Gestational diabetes: women's concerns, mood state, quality of life and treatment satisfaction.

OBJECTIVE: The aim of this observational cohort study was to explore concerns, mood state, quality of life (QoL) and treatment satisfaction of women treated for gestational diabetes (GDM). METHODS: Twenty-seven diet-treated and 18 insulin-treated women participated in a semi-structured interview and completed a series of three different questionnaires. RESULTS: Qualitative analysis identified "the baby's health" as dominant concern, but also as main motivational treatment factor. Treatment satisfaction was generally high and further increased, whereas QoL and mood state significantly dropped over time. CONCLUSIONS: Acknowledgment of women's concerns and precise information may improve treatment compliance and outcome.

Twin-to-twin delivery time: neonatal outcome of the second twin.

OBJECTIVE: To examine the effect of twin-to-twin delivery time (TTDT) on neonatal outcome. METHODS: We evaluated twin deliveries >34 weeks of gestation. Twin pregnancies with both twins delivered by cesarean section and pregnancies with antenatal complications were excluded. We analyzed TTDT and neonatal outcomes of the second twin (umbilical arterial pH value (pH(art)), Apgar scores at 1, 5 and 10 minutes, need for intensive care). The study population was divided into two homogenous groups based on the mode of delivery: (A) vertex presentation and vaginal delivery of both twins, (B) vertex presentation and vaginal or vaginal operative delivery of twin I, breech or transverse presentation and vaginal breech delivery or cesarean section (CS) of twin II. RESULTS: A total of 207 twin pairs were included in our study. In Group A (n = 151) there were no significant correlations between TTDT and pH(art) or Apgar scores at 1,5 and 10 minutes of twin II (p = .156; 0.861; 0.151 and 0.384, respectively). In Group B (n = 56), the mean pH(art) of twin II was inversely correlated to TTDT, but not significantly (p = .417). TTDT was inversely related to 1-min and 5-min Apgar scores, but not significantly (p = .330; p = .138, respectively). The 10-min Apgar score showed no correlation with TTDT (p = .638). CONCLUSION: Increasing TTDT was not associated with adverse fetal outcome. Expectant management of the second twin appears possible and elapsed time alone does not appear to be an indication for intervention.

A foodborne outbreak due to norovirus in Austria, 2007.

A foodborne norovirus outbreak occurred after a pre-Christmas celebration among a group of local foresters in Austria in December 2007. A total of 66 persons, 60 participants of the Christmas party and 6 kitchen staff members of the restaurant where the party took place, were identified as the at-risk cohort. Questioning of this cohort was performed by self-report questionnaires or telephone interviews (response rate of 95%). The outbreak attack rate was 33.3% (21 of 63 persons), including two of the kitchen staff. Three stool specimens yielded norovirus genogroup II. Univariate analysis revealed that exposure to a ham roll and pastry was possibly associated with risk of gastroenteritis (risk ratio [RR] of 4.45, 95% CI of 1.91 to 10. RR of 2.44, 95% CI of 0.93 to 6.39). After controlling for the effects of sex, age, and other food items with a log-linear model, ham roll remained significantly associated with disease risk (RR of 3.91, 95% CI of 1.57 to 9.76). Ham roll was most likely contaminated with norovirus during preparation by a disease-free kitchen assistant, whose infant became sick with laboratory-confirmed norovirus gastroenteritis 2 days before the party. Informing food handlers about the possible risk of food contamination with norovirus and training them in the appropriate measures of hand hygiene and environmental disinfection at the working place and at home are essential for preventing food-related norovirus outbreaks. Norovirus-infected household members of healthy food handlers must be considered a possible reservoir for foodborne norovirus outbreaks.

[Amniotic fluid insulin levels versus mean maternal blood glucose levels in gestational diabetes mellitus: an analysis of the neonatal outcome]. / Insulinbestimmung aus dem Fruchtwasser versus mittlere Blutglukose zur Therapieentscheidung beim Gestationsdiabetes: Eine Analyse des kindlichen Outcome.

