The New Hampshire Perinatal Program: twenty years of perinatal outreach education.

OBJECTIVE: To describe 20 years of regional outreach education by the New Hampshire Perinatal Program, its interaction with all 26 community hospitals in the state with maternity services and an additional four in adjoining Vermont. STUDY DESIGN: This paper describes educational initiatives responsive to the needs of perinatal physicians and nurses. The core of the program is the transport conference held annually at each referring hospital in which maternal-fetal and infant referrals are discussed. There are additional community hospital-based programs, programs at convenient locations in the region and medical center conferences and skills programs. RESULTS: The program annually awards 10,000 continuing medical education credits (CME) and nursing contact hours. Evaluation and feedback from all participants is encouraged. New Hampshire has one of the lowest perinatal mortality rates in the county, which reflects in part the accomplishments of the program. CONCLUSION: Perinatal outreach education is a shared responsibility of providers in both the academic center and community hospitals and is necessary to ensure optimal care for mothers and infants.     

A multicultural and multilingual outreach program for cervical and breast cancer screening

Partners in Health: The Breast and Cervical Health Cooperative is a New Orleans-based community health intervention program designed to increase the access of underserved multicultural, multiethnic, and multilingual women to cervical and breast cancer health education and screening. This article describes innovative approaches used over the past 4 years to successfully link the services of a university cancer center to women in the community through a culturally sensitive outreach program. In addition to cancer screening, health referrals were made for many other diverse medical/social complications such as hypertension, obesity, and violence. The program initially targeted African American women but during the past year has successfully integrated Latinas. Key to the program's success was the collaboration of community lay health educators, community churches, advanced practice nurses, and public health programs. This article provides an overview of program strategies and outcomes and discusses multicultural and multilingual issues.     

Establishment of a collaborative university-commercial maternal serum alpha-fetoprotein screening program: a model for tertiary center outreach

Expansion of the availability of tertiary level services beyond major medical centers has proved to be a major problem in health care delivery. Routine maternal serum alpha-fetoprotein screening for neural tube defects, and now also for aneuploidy, is a classic example in which there has been a schism between the clinical expertise to manage such a program within a tertiary level reproductive genetics center and the ability to reach patients in regions that are not routinely accessible to the tertiary center. To address this problem we have established a collaborative university-commercial laboratory statewide maternal serum alpha-fetoprotein program that we believe can serve as a model for others. In the first 4 months since its implementation, the program volume has increased tenfold. The detection frequency of neural tube defects has been consistent with that of other programs (1/1690). Three aneuploid karyotypes were found in amniotic fluid of 118 women less than 30 years old who underwent genetic amniocentesis because of a low maternal serum alpha-fetoprotein value. Thus we conclude that: the establishment of a joint university-commercial maternal serum alpha-fetoprotein program may provide a successful model for efficient tertiary center outreach, assessment of our data suggests that a population at high risk for abnormal fetuses can be identified among patients not generally considered at high risk, low maternal serum alpha-fetoprotein values may likely be a more important public health measure than high ones.     

A variety of outreach and follow-up workers play an important role in Philippine church's program

3 programs to implement family planning have been set up by the Iglesia Ni Cristo (INC), an indigenous Christian sect with 4fmillion adherents in the Philippines. The Vigilante program began in 1975 with 34 specially trained nurses and paraprofessionals stationed in parish churches to recruit family planning acceptors, follow-up women with complaints, and treat minor complaints. Major problems are sent to medical centers. Between August 1975-September 1976 Vigilantes recruited 36,621 new clients, including almost 500 sterilization referrals. About 1/2 the new clients chose condoms, 1/3 the pill. These nurses also inserted IUDs. Pill Counselors also engage in motivational work. They are not stationed at an individual church but are in neighborhoods where they are needed. 4 special workers have been trained to recruit vasectomy acceptors. All 4 are young unmarried women but they have had good success. In 1975-1976 they recruited almost 1000 vasectomy acceptors and 350 minilaparotomy acceptors in addition to supplying 300 men and women with condoms and pills. Because 1 of their hardest jobs is convincing men that sterilization will not affect their sexual powers they have been nicknamed "machismo wreckers." Saturation teams are trained groups of 9 persons each which concentrate on a small area at a time. Before they begin the area is surveyed by a field coordinator who calls on the local leader and seeks local assistance. When the team leaves, it leaves additional supplies with this leader and these supplies are replenished from time to time. INC chapels also carry supplies. In addition to family planning, INC sponsors programs to assist young people and farmers, and has nutrition education, low-cost housing, and health care programs.     

Reproductive health education program for Mexican women

Abstract

Objective: Improve knowledge, attitudes and reproductive behaviours through an educational intervention aimed at reproductive health in two groups of Mexican women.

Materials and methods: We carried out an education program targeting two segments, indigenous women and marginalised adolescents, with a pre-test, immediate post-test and post-test six months after it was carried out. Instruments used: a reproductive health history was established (pre-test and post-test six months) and a questionnaire of knowledge, attitude and conduct related to reproductive health and condom use (pre-test, immediate post-test and post-test six months).

Results: Improved test scores in reproductive health and condom use – knowledge, attitude and conduct, were notable in the group of indigenous women (p?<?.05). However, in the group of adolescents there was a significant increase (p?<?.05) only in reproductive health – knowledge and attitude; in condom usage, increase was only noted in knowledge and conduct, not in attitude (pre-test vs immediate post-test). Six months after post-test results there was a decrease in test scores in comparison with the immediate post-test results. They were however, higher than the pre-test scores.

Conclusions: Both groups significantly increased short-term knowledge, attitude and conduct related to reproductive health and condom use through the implementation of an education program. Results show that this education program can contribute to the development of an effective education program.     

