Sociodemographic Characteristics and Clinical Outcomes of People Receiving Inadequate Prenatal Care: A Retrospective Cohort Study

OBJECTIVE

This study sought to describe the incidence inadequate prenatal care (IPNC) at an urban level II hospital in Hamilton, Ontario, and to compare the characteristics and outcomes of mothers who received IPNC and their newborns with those who received adequate prenatal care (APNC). This study is the first part of a mixed-methods research program aimed at informing the development of an interdisciplinary, patient-centred, prenatal care program for people who struggle to access conventional modes of care.

METHODS

This retrospective cohort study compared mothers and neonates born at St. Joseph's Health Care Hamilton in 2016 with IPNC (fewer than or equal to four antenatal visits, or first visit in third trimester) with those born with APNC (five or more prenatal visits and initial visit before the third trimester). Cases and controls matched 3:1 for age and parity were identified through a retrospective chart review.

RESULTS

In total 3235 charts were reviewed, and 69 cases of IPNC were identified (2.1%). The IPNC group had lower education and higher unemployment levels, as well as higher rates of smoking and drug use. Our primary and secondary outcomes of newborn custody loss, neonatal intensive care unit admission, and neonatal length of stay were significantly higher in the IPNC group.

CONCLUSION

Patients delivering with IPNC represent a high-risk group with increased rates of adverse neonatal outcomes and newborn custody loss. This quantitative study will inform future research and innovative interdisciplinary program development aimed at increasing access to prenatal care in an effort to improve maternal and neonatal outcomes.

Determination of Arsenic, Cadmium, Cobalt, Chromium, Lead, Molybdenum, Nickel, and Selenium in Fertilizers by Microwave Digestion and Inductively Coupled Plasma-Optical Emission Spectrometry Detection: Collaborative Study

There is increasing regulatory interest in the non-nutritive metals content of fertilizer materials, but at present there is no consensus analytical method for acid digestion and instrument detection of those elements in fertilizer matrixes. This lack of method standardization has resulted in unacceptable variability of results between fertilizer laboratories performing metals analysis. A method has been developed using microwave digestion with nitric acid at 200C, followed by inductively coupled plasma-optical emission spectrometry instrument detection, for the elements arsenic, cadmium, cobalt, chromium, molybdenum, nickel, lead, and selenium. The method has been collaboratively studied, and statistical results are here reported. Fourteen collaborators were sent 62 sample materials in a blind duplicate design. Materials represented a broad cross section of fertilizer types, including phosphateore, manufactured phosphate products, N-P-K blends, organic fertilizers, and micro-nutrient materials. As much as possible within the limit of the number of samples, materials were selected from different regions of the United States and the world. Limit of detection (LOD) was determined using synthetic fertilizers consisting of reagent grade chemicals with near zero levels of the non-nutritive elements, analyzed blindly. Samples with high iron content caused the most variability between laboratories. Most samples reasonably above LOD gave HorRat values within the range 0.5 to 2.0, indicating acceptable method performance according to AOAC guidelines for analyses in the mg/kg range. The method is recommended for AOAC Official First Action status.

Factors responsible for mother-to-child HIV transmission in Ontario, Canada, 1996-2008

OBJECTIVE

Despite a high uptake of HIV screening and anti-retroviral prophylaxis in Ontario, several cases of mother-to-child (MTC) transmission occur every year. We wished to examine the modifiable factors responsible for MTC HIV transmission in Ontario, in particular HIV testing, antiretroviral prophylaxis and breast-feeding.

METHODS

Using the Ontario data from the Canadian Perinatal HIV Surveillance Program, we examined potential correlates of late maternal HIV diagnosis (i.e., diagnosed at or after delivery) among women delivering from 1996 to 2008. To better understand the factors responsible for MTC HIV transmission, we reviewed the medical charts of 35 HIV-infected infants born in Ontario.

RESULTS

Among the 645 HIV-infected mothers, 85 (13.2%) had late HIV diagnosis. The proportion with late HIV diagnosis significantly decreased during the study period, but did not differ by race/ethnicity group or maternal exposure category. With respect to the mothers of the 35 HIV-infected infants, 27 (77%) were diagnosed with HIV at or after delivery. The reasons no prenatal HIV test was performed were: not offered, offered but refused, no prenatal care, denied HIV testing history, and offered but not done. Reasons for no or incomplete antiretroviral  prophylaxis (ARP) among eight mothers diagnosed prior to or during pregnancy were: refused or non-compliant with ARP, and failed to inform care provider of HIV status.

CONCLUSIONS

Despite the recommendation for universal prenatal HIV counseling and voluntary testing adopted in Ontario, MTC transmission continued to occur, mostly due to late HIV diagnosis of the mother. Future work to reduce perinatal HIV infection should focus on enhancing timely HIV testing of pregnant women.

This is my story: a descriptive analysis of a peer education HIV/STD risk reduction program for women living in housing developments

Descriptive, qualitative data was collected from 30 women who participated in the Centers for Disease Control and Prevention-funded Perinatal HIV Reduction and Education Demonstration Activities (PHREDA) Project. Women were primarily heterosexual, welfare-dependent, African-American mothers. Staff trained women to conduct HIV/STD education as peer volunteers. The theory-based educational components consisted of role model stories developed by women about their experiences with HIV/STDs and discussion groups to build behavioral and communication skills. Women were given role-model stories and safer sex supplies to initiate conversations about women's health and sexual safety in their communities. PHREDA groups allowed women to identify their risk reduction, sexual, and family issues. Role model stories provided a validating medium through which high-risk women explored reproductive health risk and planned steps toward behavioral change. Descriptive data from peer volunteers can provide an important perspective on small group, peer-based community HIV/STD reduction interventions.

Scleroderma concurrent with culture proven tuberculosis in a Japanese Canadian patient

We describe a Japanese Canadian woman who presented with scleroderma and tuberculosis. We discuss the possible association between these 2 diseases.

Therapeutic value of colchicine in the treatment of patients with psoriatic arthritis

OBJECTIVE

To test the hypothesis that colchicine is an effective treatment of psoriatic arthritis.

METHODS

Twenty five patients with psoriatic arthritis were entered into a two centre, double blind, crossover study of 23 weeks' duration comparing the therapeutic effect of colchicine (0.6-1.8 mg/day) with placebo.

RESULTS

No significant difference was noted between colchicine or placebo treatment for the primary outcome measure (Lansbury joint count) or any of the seven secondary outcome measures. No change in the psoriasis was noted during active or placebo treatment. Adverse clinical effects were reported more often during treatment with colchicine (14 patients) than with the placebo (four patients), resulting in the early withdrawal of three patients receiving colchicine from the trial. Increased creatine kinase values, without weakness, occurred during treatment with colchicine (five patients) and placebo (four patients).

CONCLUSIONS

In conclusion, our study did not provide evidence that colchicine is of therapeutic value in the treatment of psoriatic arthritis.

Disseminated zygomycosis associated with systemic lupus erythematosus

We describe a 36-year-old patient who had systemic lupus erythematosus (SLE) and died of disseminated zygomycosis. There was rapid progression of his SLE, leading to suspicion of superimposed infectious disease, but the actual cause of his multiorgan failure was not recognized until after death. The manner in which systemic fungal infection may mimic SLE is discussed.