Effects of early breastfeeding on neonatal glucose levels of term infants born to women with gestational diabetes.

BACKGROUND: Infants born to diabetic women are at higher risk for hypoglycaemia related to hyperinsulinism in response to maternal hyperglycaemia during pregnancy. As such, recommendations to prevent neonatal hypoglycaemia include infant feeding in the early postpartum period. The present study aimed to examine the effect of early breastfeeding and type of nutrition used for the first feed (human milk or formula) on glucose levels in infants born to women with gestational diabetes. METHODS: The prospective pilot study of 84 infants born to gestational diabetic women examined the glycaemic levels of infants who were breastfed in the delivery room compared to glycaemic levels of those who were not. The study also compared the glycaemic levels of infants who breastfed with those who received formula for their first feed. RESULTS: Infants who were breastfed in the delivery room had a significantly lower rate of borderline hypoglycaemia than those who were not breastfed in the early postpartum period (10% versus 28%; Fisher's exact test., P = 0.05,). Likewise, infants breastfed in the delivery room had significantly higher mean blood glucose level compared to infants who were not breastfed in the delivery room (3.17 versus 2.86 mmol L(-1), P = 0.03). Additionally, breastfed infants had a significantly higher mean blood glucose level compared to those who were formula fed for their first feed (3.20 versus 2.68 mmol L(-1), P = 0.002). CONCLUSIONS: Early breastfeeding may facilitate glycaemic stability in infants born to women with gestational diabetes.

Gestational diabetes complicated by hydramnios was not associated with increased risk of perinatal morbidity and mortality.

OBJECTIVE: To determine whether gestational diabetes (GDM) complicated with hydramnios is associated with higher rates of perinatal morbidity and mortality than those with normal amniotic fluid (AFI). STUDY DESIGN: A case control study of 368 pregnant women with GDM was conducted between January 1995 and December 1996. The study group consisted of 184 women with hydramnios (AFI>25 cm) that were matched for maternal age, parity, and gestational age to 184 women with gestational diabetes and normal AFI. A Student's t-test, McNemar test and logistic regression test were used to compare the two groups. RESULTS: Both groups were under strict metabolic control; mean glucose levels of 5.2+/-2.4 mmol/l in the study group and 5.5+/-2.4 mmol/l in the controls (P>0.05). There were no significant differences between groups in the rates of severe preeclampsia, premature rupture of membranes (PROM), cesarean section rate, intrauterine growth restriction (IUGR), antepartum fetal death, fetal distress, prolapse of umbilical cord and placenta abruption. Even though the prevalence of large for gestational age (LGA) and birth weight were significantly higher in the study group (31 versus 19% and 3441+/-477 versus 3232+/-554 g, respectively), the prevalence of neonatal trauma was the same in both groups (2.6%). There was no significant difference in the Apgar scores (1 and 5 min), newborn hypoglycemia, metabolic acidosis and hyperbilirubinemia. CONCLUSIONS: Hydramnios in women with GDM was not associated with increased risk of perinatal morbidity and mortality.

Mycobacterial cervical lymphadenitis: the histological features of non-tuberculous mycobacterial infection.

AIMS: The distinction between nontuberculous mycobacterial (NTM) lymphadenitis and other causes of cervical lymphadenitis is critical, as different entities call for different treatments. Despite modern diagnostic techniques for NTM infections their prompt and accurate diagnosis is still difficult. We assessed the value of different histological features in diagnosing clinically suggestive NTM cervical lymphadenitis in cases of granulomatous cervical lymphadenitis. METHODS AND RESULTS: A retrospective study of 30 patients with a clinical diagnosis of NTM cervical lymphadenitis was carried out. The patients were divided into three subgroups and several histological parameters were examined in each subgroup. A comparison was made with cases of proven tuberculous lymphadenitis. Four histological features (presence of microabscesses, ill-defined granulomas, noncaseating granulomas and a small number of giant cells) were found with significant statistical difference when comparison was made between the NTM group and the tuberculosis group. CONCLUSIONS: A rapid and accurate diagnostic procedure for NTM lymphadenitis is not yet available. Therefore, in the presence of a suggestive clinical picture for NTM lymphadenitis, we propose four histological features which support this diagnosis, thus allowing prompt therapeutic intervention.

