Monitoring Of Pregnant Women Research Articles

Continuous glucose monitoring in pregnant women with type 1 diabetes: an observational cohort study of 186 pregnancies

Aims/hypothesisThe aim of this study was to analyse patterns of continuous glucose monitoring (CGM) data for associations with large for gestational age (LGA) infants and an adverse neonatal composite outcome (NCO) in pregnancies in women with type 1 diabetes.MethodsThis was an observational cohort study of 186 pregnant women with type 1 diabetes in Sweden. The interstitial glucose readings from 92 real-time (rt) CGM and 94 intermittently viewed (i) CGM devices were used to calculate mean glucose, SD, CV%, time spent in target range (3.5–7.8 mmol/l), mean amplitude of glucose excursions and also high and low blood glucose indices (HBGI and LBGI, respectively). Electronic records provided information on maternal demographics and neonatal outcomes. Associations between CGM indices and neonatal outcomes were analysed by stepwise logistic regression analysis adjusted for confounders.ResultsThe number of infants born LGA was similar in rtCGM and iCGM users (52% vs 53%). In the combined group, elevated mean glucose levels in the second and the third trimester were significantly associated with LGA (OR 1.53, 95% CI 1.12, 2.08, and OR 1.57, 95% CI 1.12, 2.19, respectively). Furthermore, a high percentage of time in target in the second and the third trimester was associated with lower risk of LGA (OR 0.96, 95% CI 0.94, 0.99 and OR 0.97, 95% CI 0.95, 1.00, respectively). The same associations were found for mean glucose and for time in target and the risk of NCO in all trimesters. SD was significantly associated with LGA in the second trimester and with NCO in the third trimester. Glucose patterns did not differ between rtCGM and iCGM users except that rtCGM users had lower LBGI and spent less time below target.Conclusions/interpretationHigher mean glucose levels, higher SD and less time in target range were associated with increased risk of LGA and NCO. Despite the use of CGM throughout pregnancy, the day-to-day glucose control was not optimal and the incidence of LGA remained high.

Continuous Glucose Monitoring in Pregnant Women With Type 1 Diabetes (CONCEPTT): A Multicentre International Randomized Controlled Trial

(Lancet 2017;390:2347–2359) Pregnant women with type 1 diabetes are at increased risk of preeclampsia, cesarean delivery, congenital anomalies, and other adverse pregnancy outcomes. While optimal glycemic control during pregnancy can improve outcomes, it is difficult to accomplish due to the complexity of insulin dose adjustments, changes in insulin sensitivity, and variability of insulin absorption that all occur during pregnancy. Continuous glucose monitoring (CGM) has been successful at improving glycemic control in nonpregnant women but studies in pregnant women have had conflicting results. This study aimed to evaluate the effects of CGM in women with type 1 diabetes who were pregnant or planning to become pregnant.

Diabetic Retinopathy and Pregnancy

Purpose: analysis of clinical cases of different course of diabetic retinopathy in pregnancy.Patients and methods. The article presents 5 clinical cases of different course of diabetic retinopathy in pregnancy: absence of manifestation, stable course and progression to macular edema and aggressive proliferation.Results. The reasons for progression of diabetic retinopathy during pregnancy were analyzed. The most important were the compensation of diabetes mellitus in preconception period and throughout pregnancy, the severity of retinopathy, and the presence of concomitant pathology. It is emphasized that timely detection of progression signs of retinopathy and laser coagulation during pregnancy makes it possible to stabilize the course of disease and improve visual prognosis. Thus, the monitoring of pregnant women with diabetes mellitus requires an individual approach and careful dynamic observation during pregnancy and in postpartum period. Timely laser coagulation in progression of retinopathy can contribute to preservation of visual functions.Conclusions. Clinical course of diabetic retinopathy in pregnancy is variable: no manifestation, stabilization, progression. Progression of diabetic retinopathy during pregnancy is determined by many factors, in particular, the compensation of diabetes mellitus in preconception period and throughout pregnancy, the severity and stabilization of retinopathy as results of treatment in preconception period, the presence of concomitant pathology. Timely detection of signs of diabetic retinopathy progression and its treatment, particularly laser coagulation of the retina, during pregnancy allows stabilizing the course of disease. There may be an aggressive course of diabetic retinopathy with progression in postpartum period, in connection with which, active monitoring of patients with retinopathy after childbirth is required.

