Fetal arachnoid cyst: characteristics, management in pregnancy, and neurodevelopmental outcomes

Arachnoid cysts are rarely found during the prenatal period and can exist in any part of the brain as extra-axial cysts. These cysts are usually found after the second trimester and should be differentiated from other types of brain cysts and tumors using ultrasonography and magnetic resonance imaging. Serial sonographic examinations are necessary to evaluate associated central nervous system (CNS) or extra-CNS anomalies and changes in size or shape during pregnancy. If there are other associated anomalies, prenatal genetic evaluations are strongly recommended. Surgical procedures are necessary after birth in approximately 30-60% of the patients. Most isolated cysts have favorable neurodevelopmental outcomes, although information on their prognosis is limited.

Current status of pertussis vaccination during pregnancy and influencing factors in Korea

OBJECTIVE

to investigate pertussis vaccination rates during pregnancy and the routine recommendation rates by maternity healthcare professionals (HCPs), including influencing factors, in Korea.

MATERIALS AND METHODS

Two different questionnaires were developed and conducted anonymously for pregnant or postpartum women and maternity HCPs in 30 multi-centers. Maternal pertussis vaccination rates and maternity HCPs' recommendation rates were analyzed. Independent influencing factors were analyzed using multivariate logistic regression analysis, respectively.

RESULTS

The rate of pertussis vaccination during pregnancy among 466 women was 67%. Among 164 multiparous women, 35.5% received pertussis vaccinations during every pregnancy. However, 27.9% among all pregnant women did not receive information about pertussis and vaccination. The independent influencing factors for maternal pertussis vaccination, given as the tetanus, diphtheria and acellular pertussis (Tdap), were "getting informed" (OR 18.597, 95% CI 11.206-30.861), "informed by OBGYN doctors" (OR 4.426, 95% CI 2.144-9.267), and "metropolitan residence" (OR 3.048, 95% CI 1.419-6.548). Among a total of 373 maternity HCPs, 210 (56.3%) routinely recommended pertussis vaccination, but 21.7% of the total maternity HCP participants did not know the maternal Tdap guideline. The independent factors affecting routine recommendation were the awareness of guideline (OR 9.771, 95% CI 5.227-18.265, p < 0.001) and personal pertussis vaccination within 10 years (OR 3.108, 95% CI 2.377-10.329, p < 0.001). The barriers for routine recommendation were the lack of informational materials (29%), time (25%), and knowledge (23%).

CONCLUSION

To increase pertussis vaccination coverage in pregnant women, more education for maternity HCPs, increase the personal pertussis vaccination rates of HCPs, and informational materials, are needed.

Validity of a mailed epidemiological questionnaire and physical self-assessment in Parkinson's disease

The large-scale mail questionnaire is a useful tool in epidemiological investigation and will probably come into wider use in the search for an environmental cause of Parkinson's disease (PD). To determine the validity of mail questionnaires in patients with PD, we administered a 17-item questionnaire by in-person interview, as a standard, to 68 patients (and/or a relative when necessary) and compared the results with the same questionnaire mailed at least 1 month before or after the interview. Questions in three formats requested recall of the clinical course and past environmental factors. Each patient also completed a multiple-choice physical self-assessment (a modification of four items on the Columbia Scale) immediately before seeing the neurologist, who completed the same form after the examination. Percent of patients with zero discordance between mail and interview responses averaged 52% for the nine fill-in-a-year items, 53% for the three list-generation items. Kappa statistics for the five multiple-choice items, which each offered four choices, averaged 0.67 (range 0.40-0.89). Kappa for the physical examination items, each rated on a 0-3 scale, was finger-tap 0.12, gait 0.34, tremor 0.35, and chorea 0.20. Patients' ratings tended to be more severe than neurologists' ratings. We conclude that mail surveys in PD should either be avoided or rigorously pretested for validity.