Patient attitudes toward influenza and tetanus, diphtheria and acellular pertussis vaccination in pregnancy.

BACKGROUND: Routine influenza and tetanus, diphtheria and acellular pertussis (Tdap) vaccination of pregnant women to prevent poor maternal, fetal and neonatal outcomes is recommended practice; however, actual rates of influenza vaccine acceptance are typically well below the (Healthy People 2020, 2015) goal of 80%. OBJECTIVE: We sought to identify barriers to accepting either vaccination. MATERIALS AND METHODS: From December 2014 to April 2015 women were given a questionnaire eliciting their experiences, attitudes and history of influenza and Tdap vaccination in pregnancy during their routine prenatal care appointments at a tertiary care center. Patient demographics were included in the questionnaire. A similar questionnaire was administered to prenatal care providers. Patient influenza and Tdap vaccination acceptance rates were compared and predictors of vaccine acceptance were analyzed with bivariate logistic regression. RESULTS: Out of the 400 patient questionnaires distributed, 338 (84.5%) were completed and returned; 24 of 45 (53.3%) provider questionnaires were returned. Vaccination acceptance rates were 70.7% for the influenza vaccine and 76.3% for the Tdap vaccine. The logistic regression model indicated that predictors of acceptance for either vaccine in pregnancy are patient attitude and previous vaccination history. Patient attitudes were more favorable towards Tdap than influenza vaccination. The combination of healthcare provider recommendation and educational materials was significantly predictive of both Tdap and influenza vaccine acceptance. The most common reasons given for declining the influenza vaccine were safety concerns; the most common reasons given for declining the Tdap vaccine were that patients did not think it was required again when they received the vaccine before pregnancy. CONCLUSIONS: Our study suggests that providers can improve Tdap and influenza vaccination acceptance in pregnancy by recommending the vaccination in combination with provision of educational materials on the vaccines.

Patterns of milk macronutrients and bioactive molecules across lactation in a western lowland gorilla (Gorilla gorilla) and a Sumatran orangutan (Pongo abelii).

In addition to nutrients, milk contains signaling molecules that influence offspring development. Human milk is similar in nutrient composition to that of apes, but appears to differ in other aspects such as immune function. We examine the longitudinal patterns across lactation of macronutrients, the metabolic hormone adiponectin, the growth factors epidermal growth factor (EGF) and transforming growth factor ß2 (TGF-ß2), and two receptors for these growth factors (EGF-R and TGF-ß2-RIII) in milk samples collected between days 175 and 313 postpartum from a Sumatran orangutan (Pongo abelii) and between days 3 and 1,276 from a western lowland gorilla (Gorilla gorilla), and compare the results with human data from the literature. Milk macronutrients and hormones were measured using standard nutritional assays and commercially available enzyme immunoassay kits. Ape milk fat content was lower than human milk values, but protein and sugar were similar. Concentrations of all bioactive molecules were consistently detectable except for TGF-ß2 in orangutan milk. Concentrations of adiponectin, EGF, and TGF-ß2 in both ape milks were lower than found in human breast milk. Concentrations declined with infant age in orangutan milk; in gorilla milk concentrations were high in the first months, and then declined to stable levels until 2-3 years after birth when they increased. However, when expressed on a per energy basis milk constituent values did not differ with age for orangutan and the variation was reduced at all ages in gorilla. In orangutan milk, the ratio of EGF-R to EGF was constant, with EGF-R at 7.7% of EGF; in gorilla milk the EGF-R concentration was 4.4 ± 0.2% of the EGF concentration through 3 years and then increased. These data indicate that potent signaling molecules such as EGF and adiponectin are present in ape milk at physiological concentrations. However, human breast milk on average contains higher concentrations.

Influenza Vaccination among Pregnant Women: Patient Beliefs and Medical Provider Practices.