Continuous Glucose Monitoring in Pregnant Women With Type 1 Diabetes (CONCEPTT): A Multicenter International Randomised Controlled Trial

(Abstracted from Lancet 2017;390:2347–2359) It is established that optimal maternal glycemic control throughout pregnancy is associated with a decrease in adverse fetal outcomes. A proper glycemic index can be difficult to control in women with type 1 diabetes during pregnancy because of the complexity of insulin dose adjustment, gestational changes in insulin sensitivity, and day-to-day changes to insulin absorption in late pregnancy. Nationwide UK data show the rates of severe hypoglycemia, particularly in early pregnancy, are 5 times higher among pregnant women than nonpregnant and that only 40% of women with type 1 diabetes achieve target glycated hemoglobin (HbA1c) after 24 weeks of gestation. Continuous glucose monitoring (CGM) provides real-time quantitative information on the direction and rate of change of glucose levels.

Association between maternal body height and risk of preterm birth

Objective: To investigate the association between maternal body height and risk of preterm birth. Methods: A total of 11 311 pregnant women who gave birth of live singletons were recruited from the Healthy Baby Cohort Study in Hubei province, China from September 2012 to October 2014. Finally 11 070 pregnant women were selected as study subjects. Data were collected by using questionnaires, their prenatal care records and medical records. The women were divided into 4 groups according to the quartiles distribution (<158 cm, 158- cm, 160- cm, and >164 cm). Gestational age was estimated according to maternal last menstrual time. Preterm birth was defined as delivering a live singleton infant at 28-37 weeks' gestational age. Logistic regression was used to calculate the odds ratios (OR) and 95% confidence intervals (CI) for the association between body height and preterm birth. Results: Among the 11 070 pregnant women, the incidence of preterm birth was 5.9%. Logistic regression analysis indicated that women in group with body height <158 cm had 46% (OR=1.46, 95%CI: 1.16-1.83) higher risk of giving preterm birth than those in group with body height >164 cm after adjustment for potential confounders. Every 1- cm increase in body height was associated with 3% lower risk of preterm birth (OR=0.97, 95%CI: 0.95-0.99). Conclusion: Shorter body height was a risk factor for preterm birth. It is necessary to strengthen the monitoring in pregnant women with short body height to reduce the risk of preterm birth.

Continuous glucose monitoring in pregnant women with Type 1 diabetes: benefits for mothers, using pumps or pens, and their babies.

To review the current literature on the use of continuous glucose monitoring during pregnancy in women with Type 1 diabetes. We searched the literature for randomized controlled trials using continuous glucose monitoring during pregnancy in women with Type 1 diabetes. Three randomized trials were found and discussed in this review. One UK study found a reduction in large-for-gestational-age infants; however, only masked continuous glucose monitoring was used in that study. A Danish study used intermittent real-time continuous glucose monitoring and found no differences. The present authors conducted the CONCEPTT trial, in which pregnant women and women planning pregnancy were randomized to receive continuous glucose monitoring or standard care. We found a greater drop in HbA1c , more time spent in the target range, and a reduction in some adverse neonatal outcomes in women using continuous glucose monitoring. Numbers-needed-to-treat to prevent a large-for-gestational-age infant, a neonatal intensive care unit admission for >24 h, and a neonatal hypoglycaemia event were low. These findings were seen in both injection and pump users and across all countries. Possible reasons for differences in study findings are discussed. In addition, several issues need further study. Glycaemic variability and differences in dietary intake may also have played a role. Despite excellent glycaemic control, babies continue to be large. More research is needed to understand the role of glucose targets and the dynamic placental processes involved in fetal growth. The use of continuous glucose monitoring in women with Type 1 diabetes in pregnancy is associated with improved glycaemic control and neonatal outcomes. Further research examining the glycaemic and non-glycaemic variables involved in fetal growth and the cost-benefit of using continuous glucose monitoring in pregnancy is warranted.

Optimal timing of viral load monitoring during pregnancy to predict viraemia at delivery in HIV-infected women initiating ART in South Africa: a simulation study.