How automatic is manual gear shifting?

Manual gear shifting is often used as an example of an automated (vs. controlled) process in driving. The present study provided an empirical evaluation of this assumption by evaluating sign detection and recall performance of novice and experienced drivers driving manual shift and automatic transmission cars in a downtown area requiring frequent gear shifting. The results showed that manual gear shifting significantly impaired sign detection performance of novice drivers using manual gears compared with novice drivers using an automatic transmission, whereas no such differences existed between the two transmission types for experienced drivers. The results clearly demonstrate that manual gear shifting is a complex psychomotor skill that is not easily (or quickly) automated and that until it becomes automated, it is an attention-demanding task that may impair other monitoring aspects of driving performance. Actual or potential applications of this research include a reevaluation of the learning process in driving and the need for phased instruction in driving from automatic gears to manual gears.

Crisis intervention for community-based individuals with developmental disabilities and behavioral and psychiatric disorders.

When individuals with a developmental disability experience a behavioral or psychiatric crisis, their community placement may be threatened. A model crisis intervention program for individuals with dual diagnoses was discussed and performance and outcomes of such a service for 267 children and adults reviewed. Analysis indicated that 69% of the individuals required only one crisis intervention. Of the 31% requiring two or more, nearly all were re-referred earlier than 2 years post initial crisis intervention. The central, gulf-bridging role of a crisis intervention service in a comprehensive, coordinated, community-based mental health system for dually diagnosed individuals was discussed.

Characteristics of community-based individuals with mental retardation and aggressive behavioral disorders.

A cohort of 199 individuals with mental retardation referred for behavioral and psychiatric crisis intervention services was studied to determine attributes differentiating physically aggressive behavior from other behavioral problems. Individuals with aggressive and nonaggressive behavior had similar neurological histories and current medical status and similar levels of seizure disorders and CNS abnormalities. Aggressive individuals more often had psychiatric diagnoses of organic brain syndrome, but frequencies of this diagnosis in each group were small. Current aggression was predicted by gender, level of mental retardation, and history of previous institutional placement; the strongest predictor was history of aggression. These data suggest a complex equation to describe social inadequacy involving interactions between CNS functioning and developmental cognitive and social variables that are only partially defined at this time. Further work to characterize this interaction almost certainly must include a prospective longitudinal analysis of social and developmental functions early in life.

Prevalence of Chlamydia pneumoniae antibodies in patients with acute respiratory infections in Israel.

AIMS: To evaluate the prevalence of antibodies to Chlamydia pneumoniae (TWAR) in relation to other aetiological agents of acute respiratory infections in Israeli patients. METHOD: Serum samples from 604 patients (183 children and 421 adults) were collected over three years. Antibodies to C pneumoniae, C trachomatis, and Legionella sp were evaluated using the microimmunofluorescence (MIF) assay. Antibodies to Mycoplasma pneumoniae were detected using the Serodia Myco II test. RESULTS: Antibodies to TWAR were detected in 319 (51.3%) sera. Twenty one patients had MIF results indicative of recent infection. TWAR prevalence and antibody titres in children (aged 1-10 years) were low, gradually increased in teenagers (11-18 years), and were highest in adults and elderly patients. In contrast to the consistently noted TWAR antibody prevalence and serological evidence of recent infection during the study period, a significant decrease in those variables was recorded for C trachomatis. Six patients had serological evidence of recent infection with both C pneumoniae and C trachomatis. The presence of antibodies to Mycoplasma pneumoniae and Legionella sp was tested in 473 of the patients; 29 had antibodies to M pneumoniae and 23 to Legionella sp. Six patients (including five children) had serological evidence of recent infection with M pneumoniae and four with Legionella sp. CONCLUSION: C pneumoniae should be considered in patients with acute respiratory diseases. MIF is the preferred method for monitoring the presence of antibodies to this organism.

Premature delivery of small versus appropriate-for-gestational-age neonates. A comparative study of maternal characteristics.

