socio-economic determinants consisted of one-person households, persons with low income and mean property value. However, the association between HCV risk and demographic as well as socio-economic determinants displayed strong regional and intra-urban differences.

Discussion

The detection of local hotspots in our study may serve as a basis for prioritization of areas for future targeted interventions. Demographic and socio-economic determinants associated with HCV risk show regional differences underlining that a one-size-fits-all approach even within small geographic areas may not be appropriate. Future screening interventions need to consider the spatially varying association between HCV risk and associated demographic and socio-economic determinants.     

Statistical Methods for Integrating Randomized Clinical Studies for Evaluation of Combination Treatment Therapy

In regulatory applications, evaluation of a combination drug at a fixed dose is based on pairwise comparisons of the combination with its component drugs. These comparisons generate the least expected gain of the combination relative to its components as the key effect parameter for evaluation. Two test methods are developed for the evaluation to combine multiple clinical studies that are deemed combinable. One test method is based on a linear combination of the Min tests from individual studies. In the other test method, weighted estimators are first derived for the pairwise comparisons between the combination and the respective components by combining the studies. A Min test is then applied to these estimators. The latter test method tends to be more powerful than the former test method. A test-based confidence interval is constructed for the least expected gain of the combination relative to its components. A test for heterogeneity across studies is also developed.     

Performance of the CareStart? G6PD Deficiency Screening Test,a Point-of-Care Diagnostic for Primaquine Therapy Screening

Development of reliable, easy-to-use, rapid diagnostic tests (RDTs) to detect glucose-6-phosphate dehydrogenase (G6PD) deficiency at point of care is essential to deploying primaquine therapies as part of malaria elimination strategies. We assessed a kit under research and development called CareStart™ G6PD deficiency screening test (Access Bio, New Jersey, USA) by comparing its performance to quantitative G6PD enzyme activity using a standardized spectrophotometric method (‘gold standard’). Blood samples (n = 903) were collected from Cambodian adults living in Pailin province, western Cambodia. G6PD enzyme activities ranged from 0 to 20.5 U/g Hb (median 12.0 U/g Hg). Based on a normal haemoglobin concentration and wild-type G6PD gene, the normal values of G6PD enzymatic activity for this population was 3.6 to 20.5 U/g Hg (95^th percentiles from 5.5 to 17.2 U/g Hg). Ninety-seven subjects (10.7%) had <3.6 U/g Hg and were classified as G6PD deficient. Prevalence of deficiency was 15.0% (64/425) among men and 6.9% (33/478) among women. Genotype was analyzed in 66 G6PD-deficient subjects and 63 of these exhibited findings consistent with Viangchang genotype. The sensitivity and specificity of the CareStart™ G6PD deficiency screening test was 0.68 and 1.0, respectively. Its detection threshold was <2.7 U/g Hg, well within the range of moderate and severe enzyme deficiencies. Thirteen subjects (1.4%, 12 males and 1 female) with G6PD enzyme activities <2 U/g Hg were falsely classified as “normal” by RDT. This experimental RDT test here evaluated outside of the laboratory for the first time shows real promise, but safe application of it will require lower rates of falsely “normal” results.     

Detection of Cervical Cancer—A Study of Motivation for Cytological Screening

Annual cytological examination of cervical scrapings should virtually eliminate deaths from cervical cancer, but many deaths still occur because not all women are sufficiently motivated to have the examination.As part of a San Diego County Medical Society cancer control project, 2000 women were interviewed to evaluate motivating influences. It was found that most of the 70 per cent who had had the examination were motivated by the advice of physicians, rather than directly by lay publicity. Women who had not had the examination, more commonly the old and the poor, were not antagonistic but mostly unmotivated. Lay education to induce women to seek medical advice, and education of physicians to get them to urge and to carry out their part in routine annual cytologic examination of cervical exudate probably could bring about virtual elimination of death from cervical cancer.     