ACOG's research department recruited four medical centers to participate in a study on the attitudes and practices of medical providers and pregnant patients regarding influenza vaccination. Medical providers and patients were given voluntary surveys and medical record data was collected over two flu seasons, from 2013 to 2015. Discrepancies between self-reports of medical providers and patients and medical records were observed. Nearly 80% of patients self-reported accepting the influenza vaccine, but medical record data only reported 36% of patients accepting the vaccine. Similarly, all medical providers reported giving recommendations for the vaccine, but only 85% of patients reported receiving a recommendation. Age, education, a medical provider's recommendation, and educational materials were found to positively influence patient beliefs about the influenza vaccine. Accepting the vaccine was influenced by a patient's previous actions, beliefs, and a medical provider's recommendation. Patients who reported previously not accepting the vaccine and had negative feelings towards the vaccine but accepted it while pregnant reported concern for the health and safety of their baby. Future research should focus on groups that may be less likely to accept the vaccine and ways to dispel negative myths. Medical provider should continue to strongly recommend the vaccine and provide educational materials.

Metabolic screening in patients with polycystic ovary syndrome is largely underutilized among obstetrician-gynecologists.

Women with polycystic ovary syndrome have substantially higher rates of insulin resistance, impaired glucose tolerance, type 2 diabetes, dyslipidemia, and metabolic syndrome when compared with women without the disease. Given the high prevalence of these comorbidities, guidelines issued by the American College of Obstetricians and Gynecologists and the Endocrine Society recommend that all women with polycystic ovary syndrome undergo screening for impaired glucose tolerance and dyslipidemia with a 2 hour 75 g oral glucose tolerance test and fasting lipid profile upon diagnosis and also undergo repeat screening every 2-5 years and every 2 years, respectively. Although a hemoglobin A1C and/or fasting glucose are widely used screening tests for diabetes, both the American College of Obstetricians and Gynecologists and the Endocrine Society preferentially recommend the 2 hour oral glucose tolerance test in women with polycystic ovary syndrome as a superior indicator of impaired glucose tolerance/diabetes mellitus. However, we found that gynecologists underutilize current recommendations for metabolic screening in women with polycystic ovary syndrome. In an online survey study targeting American College of Obstetricians and Gynecologists fellows and junior fellows, 22.3% of respondents would not order any screening test at the initial visit for at least 50% of their patients with polycystic ovary syndrome. The most common tests used to screen for impaired glucose tolerance in women with polycystic ovary syndrome were hemoglobin A1C (51.0%) and fasting glucose (42.7%). Whereas 54.1% would order a fasting lipid profile in at least 50% of their polycystic ovary syndrome patients, only 7% of respondents order a 2 hour oral glucose tolerance test. We therefore call for increased efforts to encourage obstetrician-gynecologists to address metabolic abnormalities in their patients with polycystic ovary syndrome. Such efforts should include education of physicians early in their careers, at the medical student and resident level. Efforts should also include implementation of continuing medical education activities, both locally and at the national level, to improve understanding of the metabolic implications of polycystic ovary syndrome. Electronic medical record systems should be utilized to generate prompts for appropriate screening tests in patients with a diagnosis of polycystic ovary syndrome. Because obstetrician-gynecologists may be the only physicians seen by many polycystic ovary syndrome patients, particularly those in their young reproductive years, such interventions could effectively promote optimal preventative health care and early diagnosis of metabolic comorbidities in these at-risk women.

Surgical Techniques at Cesarean Delivery: A U.S. Survey.