Prematurity and growth retardation of the fetus are major factors affecting perinatal outcome. The purpose of this study was to compare maternal characteristics of 63 women who delivered a preterm, small-for-gestational-age (SGA) neonate with those of 63 women matched for parity and gestational age who delivered a preterm, appropriate-for-gestational-age (AGA) neonate. All women delivered at the Soroka Medical Center between January 1, 1985, and December 31, 1990. Mothers of SGA neonates were more likely than those of AGA neonates to be over the age of 35 years (P = .043), to have hypertensive disorders and oligohydramnios (P < .001), to have induced labor (P < .001) and to deliver by cesarean section (P < .001). In addition, they had a higher rate of morbidity in the puerperium (P = .015) and were more likely to have longer hospitalization (P = .002). In contrast, previous preterm deliveries were significantly more common in the AGA group than in the SGA group (P = .034). The results of this study indicate that women who deliver preterm SGA neonates belong to a special subgroup with unique characteristics in comparison to those who deliver preterm AGA neonates.

Obstetric performance in Ethiopian immigrants compared with Israeli parturients.

It was the aim of this study to evaluate the obstetric performance of Ethiopian Jewish immigrants in comparison to the general Jewish obstetric population. The study was performed at the Soroka Medical Center, Beer Sheva, which manages the busiest delivery ward in Israel. Between 1988 and 1991 a total of 20,047 non-Ethiopian women (Group N) and 431 parturients of Ethiopian origin (group E) delivered at the Soroka Medical Center. Group E included a significantly higher percentage of grandmultiparous women than group N. Among diseases complicating pregnancy there was a statistically significant higher incidence of severe pregnancy-induced hypertension (PIH) in group E than in group N. Mild PIH and chronic hypertension were of comparable prevalence in both groups. The prevalence of class A diabetes mellitus was significantly lower in group E than in group N; the same trend was also observed for diabetes class B but without reaching statistical significance. There was no significant difference between the groups in the prevalence of polyhydramnios, postdatism and poor obstetric history, or fetal distress, s/p cesarean section, and prolapse of cord. Statistical analysis indicated a tendency towards significance for higher prevalence of premature rupture of membranes in group N. Malpresentations and malpositions were of similar prevalence in both groups. The incidence of premature delivery in group E showed a higher relative risk, suggesting a tendency of significance. The incidence of meconium-stained amniotic fluid in group E was significantly higher than in group N. There was no significant difference in the prevalence rates of placental complications such as placenta previa and abruption of placenta between the groups. The mode of delivery, the prevalence of complications during the third stage of labor, birthweight of infants and perinatal mortality were similar for both groups. In conclusion, the obstetric performance in Ethiopian Jewish immigrants is surprisingly similar to that of Israeli Jewish parturients. The only prominent pathology that does not seem to be related to life-style and nutrition is pregnancy-induced hypertension.

Relatively reduced values of plasma alpha-fetoprotein at early second trimester of pregnancies with hypertensive disorders.

Hypertensive disorders during pregnancy implicate placental pathologic conditions, which may interfere with the normal passage of alpha-fetoprotein (AFP) to the maternal blood. We compared the levels of maternal serum (MS) in early second trimester of pregnancies complicated by hypertensive disorders with those of matched controls. The distribution in the study group of MS-AFP multiple of median values was significantly different from the distribution in the control group. Moreover, up to multiple of the median 1.00, the number of hypertensive patients was larger than the number of normotensive pregnant women. The mean level of multiples of the median in the study group was significantly lower than that of the control group (p value = 0.003, 95% confidence interval: -0.30, -0.05). In the analysis of the distinct types of hypertension, the difference remained significant for 85 women in the moderate hypertension subgroup (p value = 0.032, confidence interval: -0.34, -0.02) and was not significant for the severe hypertension subgroup of 22 women (p value = 0.24, 95% confidence interval: -0.57, 0.15) and chronic hypertension subgroup of women (p value = 0.52, 95% confidence interval: -0.44, 0.00). The trend was consistent in all the subgroups. Relatively low values of maternal serum AFP at early second trimester of pregnancies with hypertensive disorders may be a result of placental pathologic involvement and can help in the identification of the women at risk.

