Neonatal outcomes following planned preterm delivery in diabetic mothers.

OBJECTIVE: Women with diabetes may need elective preterm delivery due to pregnancy or diabetes related complications. The aim of this study was to describe the neonatal outcomes arising from elective preterm delivery in diabetic women. METHOD: Suitable patients were identified by the obstetric team at Hull Royal Infirmary Women and Children's Hospital and data was extracted from their case notes. 45 diabetic women with planned preterm delivery were identified within a set time frame, resulting in 48 babies. RESULTS: Of the 48 babies born, 47 survived. 36 out of 48 were delivered via caesarean section. Gestational ages ranged from 29+3 to 36+6 weeks, and 24 out of 48 (50%) had a birth weight greater than the 90th centile for gestational age.34 out of the 48 babies experienced some form of neonatal complication and were admitted to the neonatal unit. The median duration of stay in the neonatal unit was 7 days. 14 of the surviving neonates suffered from respiratory distress, although only 4 required surfactant therapy to regain respiratory function. However, the incidence of serious neonatal complications in those born after 34 weeks was shown to be low. CONCLUSIONS: Elective preterm delivery after 34 weeks had little effect on overall neonatal outcome. Therefore it could be proposed that elective preterm delivery after 34 weeks gestation may be an acceptable option in diabetic women if there are maternal or obstetric complications.

Elderly African-Americans and the influenza vaccine: the impact of the primary care physician.

BACKGROUND: Despite recommendations for annual vaccinations against influenza, many older African-Americans do not receive this vaccine. For 1 month in our private medical offices, we conducted a survey to estimate the vaccination rate for our practice, the reasons why older African-Americans declined to be vaccinated, and any impact we could make on their misconceptions about its safety and efficacy. SETTING: The study was conducted in a three-physician private practice of geriatric/internal medicine in the borough of Queens, New York. PARTICIPANTS: 231 consecutive community-residing patients aged 65 or older were evaluated starting in October 1999. METHODS: A total of 231 patients aged 65 to 96 were given a questionnaire asking if they planned to or had already received the influenza vaccine for the 1999-2000 season. Those who had no intention of taking the vaccine were asked why. Categories included: Vaccine not recommended/not recommended strongly enough, vaccine has no benefit, I became ill after being vaccinated, too afraid, I heard it makes people sick, no special reason, allergy to eggs, never had the flu. Those who refused had a brief discussion with their physician and it was noted whether they agreed later to be vaccinated. Ten patients who were not black were excluded. RESULTS: Forty-four percent (98/221) of patients intended to be vaccinated before discussion with their physician. After discussion with their physician about potential side effects, efficacy,safety, the percentage rose to 63% (139/221). This compares favorably with the national health objective of 60% or greater for the year 2000 in this population. CONCLUSIONS: The primary care physician had a significant impact on the increase of the influenza vaccination rate among older African-Americans in our study from 44 to 63%.

A sex comparison of increments in FOS immunoreactivity in forebrain neurons of gonadectomized, testosterone-treated rats after mounting an estrous female.

The protein product of the immediate-early gene, c-fos, was visualized immunocytochemically in forebrain neurons of gonadectomized male and female rats which were injected daily with testosterone propionate (TP) and either tested for mounting directed toward a sexually receptive female or left alone in a test arena. Lidocaine anesthetic paste was applied to the genital region of all subjects in an attempt to reduce the incidence of intromissive behavior patterns. In this way we hoped to compare the relative contribution in the two sexes of vomeronasal/olfactory, as opposed to genital/somatosensory, stimuli to mounting-induced forebrain Fos immunoreactivity (FOS-IR). Males displayed high levels of mounting, with very few intromissions; females displayed a similar level of mounting coupled with a significantly higher number of intromissive behavior patterns than males. Significant increments in the number of FOS-IR neurons were seen in the medial amygdala (mAMYG) and medial preoptic area (mPOA) of males and females killed 1 h after testing. In experiment 2, ovariectomized, TP-treated females were given a unilateral lesion of the olfactory peduncle and subsequently tested with an estrous female as in Experiment 1. Unilateral lesions significantly reduced the number of FOS-IR neurons counted in the ipsilateral piriform (primary olfactory) cortex, but failed to attenuate the ability of stimuli associated with mounting an estrous female to augment FOS-IR in ipsilateral mAMYG or mPOA neurons. The results suggest that vomeronasal/olfactory stimuli were primary determinants of the mounting-induced increments in neuronal FOS-IR observed in males, whereas in females a combination of genital/somatosensory and olfactory/vomeronasal stimuli account for the observed induction of forebrain FOS-IR.