bluuebunny/crossref_metadata_2025 huggingface dataset:
The Late Prehistoric–Early Historic Game Sink in the Northwestern United States
Authors: Lyman R. Lee , Wolverton Steve
Published: March 2003

Abstract: Historical data provide valuable information on ecosystem structure, function, and processes. The number of big game killed by the Corps of Discovery in 1805–1806 and recorded by Lewis and Clark suggests that ungulates were abundant in central and eastern Montana and rare in western Montana, central Idaho, and southeastern Washington during the early nineteenth century. Paleoecologists Paul Martin and Chris Szuter conclude that this difference was a function of human predation. They support their conclusion that ungulates would have been abundant in southeastern Washington had humans not hunted them by arguing that the nineteenth‐century livestock industry was successful without supplemental feeding. The livestock industry was, however, not consistently successful until artificial feeding was initiated. Archaeological data from eastern Washington indicate that ungulates have been taken by human hunters more frequently than small‐mammal prey throughout the last 10,000 years and that ungulates decreased relative to small mammals coincident with changes in climate. Bison ( Bison bison) and elk (Cervus canadensis) were present in eastern Washington throughout the Holocene, but bison were abundant there only during a cooler and moister period; elk have been abundant only in the twentieth century, subsequent to transplants and the extermination of predators. Geographic variation in the abundance of bison across Montana, Idaho, and eastern Washington has been influenced by human predation but has also been influenced by biogeographic history, habitat differences, and climatic change.
GIS‐Generated, Expert‐Based Models for Identifying Wildlife Habitat Linkages and Planning Mitigation Passages
Authors: Clevenger Anthony P. , Wierzchowski Jack , Chruszcz Bryan , Gunson Kari
Published: March 2003

Abstract: We developed three black bear (   Ursus americanus) habitat models in the context of a geographic information system to identify linkage areas across a major transportation corridor. One model was based on empirical habitat data, and the other two (opinion‐ and literature‐based) were based on expert information developed in a multicriteria decision‐making process. We validated the performance of the models with an independent data set. Four classes of highway linkage zones were generated. Class 3 linkages were the most accurate for mapping cross‐highway movement. Our tests showed that the model based on expert literature most closely approximated the empirical model, both in the results of statistical tests and the description of the class 3 linkages. In addition, the expert literature–based model was consistently more similar to the empirical model than either of two seasonal, expert opinion–based models. Among the expert models, the literature‐based model had the strongest correlation with the empirical model. Expert‐opinion models were less in agreement with the empirical model. The poor performance of the expert‐opinion model may be explained by an overestimation of the importance of riparian habitat by experts compared with the literature. A small portion of the empirical data to test the models was from the pre‐berry season and may have affected how well the model predicted linkage areas. Our empirical and expert models represent useful tools for resource and transportation planners charged with determining the location of mitigation passages for wildlife when baseline information is lacking and when time constraints do not allow for data collection before construction.
Fluctuating Asymmetry as an Early Warning System in the Critically Endangered Taita Thrush
Authors: Lens Luc , Van Dongen Stefan , Matthysen Erik
Published: March 2003

Abstract:Environmental and genetic factors increasingly stress natural populations, and conservationists need simple tools to measure the effect of these stresses before populations become irreversibly affected. The inability of an organism to withstand random perturbations during its development—so‐called developmental instability—has been proposed as a potential early indicator of stress. To act as a true early warning system, however, stress‐mediated changes in developmental instability should be manifest in the phenotype before major changes occur in more direct components of fitness. We tested this hypothesis by estimating the survival probabilities of 260 Taita Thrushes (   Turdus helleri) inhabiting three differentially disturbed forest fragments (  little, moderately, and highly deteriorated) and relating these to individual estimates of tarsus asymmetry (a measure of developmental instability), two other putative indices of expected fitness (size and body condition), and a coefficient of inbreeding. Tarsus symmetry, but not survival, was lower in the moderately disturbed population than in the least disturbed one, whereas both symmetry and survival were lower in the most disturbed population. Thus, higher levels of habitat disturbance were reflected by increased population levels of asymmetry before a decrease in survival became apparent. In contrast, none of the other variables showed a significant response to habitat disturbance. At the individual level, asymmetric thrushes showed lower probabilities of survival than more symmetric ones, and the magnitude of the relationship increased with habitat disturbance. Birds in better condition (i.e., higher residual body mass) survived better, irrespective of the quality of the habitat. The key finding that stress‐mediated increase in fluctuating asymmetry may precede decrease in survival suggests that single‐trait asymmetry can serve as an early warning system in conservation.
Snowmobile Activity and Glucocorticoid Stress Responses in Wolves and Elk
Authors: Creel Scott , Fox Jennifer E. , Hardy Amanda , Sands Jennifer , Garrott Bob , Peterson Rolf O.
Published: March 2003

