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Medicine, South Africa

David McIntyre H.,University of Queensland | David McIntyre H.,Materials Medical Research Institute | Gibbons K.S.,Materials Medical Research Institute | Gibbons K.S.,Clinical Research Support Unit | And 3 more authors.
Medical Journal of Australia | Year: 2012

Objectives: To document temporal trends in maternal overweight and obesity in Australian women and to examine associations with pregnancy outcomes. Design, setting and participants: Retrospective 12-year cohort study of 75 432 women with singleton pregnancies who had pre-pregnancy height and weight data available and who gave birth in a tertiary referral maternity hospital in Brisbane between January 1998 and December 2009. Main outcome measures: Maternal body mass index (BMI); prevalence of overweight and obesity, and pregnancy complications including hypertension, gestational diabetes, caesarean delivery, and perinatal morbidity and mortality. Results: From 1998 to 2009, class III and class II obesity increased significantly (from 1.2% to 2.0%, and 2.5% to 3.2%, respectively), while the proportions of underweight women and those with class I obesity fell slightly (from 7.9% to 7.4%, and 7.7% to 7.5%, respectively). Increasing maternal BMI was associated with many adverse pregnancy outcomes, including hypertension in pregnancy, gestational diabetes, caesarean delivery, perinatal mortality (stillbirth and neonatal death), babies who were large for gestational age, and neonatal morbidities including hypoglycaemia, jaundice, respiratory distress and the need for neonatal intensive care (P < 0.001 for all). Most associations remained significant after adjusting for maternal age, parity, insurance status, smoking status, ethnicity and year of the birth. The frequency of congenital anomalies was not associated with maternal BMI (P=0.71). Conclusions: Maternal overweight and obesity are endemic challenges for Australian obstetric care and are associated with serious maternal and neonatal complications, including perinatal mortality. Source

Hawkes M.,University of Toronto | Schuh S.,Paediatric Emergency Medicine | Ipp M.,Paediatric Medicine | Bitnun A.,University of Toronto | And 6 more authors.
Academic Pediatrics | Year: 2011

Objective: The pandemic influenza H1N1 2009 (pH1N1) virus is expected to remain a prominent circulating strain in the current and subsequent influenza seasons. The objective of this study was to compare the clinical course of infection with laboratory-confirmed pH1N1 and seasonal influenza A and B in a cohort of previously healthy children managed in the outpatient setting without antiviral therapy. Methods: Previously healthy children 17 years of age or younger were prospectively enrolled during the first wave of the 2009 pandemic (May-July 2009) and the 2 preceding influenza seasons from a single primary care physician office and a tertiary children's hospital emergency department. Inclusion criteria were: age ≤17 years; laboratory-confirmed influenza; and not receiving antiviral agents. Follow-up telephone interviews were conducted approximately 2 days and 14 days after presentation to assess symptom duration. Results: A total of 251 patients (101 with pH1N1, 90 with seasonal influenza A, 60 with seasonal influenza B) were included. Presenting symptoms and duration of symptoms associated with pH1N1 were similar to those with seasonal influenza. Median fever duration in pH1N1 was 3 days and had resolved within 8 days in 95% of patients. Among patients with pH1N1, abnormalities on chest auscultation (10 of 101), the hospitalization rate (2 of 101), the proportion of children receiving intravenous fluid therapy (1 of 101) or supplemental oxygen (1 of 101) were not significantly different from patients with seasonal influenza. Conclusions: In most children without underlying risk factors for severe influenza, pH1N1 virus causes an uncomplicated respiratory tract illness, no more severe than seasonal influenza. Copyright © 2011 by Academic Pediatric Association. Source

Whitelaw A.,UCT | Whitelaw A.,National Health Laboratory Service | Peter J.,UCT | Sohn H.,McGill University | And 8 more authors.
European Respiratory Journal | Year: 2011

Light-emitting diode (LED) microscopy has recently been endorsed by the World Health Organization (WHO). However, it is unclear whether LED is as accurate and cost-effective as Ziehl-Neelsen (ZN) microscopy or mercury vapour fluorescence microscopy (MVFM) in tuberculosis (TB)-HIV-co-infected subjects. Direct and concentrated sputum smears from TB suspects were evaluated using combinations of LED microscopy, ZN microscopy and MVFM. Median reading time per slide was recorded and a cost analysis performed. Mycobacterial culture served as the reference standard. 647 sputum samples were obtained from 354 patients (88 (29.8%) were HIV-infected and 161 (26%) were culture-positive for Mycobacterium tuberculosis). Although overall sensitivity of LED compared with ZN microscopy or MVFM was similar, sensitivity of all three modalities was lower in HIV-infected patients. In the HIV-infected group, the sensitivity of LED microscopy was higher than ZN microscopy using samples that were not concentrated (46 versus 39%; p=0.25), and better than MVFM using concentrated samples (56 versus 44; p50.5). A similar trend was seen in the CD4 count <200 cells·mL -1 subgroup. Median (interquartile range) reading time was quicker with LED compared with ZN microscopy (1.8 (1.7-1.9) versus 2.5 (2.2-2.7) min; p≤0.001). Average cost per slide read was less for LED microscopy (US$1.63) compared with ZN microscopy (US$2.10). Among HIV-TB-co-infected patients, LED microscopy was cheaper and performed as well as ZN microscopy or MVFM independent of the staining (ZN or auramine O) or processing methods used. Source

Piot E.,Metz Thionville Regional Hospital | Leheup B.F.,Metz Thionville Regional Hospital | Goetz C.,Clinical Research Support Unit | Quilliot D.,University of Lorraine | And 3 more authors.
American Journal of Hospice and Palliative Medicine | Year: 2015

Background: Withdrawing artificial nutrition in palliative care is an issue that often leads to ethical dilemmas among health care providers, despite clinical guidelines. Objectives: To describe the experience of health care providers confronted with the withdrawing of artificial nutrition at the end of life and identifying the factors related to the level of ethical dilemmas. Methods: Cross-sectional survey questionnaire of all the nurses and nurses’ aides working in medicine, surgery, and palliative care departments of a regional hospital and who have already been confronted with the withdrawal of artificial nutrition. Results: Of 818 questionnaires sent, 274 were returned (response rate 33.5%); 60% (163) of the care providers who responded were involved in withdrawing artificial nutrition at the end of life. Among these, 42 (25.8%) had always or often been affected with ethical dilemmas, and 97 (60%) responded that withdrawing artificial nutrition had always or often been preceded by a multidisciplinary discussion. Items significantly associated with a high level of ethical dilemmas were (1) existence of differences in opinion within the health care team, (2) lack of information regarding the indication of the withdrawal of artificial nutrition, (3) feeling uncomfortable with the patient and his or her relatives, (4) guilt, (5) feeling of abandonment of care, and (6) uneasiness. Conclusion: Health care providers seem to have a lack of information and consensus regarding the withdrawal of artificial nutrition at the end of life. The ethical dimension of withdrawing artificial nutrition in palliative care has a strong impact on care providers, regardless of the circumstances of the withdrawal. © 2014, © The Author(s) 2014. Source

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