First-trimester maternal ophthalmic artery Doppler analysis for prediction of pre-eclampsia.

OBJECTIVE: To determine the performance of a multiparametric test comprising maternal risk factors, uterine artery Doppler and ophthalmic artery Doppler in the first trimester of pregnancy for the prediction of pre-eclampsia (PE). METHODS: This prospective observational cohort study recruited patients in the first trimester of pregnancy. Maternal uterine artery and ophthalmic artery Doppler assessments were performed in 440 singleton pregnancies at 11-14 weeks of gestation. Additional history was obtained through participant questionnaires, and follow-up occurred to discharge postdelivery. The normotensive and pre-eclamptic groups were compared using parametric (Student's t-test) and non-parametric (Mann-Whitney U-test) tests. Univariable and multivariable logistic regression analyses were performed to determine which biophysical factors, and which of the factors among the maternal characteristics and medical and obstetric history, had a significant contribution to the prediction of PE in a multiparametric model. RESULTS: Thirty-one (7%) patients developed PE, including nine (2%) who required delivery before 34 weeks (early PE) and 22 (5%) with late PE. There were statistically significant differences in uterine artery pulsatility index (UtA-PI) and ophthalmic artery first diastolic peak (PD1) mean values between the PE and control groups. In a multiparametric model, both UtA-PI and PD1 achieved a 67% detection rate for early PE, although when combined, the detection rate only increased to 68%. CONCLUSIONS: The efficiency of ophthalmic artery PD1 in the first trimester as a predictive marker for the later development of PE was approximately equal to that described for uterine artery Doppler. Although these findings do not support the replacement of uterine artery Doppler analysis in multiparametric predictive models for PE, they do provide novel insights into first-trimester maternal systemic vascular changes that precede the clinical development of this condition.

Prostitution and the military: planning AIDS intervention in Belize.

First world militaries based in 'third world' countries offer an appropriate context for developing AIDS intervention models that are keyed to large-scale population movements and regional differences in HIV infection. In this work, the ethnographic concept of 'social interface' replaces the epidemiological concept of 'risk group' to allow for a more dynamic analysis of the particular forms of interactions between groups that may be linked to the sexual transmission of HIV. The social interface between military and sex workers in Belize displays two distinct forms of organization: (1) 'recognized prostitution' in health-regulated brothels, and (2) 'quasi-prostitution' in non-health regulated public sites such as bars and hotels. These two forms are also distinguished by the ethnicity, national origin, and professional identity of sex workers. Based on survey-form participant-observation in Belize and cross-cultural data on condom use, the social identity of sex workers emerges as a factor crucial to understanding how public health information is incorporated by heterosexuals who put themselves at risk for HIV in different social contexts. The scope of analysis shifts between the personal and transnational; discussion of the possibilities for inter-governmental negotiations regarding AIDS policy issues is included.