Abstract:The effect of human activities on animal populations is widely debated, particularly since a recent decision by the U.S. Department of the Interior to ban snowmobiles from national parks. Immunoassays of fecal glucocorticoid levels provide a sensitive and noninvasive method of measuring the physiological stress responses of wildlife to disturbances. We tested for associations between snowmobile activity and glucocorticoid levels in an elk (Cervus elaphus) population in Yellowstone National Park and wolf (Canis lupus) populations in Yellowstone, Voyageurs, and Isle Royale national parks. For wolves, comparisons among populations and years showed that fecal glucocorticoid levels were higher in areas and times of heavy snowmobile use. For elk, day‐to‐day variation in fecal glucocorticoid levels paralleled variation in the number of snowmobiles after we controlled for the effects of weather and age. Also for elk, glucocorticoid concentrations were higher in response to snowmobiles than to wheeled vehicles after we controlled for the effects of age, weather, and number of vehicles. Despite these stress responses, there was no evidence that current levels of snowmobile activity are affecting the population dynamics of either species in these locations.
Sustainability of Harvested Pacú (Colossoma macropomum) Populations in the Northeastern Bolivian Amazon
Authors: Reinert Thomas R. , Winter Kimberly A.
Published: March 2003

Abstract: The pacú (Colossoma macropomum) is an important commercial and subsistence fish resource in Amazonia. Pacú depend on the unique hydrology of the Amazon Basin, in particular the occurrence of annual floods, and require a healthy and intact flooded forest ( várzea) for food resources during the wet season. From March to December of 1999, 128 pacú were collected and aged ( by means of otoliths) from subsistence harvests in the town of Bella Vista, located at the juncture of the San Martín and Blanco rivers in northeastern Bolivia. The age structure of the harvested population implied a healthy and lightly exploited stock and suggested that sustainable harvest is occurring. Population parameters at our site were similar to the neighboring, lightly exploited Mamoré River system but differed slightly from heavily exploited stocks in Brazil. Pacú harvested near Bella Vista are of special concern because of poaching and the increasing regional demand for fish, and because the várzea habitat on which the pacú depends is currently threatened by cattle production, development activities, and land‐tenure conflicts. As development increases throughout Amazonia, careful management of pacú fisheries and the flooded forest on which they depend will be of critical importance.
Quality of Agroecological Matrix in a Tropical Montane Landscape: Ants in Coffee Plantations in Southern Mexico
Authors: Perfecto Ivette , Vandermeer John
Published: March 2003

Abstract: Conservation efforts in fragmented landscapes frequently focus on characteristics of the habitat fragments. We propose that the matrix within which habitat fragments occur is of equal importance and focus on quality of the matrix as an interesting variable. We studied ground‐foraging ants in isolated montane forest fragments in the matrix of coffee agroecosystems of southwestern Chiapas, Mexico. We sampled the ants, with tuna fish as bait, in plots at various distances from a forest fragment (2–750 m) on two farms, one an organic farm with considerable shade, the other a conventional farm with only spotty shade. Each plot contained a grid of 49 ( 7 × 7) or 100 (10 × 10) baits. The species richness of ground‐foraging ants was not significantly different between the forest fragment and the high‐quality matrix, but it was significantly lower in the low‐quality matrix than in the forest. Furthermore, species richness decreased with distance from the forest fragment in both matrix types. However, the rate of decrease in species richness was greater in the conventional farm (  poor‐quality matrix) than in the organic farm (  high‐quality matrix), suggesting that the quality of the agricultural matrix is important for the conservation of ant diversity.
Studying Biodiversity on Private Lands
Authors: Hilty Jodi , Merenlender Adina M.
Published: March 2003