Introduction HIV viral load (VL) monitoring is a central tool to evaluate ART effectiveness and transmission risk. There is a global movement to expand VL monitoring following recent recommendations from the World Health Organization (WHO), but there has been little research into VL monitoring in pregnant women. We investigated one important question in this area: when and how frequently VL should be monitored in women initiating ART during pregnancy to predict VL at the time of delivery in a simulated South African population.MethodsWe developed a mathematical model simulating VL from conception through delivery using VL data from the Maternal and Child Health – Antiretroviral Therapy (MCH‐ART) cohort. VL was modelled based on three major compartments: pre‐ART VL, viral decay immediately after ART initiation and viral maintenance (including viral suppression and viraemic episodes). Using this simulation, we examined the performance of various VL monitoring schema in predicting elevated VL at delivery.Results and discussionIf WHO guidelines for non‐pregnant adults were used, the majority of HIV‐infected pregnant women (69%) would not receive a VL test during pregnancy. Most models that based VL monitoring in pregnancy on the time elapsed since ART initiation (regardless of gestation) performed poorly (sensitivity <50%); models that based VL measures in pregnancy on the woman's gestation (regardless of time on ART) appeared to perform better overall (sensitivity >60%). Across all permutations, inclusion of pre‐ART VL values had a negligible impact on predictive performance (improving test sensitivity and specificity <6%). Performance of VL monitoring in predicting VL at delivery generally improved at later gestations, with the best performing option a single VL measure at 36 weeks’ gestation.ConclusionsDevelopment and evaluation of a novel simulation model suggests that strategies to measure VL relative to gestational age may be more useful than strategies relative to duration on ART, in women initiating ART during pregnancy, supporting better integration of maternal and HIV health services. Testing turnaround times require careful consideration, and point‐of‐care VL testing may be the best approach for measuring VL at delivery. Broadening the scope of this simulation model in the light of current scale up of VL monitoring in high burden countries is important.

Continuous glucose monitoring in pregnant women with type 1 diabetes

Continuous glucose monitoring in pregnant women with type 1 diabetes

Continuous glucose monitoring in pregnant women with type 1 diabetes (CONCEPTT): a multicentre international randomised controlled trial

SummaryBackgroundPregnant women with type 1 diabetes are a high-risk population who are recommended to strive for optimal glucose control, but neonatal outcomes attributed to maternal hyperglycaemia remain suboptimal. Our aim was to examine the effectiveness of continuous glucose monitoring (CGM) on maternal glucose control and obstetric and neonatal health outcomes.MethodsIn this multicentre, open-label, randomised controlled trial, we recruited women aged 18–40 years with type 1 diabetes for a minimum of 12 months who were receiving intensive insulin therapy. Participants were pregnant (≤13 weeks and 6 days' gestation) or planning pregnancy from 31 hospitals in Canada, England, Scotland, Spain, Italy, Ireland, and the USA. We ran two trials in parallel for pregnant participants and for participants planning pregnancy. In both trials, participants were randomly assigned to either CGM in addition to capillary glucose monitoring or capillary glucose monitoring alone. Randomisation was stratified by insulin delivery (pump or injections) and baseline glycated haemoglobin (HbA1c). The primary outcome was change in HbA1c from randomisation to 34 weeks' gestation in pregnant women and to 24 weeks or conception in women planning pregnancy, and was assessed in all randomised participants with baseline assessments. Secondary outcomes included obstetric and neonatal health outcomes, assessed with all available data without imputation. This trial is registered with ClinicalTrials.gov, number NCT01788527.FindingsBetween March 25, 2013, and March 22, 2016, we randomly assigned 325 women (215 pregnant, 110 planning pregnancy) to capillary glucose monitoring with CGM (108 pregnant and 53 planning pregnancy) or without (107 pregnant and 57 planning pregnancy). We found a small difference in HbA1c in pregnant women using CGM (mean difference −0·19%; 95% CI −0·34 to −0·03; p=0·0207). Pregnant CGM users spent more time in target (68% vs 61%; p=0·0034) and less time hyperglycaemic (27% vs 32%; p=0·0279) than did pregnant control participants, with comparable severe hypoglycaemia episodes (18 CGM and 21 control) and time spent hypoglycaemic (3% vs 4%; p=0·10). Neonatal health outcomes were significantly improved, with lower incidence of large for gestational age (odds ratio 0·51, 95% CI 0·28 to 0·90; p=0·0210), fewer neonatal intensive care admissions lasting more than 24 h (0·48; 0·26 to 0·86; p=0·0157), fewer incidences of neonatal hypoglycaemia (0·45; 0·22 to 0·89; p=0·0250), and 1-day shorter length of hospital stay (p=0·0091). We found no apparent benefit of CGM in women planning pregnancy. Adverse events occurred in 51 (48%) of CGM participants and 43 (40%) of control participants in the pregnancy trial, and in 12 (27%) of CGM participants and 21 (37%) of control participants in the planning pregnancy trial. Serious adverse events occurred in 13 (6%) participants in the pregnancy trial (eight [7%] CGM, five [5%] control) and in three (3%) participants in the planning pregnancy trial (two [4%] CGM and one [2%] control). The most common adverse events were skin reactions occurring in 49 (48%) of 103 CGM participants and eight (8%) of 104 control participants during pregnancy and in 23 (44%) of 52 CGM participants and five (9%) of 57 control participants in the planning pregnancy trial. The most common serious adverse events were gastrointestinal (nausea and vomiting in four participants during pregnancy and three participants planning pregnancy).InterpretationUse of CGM during pregnancy in patients with type 1 diabetes is associated with improved neonatal outcomes, which are likely to be attributed to reduced exposure to maternal hyperglycaemia. CGM should be offered to all pregnant women with type 1 diabetes using intensive insulin therapy. This study is the first to indicate potential for improvements in non-glycaemic health outcomes from CGM use.FundingJuvenile Diabetes Research Foundation, Canadian Clinical Trials Network, and National Institute for Health Research.

