In December 2000, 149 heads of state and or government and 189 Member States jointly endorsed the Millennium Declaration, thereby committing themselves to achieving, by 2015, ambitious goals including reducing poverty, hunger and disease. These goals are known collectively as the Millennium Development Goals (MDGs) and they will serve as a basis for recording progress in development for the next 15 years.
Newborn screening is the largest screening program in the United States with approximately four million newborns screened yearly. It is a mandated public health program designed for the identification of disorders in children. It is designed to provide rapid diagnosis and allow early therapy for specific metabolic, infections, and other genetic disorders for which early intervention reduces disabilities and death. This important practice typically occurs before the development of signs or symptoms of disease. Newborn screening programs are comprised of a complex, integrated clinical service of education, screening, diagnosis, follow-up, evaluation, and often long-term management. The list of recommended conditions for newborn screening programs is continually being evaluated. Integrating education about newborn screening into prenatal care allows parents to be prepared for having their child undergo screening as well as for receiving newborn screening test results. Furthermore, parents often view their care from prenatal management through pediatrics as a continuum of care without health care provider distinctions. This can be accomplished at different moments in prenatal care: 1) during the first-trimester new obstetric visit and include written or web-site information along with other patient education materials, 2) later in pregnancy with other educational information is routinely distributed, such as at the time of glucola or group B streptococcal screening in the third trimester, 3) during a discussion of past adverse pregnancy outcomes related to a positive newborn screening test result or birth defect, at the same time that options for prenatal or preimplantation genetic screening or diagnostic testing are considered.
It is important to improve the necessary knowledge of healthcare providers to make the correct and early diagnosis of interstitial cystitis (IC). Also, even for clinicians who are aware of interstitial cystitis (IC), some patients present with atypical symptoms or co-morbid conditions that make the correct diagnosis challenging. It is also important to note that, whereas IC may present as urgency and frequency without pain, the presence of pain is required for the diagnosis. This review summarizes discussions of issues identified as being of concern in several surveys, interviews, and question-answer sessions at professional educational activities.
Posttraumatic stress disorder (PTSD) is a serious anxiety disorder triggered by the experience of trauma. One in 4 individuals exposed to trauma will develop PTSD. Victims of trauma are frequent users of health care, but screening is rarely done and most sequelae remain undetected. In recent years, it has become evident that PTSD is a major health concern both in United States and worldwide. It is a debilitating form of an anxiety disorder triggered by personal experience of serious trauma (e.g., sexual abuse or assault, victim of violent crime or severe motor vehicle accident). The course of untreated disease averages more than 5 years and may lead to additional psychiatric comorbidities, including a greatly increased risk of major depression and suicide. The medicines to treat PTSD with fewer side effects is a possibility and it remains an intriguing idea, and one that ushers in an era of effective drugs with much less side effects.
The perinatal complications associated with maternal tobacco use include preterm delivery, premature rupture of membranes, spontaneous abortion, ectopic pregnancy, low birth weight, intra-uterine growth restriction, placental abruption, placenta previa, still birth, and sudden infant death syndrome (SIDS). Smoking cessation and the resources available are also discussed. Screening for tobacco use can be done efficiently as a vital sign at every clinical visit. Tobacco control is one of the most rational, evidence-based policies in medicine. The Millennium Development Goals do not include an explicit target for reducing tobacco use, but this article explains how lower tobacco use could contribute to their achievement.
In gynecologic oncology, every clinical intervention has two distinct aims. One is to produce objective improvement in the patient’s medical condition and second aim, regardless of whether medical improvement is possible, is to produce amelioration of the patient’s subjective symptoms. Helping the patient get better and feel better. Communication skills are essential for both. While there has been a dramatic improvement in the cure rate of gynecological malignancies and women survive longer than 5 years, with what is commonly considered a “chronic” cancer. In each phase of the illness — diagnosis, surgery and chemotherapy with curative intent, remission and survivorship, relapse and sequential chemotherapy, bowel obstruction and end of life; quality of life (QOL) is one of the most important considerations. There has recently been a large increase in studies reporting the assessment of QOL; that has changed the field from descriptive reporting to quantitative science. History and development of QOL evaluation and various approaches to QOL assessment (psychometric based and utility based) are also discussed. It describes strategies for meaningful interpretation of QOL profiles. We hope the science of the study of QOL will be the foundation and confirmation of many of the anticipated advances for patients.
Loss of control of urine, gas and stool can have a significant impact on the social well-being of affected women. It is a social and hygienic problem and leads to social distress. Urinary and fecal incontinence and related psychosocial distress constitute a spectrum related to the actual severity of the loss of control and to the woman’s perception of her disability. Great stigma and shame is associated with urinary and fecal incontinence. The purpose of this document is to provide a better understanding of this devastating situation and provide management. Forums and management guidelines hope to provide the incentive for social and psychological programs to help women who are unfortunate victims of the situation.
Ultrasound emerged as a major tool in medical imaging in the 1970s, and its impact has been very dramatic in obstetrics. The ability of sonography to detect fetal abnormalities prior to delivery and to direct minimally invasive therapy has revolutionized the field of obstetrics. The marked improvement in ultrasound image quality in recent years and the ability to store high quality digital images and video clips have enhanced ultrasound’s role in obstetrics. The purpose of this document is to discuss various diagnostic procedures available and their indications. The most commonly used ultrasound-guided diagnostic obstetrical procedures are: 1) Amniocentesis; 2) Chorionic Villus Sampling (CVS); 3) Percutaneous Umbilical Blood Sampling.
Bleeding in the second half of pregnancy and in labor due to placental abnormalities include placenta previa, abruptio placentae, placenta accreta and vasa previa. Third-trimester bleeding complicates about 3.8% of all pregnancies. The purpose of this document is to present evidence-based approach to the management of placental abnormalities and major obstetric hemorrhage. Attention to improving the hospital systems is necessary for the care of women at risk for major obstetric hemorrhage. It is important in the effort to decrease maternal mortality from hemorrhage. Multidisciplinary team implementation systemic changes are also discussed. It is the responsibility of the physician to decide without delay whether the cause is benign or potentially life-threatening to the mother, fetus, or both. The potential harm from either procrastination or unnecessary intervention may be extreme.
Over the past two decades, the use of assisted reproductive technology (ART) has increased dramatically worldwide and has made pregnancy possible for many infertile couples. ART encompasses all techniques involving direct manipulation of oocytes outside of the body. The purpose of this document is to provide an understanding, overview and indications for assisted reproductive technologies (ART). The results and complications of ART with an emphasis on newly developing technologies and areas of controversy are also discussed. Pregnancy rates after ART have shown nearly continuous improvement in the years since its conception. A number of factors affect the pregnancy rate, with the most important being a woman’s age. Many studies are now finding that there is a slight increase in adverse pregnancy outcomes after ART. Although the vast majority of children born from these procedures are healthy, there is some concern about increased rates of prematurity, small for gestational age infants and a slight increase in the rates of birth defects following ART. Some of these complications can be linked to the problem of multiple gestations which are common following ART.