Abstract: More than half of the land in the United States is privately owned. Private lands harbor a great amount of biodiversity, including at least some habitat for 95% of the federally listed species in the United States. It is important to conduct conservation biology research on private lands, but our review of the literature indicates that few conservation‐oriented field studies are conducted on private property. Based on our success in obtaining permission to conduct research on 43 land parcels in Sonoma County, California, we developed methods to enhance a conservation biologist's chance of obtaining permission to work on private lands. We provide guidelines for researchers to conduct studies successfully on private land with the goal of improving access, data collection, and relationships with private landowners. We also discuss constraints researchers face, such as designing studies appropriate for working on privately owned parcels. In light of the importance of these lands to biodiversity conservation, greater effort should be made to conduct research on private lands.
Mapping the Conservation Landscape
Authors: Redford Kent H. , Coppolillo Peter , Sanderson Eric W. , Da Fonseca Gustavo A. B. , Dinerstein Eric , Groves Craig , Mace Georgina , Maginnis Stewart , Mittermeier Russell A. , Noss Reed , Olson David , Robinson John G. , Vedder Amy , Wright Michael
Published: March 2003

Abstract: Before widespread, informed collaboration can take place in conservation there must be a process of understanding the different approaches employed by different conservation organizations to conserve biodiversity. To begin this process and to help build understanding and collaboration, we provide a conceptual map of 21 approaches currently being implemented by 13 conservation organizations. We examined each of these approaches according to (1) the nature of the conservation target—the object(s) of the conservation action; ( 2 ) whether the question addressed is where conservation should be done or how conservation should be done; ( 3 ) the scale ( both grain and extent ) of the approach; and (4 ) the principles that underlie the approach. These questions provide a good way of distinguishing between most of the approaches and reveal that there is less competition between them than is assumed. We conclude that only with explicit understanding can the conservation community and its supporters critically compare approaches and come to a consensus about a set of metrics for measuring and achieving global conservation.
Forecasting Biological Invasions with Increasing International Trade
Authors: Levine Jonathan M. , D'Antonio Carla M.
Published: March 2003

Abstract: We used historical data to parameterize species‐accumulation models relating international trade to the establishment rates of nonindigenous species in the United States over the past century. We then coupled these relationships with published trade forecasts to predict future invasion rates for insects, plant pathogens, and mollusks. Relationships between the accumulation of non‐native species and merchandise imports were reasonably described by log‐log and log‐linear species‐area models and Michaelis‐Menten accumulation functions. However, the latter two models produced markedly better fits. When coupled with projected trade forecasts, the log‐linear species‐area model predicted 16–24% taxon‐specific increases in the number of nonindigenous species established in the United States from 2000 to 2020. The Michaelis‐Menten model predicted much lower 3–6% increases, but even this meant 115 new insect species and 5 new plant pathogens. These results suggest that the ecological and economic costs associated with human‐caused biological invasions may continue to rise substantially over the coming decades.
A National Survey of Use of Obstetric Procedures and Technologies in Canadian Hospitals: Routine or Based on Existing Evidence?
Authors: Kaczorowski Janusz , Levitt Cheryl , Hanvey Louise , Avard Denise , Chance Graham
Published: March 2003

Background:

The objective of this national survey was to describe the routine use of procedures and technologies in Canadian hospitals providing maternity care, and to determine the extent to which current use was consistent with the existing evidence and recommended guidelines for maternal and newborn care.

Methods:

Representatives of 572 hospitals providing maternity care across Canada were sent questionnaires in the spring and summer of 1993; 523 (91.4%) responded. The primary outcome measures consisted of the self‐reported use of obstetric procedures and technologies (perineal shaves, enemas/suppositories, intravenous infusions, initial and continuous electronic fetal heart monitoring, episiotomy rates). Hospitals were grouped according to location, size (number of live births per year), and university affiliation status.