Spontaneous Rupture of Subserous Uterine Vein in Late Pregnancy

Objective: Premature uterine contraction caused by spontaneous rupture of subserous uterine vein resulting intrauterine asphyxia.Method &amp; Results: A primigravida with uneventful pregnancy having regular antenatal care attended a private clinic at her 38 week of pregnancy with slight pain in whole abdomen and hardening of uterus. After giving rest in left lateral position &amp; oxygen inhalation, hardening of uterus persisted. By that time she developed fetal tachycardia and had to undergo caesarean section, there was hemoperitonum and an asphyxiated male baby was delivered. On exploration a subserous uterine vein was detected on the posterior wall of the uterus. Complete hemostasis was achieved with interrupted sutures and electrocauterization of the bleeding points. Post-operative period was uneventful for the mother but the baby was managed in neonatal care unit. Both of them were well during discharge.Conclusion: Monitoring of pregnant women at last trimester is very important. Any deviation from normal like hardening of uterus should be carefully taken care of for good maternal and fetal outcome.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 87-89

Wireless Vital Sign Monitoring in Pregnant Women: A Functionality and Acceptability Study.

To test the functionality and acceptability of a wireless vital sign monitor in an inpatient obstetric unit. Pregnant women at a U.S. tertiary-care hospital wore a wireless vital sign sensor that captures heart rate, respiratory rate, and temperature. Measurements were compared with vital signs obtained by standard devices. We defined continuous capture of vital signs for 30 min with wireless data transfer to a central monitor as functional success. Acceptability was assessed per the pregnant women and nurses observing the device. Bland-Altman plots were constructed to assess agreement between the wireless sensor and standard measurements. Thirty of 32 enrolled pregnant women had successful monitoring; 2 cases were stopped early for non-study-related reasons. Comparing wireless sensor and standard measurements, the mean difference (limits of agreement) values at the 25th and 75th percentiles were 1.6 (±13.2) and 4.2 (±18.6) heartbeats/min, 4.2 (±6.1) and 0.7 (±5.4) respirations/min, and 0.02°C (±1.5) and 0.5°C (±1.8), respectively. Most pregnant women found the device comfortable, likeable, and useful (78%, 81%, and 97%, respectively); 80% of nurses found the monitor easy to use, and 84% would recommend it to a patient. We successfully obtained maternal vital signs using a simple wireless monitor with high acceptability. Well-validated monitors of this nature could significantly alleviate the human resource burden of monitoring during labor and confer greatly desired mobility to laboring pregnant women, although incorporation of blood pressure monitoring will be critical.