Evaluation of GFP Tag as a Screening Reporter in Directed Evolution of a Hyperthermophilic β-Glucosidase

By applying a directed evolution methodology specific enzymatic characteristics can be enhanced, but to select mutants of interest from a large mutant bank, this approach requires high throughput screening and facile selection. To facilitate such primary screening of enhanced clones, an expression system was tested that uses a green fluorescent protein (GFP) tag from Aequorea victoria linked to the enzyme of interest. As GFP’s fluorescence is readily measured, and as there is a 1:1 molar correlation between the target protein and GFP, the concept proposed was to determine whether GFP could facilitate primary screening of error-prone PCR (EPP) clones. For this purpose a thermostable β-glucosidase (BglA) from Fervidobacterium sp. was used as a model enzyme. A vector expressing the chimeric protein BglA-GFP-6XHis was constructed and the fusion protein purified and characterized. When compared to the native proteins, the components of the fusion displayed modified characteristics, such as enhanced GFP thermostability and a higher BglA optimum temperature. Clones carrying mutant BglA proteins obtained by EPP, were screened based on the BglA/GFP activity ratio. Purified tagged enzymes from selected clones resulted in modified substrate specificity.     

Coronary Cineangiography—Clinical Studies for Evaluation in Equivocal Cases

Coronary cineangiography was helpful in the following circumstances:1. A patient with an abnormal electrocardiogram and no evidence of coronary artery disease.2. A patient with thoracic pain in whom the diagnosis of coronary artery disease was questioned.3. A patient with intractable angina pectoris who was being studied for possible surgical therapy.4. A patient with coronary insufficiency and aortic stenosis who was being evaluated for operation on the aortic valve.     

Screening for Distress in Routine Oncological Care—A Survey in 520 Melanoma Patients

Introduction

Despite the increasing incidence of melanoma little is known about patients'' emotional distress associated with this disease. Supplemented by the problem list (PL), the distress thermometer (DT) is a recommended screening instrument to measure psychosocial distress in cancer patients. Our objective was to explore the acceptance and the feasibility of the DT and PL as a concise screening tool in an ambulatory setting for routine care and to elucidate determinants of distress in melanoma patients with regard to sociodemographic and clinical variables.

Methods

Consecutive melanoma outpatients were asked to complete the DT with the PL prior to their scheduled consultation. Demographic and clinical data were obtained from the patients'' charts. Clinical data included melanoma stage, time since diagnosis, previous treatment, current treatment, and other cancer disease.

Results

Out of 734 patients recruited into the study, 520 patients (71%) completed both the DT and the PL. Forty-seven percent met the ≥5 cut-off score for distress. Younger and employed patients reported higher distress than older and retired patients. A cut-off score of ≥5 was closely associated with self-reported emotional sources of distress, with practical problems, especially at work, family problems (dealing with the partner), and physical problems like pain, appearance, getting around, and nausea. Apart from higher distress under current systemic treatment, no associations were found between distress and clinical data.

Conclusion

The DT together with the PL seems to be an economically reasonable screening tool to measure psychosocial distress in melanoma patients. In particular, younger melanoma patients who are currently employed are prone to experience distress at some point after diagnosis, but there appears to be almost no association between clinical data and the extent of distress. To characterize the impact of distress on disease outcome and quality of life in melanoma patients, further research is needed.     

HYPERCHOLESTEROLEMIA—Use of Niacin and Niacin Combinations in Therapy

Niacin or niacin combinations were administered in dosage of 1.0 to 6.0 gm. to 31 hypercholesterolemic patients for periods up to three years. Eighty per cent were able to continue medication for long periods without significant side effects. Jaundice, apparently due to nicotinic acid, occurred in one patient. Liver toxicity will probably be a hazard in the use of this therapy.Significant and maintained serum cholesterol depression was achieved in 80 per cent of the patients who were able to take adequate dosage. Reduction in xanthomata was observed with cholesterol reduction. In some cases, when larger doses were not tolerated or were unsuccessful, combining 1.5 gm of niacin with small doses of estrogen or triparanol achieved the desired effect. Aluminum nicotinate had no important advantage over plain niacin.     