Results:

The hospitals in the Prairie provinces, in Quebec, and in the Atlantic provinces were significantly less likely than those in Ontario to restrict their use of perineal shaves and enemas to women on admission in labor. Small hospitals were significantly more likely than large hospitals (> 1000 live births) to restrict their use of intravenous infusions, and initial and continuous electronic fetal monitoring. The university‐affiliated and nonteaching hospitals were significantly less likely than the university teaching hospitals to have episiotomy rates of less than 40 percent for primiparous women. Small hospitals were more likely than large hospitals to report episiotomy rates of less than 20 percent for multiparous women.

Conclusions:

Considerable variations occur in the routine use of obstetric procedures and technologies in Canadian hospitals providing maternity care, according to hospital location, size, and university affiliation status. Despite the existing evidence suggesting that the routine use of these practices and procedures is both unnecessary and potentially harmful, a significant number of Canadian hospitals continued to use them routinely in 1993. (BIRTH 25:1, March 1998)
A Comparison of Breast Stimulation and Intravenous Oxytocin for the Augmentation of Labor
Authors: Curtis Peter , Resnick Jacqueline C , Evens Susan , Thompson Corleen J
Published: March 2003

Background: Breast stimulation to augment labor has been used for centuries in tribal societies and by midwives. In recent years it has been shown to be effective in ripening the cervix, inducing labor, and as an alternative to oxytocin for the contraction stress test. This study compared the effectiveness of breast stimulation with oxytocin infusion in augmenting labor. Methods: Women admitted to the labor ward were eligible for the study if they had inadequate labor with premature rupture of the membranes and met inclusion criteria. They were assigned to oxytocin augmentation or breast stimulation (manual or pump), and were switched to oxytocin in the event of method failure. Outcomes included time to delivery, intervention to delivery, proportion of spontaneous deliveries, and Apgar scores. One hundred participants were needed in each arm of the study to demonstrate a 2‐ to 3‐hour difference in delivery time, with a power of 80 percent. Results: Analysis was performed on 79 women, of whom 49 were in the breast stimulation group and 30 in the oxytocin group. Sixty‐five percent of the participants failed breast stimulation and were switched to oxytocin infusion. Although augmentation start to delivery was shorter for the oxytocin group (
p < 0.001), no differences in total labor time occurred between the groups. Nulliparas receiving breast stimulation had more spontaneous (relative risk 1.7,
p= 0.04). and fewer instrumental deliveries than those receiving oxytocin (relative risk 0.2,
p= 0.02). No significant differences in adverse fetal outcomes occurred between the study groups. Conclusions: The small number of participants and a variety of problems with the conduct of the study prevented the formulation of reliable conclusions from the results. However, the study provided important insights into the feasibility and problems of developing a high‐quality randomized trial of augmentation by breast stimulation.
Cesarean Delivery in Shantou, China: A Retrospective Analysis of 1922 Women
Authors: Wu Wang‐ling
Published: March 2003

Background:
In China the cesarean section rate increased significantly during the past four decades. This study examined the frequency and indications of cesarean birth in Shantou, a southern city in China.
Methods:
An analysis was conducted of the medical records of 1922 women who had cesarean deliveries at Shantou City 2nd People's Hospital between January 1990 and December 1997. The medical records of 10,490 women who gave birth during this period were examined.
Results:
The average rate of cesarean delivery during the 8‐year period was 19.4 ± 2.3 percent (means ± standard error). From 1990 to 1997 the cesarean delivery rates ranged from 11.05 to 29.9 percent, respectively, although during this period the total annual number of deliveries decreased significantly from 1683 to 951. The rates of the most common indications per 100 women for cesarean delivery were failure to progress (23%), premature rupture of membranes (20%), fetal distress (19.4%), breech presentation (18.1%), uterine scar (14.6%), and prolonged pregnancy (11.3%).
Conclusion:
The cesarean delivery rate in Shantou, China, has increased steadily and significantly between 1990 and 1997, despite a decrease in the total number of births during the same period. This study showed that on an individual basis vaginal delivery was often possible and reduction of the cesarean delivery rate could be achieved safely by paying greater heed to appropriate indications.
Women's Perceptions of Outcomes of Prenatal Case Management
Authors: Issel L. Michele
Published: March 2003