Objective To assess the frequency of surgical techniques at cesarean delivery (CD) among U.S. obstetricians. Methods Members of the American College of Obstetrician Gynecologists were randomly selected and e-mailed an online survey that assessed surgical closure techniques, demographics, and reasons. Data were analyzed using SPSS (IBM Corp., Armonk, New York, United States), descriptive statistics, and analysis of variance. Results Our response rate was 53%, and 247 surveys were analyzed. A similar number of respondents either "always or usually" versus "rarely or never" reapproximate the rectus muscles (38.4% versus 43.3%, p = 0.39), and close parietal peritoneum (42.5% versus 46.9%, p = 0.46). The most frequently used techniques were double-layer hysterotomy closure among women planning future children (73.3%) and suturing versus stapling skin (67.6%); the least frequent technique was closure of visceral peritoneum (12.2%). Surgeons who perform double-layer hysterotomy closure had fewer years in practice (15.0 versus 18.7 years, p = 0.021); surgeons who close visceral peritoneum were older (55.5 versus 46.4 years old, p < 0.001) and had more years in practice (23.8 versus 13.8 years practice; p < 0.001). Conclusion Similar numbers of obstetricians either reapproximate or leave open the rectus muscles and parietal peritoneum at CD, suggesting that wide variation in practice exists. Surgeon demographics and safety concerns play a role in some techniques.

Knowledge, Attitudes, and Practices of Obstetrician-Gynecologists Regarding Influenza Prevention and Treatment Following the 2009 H1N1 Pandemic.

BACKGROUND: Pregnant women are at increased risk for complications associated with influenza. Influenza vaccination during pregnancy helps protect both pregnant women and infants less than 6 months of age from contracting the flu. This study investigated influenza prevention and treatment practices of obstetrician-gynecologists (ob-gyns) during the influenza season immediately following the 2009-2010 H1N1 season. METHODS: In 2011, surveys were sent to two groups of Fellows of the American College of Obstetricians and Gynecologists. Group 1 was 907 ob-gyns who responded to our previous survey on practice and knowledge of influenza vaccination, diagnosis, and treatment during the 2009-2010 H1N1 influenza pandemic. Group 2 was 2,293 new recipients randomly selected from the American College of Obstetricians and Gynecologists database. Data were analyzed in 2013. RESULTS: A high proportion of pregnant patients were reported to be vaccinated against influenza (71.7%); however, the data suggest that in general preventative practices decreased between the 2009-2010 H1N1 season and 2010-2011 season. A higher proportion of women eligible for Medicaid in a practice was associated with a lower estimate of vaccination rate. Ob-gyns with more than 20 years of practice were more likely to be concerned about the risks of antivirals and less likely to routinely prescribe them. CONCLUSIONS: Ob-gyns may be overestimating the proportion of pregnant women being vaccinated. The gains in vaccination and influenza prevention practices from the H1N1 pandemic have not been completely retained. Discrepancies in the use of anti-virals to treat suspected or confirmed influenza in pregnant patients exist and need to be addressed.

Proximate composition of milk of the bongo (Tragelaphus eurycerus) in comparison to other African bovids and to hand-rearing formulas.

African bovids represent a highly diverse group with divergent neonatal care strategies. The extent to which their milks reflect this diversity is poorly understood. We analyzed milk of the bongo (Tragelaphus eurycerus) to compare its composition to milks of other African bovids and to evaluate bongo milk replacement formulas. Milk samples from three individuals (0 through 300 days postpartum, n = 28) were assayed for dry matter (total solids), crude fat, crude protein, total sugar, ash, calcium, and phosphorus; gross energy was assayed on a subset of samples and compared to calculated values. Nutrient composition changed very little over the lactation period except for day 0 (colostrum) and the last sample (day 300). Bongo milk (days 6-286) contained (mean ± SEM): 28.1 ± 0.7% dry matter (71.9 ± 0.7% water), 12.3 ± 0.6% fat, 10.6 ± 0.3% crude protein, 3.6 ± 0.1% sugar, 1.05 ± 0.03% ash, 0.26 ± 0.01% calcium, 0.16 ± 0.01% phosphorus, and a GE of 1.88 ± 0.06 kcal/g. The protein content of bongo milk accounts for 33% of energy. High protein energy appears to be typical of Tragelaphines and of African bovids that utilize a "hider" system of postnatal care. The stability of milk composition until day 300 suggests complete weaning may not occur until 9 months rather than at 6 months of age, as commonly assumed. None of the milk replacement formulas previously used for bongos was well matched to bongo milk composition; therefore, a new milk replacement formula is proposed.