Intron III-Specific Markers for Screening of β-amylase Alleles in Barley Cultivars

In modern malting barley breeding it is important to increase the level of -amylase activity level in barley. The aim of this study was to investigate if a PCR method for screening -amy1 alleles can be used as an indicator for -amylase activity level in barley. Activity was assayed from 24 cultivars, 7 lines, and a Hordeum spontaneum PI 296897 strain grown in the same field. The -amy1 alleles were identified by amplifying the intron III-specific region of the gene using PCR. No new alleles were detected in addition to the three alleles found earlier: cv Adorra-like, cv Haruna Nijo-like and PI 296897-like -amy1 allele. Samples were grouped according to the nature of their -amy1 locus and enzyme activities were compared between the groups. Cultivars carrying a cv Haruna Nijo-like -amy1 allele had 1.3 times and lines carrying a PI 296897-like -amy1 allele had 2.1 times higher -amylase activity than cultivars carrying a cv Adorra-like -amy1 allele. The mean activities are significantly different in the allele groups (Kruskal–Wallis: for protein H= 11.54, P< 0.01; for meal H= 12.74, P< 0.01). PCR fragments can be used as allele specific markers to predict the level of -amylase activity in breeding when such variation of the intron III is concerned.     

Screening and Production of Arylsulfatases for Target Therapy with Etoposide 4′-Sulfate,an Antitumor Prodrug

Two arylsulfatase-producing streptomycetes that desulfated etoposide 4′-sulfate were isolated from soil samples. Taxonomical study identified one soil isolate as Streptomyces griseorubiginosus S980-14 (Es-1 arylsulfatase producer), while the other was considered new and tentatively designated Streptomyces sp. T109-3 (Es-2 arylsulfatase producer). Both strains produced extracellular arylsulfatase activities, provided that cultivation media were prepared with distilled water. Unlike the two known types of arylsulfatases, which had significant activity on p-nitrophenyl sulfate but none on etoposide 4′-sulfate, the crude streptomycete arylsulfatases efficiently desulfated etoposide 4′-sulfate and p-nitrophenyl sulfate, which supports the establishment of a new type of arylsulfatases.     

Child Behavior Checklist—Mania Scale (CBCL-MS): Development and Evaluation of a Population-Based Screening Scale for Bipolar Disorder

Context

Early identification of Bipolar Disorder (BD) remains poor despite the high levels of disability associated with the disorder.

Objective

We developed and evaluated a new DSM orientated scale for the identification of young people at risk for BD based on the Child Behavior Checklist (CBCL) and compared its performance against the CBCL-Pediatric Bipolar Disorder (CBCL-PBD) and the CBCL-Externalizing Scale, the two most widely used scales.

Methods

The new scale, CBCL-Mania Scale (CBCL-MS), comprises 19 CBCL items that directly correspond to operational criteria for mania. We tested the reliability, longitudinal stability and diagnostic accuracy of the CBCL-MS on data from the TRacking Adolescents'' Individual Lives Survey (TRAILS), a prospective epidemiological cohort study of 2230 Dutch youths assessed with the CBCL at ages 11, 13 and 16. At age 19 lifetime psychiatric diagnoses were ascertained with the Composite International Diagnostic Interview. We compared the predictive ability of the CBCL-MS against the CBCL-Externalising Scale and the CBCL-PBD in the TRAILS sample.

Results

The CBCL-MS had high internal consistency and satisfactory accuracy (area under the curve = 0.64) in this general population sample. Principal Component Analyses, followed by parallel analyses and confirmatory factor analyses, identified four factors corresponding to distractibility/disinhibition, psychosis, increased libido and disrupted sleep. This factor structure remained stable across all assessment ages. Logistic regression analyses showed that the CBCL-MS had significantly higher predictive ability than both the other scales.

Conclusions

Our data demonstrate that the CBCL-MS is a promising screening instrument for BD. The factor structure of the CBCL-MS showed remarkable temporal stability between late childhood and early adulthood suggesting that it maps on to meaningful developmental dimensions of liability to BD.     

Young People’s Preferences for Family Planning Service Providers in Rural Malawi: A Discrete Choice Experiment

Objective

To quantify the impact of service provider characteristics on young people’s choice of family planning (FP) service provider in rural Malawi in order to identify strategies for increasing access and uptake of FP among youth.

