All physicians, even those not routinely involved in prenatal care, should be aware of the laboratory tests recently recommended for inclusion in prenatal care. All pregnant women should undergo blood glucose testing to detect gestational diabetes mellitus. Women at risk for hepatitis B, Chlamydia trachomatis infection, or human immunodeficiency virus infections should be tested. All women should also be offered alpha fetoprotein testing for detection of neural tube defects. If test results are abnormal, appropriate management and/or counseling should be provided.
Digital healthcare is a rapidly growing healthcare sector. Its importance has been recognised at both national and international level, with the WHO recently publishing its first global strategy for digital health. The use of digital technology within cystic fibrosis (CF) has also increased. CF is a chronic, life-limiting condition, in which the treatment burden is high and treatment regimens are not static. Digital technologies present an opportunity to support the lives of people with CF. We included 59 articles and protocols in this state-of-the-art review, relating to 48 studies from 1999 until 2019. This provides a comprehensive overview of the expansion and evolution of the use of digital technology. Technology has been used with the aim of increasing accessibility to healthcare, earlier detection of pulmonary exacerbations and objective electronic adherence monitoring. It may also be used to promote adherence and self-management through education, treatment management Apps and social media.
Children are the most frequent victims of bicycling accidents. Among fatal accidents, head injury is the most common cause of death. Because bicycling helmets may reduce the risk of serious head injury, this study was undertaken to determine the frequency with which children and adolescents in various age groups use bicycle helmets. Students were observed arriving at four elementary schools, three junior high schools, three senior high schools, and one university campus. The number of students riding bicycles and the percentage wearing helmets were noted. Of 108 elementary schools bicyclists, only two (1.85%) wore helmets. None of 103 junior high bicyclists and only two of 107 (1.86%) senior high bicyclists wore helmets. Ten percent (15/150) of university bicyclists wore helmets; this is a significantly higher rate than in the other age groups (χ2 = 10.27, P < .01). The failure of school-aged children to wear bicycling helmets represents a potentially serious health hazard. Pediatricians and family physicians have a unique opportunity to provide education to families and communities about the importance of using helmets.
Sao Paulo State Univ UNESP, Ctr Human Reprod Prof Franco Jr, Paulista Ctr Diag Res & Training, Dept Gynecol & Obstet,Botucatu Med Sch, Ribeirao Preto, Brazil
In aortic insufficiency, study of the anterior leaflet of the mitral valve may indicate the amount of regurgitant flow. In 100 patients with various cardiac abnormalities the aortic valve was identified in 70 per cent of those in whom echocardiography was attempted. The method used, the variations of normal echo patterns, and certain pathologic correlations are described.
In response to the growing population of older patients with incontinence, pharmaceutical companies are developing new drugs to treat the condition. Before prescribing medications for incontinence, however, physicians should determine the nature and cause of the patient's incontinence. The evaluation should rule out reversible conditions, conditions requiring special evaluation, and overflow bladder. The best treatment for urge incontinence is behaviour therapy in the form of pelvic floor muscle exercises. Medications, used as an adjunct to behaviour therapy, can provide additional benefit. Many therapies are available for patients with stress incontinence, including pelvic floor muscle exercise, surgery, intravaginal support devices, pessaries, peri-urethral injections, magnetic chairs, and intra-urethral inserts. No medication has been approved for the treatment of stress incontinence, although medications are under development.
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