Insufficient prenatal care in Finland and Baden-Wurttemberg: Characteristics of women and infant outcome

The amount of prenatal care and the relationship between insufficientprenatal care, mothers' characteristics and infant outcome werestudied in Finland and in Baden-Württemberg, Germany. Themain sources of data were the Finnish Medical Birth Register(N=193,659) and the Perinatal Survey of Baden-Württemberg(N=307,152) in 1991–1993. Insufficient prenatal care wasdefined as no visits, 1 or 2 visits or late attendance. Mostof the women - also those in the risk groups for low use ofcare (foreigners, young mothers, grand multiparas, single mothersand women with a poor social status) - were using prenatal careextensively. The proportion of women having insufficient carewas 3.4% in Finland and 8.1% in Baden-Württemberg, mostof them being late attenders. Among women with insufficientcare, 39% in Finland and 55% in Baden-Württemberg werefrom the risk groups identified. Foreign nationals contributed10% of the women with insufficient care in Finland and 44% inBaden-Württemberg. The group of women with insufficientprenatal care was heterogeneous and it could not be definedby using traditional risk factors only. Infants of mothers withfew prenatal visits had poorer outcomes, but the attributableproportion of insufficient prenatal care to infant outcome wassmall.     

Solution synthesis of antigenic and inhibiting peptides of the human renin prosegment-2

The [Tyr⁴⁰]preprorenin (40–50) peptide methyl ester, an undecapeptide related to the human renin prosegment, has been synthesized using a stepwise strategy with hydrogenolisable protections on the side chains. The final deprotection was very difficult as observed by ¹ H NMR and reversed phase HPLC. 2D ¹ H NMR spectroscopy of the purified peptide allowed the assignment of all protons.     

Influence of Sympathetic Heart Rate Modulation on RT Interval Rate Adaptation in Conscious Dogs

PLADYS, P., et al. : Influence of Sympathetic Heart Rate Modulation on R Interval Rate Adaptation In Conscious Dogs . The objective was to test if changes in autonomic tone still influenced the RT-RR relationship when full RT adaptation is completed, when heart rate is controlled, and when beat-to-beat variability is abolished by atrial pacing. Eight dogs (8–11 kg) were chronically instrumented with atrial pacing electrodes. Digital ECG (1,000 Hz, 12 bits) were recorded from healthy conscious dogs during spontaneous sinus rhythm and during atrial pacing. The protocol was repeated before and after atenolol (2 mg/kg), prazosin (0.5 mg/kg), or atenolol + prazosin. A vocal incitation was used as sympathetic stimulation. Beat-to-beat quantitative analysis of the RT interval (from QRS apex to end of T wave) was correlated with the preceding RR by linear regression. In spontaneous rhythm, atenolol increased RR (P < 0.001), RT (P < 0.001), and short-term heart rate variability (P < 0.01) and decreased RT-RR slopes (P < 0.001). Prazosin did not significantly modify any parameter. Sympathetic stimulation decreased RR (P < 0.001), RT (P < 0.05), and short-term heart rate variability (P < 0.01) and increased RT-RR slopes (P < 0.001). In atrial pacing, the RTRR slopes were steeper during pacing than during spontaneous rhythm but were not modified by pharmacological manipulation of the autonomic nervous system. During sinus rhythm the RT-RR relationship is increased by sympathetic stimulation and decreased by β–blockade. When heart rate modulation and the effects of the time delay in RT rate adaptation are abolished by atrial pacing, the influence of autonomic tone on RT rate adaptation disappears.     

Voluntary involvement in community health promotion: the Pawtucket Heart Health Program

The Pawtucket Heart Health Program employs a community activationapproach aimed at reducing cardiovascular morbidity and mortality.This approach is put into operation through the recruitmentof lay volunteers from the community to assist in planning,implementing, evaluating and managing various components ofthe Program. This unique approach of voluntary delivery of programmesis presented in this report. Strategies for the recruitment,interview and placement, training, maintenance and evaluationof volunteers are discussed. The characteristics of people whohave volunteered for specific administrative and service deliveryjobs with the Pawtucket Heart Health Program are also described.The volunteer delivery focus of the Program provides a modelfor adaptation by other public health projects.     

Effects of Procainamide on the Excitable Gap Composition in Common Human Atrial Flutter

The composition of the excitable gap (EG) in common atrial flutter (AFI) was determined before and during infusion of procainamide (PA) in 9 patients (6 men and 3 women; age 70 ± 7 years). The EG was determined by introducing a premature stimulus after every 20th AFI complex detected using a quadripolar electrode catheter placed just above the tricuspid valve. Diastole was scanned in 2- to 4-ms decrements to the atrial effective refractory period (ERP). The relationship between the coupling interval and the return cycle length (CL) determined a reset-response curve (RRC), which described the EG. PA (15 mg/kg) was administered during AFl over 30 minutes and RRC was repeated at maximum AFI CL. PA prolonged AF1 CL from 227 ± 29 to 296 ± 62 ms (P < 0.01) but did not terminate AFI. ERP during AFl prolonged from 169 ± 24 to 219 ± 41 ms (P < 0.01). Control EG was 57 ± 16 ms or 25%± 6% of AFl CL and on PA EG was 77 ± 30 ms (P = 0.01), which was still 26%± 7% of the CL. Without drug, RRC was mixed in eight cases demonstrating an EG composed of fully excitable tissue (10 ± 4 ms or 19%± 10% of the EG) and partially refractory tissue (48 ± 18 ms), PA did not change the duration of the fully excitable region (13 ± 10 ms or 19%± 15% of EG). Peak PA plasma concentration was 47 ± 20 μmol/L. PA prolonged AFI CL, ERP, and EG duration but did not change the proportion of AFI CL occupied by the EG. The persistence of fully excitable tissue at the head of the wavefront in the presence of PA may largely explain its inefficacy in the acute termination of common AFl.     

A Mini-System for Storage, Retrieval and Management of Pacemaker Data

Information processing is becoming a necessity for the management and the analysis of data at Cardiac Electrostimulation Centers, particularly since pacemaker implantation is becoming more frequent and the material more diversified. The mini system described allows retrieving of simple data and allows a real time acquisition of spike parameters by means of an electronic coupling unit with an impulse analyser. Its simplicity, availability and low cost are desirable qualities needed for the proper functioning of a Pacemaker Implantation Center.