Methods and Findings

A discrete choice experiment was developed to assess the relative impact of service characteristics on preferences for FP service providers among young people (aged 15–24). Four alternative providers were included (government facility, private facility, outreach and community based distribution of FP) and described by six attributes (the distance between participants’ home and the service delivery point, frequency of service delivery, waiting time at the facility, service providers’ attitude, availability of FP commodities and price). A random parameters logit model was used to estimate preferences for service providers and the likely uptake of services following the expansion of outreach and community based distribution (CBDA) services. In the choice experiment young people were twice as likely to choose a friendly provider (government service odds ratio [OR] = 2.45, p<0.01; private service OR = 1.99, p<0.01; CBDA OR = 1.88, p<0.01) and more than two to three times more likely to choose a provider with an adequate supply of FP commodities (government service OR = 2.48, p<0.01; private service OR = 2.33, p<0.01; CBDA = 3.85, p<0.01). Uptake of community based services was greater than facility based services across a variety of simulated service scenarios indicating that such services may be an effective means of expanding access for youth in rural areas and an important tool for increasing service uptake among youth.

Conclusions

Ensuring that services are acceptable to young people may require additional training for service providers in order to ensure that all providers are friendly and non-judgemental when dealing with younger clients and to ensure that supplies are consistently available.     

Evaluation of the Redesigned Enterotube—a System for the Identification of Enterobacteriaceae

The redesigned Enterotube has been evaluated with 414 unknown Enterobacteriaceae cultures from the stock culture collection of the Center for Disease Control. When the Enterotube was used as recommended by the manufacturer, an average of 96.4% of these cultures were correctly identified. Only two groups (Salmonella and Edwardsiella) were identified with less than 90% accuracy (89.2 and 87.5%, respectively). The Enterotube now provides a convenient, rapid, and accurate test system for the identification of typically reacting enteric bacteria.     

Cell Replacement Therapy in Parkinson’s Disease—History of Development and Prospects for Use in Clinical Practice

Molecular Biology - Parkinson’s disease is a widespread neurodegenerative disease, which is characterized by the death of dopaminergic neurons in the substantia nigra of the midbrain....     

BRAIN-DAMAGED CHILDREN—The Problem of Relations in the Family Group

Children with minimal brain damage show a characteristic pattern of behavior.Often there are no physical signs of abnormality, but the diagnosis can be made from the history, electroencephalographic tracings, psychologic tests and repeated observations.The behavior is a composite of the effects of the brain damage and the response of the child to his environment. The behavior of the brain-damaged child is frequently so frustrating to parents that attitudes of rejection, withdrawal or excessive punitive measures occur.In the present study, when drugs were given and the child''s behavior improved, the parents were better able to understand the needs of the child and create a better home environment in which there was less frustration and emotional pressure.     

Spot the Difference—Development of a Syndrome Based Protein Microarray for Specific Serological Detection of Multiple Flavivirus Infections in Travelers

BackgroundThe family Flaviviridae, genus Flavivirus, holds many of the world’s most prevalent arboviral diseases that are also considered the most important travel related arboviral infections. In most cases, flavivirus diagnosis in travelers is primarily based on serology as viremia is often low and typically has already been reduced to undetectable levels when symptoms set in and patients seek medical attention. Serological differentiation between flaviviruses and the false-positive results caused by vaccination and cross-reactivity among the different species, are problematic for surveillance and diagnostics of flaviviruses. Their partially overlapping geographic distribution and symptoms, combined with increase in travel, and preexisting antibodies due to flavivirus vaccinations, expand the need for rapid and reliable multiplex diagnostic tests to supplement currently used methods.GoalWe describe the development of a multiplex serological protein microarray using recombinant NS1 proteins for detection of medically important viruses within the genus Flavivirus. Sera from clinical flavivirus patients were used for primary development of the protein microarray.ResultsResults show a high IgG and IgM sensitivity and specificity for individual NS1 antigens, and limited cross reactivity, even within serocomplexes. In addition, the serology based on this array allows for discrimination between infection and vaccination response for JEV vaccine, and no cross-reactivity with TBEV and YFV vaccine induced antibodies when testing for antibodies to other flaviviruses.ConclusionBased on these data, multiplex NS1-based protein microarray is a promising tool for surveillance and diagnosis of flaviviruses.