Effect of successive single-gestation pregnancies on the course of maternal human immunodeficiency virus disease and perinatal transmission

Objective: This study was undertaken to examine the effect of successive pregnancies over a 3-year period on the course of maternal human immunodeficiency virus (HIV) infection and the rate of perinatal transmission of HIV.Methods: A retrospective analysis of 32 pregnancies in 14 known HIV-infected women vs. a matched control group of HIV-infected women who had been pregnant only once was done.Results: The multiple-pregnancy group was similar to the single-pregnancy group for age, race, duration of known HIV infection, initial CD(4) count, and date of first pregnancy. The delivery data were similar as well. The CD(4) counts in the multiple-pregnancy group fell from 595 to 460, while counts in the single-pregnancy group fell comparably from 669 to 638, both over 37 months (P = 0.1476). Five of 5 second-born infants of known serostatus vs. 8 of 21 first-born infants were HIV-infected (P < 0.05).Conclusions: Successive pregnancies do not alter the course of HIV infection in asymptomatic women followed up to 3 years. The infants of second pregnancies of known HIV-infected women may be at higher risk for perinatal transmission.     

Perioperative urinary catheterisation in conjunction with epidural anaesthesia for hip and knee arthroplasty. Is it safe?

The place of indwelling urinary catheterisation following epidural anaesthesia to prevent acute retention of urine after hip and knee arthroplasty is controversial. Even with the use of aseptic techniques and closed sterile drainage, bacteriuria has been reported in 10-27% of catheterised patients. A prospective trial was carried out in 68 consecutive patients undergoing knee or hip joint arthroplasty with epidural anaesthesia to investigate the perioperative complications of short term urinary catheterisation. Following establishment of combined epidural and general anaesthesia, all patients underwent urinary catheterisation under aseptic technique by a member of the surgical team. Prophylactic antibiotics were given prior to insertion and continued for 24-48h postoperatively to minimise the risk of prosthetic infection. The mean indwelling urinary catheter (IDC) period was 3.6 days (range 2-14). There were three (4.4%) urinary tract infections (UTIs) all of which resolved with appropriate antibiotics. Two were detected upon removal of the urinary catheter and one was detected on the seventh postoperative day when symptoms were detected. No patient required recatheterisation. There was no other infective morbidity or wound infection. Our findings suggest the use of IDC for short periods combined with prophylactic antibiotics is safe in the perioperative phase of joint arthroplasty.     

Histiocytic lesion mimicking intrinsic brainstem neoplasm. Case report

This 10-year-old girl presented with a 1-month history of progressive bulbar palsy and a solitary enhancing mass originating within the floor of the fourth ventricle. Results of initial imaging studies and presentation were suggestive of neoplasia. Subtotal resection was performed and pathological examination revealed the mass to be a histiocytic lesion, with no evidence of a glioma. The patient had no other stigmata of histiocytosis and was treated with steroid medications, resulting in prolonged resolution of the lesion. This case demonstrates that for discrete brainstem lesions the differential diagnosis includes entities other than glioma for which treatment is available. Biopsy sampling should be considered when technically feasible.     

Comparison of Cancer-specific and General Health Literacy Assessments in an Educated Population: Correlations and Modifying Factors

An information onslaught accompanies cancer diagnoses, but patient comprehension (health literacy; HL) is frequently low, impacting both immediate care and longer term follow-up. Knowledge and adoption of preventive measures is especially important for cancer survivors due to their increased risk of secondary malignant neoplasms. We sought to evaluate the Test of Functional Health Literacy Adult (S-TOFHLA) against the recently developed cancer-specific Cancer Message Literacy Test (CMLT-r) among an educated population of both cancer survivors and those cancer-free. Participants were recruited 2013 (May through December) from various units within a local hospital and from several local churches, and each completed the S-TOFHLA and CMLT-r and provided demographic information and cancer status. The 109 participants had a mean age of 58 years and were as follows: 65.1 % female; 92.7 % white, 50.4 % college graduates, and 41.3 % cancer survivors. S-TOFHLA scores ranged from 12–36 (mean 34.1) and non-significantly varied by gender, education, cancer status, and age. CMLT-r scores ranged from 28.6–100 % (mean 86.4 %) and significantly varied by education (p?=?0.013), but not by gender, cancer status, or age. Overall, CMLT-r and S-TOFHLA significantly correlated (p?<?0.001). Assessment scores were skewed towards the maximum with non-significant differences by cancer status. As cancer survivorship improves and as the population becomes more educated, more refined approaches to assess health literacy should be considered. Increased education does not imply increased health literacy, and cancer survivorship does not imply higher health or cancer literacy. Concerted efforts to improve patient understanding and implementation of preventive measures are imperative.     

Effects of Culturally Tailored Nutrition Education on Dietary Quality of Hispanic Mothers: A Randomized Control Trial

ObjectiveTo assess whether participation in a culturally tailored nutrition education program increases diet quality of Hispanic mothers.DesignA randomized controlled trial.SettingCommunity centers and universities.ParticipantsSixty-five mothers (35 in experimental group, 30 in control group) completed pre- and postworkshop surveys. Eligibility criteria included being of Mexican or Puerto Rican descent and having a child between the ages of 6 and 18 years who could participate in the workshops with the parent.InterventionFamilies in the experimental group participated in a 6-week workshop series that included weekly nutrition education classes.Main Outcome MeasureDiet quality was assessed by the Rate Your Plate questionnaire.AnalysisRepeated measures ANOVA was used to compare differences between the experimental and control groups. A Wilcoxon signed rank test was conducted to test for significant shifts in categorization pre- and postprogram.ResultsThere was a significant change in diet quality categorization after participating in the workshops (P < .001, effect size 0.39). No changes were found in the control group.Conclusions and ImplicationsAbriendo Caminos was effective at increasing the diet quality of Hispanic mothers who participated the most in the program. More research is needed in this at-risk population to determine the relationships among nutrition knowledge, diet quality, and achievement of healthy weight.