The influence of obesity and diabetes on the risk of cesarean delivery

OBJECTIVE: To determine the influence of pregravid obesity and diabetes on cesarean delivery (CD) risk. STUDY DESIGN: Women with singleton pregnancies of 23 weeks or more estimated gestational age who were undergoing a trial of labor January 1997 through June 2001 were categorized by pregravid body mass index (underweight [<19.8 kg/m 2 ], normal [19.8-25 kg/m 2 ], overweight [25.1-30 kg/m2], obese [>30 kg/m2]). Diabetes (DM) was divided into categories of gestational, treated with diet modification (A1GDM) or insulin (A2GDM), and pregestational (PDM). Prior CDs were excluded. CD rates for each group were compared in univariate analyses stratified by estimated gestational age (term, preterm, total). Other variables examined included DM, macrosomia (birth weight 4500 g or more), induction, and parity. Multiple regression included significant variables to predict the influence of diabetes and obesity on CD risk. RESULTS: Records for 12,303 deliveries were evaluated (obese: 2828 [22.9%]; overweight: 2605 [21.2%]; A1GDM: 270 [2.2%]; A2GDM: 93 [0.8%]; PDM: 126 [1%]). Obese and overweight subjects had a higher risk for CD, compared with normal subjects (13.8% and 10.4% versus 7.7%, P < .0001 for each). Other CD risk factors were macrosomia (25% versus 9.4%), nulliparity (16.5% versus 4.7%), induction (17.4% versus 8.3%), diabetes (A1GDM: 16.7% versus 9.4%; A2GDM: 24.7% versus 9.5%; PDM: 34.9% versus 9.3%) and black race (10.7% versus 8.8%) ( P < .0001 for each). In multiple regression models including term deliveries, obesity and PDM were independent CD risk factors ([adjusted OR overweight: 1.5, P < .0001; adjusted OR PDM: 2.9, P = .01]; [adjusted OR obese: 2.4, P < .0001, PDM: 2.9, P = .0002]). CONCLUSION: Pregravid obesity and diabetes independently increase the risk for CD. Given the disparate prevalence of obesity and diabetes in the United States, body habitus has a significantly larger impact on CD risk.     

Focal liver lesions in the cirrhotic patient: multislice spiral CT evaluation

Imaging of the cirrhotic patient is a very difficult task due to the several morphologic and structural alterations that occur in the hepatic parenchyma. The presence of areas of fibrosis and regenerative nodules, often associated with haemodynamic alterations due to the portal hypertension, can make the identification of hepatocellular carcinoma very difficult or, in many cases, simulate the presence of tumour. Despite the use of state-of-the-art equipment and optimised study protocols, computed tomography (CT) has poor sensitivity for the detection of hepatocellular carcinoma. The present article illustrates the spiral CT findings that most often can be found in the evaluation of cirrhotic patients. In particular, the authors illustrate the CT patterns of regenerative nodules, dysplastic nodules, hepatocellular carcinomas and of all lesions that may mimic hepatocellular carcinoma.     

Anxiety and depression in hospitalized patients in resistant organism isolation

BACKGROUND: Previous studies have reported an increase in psychiatric symptoms in seriously ill patients who were placed in resistant organism isolation. We conducted this study to assess whether there is an increase in symptoms of anxiety and depression in patients who are not critically ill and are placed in isolation. METHODS: Patients hospitalized with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus species infections were evaluated with the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale at baseline and again during hospitalization. The results were then compared with the results of patients who were hospitalized for infectious diseases that did not require isolation. RESULTS: Patients in isolation had significantly higher scores on both the anxiety and depression scales at the time of follow-up than did patients who were not isolated. There was no significant difference between the scores of the two groups before isolation. CONCLUSION: The results of this preliminary study suggest that placement in resistant organism isolation may increase hospitalized patients' levels of anxiety and depression.     

Participation in “Parents Who Care”: Predicting Program Initiation and Exposure in Two Different Program Formats

Predictors of participation and exposure across two formats of a universal prevention program are examined here. Families of 225 8th-grade students, balanced by race (African American and European American) and gender, were assigned to a parent and adolescent group format (PAG) or a self-administered format (SA). Logistic regression showed greater program initiation in SA than in PAG. Hierarchical regression showed only one variable (parent high-risk behavior) to be associated with lower program exposure in the self-administered format. In contrast, demographic variables (e.g., being African American) predicted lower exposure in PAG. Overall, the findings of this study were notable in that most of the variables that have been identified in past research as lowering participation rates were not related to program initiation or level of exposure to either format of Parents Who Care. Further, the self-administered format may be particularly useful to increase program participation for families, even those who are traditionally difficult to reach. Editors' Strategic Implications: The authors make a promising contribution to the literature on program engagement by presenting experimental data highlighting different risk factors for nonparticipation across program formats. Their discussion of barriers will help program designers and practitioners decide on the most appropriate strategies for the dissemination of prevention-related materials to parents.