Pengembangan Sistem informasi Pemantauan Ibu Hamil Berisiko di Puskesmas Ngemplak Simongan Semarang

The monitoring of pregnant women at risk in the clinic is very important, not only giving information about risk factors but also providing treatment during pregnancy and childbirth. Treatment of pregnant women during pregnancy, childbirth and postpartum is needed to reduce the risks that can occur during pregnancy, childbirth, and postpartum. Maternal mortality is also one of the targets of Millennium Development Goals (MDGs), that is the fifth goal, to improve maternal health. Puskesmas Ngemplak Simongan had many obstacles on the monitoring system of pregnant women at risk, such as there is no information system to monitor the pregnant women. This research aims to design the information system for pregnant women at risk to in PHC Ngemplak Simongan Semarang. This was qualitative descriptive study by applying the method of system development life cycle approach. The subjects of this study were Meternal and Children Health officers, theywere the head of public health center. The object was the Information System for Pregnant Women at risk monitoring in Ngemplak Simongan Public Health Center. The result of this research was an information system that was useful for monitoring of pregmant women at risk. The information system simplify the process of data input and expedite data delivery to health office. The implementation of the information system in Public Health Center can be used as a tool to monitor pregnant women at risk in order to reduce maternal risk and maternal mortality. Keywords: Information Systems, Monitoring Pregnant Women at Risk

Regional obstetric monitoring in the Sverdlovsk region. Innovative tools for reduction of maternal and perinatal mortality rate

According to the State program of the Russian Federation «Health care development» till 2020 approved by the decree of the Russian Federation government dated 24.12.2012 N 2511-p, the principle of the cluster approach became the one of the directions of informatization of healthcare. Subsystem perinatal cluster is the continuous monitoring of pregnant women. Its main advantage is the formation of a unified information space of the hospitals in the region that allows you to reliably group out pregnant females according to the risk of complications of pregnancy and childbirth, to determine the routing for all the patients. The goal of the system is a significant improvement of the assistance within a cluster (group), the formation of a standardized approach to the medical care, management of emergency situations in the occurrence of life-threatening conditions, the reduction of maternal and perinatal mortality rate. Computerization of medical care in obstetrics was implemented in the automated system «Program monitoring for pregnant females».

An Hybrid Approach for Prediction Based Health Monitoring in Pregnant Women

Pregnancy is a delicate stage requiring utmost care and medical attention towards health, as several abnormalities are induced in pregnant women health throughout this period. Health monitoring during pregnancy period can control, manage maintain and prevent abnormalities induced in physiological parameters, which may otherwise lead to severe complications leading to maternal and fetal mortality if un-noticed. The present research aims at catering health monitoring to women during pregnancy period to protect them from possible future complication in health. The proposed hybrid approach bestows risk predictions based on values of a set of physiological parameters obtained from pregnant women thus providing them with an opportunity to control, manage, maintain and prevent probable severe health complications thus catering pregnant women with self-health care services.

Image corporelle et grossesse : examen des propriétés psychométriques de la traduction française de la Pregnancy and Weight Gain Attitude Scale (PWGAS)

Body dissatisfaction among pregnant women can provoke behaviors to control weight gain and make them more vulnerable to eating disorders. Body dissatisfaction and strategies to control weight during pregnancy can have many consequences for both the mother and baby. Excessive weight gain may cause complications during childbirth and, reciprocally, a too weak weight gain could be associated with the risk of having a baby with a very low birth weight. Thus, it appears important to have a tool to detect these body image disorders in this population. As far as we know, no French-speaking tool exists, and the objective of this study was to investigate the psychometric properties of the French translation of the Pregnancy and Weight Gain Attitude Scale (PWGAS), which assesses the attitudes about weight gain during pregnancy. The sample consisted of 553 women (29.32±4.82 years) in their third trimester of pregnancy. Participants were volunteer women recruited in hospitals during obstetric consultation. All participants completed an anamnestic questionnaire, the PWGAS and a questionnaire assessing body dissatisfaction (Body Shape Questionnaire [BSQ]). The PWGAS, in its original version, includes 18 items and consists of four subscales: Positive Pregnancy Body Image; Negative Pregnancy Body Image; Indifference toward Weight Gain and Weight Gain Restrictive Behaviors. The instrument was translated and verified by expert translators. Confirmatory factor analysis of the original version showed fit indices below recommended limits. An exploratory factor analysis on the PWGAS revealed the existence of five factors: "Fear about weight gain" (4 items); "Absence of weight gain preoccupation" (2 items); "Positive attitudes about weight gain" (4 items); "Feeling overwhelmed by weight gain" (3 items); and "Control over weight gain" (3 items). The goodness-of-fit of the five-factor model was satisfactory. The PWGAS (total and factors) is negatively correlated with the BSQ demonstrating its concurrent validity. The PWGAS has satisfactory psychometric properties. This questionnaire could certainly be integrated in the monitoring of pregnant women in order to detect and guide those who show negative attitudes about the weight gain so that they can benefit from adequate care and prevent the development of eating disorders.

