No abstract

Background: Maternity care is all care in relation to pregnancy, childbirth and the postpartum period. In the Netherlands maternity care is provided by midwives and general practitioners (GPs) in primary care and midwives and gynecologists in secondary care. To be able to interpret women's experience with the quality of maternity care, it is necessary to take into account their 'care path', that is: their route through the care system.

ObjeCtiveTo perform an external validation and direct comparison of published prognostic models for early prediction of the risk of gestational diabetes mellitus, including predictors applicable in the first trimester of pregnancy. DesignExternal validation of all published prognostic models in large scale, prospective, multicentre cohort study. setting 31 independent midwifery practices and six hospitals in the Netherlands. PartiCiPantsWomen recruited in their first trimester (<14 weeks) of pregnancy between December 2012 and January 2014, at their initial prenatal visit. Women with pre-existing diabetes mellitus of any type were excluded. Main OutCOMe MeasuresDiscrimination of the prognostic models was assessed by the C statistic, and calibration assessed by calibration plots. results 3723 women were included for analysis, of whom 181 (4.9%) developed gestational diabetes mellitus in pregnancy. 12 prognostic models for the disorder could be validated in the cohort. C statistics ranged from 0.67 to 0.78. Calibration plots showed that eight of the 12 models were well calibrated.The four models with the highest C statistics included almost all of the following predictors: maternal age, maternal body mass index, history of gestational diabetes mellitus, ethnicity, and family history of diabetes. Prognostic models had a similar performance in a subgroup of nulliparous women only. Decision curve analysis showed that the use of these four models always had a positive net benefit. COnClusiOnsIn this external validation study, most of the published prognostic models for gestational diabetes mellitus show acceptable discrimination and calibration. The four models with the highest discriminative abilities in this study cohort, which also perform well in a subgroup of nulliparous women, are easy models to apply in clinical practice and therefore deserve further evaluation regarding their clinical impact. IntroductionIn the field of obstetrics, the number of publications on prognostic models has more than tripled in the past decade, 1 which reflects an increasing interest in risk based medicine. Risk based medicine aims to provide the most appropriate care to each patient, often guided by outcome risk estimates based on individual patient characteristics, test results, or even genetic information. 2 As a result of the obesity pandemic, the incidence of gestational diabetes mellitus, notably occurring in the second or third trimester, is rising and is increasingly contributing to perinatal complications such as macrosomia, shoulder dystocia, caesarean section, and neonatal hypoglycaemia. 3 4 Moreover, long term sequelae of gestational diabetes mellitus are type 2 diabetes in mothers and obesity in their offspring. 5 6 Early diagnosis and treatment of gestational diabetes mellitus have been proven to improve pregnancy outcomes. 7 8 Some guidelines propose a population strategy for diagnosing the disorder [9][10][11][12] (that is, an oral glucose tolerance test) in all pregnant women, whereas others opt for a high ri...

AimStudies carried out in the early 2000s found that the number of influenza‐associated hospitalizations and deaths was highest in seasons dominated by A(H3N2), suggesting that the clinical presentation and severity of influenza may differ across virus types, subtypes, and lineages. We aimed to review the studies that examined this hypothesis.MethodWe conducted a literature review of studies published until January 2017 that compared the clinical presentation, disease severity, and case‐fatality ratio of influenza patients infected with different virus types (A, B), subtypes (pre‐pandemic A(H1N1), A(H1N1)p, A(H3N2)), and lineages (Victoria, Yamagata).ResultsThe literature search resulted in over 1700 entries: After applying in‐ and exclusion criteria, 47 studies were included in the literature review. Studies showed a wide diversity in setting and populations. Only a minority of studies provided results adjusted by patient's age and other potential confounders. There were very few differences in the clinical presentation of patients infected with different influenza viruses. We found weak evidence that the A(H1N1)p subtype in the post‐pandemic period was more often associated with secondary bacterial pneumonia, ICU admission, and death, than the other influenza virus (sub)types.ConclusionContrary to what is commonly assumed, the causal virus subtype does not seem to be a major determinant of clinical presentation and severity of influenza illness. However, drawing conclusions was made difficult by the low comparability and methodological shortcomings of included studies, and more well‐designed studies are warranted.

BackgroundDespite the potential of prenatal care for addressing many pregnancy complications and concurrent health problems, non-western women in industrialized western countries more often make inadequate use of prenatal care than women from the majority population do. This study aimed to give a systematic review of factors affecting non-western women’s use of prenatal care (both medical care and prenatal classes) in industrialized western countries.MethodsEleven databases (PubMed, Embase, PsycINFO, Cochrane, Sociological Abstracts, Web of Science, Women’s Studies International, MIDIRS, CINAHL, Scopus and the NIVEL catalogue) were searched for relevant peer-reviewed articles from between 1995 and July 2012. Qualitative as well as quantitative studies were included. Quality was assessed using the Mixed Methods Appraisal Tool. Factors identified were classified as impeding or facilitating, and categorized according to a conceptual framework, an elaborated version of Andersen’s healthcare utilization model.ResultsSixteen articles provided relevant factors that were all categorized. A number of factors (migration, culture, position in host country, social network, expertise of the care provider and personal treatment and communication) were found to include both facilitating and impeding factors for non-western women’s utilization of prenatal care. The category demographic, genetic and pregnancy characteristics and the category accessibility of care only included impeding factors.Lack of knowledge of the western healthcare system and poor language proficiency were the most frequently reported impeding factors. Provision of information and care in women’s native languages was the most frequently reported facilitating factor.ConclusionThe factors found in this review provide specific indications for identifying non-western women who are at risk of not using prenatal care adequately and for developing interventions and appropriate policy aimed at improving their prenatal care utilization.