Background:Comprehensive case management is a multidisciplinary, community‐based service often available to Medicaid‐eligible women. The purpose of the study was to identify the variety of maternal outcomes, other than birth outcomes, attributable to comprehensive prenatal case management.Method:This qualitative study used a social ecological approach. Twenty‐four women were interviewed about the outcomes they experienced as a result of comprehensive prenatal case management. Ethnographic content analysis was used for data reduction. The participants' mean age was 25.4 (SD = 8.4) years, with an average parity of 1.9 (SD = 1.1). Fifteen participants (68%) had a 12th grade education or less. Ethnic minorities were included in the sample. Eleven participants (47%) worked at least part‐time, although 23 (98%) were receiving Medicaid and 21 (88%) were receiving the Women, Infants, and Children's (WIC) supplementary nutrition program.Results:The women attributed improvements of various types to the actions of the case manager, specifically in the areas of emotional well‐being, learning, lifestyle behaviors, financial situation, services utilization, and maternal and infant physical health.Conclusion:Case management appeared to have immediate effects on the women, as well as intermediate effects, such as changes in lifestyle behaviors and services utilization. The women attributed those changes to having a healthy pregnancy.
SELECTED COCHRANE SYSTEMATIC REVIEWS Absorbable Synthetic Versus Catgut Suture Material for Perineal Repair
Authors: Kettle C. , Johanson R.B.
Published: March 2003

A substantive amendment to this systematic review was last made on 19 May 1999. Cochrane reviews are regularly checked and updated if necessary.

Background and objectives: Approximately 70% of women will experience some degree of perineal trauma following vaginal delivery and will require stitches. This may result in perineal pain and superficial dyspareunia. The objective of this review was to assess the effects of absorbable synthetic suture material as compared with catgut on the amount of short‐ and long‐term pain experienced by mothers following perineal repair.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register.

Selection criteria: Randomised trials comparing absorbable synthetic (polyglycolic acid and polyglactin) with plain or chromic catgut suture for perineal repair in mothers after vaginal delivery.

Data collection and analysis: Trial quality was assessed independently by two reviewers. Data were extracted by one reviewer and checked by the second reviewer.

Main results: Eight trials were included. Compared with catgut, the polyglycolic acid and polyglactin groups were associated with less pain in first three days (odds ratio 0.62, 95% confidence interval 0.54–0.71). There was also less need for analgesia (odds ratio 0,63, 95% confidence interval 0.52–0.77) and less suture dehiscence (odds ratio 0.45, 95% confidence interval 0.29–0.70). There was no significant difference in long‐term pain (odds ratio 0.81, 95% confidence interval 0.61–1.08). Removal of suture material was significantly more common in the polyglycolic acid and polyglactin groups (odds ratio 2.01, 95% confidence interval 1.56–2.58). There was no difference in the amount of dyspareunia experienced by women.

Reviewers' conclusions: Absorbable synthetic suture material (in the form of polyglycolic acid and polyglactin sutures) for perineal repair following childbirth appears to decrease women's experience of short‐term pain. The length of time taken for the synthetic material to be absorbed is of concern. A trial addressing the use of polyglactin has recently been completed and this has been included in this updated review.

Citation: Kettle C, Johanson RB. Absorbable synthetic versus catgut suture material for perineal repair (Cochrane Review). In: The Cochrane Library, Issue 4, 1999, Oxford: Update Software.

•••

The preceding report is an abstract of regularly updated, systematic reviews prepared and maintained by the Cochrane Collaboration. The full texts of the reviews are available in The Cochrane Library (ISSN 1464‐780X).

