Optimus Health Care: Weight Gain Patterns and Nutritional Services Among Underserved Pregnant Women

Abstract Background Optimus, a Joint Commission accredited and a federally qualified healthcare center (FQHC), serves over 1200 pregnant women a year. Excessive Gestational Weight Gain (GWG) can lead to maternal health complications, including gestational diabetes, preeclampsia and increased risk for C-section. This study seeks to assess the prevalence and magnitude of GWG among Optimus clients, evaluate nutrition services available for pregnant women at Optimus, and identify approaches to enhancing pregnancy outcomes through optimum GWG that can be made available to Optimus clients. Methods Data on weight gain patterns, socio- demographic information, and health history for all pregnant women with clinic visits between 01/01/2013 and 12/31/2013 were extracted from the Optimus’ electronic medical records system. Trends in weight gain during each trimester were compared and analyzed by age, education, race/ethnicity, country of origin and language. Gaps in available nutrition services for pregnant women were determined through staff interviews and surveys. Results Overall, the weight trends of the clients who used Optimus’ prenatal services in 2013 increased across the trimesters. There were no significant differences in weight gain between trimesters by all variables evaluated (age, education, race/ethnicity, country of origin and language). Teenage mothers had the lowest weights during each trimester of pregnancy while mothers with advanced maternal age had the highest average weights per trimester. On average, Black women had the highest weight from the first trimester and continued to do so throughout pregnancy. Women with only elementary or middle school education gained on average of 9.19lbs over the course of the three trimesters. This value is lower than the minimum that is recommended by the Institute of Medicine for any women in spite of their 3 BMI (11lbs). Results from the survey showed that Optimus’ staff consider cost, time and emotional barriers to be potential barriers to caring for pregnant women at Optimus. Conclusions Special educational nutrition services should be offered to women who represent the highest risk groups at Optimus (teenage mothers, mothers of advance maternal age, mothers with only middle school education or lower and also African American women). Optimus’ staff should account for cost, time and emotional barriers when designing nutritional and other support services for Optimus’ clients.https://elischolar.library.yale.edu/ysph_pbchrr/1004/thumbnail.jp

Asymptomatic lymphogranuloma venereum among Nigerian men who have sex with men

Objectives: Recent outbreaks of anorectal lymphogranuloma venereum (LGV) among men who have sex with men (MSM) have been characterised by proctocolitis requiring extended antibiotic treatment compared with infections caused by other serovars of Chlamydia trachomatis (CT). We describe the prevalence and clinical features of LGV among Nigerian MSM diagnosed with anorectal CT. Methods: MSM were recruited for this observational cohort in Lagos, Nigeria, using respondent-driven sampling and screened for HIV and bacterial STIs every three months for up to 18 months. Nucleic acid amplification tests for CT were performed on rectal swab specimens. Prevalent and incident cases of anorectal CT underwent additional testing to identify LGV using novel real-time PCR assays specific for the L-serovars of CT. Results: From April 2014 to July 2016, 420 MSM underwent testing for rectal STIs, of whom 66 (15.7%) had prevalent anorectal CT. Among those without prevalent disease, 68 developed incident infections during 208 person-years of follow-up. Of 134 prevalent and incident cases of anorectal CT, 7 (5.2%) were identified as LGV. None of the seven participants with LGV reported any symptoms. Two of the participants with LGV were simultaneously coinfected with rectal gonorrhoea. HIV coinfection was common among participants with both LGV (n=5, 71%) and non-LGV (n=98, 77%) serovars of CT (P=0.66). Conclusions: Anorectal LGV was uncommon but present among Nigerian MSM in this study. Consistent screening for L-serovars of CT, or presumptive treatment for LGV in cases with a high suspicion for this diagnosis, could potentially improve patient outcomes and decrease transmission

1327. The Diagnosis of Subarachnoid Neurocysticercosis Is Often Delayed And Other Findings of a Multicenter Retrospective in the USA

Abstract Background Subarachnoid (racemose) neurocysticercosis (SANCC) is an uncommon but severe form of Taenia solium infection. There is limited evidence to guide clinical management of these patients. Methods We performed a multicenter retrospective chart review of 15 U.S. sites. A total of 69 subjects with racemose disease were entered. Results The most common region of exposure was Mexico (67%) followed by Central America (24%). Median age was 43 years (range 15-76) and 71% were male. Common symptoms at the time of index admission were headache (80%), nausea/vomiting (46%), dizziness (44%), and blurry vision (33%). Cysts were intracranial in 64 (93%) subjects and exclusively intraspinal in 4. One patient had meningitis without visible cystic lesions. Incident admission magnetic resonance imaging (MRI) demonstrated ventriculomegaly in 41 (59%) and focal findings in 9 (13%) including ischemic infarct, subarachnoid hemorrhage, and/or arterial aneurysm. For 55 (80%), SANCC was first diagnosed during the index admission. Of these, 23 (42%) had prior medical visits and substantial delay in diagnosis (i.e. previously seen with hydrocephalus [27%], stroke [5.5%], and/or meningitis [11%], missed diagnostic radiologic features [4%], or inadequate imaging [5.5%]). Of the 69 subjects, 54% underwent a neurosurgical procedure during index admission (cyst removal n=16, EVD/shunt/ventriculostomy n=24). At the time of discharge, 6 (8.6%) patients were not given albendazole and/or praziquantel due to cost or availability. Six months following discharge, 4 weeks was associated with increased risk for new cyst development on follow up imaging at a median of 3.8 years following discharge (range 2.6 months-8 years). Those with a delayed diagnosis received a significantly longer duration of corticosteroids (median 8 weeks) than those without a delay (median 5 weeks, p=0.047). Conclusion The diagnosis of SANCC is often missed, and most patients require neurosurgical intervention. Antiparasitic therapy is suboptimal, especially with regimens developed for parenchymal NCC. Disclosures Jeffrey D. Jenks, MD, MPH, Astellas: Grant/Research Support|F2G: Grant/Research Support|Pfizer: Grant/Research Suppor