Retention of basic laparoscopic skills after a structured training program

The purpose of this study was to test the retention of basic laparoscopic skills on a box trainer 1 year after a short training program. For a prior study, eight medical students without prior experience (novices) underwent baseline testing, followed by five weekly training sessions and a final test. During each of seven sessions, they performed five tasks on an inanimate box trainer. Scores were calculated by adding up the time to completion of the task with penalty points, consequently rewarding speed and precision. The sum score was the sum of the five scores. One year later, seven of them underwent retention testing for the current study. The final test results were compared with retention test results as a measure of durability of acquired skills. Novices’ scores did not worsen significantly for four out of five tasks (i.e., placing a pipe cleaner p = 0.46, placing beads p = 0.24, cutting a circle p = 0.31, and knot tying p = 0.13). However, deterioration was observed in the performance on stretching a rubber band (p < 0.05), as well as in the sum score (p < 0.05). Nevertheless, all retention scores remained better than the baseline results. In conclusion, basic laparoscopic skills acquired during a short training program merely sustain over time. However, ongoing practice is advisable, especially to preserve tissue-handling skills, since these may be the first to deteriorate.     

Defining a structured training program for acquiring basic and advanced laparoscopic psychomotor skills in a simulator

The effect of different structured training programs on basic laparoscopic psychomotor skills (LPS), as assessed by hand–eye coordination (HEC), and on advanced LPS, as assessed by laparoscopic intracorporeal knot tying (LICK), was evaluated. Sixty gynecologists without laparoscopic experience were randomly allocated to three groups for different HEC training and similar LICK training. During HEC training, group 1 (G1) trained the dominant hand (DH) and the nondominant hand, G2 trained the DH only, and G3 did not train at all. All groups then underwent LICK training. HEC and LICK training consisted of 60 repetitions of the relevant task. All participants were tested at the beginning of the study (T1), before LICK training (T2), and after LICK training (T3). The time to correctly performed exercise was scored. The groups had comparable scores at T1. At T2, G1 and G2 improved their relevant HEC scores (both hands in G1, DH in G2), and LICK scores improved according to the previous HEC training (G1 > G2 or G3 and G2 > G3). At T3, all groups further improved their LICK scores up to the same level. The LICK training did not provide any additional improvement in HEC for G1 and G2, but it further improved HEC for G3, though not up to the same level of the other groups. This study confirms that training improves laparoscopic skills and indicates that many repetitions are required for reaching proficiency. Full acquisition of LPS (e.g., HEC) facilitates the acquisition of more complex laparoscopic tasks (e.g., LICK). Mastering LICK is not sufficient for acquiring HEC skills, the clinical relevance of which still needs to be evaluated. Mastering both skills before starting a training program in the operating theater is advisable.     

Perinatal tuberculosis in a three-month-old infant.

Perinatal tuberculosis is a rare disease with a high mortality rate and is difficult to diagnose. We report a case of perinatal tuberculosis diagnosed by postmortem study at the age of 3 months. An 83-day-old male infant presented with cough for 3 weeks and intermittent fever for 1 week. A focal tonic convulsion occurred on the day of admission. Physical examination revealed failure to thrive, tachypnea, and marked hepatosplenomegaly. Chest roentgenogram showed bilateral nodular alveolar-interstitial infiltrates. Abdominal computed tomography showed multiple nodules in the liver and spleen as well as lymphadenopathy in the hepatic portal hilum. Antituberculous therapies were prescribed on the second hospital day. The patient died from respiratory failure on the sixth hospital day. Mycobacterium tuberculosis was cultured from gastric aspirates and cerebrospinal fluid 4 weeks after inoculation. Postmortem examination revealed disseminated necrotizing granulomas in several organs and tissues, including the porta hepatis lymph nodes, a primary hepatic complex. M. tuberculosis infection was diagnosed in his mother based on positive findings of Mautoux test and chest roentgenogram. This case illustrates that tuberculosis, though rare, still should be considered in poor-weight-gain neonates with cough, fever, and/or hepatosplenomegaly. Careful maternal and other family contact history is essential to establishing the diagnosis.     

Perinatal listeriosis. A report of six cases

Summary. The clinical and pathological findings in six patients with perinatal listeriosis are presented. One pregnancy resulted in a liveborn infant who developed listerial septicaemia but made a complete recovery following prompt treatment. The other pregnancies ended in intrauterine death. Often antecedent maternal prodromal illness preceded expulsion of a macerated fetus by only a matter of hours making early diagnosis difficult. In all cases the diagnosis of listerial infection was apparent only after the birth of the fetus or new born.     

Perinatal listeriosis. A report of six cases

The clinical and pathological findings in six patients with perinatal listeriosis are presented. One pregnancy resulted in a live-born infant who developed listerial septicaemia but made a complete recovery following prompt treatment. The other pregnancies ended in intrauterine death. Often antecedent maternal prodromal illness preceded expulsion of a macerated fetus by only a matter of hours making early diagnosis difficult. In all cases the diagnosis of listerial infection was apparent only after the birth of the fetus or new born.     

Perinatal outcome for women in prison.

Pregnancy outcome for 233 women in prison was reviewed. This group of patients presented with multiple perinatal high-risk factors: history of illicit drug use (71%), smoking (70%), and obstetrical (27%), medical (21%), nutritional (20%), and infectious complications (20%). Maternal morbidity was uncommon and the overall cesarean section rate for all prisoners was 16%. There was 1 stillbirth and 236 live-born infants, all of whom were discharged in good health. Prematurity (3%) and delivery of small-for-gestational-age (SGA) (8%) infants was less common among 187 women who received adequate prenatal care than in 46 prisoners with poor or late prenatal care (prematurity 20% and SGA 28%). Good perinatal outcome for women in prison can be achieved if comprehensive prenatal care is available.