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Memory for Labor Pain: A Review of the Literature
Authors: Niven Catherine A , Murphy‐Black Tricia
Published: March 2003

Background:
Women's ability and accuracy in recalling labor pain are widely debated, even though clinicians commonly use such retrospective information in their practice. The objectives of this paper are to review the literature to establish if labor pain is forgotten, if recall is accurate, factors that affect the accuracy of recall, and consequences of recall.
Methods:
An electronic search of Medscape, Psychlit, Bath Information and Data Services, and CINAHL between 1990 and 1999 was undertaken using the key words “labor” and “labour,”“pain,” and “memory.” Each key word produced thousands of hits, but the combination of all three was surprisingly unsuccessful. This review, therefore, used a manual and print search and a detailed knowledge of work in this and related fields.
Results:
The literature was relatively limited, and many studies demonstrated methodological problems. Inductive and deductive analysis suggested that women do not completely forget labor pain, and recall is often vivid but not always entirely accurate.
Conclusions:
Memories of labor pain can evoke intense negative reactions in a few women, but are more likely to give rise to positive consequences related to coping, self‐efficacy, and self‐esteem.
Using Music During Childbirth
Authors: Browning Caryl Ann
Published: March 2003

Background:
The application of music in pain management has become popular in the past two decades. This article describes the responses of primiparas to the use of music therapy during the births of their children.
Method:
Eleven women who attended childbirth education classes in Brantford, Ontario, Canada, volunteered to participate in a music therapy exercise. During pregnancy each participant selected preferred music, listened to it daily, and received instruction about focused listening. Within 72 hours after birth they were interviewed about their use of music as a coping strategy during labor.
Results:
Women selected the combination of music and labor support as a helpful coping strategy during labor. All women used the music during labor to help distract them from the pain or their current situation.
Conclusion:
The planned use of music by mothers and caregivers can be an aid to prenatal preparation and an important adjunct in pain and stress management during labor and birth.
Maternal Analgesia During Labor Disturbs Newborn Behavior: Effects on Breastfeeding, Temperature, and Crying
Authors: Ransjö‐Arvidson Anna‐Berit , Matthiesen Ann‐Sofi , Lilja Gunilla , Nissen Eva , Widström Ann‐Marie , Uvnäs‐Moberg Kerstin
Published: March 2003

Background:
Newborns not exposed to analgesia, when placed on the mother's chest, exhibit an inborn prefeeding behavior. This study was performed to assess the effects of different types of analgesia during labor on the development of spontaneous breastfeeding movements, crying behavior, and skin temperature during the first hours of life in healthy term newborns.
Methods:
Video recordings were made of 28 newborns who had been dried and placed in skin‐to‐skin contact between their mother's breasts immediately after delivery. The video recordings were analyzed blindly with respect to infant exposure to analgesia. Defined infant behaviors were assessed every 30 seconds. Group 1 mothers (n = 10) had received no analgesia during labor, group 2 mothers (n= 6) had received mepivacaine via pudendal block, and group 3 mothers (n= 12) had received pethidine or bupivacaine or more than one type of analgesia during labor.Results:All infants made finger and hand movements, but the infant's massagelike hand movements were less frequent in infants whose mothers had received labor analgesia. A significantly lower proportion of group 3 infants made hand‐to‐mouth movements (p < 0.001), and a significantly lower proportion of the infants in groups 2 and 3 touched the nipple with their hands before suckling (p < 0.01), made licking movements (p < 0.01), and sucked the breast (p < 0.01). Nearly one‐half of the infants, all in groups 2 or 3, did not breastfeed within the first 2.5 hour of life. The infants whose mothers had received analgesia during labor had higher temperatures (p= 0.03) and they cried more (p= 0.05) than infants whose mothers had not received any analgesia.Conclusions:The present data indicate that several types of analgesia given to the mother during labor may interfere with the newborn's spontaneous breast‐seeking and breastfeeding behaviors and increase the newborn's temperature and crying.
Pregnant Women's Perceptions of Their Nurse's Role During Labor and Delivery
Authors: Tumblin Ann , Simkin Penny
Published: March 2003