Chronic suppurative otitis media without cholesteatoma in children in southern Israel: incidence and risk factors.

The incidence and risk factors for chronic suppurative otitis media without cholesteatoma in children in Southern Israel were determined by comparing 88 children with the disease to 76 controls with similar age distribution who visited 3 clinics serving representative populations of the region. Data were collected during the child's visit to the clinic by means of a structured interview with the parents and by extracting information from medical records. The calculated yearly incidence was 39/100,000 children 0 to 15 years of age. Significantly increased risk for chronic suppurative otitis media was associated with a history of acute and recurrent otitis media, a parental history of chronic otitis media, larger families and more siblings, a higher crowding index and care in large daycare centers. The sex, parental age and education, allergy, sinusitis and recurrent upper respiratory tract infections were not associated with chronic suppurative otitis media.

[Anemia in children: hemoglobin changes in mild, acute infections].

Anemia is commonly discovered in children when a complete blood count is routinely performed during acute and febrile illnesses. In this study-recovery of hemoglobin levels in children after acute infections was evaluated. Hemoglobin levels were measured in capillary blood of 70 patients who visited a community primary pediatric clinic with an acute infectious illness (37 boys, 33 girls; mean age 22 months, mode 18; 58 had fever of 38 degrees or higher). The most frequent diagnoses were upper respiratory tract infection, acute otitis media and pharyngitis. Follow-up hemoglobin measurements were performed after at least 3 days without fever and when the children were considered well by their parents. The average time between the 2 measurements was 12 +/- 9 days.

The structure of spatial ability items: a faceted analysis.

800 individuals were given a battery of 8 spatial tests which had been assembled with the aid of a mapping sentence of four content facets: rule type, dimensionality, presence or absence of rotation, and test format. An intercorrelation matrix of 49 items from these tests was analyzed by Smallest Space Analysis, SSA-I. All three facets formed distinct regions in a two-dimensional projection of a three-dimensional space. It is suggested that further facets be hypothesized to elaborate on the structure of spatial abilities.

Sexual knowledge, attitudes, and practice of Israeli adolescents.

A study of 4,976 high-school students in Israel, representative of this age group for the entire country except for 13 percent who attend religious schools, revealed that about one-third of the boys aged 14-15 and almost one-half of those in the 16-17 age category have had sexual intercourse. The respective figures for girls are 6 percent and 16 percent. Age at onset of sexual activity was found to be higher and the level of knowledge about the same as in reports from the Western world. Students of Oriental origin, as well as those considering themselves religious or traditional tended to be less active sexually, more conservative in their attitudes, and less knowledgeable. In contrast, students of both sexes residing in kibbutzim were found to be more active sexually and more knowledgeable. A double standard for girls was accepted, especially among the female respondents, except in the kibbutzim. A subgroup of girls highly sexually active, in contrast to their own attitudes, has been identified, and possible reasons for this discordance discussed. As sexual activity among teenagers is becoming more prevalent, comprehensive and early sex education school programs should be encouraged.

PIP: A study of 5198 high school students in Israel, representative for this age group for the entire country, except for 13% who attend religious schools, revealed that about 1/3 of the boys aged 14-15 years, and almost 1/2 of those aged 16-17 years have had sexual intercourse. The boys' level of knowledge was higher than the girls', older students were better informed than younger ones, and kibbutz and regular school students fared better than students in vocational or agricultural schools. Students of Oriental origin, as well as those considering themselves religious or traditional tended to be less active sexually, more conservative in their attitudes, and less knowledgeable. More than 80% of the sexually active girls had intercourse with just 1 partner while only 40% of the boys so reported. Reasons for first intercourse included love, sexual drive, curiosity, and unpremeditated action. Only 1/3 of the sexually active girls and 1/2 of the sexually active boys used contraceptives; the most prevalent reasons for this were, "I was not prepared," and "I did not think of it." Pregnancy occurred before the age of 16 in more than 75% of all the girls who became pregnant. A double standard was very evident among all sex/age groups, but more so among the girls. A subgroup of sexually active girls, in contrast to their attitudes, was identified. As adolescent sexual activity is on the increase, early and comprehensive sex education school programs should be encouraged.