Analysis of Continuous Glucose Monitoring in Pregnant Women With Diabetes: Distinct Temporal Patterns of Glucose Associated With Large-for-Gestational-Age Infants.

Continuous glucose monitoring (CGM) is increasingly used to assess glucose control in diabetes. The objective was to examine how analysis of glucose data might improve our understanding of the role temporal glucose variation has on large-for-gestational-age (LGA) infants born to women with diabetes. Functional data analysis (FDA) was applied to 1.68 million glucose measurements from 759 measurement episodes, obtained from two previously published randomized controlled trials of CGM in pregnant women with diabetes. A total of 117 women with type 1 diabetes (n = 89) and type 2 diabetes (n = 28) who used repeated CGM during pregnancy were recruited from secondary care multidisciplinary obstetric clinics for diabetes in the U.K. and Denmark. LGA was defined as birth weight ≥90th percentile adjusted for sex and gestational age. A total of 54 of 117 (46%) women developed LGA. LGA was associated with lower mean glucose (7.0 vs. 7.1 mmol/L; P < 0.01) in trimester 1, with higher mean glucose in trimester 2 (7.0 vs. 6.7 mmol/L; P < 0.001) and trimester 3 (6.5 vs. 6.4 mmol/L; P < 0.01). FDA showed that glucose was significantly lower midmorning (0900-1100 h) and early evening (1900-2130 h) in trimester 1, significantly higher early morning (0330-0630 h) and throughout the afternoon (1130-1700 h) in trimester 2, and significantly higher during the evening (2030-2330 h) in trimester 3 in women whose infants were LGA. FDA of CGM data identified specific times of day that maternal glucose excursions were associated with LGA. It highlights trimester-specific differences, allowing treatment to be targeted to gestational glucose patterns.

Is autoimmune thyroid dysfunction a risk factor for gestational diabetes?

Abstract Objective Some recent studies have related autoimmune thyroid dysfunction and gestational diabetes (GD). The common factor for both conditions could be the existence of pro-inflammatory homeostasis. The study objective was therefore to assess whether the presence of antithyroid antibodies is related to the occurrence of GD. Material and methods Fifty-six pregnant women with serum TSH levels ≥ 2.5 mU/mL during the first trimester were retrospectively studied. Antithyroid antibodies were measured, and an O'Sullivan test was performed. GD was diagnosed based on the criteria of the Spanish Group on Diabetes and Pregnancy. Results Positive antithyroid antibodies were found in 21 (37.50%) women. GD was diagnosed in 15 patients, 6 of whom (10.71%) had positive antibodies, while 9 (16.07%) had negative antibodies. Data were analyzed using exact logistic regression by LogXact-8 Cytel; no statistically significant differences were found between GD patients with positive and negative autoimmunity (OR = 1.15 [95%CI = 0.28–4.51]; P = 1.00). Conclusions The presence of thyroid autoimmunity in women with TSH above the recommended values at the beginning of pregnancy is not associated to development of GD. However, GD prevalence was higher in these patients as compared to the Spanish general population, suggesting the need for closer monitoring in pregnant women with TSH levels ≥ 2.5 mU/mL.