Background:
Little has been studied about pregnant women's perceptions of their nurse's role during labor and delivery. The objective of this study was to determine nulliparous pregnant women's expectations of their nurse's role during labor and delivery as expressed during the last trimester of pregnancy.
Method:
Nulliparous women in childbirth classes were asked on a questionnaire, “What do you think your nurse's role will be during labor and delivery? You may list as many things as you wish.”
Results:
Fifty‐seven completed surveys were collected. The women listed a total of 174 items. Approximately 29 percent of the nursing tasks listed by the nulliparous women were related to providing them with physical comfort and emotional support, 24 percent related to providing informational support, almost 21 percent were related to providing technical nursing care, and 21 percent related to monitoring of the baby, mother, or labor progress; approximately 5 percent related to indirect care (outside the room).
Conclusion:
The expectations of women in our study were in contrast with findings from two previous work sampling studies, in which nurses provided much less time giving women physical comfort, emotional support, and informational support than would have been expected by women in our study. Fulfilling women's expectations about childbirth can increase women's satisfaction with their birth experiences. Further studies can help maternity caregivers learn more about women's expectations.
A Waste of Life: Fathers' Experience of Losing a Child Before Birth
Authors: Samuelsson Margaret , Rådestad Ingela , Segesten Kerstin
Published: March 2003

Background:The prenatal loss of an expected child entails parental despair and grief. The grief after a stillborn child is sometimes described as a “forgotten form of grief” and the fathers as the “forgotten mourners.” Our aim was to describe how fathers experienced losing a child as a result of intrauterine death.Method:Eleven men were interviewed 5 to 27 months after the intrauterine death of their child during weeks 32 to 42 of pregnancy. The interviews were analyzed using a phenomenological methodology.Results:After being informed of the infant's death, most fathers first wanted their partners to have a cesarean section, but all later thought that it would be right for the child to be delivered vaginally. A strong feeling of frustration and helplessness came over them during and after the delivery. Several men found meaning and relief in their grief by supporting their partner. Tokens of remembrance from the child were invaluable, and fathers appreciated that the staff collected these items, even if the parents declined them. The perceived prerequisite for resuming their everyday lives consisted of the support they received from the hospital staff and precious memories of the child. The most important comfort in their grief was a good relationship with their partner. Some fathers missed having a man to talk to both at the time of the stillbirth and subsequently.Conclusion:The fathers' general trust in life and the natural order was suddenly and unexpectedly severely tested by the death of their child, which they perceived as a terrible waste of life. They sought understanding as grieving men and fathers from both the hospital personnel and their partners, as well as from relatives. Being able to protect their partner and to grieve in their own way was important to the fathers.
Trends in the Use of Episiotomy in the United States: 1980–1998
Authors: Weeks Julie Dawson , Kozak Lola Jean
Published: March 2003

Background: Despite a relative paucity of clinical evidence justifying its routine use, approximately 40 percent of all vaginal deliveries include an episiotomy. The purpose of this study is to examine trends in episiotomy in the United States from 1980 through 1998, a period during which calls increased to abandon routine episiotomy. Methods: Data were obtained from the National Hospital Discharge Survey, which is conducted annually and based on a nationally representative sample of discharges from short‐stay non‐Federal hospitals. Results: From 1980 through 1998 the episiotomy rate in the United States dropped by 39 percent. Rates decreased for all age and racial groups investigated, in all four geographic regions, and for all sources of payment. Significant differences remained between groups in 1998, including a higher rate for white women than for black women, and a higher rate for women with private insurance than for women with Medicaid or in the self‐pay category. The incidence of first‐ and second‐degree lacerations to the perineum increased for women without episiotomies, but the more severe third‐ and fourth‐degree lacerations remained more frequent for women with episiotomies. Women with episiotomies were more likely to have forceps‐assisted deliveries or vacuum extractions. Conclusions: Despite dramatic declines in the use of episiotomy during the last two decades, it remains one of the most frequent surgical procedures performed on women in the United States, and it continues to be performed at a higher rate for certain groups of women.
Experiences of Fears Associated with Pregnancy and Childbirth: A Study of 329 Pregnant Women
Authors: Hanna‐Leena Melender RM
Published: March 2003

Background:  Women may experience a variety of fears in association with pregnancy and childbirth. The purpose of this study was to describe their objects, causes, and manifestations, and to identify factors associated with the fears.