PURPOSE: To compare the obstetric and neonatal outcome in pregnancies complicated by gestational diabetes mellitus after amniocentesis for amniotic fluid insulin measurement or maternal blood glucose monitoring or both as selection criterion for therapy. MATERIAL AND METHODS: In a retrospective study, 408 diabetic pregnancies were analyzed; 307 were treated with diet alone (group 1) and 101 with diet and insulin (group 2). Pearson's chi2 or Fisher's exact test was used to assess obstetric and anthropometric data within these groups, and p values <0.05 were considered statistically significant. RESULTS: Group 1 - According to the method used, no significant differences were found for gestational age at birth (p = 0.396), mode of delivery (p = 0.79) and neonatal outcome parameters determined as mean birth weight (p = 0.348), birth weight above the 75th percentile (p = 0.473), mean ponderal index (PI; p = 0.434), pH of umbilical artery (p = 0.065) and of umbilical-vein blood (p = 0.052), mean Apgar scores at 1 (p = 0.56) and 5 min (p = 0.072), insulin (p = 0.25) and glucose (p = 0.535) in cord blood. Significant differences were found for birth weight above the 90th percentile (p = 0.005) and Apgar score <7 at 1 min (p = 0.019). Group 2 - Again, no significant differences were observed in terms of gestational age at birth (p = 0.219), mode of delivery (p = 0.386), mean birth weight (p = 0.59), birth weight above the 75th (p = 0.701) and 90th percentiles (p = 0.487), mean PI (p = 0.156), pH of umbilical-artery (p = 0.197) and umbilical vein blood (p = 0.056), Apgar scores at 1 (p = 0.58) and 5 min (p = 0.52), insulin (p = 0.67) and glucose (p = 0.11) in cord blood. CONCLUSION: In retrospective analysis there was no significant difference in outcome parameters in pregnancies complicated by gestational diabetes dependent on the method used as selection criterion for therapy.

Maternal urine for prenatal diagnosis--an analysis of cell-free fetal DNA in maternal urine and plasma in the third trimester.

OBJECTIVES: The aim of the study was the detection, quantification and correlation of cell-free fetal (cff) DNA in maternal urine and plasma in normal and complicated pregnancies during the third trimester. METHODS: One hundred and fifty-one urine and plasma samples obtained from 96 women carrying male fetuses, and 55 carrying female fetuses were collected and analyzed for cff-DNA using fluorescent PCR and quantitative real-time PCR. DNA was extracted from 1 mL maternal urine and analyzed with two different primer sets (SRY and DYS-14). The concentrations of cff and total DNA in maternal plasma were correlated with maternal and obstetric parameters using appropriate correlation analyses. RESULTS: Y-chromosome-specific sequences were detected in 31 of 96 (32.3%) urine samples collected from women pregnant with male fetuses using DYS-14 and in 6 of 96 (6.3%) urine samples using SRY as primers using real-time PCR. All 96 plasma samples obtained from women carrying male fetuses were positive for cff-DNA using real-time PCR. Cff-DNA exhibited a correlation with gestational age (R = 0.244; P = 0.018) and an inverse correlation with the latency between blood collection and birth (R = - 0.218; P = 0.036). Total DNA showed a correlation with placental weight (R = 0.182; P = 0.034) and pregnancy-associated complications (R = 0.280; P < 0.001). CONCLUSION: Our data confirm that cff-DNA is cleared by the kidneys in detectable amounts, but due to its low concentration or problematic detection in maternal urine this source seems inappropriate for noninvasive prenatal diagnosis.

A case of healthcare-associated, multidrug-resistant tuberculosis in Austria: reconsidering the value of cohorting of patients with culture-positive tuberculosis.

Cohorting of patients with culture-positive tuberculosis is still widely practiced in Austria, a country where approximately 1% of Mycobacterium tuberculosis isolates are multidrug resistant. Cohorting of patients with tuberculosis prior to determination of drug susceptibility is unacceptable because M. tuberculosis superinfection can occur.