Characterization of staphylococci and their role in pathology of children

The problem of human staphylococcal infection in the world has been considered. It is known that there are 27 species of staphylococci, 14 of them colonize the skin and mucous membranes of humans, and 3 of them may cause diseases. They are Staphylococcus aureus, S. epidermidis and S. saprophyticus. Staphylococci are causative agents of the large part of community-acquired and nosocomial bacteremia, pneumonia, infections of skin and soft tissues, bones and joints. Of all cases of nosocomial infections, S. aureus accounts for 31%. During the identification of 65 strains of bacteria isolated from people with respiratory tract lesions, it was found that 58.5% of cases were connected with presence of staphylococci. 86.8% of isolates identified belong to species S. aureus and 13.2% to S. saprophyticus. Study of pathogenicity factors manifestation revealed that all strains identified as S. aureus had plasmocoagulase; lipase and lecitinase were simultaneously detected in 78.3% of them, among S. saprophyticus strains in 20%. Presence of haemolysins was determined for 82.1% of strains of staphylococci. Ability to film formation was detected in 21 (63.6%) strains of S. aureus and 2 (40%) of S. saprophyticus strains. Given high frequency of carriers of staphylococci among healthy individuals, they should be considered as potentially pathogenic microorganisms and opportunistic pathogens. Due to their pathogenicity factors (adhesins, capsule, cell wall components, enzymes and toxins), staphylococci may cause diseases such as sepsis, meningitis, peritonitis, endocarditis, pneumonia, tonsillitis, and in young children they may result in serious Ritter illness (“babies scalded syndrome”), foodstuff infection and staphylococcal enterocolitis, in lactating women – mastitis, toxic shock syndrome. To solve the problem of staphylococcal infection prevention, it is necessary to use the following prophylaxis methods: to avoid decrease in immunity, to observe the rules of hygiene, sterility, disposability, disinfection, strict control of sanitary and epidemiological profile of healthcare institutions, to ensure monitoring of pregnant women, infants and early diagnostics and treatment of the inflammatory diseases at their initial stages. Furthermore, there is a need in monitoring of these bacteria spreading.

¿Existe mayor riesgo de diabetes gestacional en pacientes con disfunción tiroidea autoinmune?

ObjectiveSome recent studies have related autoimmune thyroid dysfunction and gestational diabetes (GD). The common factor for both conditions could be the existence of pro-inflammatory homeostasis. The study objective was therefore to assess whether the presence of antithyroid antibodies is related to the occurrence of GD. Material and methodsFifty-six pregnant women with serum TSH levels≥2.5 mU/mL during the first trimester were retrospectively studied. Antithyroid antibodies were measured, and an O'Sullivan test was performed. GD was diagnosed based on the criteria of the Spanish Group on Diabetes and Pregnancy. ResultsPositive antithyroid antibodies were found in 21 (37.50%) women. GD was diagnosed in 15 patients, 6 of whom (10.71%) had positive antibodies, while 9 (16.07%) had negative antibodies. Data were analyzed using exact logistic regression by LogXact-8 Cytel; no statistically significant differences were found between GD patients with positive and negative autoimmunity (OR=1.15 [95%CI=0.28-4.51]; P=1.00). ConclusionsThe presence of thyroid autoimmunity in women with TSH above the recommended values at the beginning of pregnancy is not associated to development of GD. However, GD prevalence was higher in these patients as compared to the Spanish general population, suggesting the need for closer monitoring in pregnant women with TSH levels≥2.5mU/mL.

Family medicine model in Turkey: a qualitative assessment from the perspectives of primary care workers.

BackgroundA person-list-based family medicine model was introduced in Turkey during health care reforms. This study aimed to explore from primary care workers’ perspectives whether this model could achieve the cardinal functions of primary care and have an integrative position in the health care system.MethodsFour groups of primary care workers were included in this exploratory-descriptive study. The first two groups were family physicians (FP) (n = 51) and their ancillary personnel (n = 22). The other two groups were physicians (n = 44) and midwives/nurses (n = 11) working in community health centres. Participants were selected for maximum variation and 102 in-depth interviews and six focus groups were conducted using a semi-structured form.ResultsData analysis yielded five themes: accessibility, first-contact care, longitudinality, comprehensiveness, and coordination. Most participants stated that many people are not registered with any FP and that the majority of these belong to the most disadvantaged groups in society. FPs reported that 40-60% of patients on their lists have never received a service from them and the majority of those who use their services do not use FPs as the first point of contact. According to most participants, the list-based system improved the longitudinality of the relationship between FPs and patients. However, based on other statements, this improvement only applies to one quarter of the population. Whereas there was an improvement limited to a quantitative increase in services (immunisation, monitoring of pregnant women and infants) included in the performance-based contracting system, participants stated that services not among the performance targets, such as family planning, postpartum follow-ups, and chronic disease management, could be neglected. FPs admitted not being able to keep informed of services their patients had received at other health institutions. Half of the participants stated that the list-based system removed the possibility of evaluating the community as a whole.ConclusionsAccording to our findings, FPs have a limited role as the first point of contact and in giving longitudinal, comprehensive, and coordinated care. The family medicine model in Turkey is unable to provide a suitable structure to integrate health care services.