Methods: The study sample comprised 481 pregnant women in western Finland, of whom 329 (response rate 69%) completed a questionnaire. It was developed on the basis of semi‐structured interviews and previous studies and had a 4‐point scale and a dichotomous scale. Data were subjected to rotated factor analysis, and sum variables were produced. The effects of various demographic variables were calculated using the Kruskal‐Wallis and Mann‐Whitney U tests.

Results: Of the 329 respondents, 78 percent expressed fears relating to pregnancy, to childbirth, or to both. Specific fears concerned childbirth, the child's and mother's well‐being, health care staff, family life, and cesarean section. Causes of fears were negative mood, negative stories told by others, alarming information, diseases and child‐related problems, and, in multiparas, negative experiences of previous pregnancy, childbirth, and baby's health and care; causes were significantly related to occupation. Fears were manifested as symptoms of stress, effects on everyday life, and a wish to have a cesarean section or to avoid pregnancy and childbirth; employment situation and elective cesarean section were the most important factors related to manifestation of fears. Parity and antenatal training were the most important variables related to objects of fears.

Conclusions: Women's fears that are associated with pregnancy and childbirth can be explained by different factors. It is important for perinatal health caregivers to ask pregnant women about their feelings related to the current pregnancy, childbirth, and future motherhood, and to give women who express fears an opportunity to discuss them, paying special attention to primiparas and to multiparas with negative experiences of earlier pregnancies. (BIRTH 29:2 June 2002)
Does Birth Center Care During a Woman's First Pregnancy Have Any Impact on Her Future Reproduction?
Authors: Gottvall Karin , Waldenström Ulla
Published: March 2003

ABSTRACT: Background: Women's experiences of childbirth may affect their future reproduction, and the model of care affects their experiences, suggesting that a causal link may exist between model of care and future reproduction. The study objective was to examine whether the birth center model of care during a woman's first pregnancy affects whether or not she has a second baby, and on the spacing to the next birth.

Methods: Between October 1989 and July 1993, a total of 1860 women at low medical risk in early pregnancy, who participated in a randomized controlled trial of in‐hospital birth center care versus standard care, gave birth. The 1063 primiparas in the trial, 543 in the birth center group and 520 in the standard care group, were included in a secondary analysis in which women's personal identification codes were linked to the Swedish National Birth Register, which included information about their subsequent birth during the following 7 to10 years. Time to an event curves were constructed by means of the Kaplan Meier method.

Results: The observation period after the first birth was on average 8.8 years in the birth center group and 8.7 years in the standard care group. No statistical difference was found between the groups in time to second birth, which was 2.85 and 2.82 years, respectively (median; log‐rank 1.26; p=0.26).

Conclusion: A woman's model of care, such as birth center care, during her first pregnancy does not seem to be a sufficiently important factor to affect subsequent reproduction in Sweden. (BIRTH 29:3 September 2002)
Sinister Misconceptions
Authors: Hall Philip F.
Published: March 2003

Commentary on: Kieler H, Cnattingius S, Haglund B, Palmgren J, Axelsson O. Sinistrality—a side‐effect of prenatal sonography: A comparative study of young men. Epidemiology 2001;12:618–623.
Quadruple Therapy Is Effective for Eradicating Helicobacter pylori After Failure of Triple Proton‐Pump Inhibitor–Based Therapy: A Detailed, Prospective Analysis of 21 Consecutive Cases
Authors: Gomollón Fernando , Ducóns J.A. , Ferrero M. , Cabezudo J. García , Guirao R. , Simón M.A. , Montoro M.
Published: March 2003

Background. Data regarding the effectiveness of second‐line treatment of Helicobacter pylori infection are limited, especially if microbiological studies are considered.

Methods and Patients. We conducted a prospective, uncontrolled study of a consecutive series of 21 peptic ulcer patients with failure of 1‐week lansoprazole, amoxicillin, and clarithromycin. H. pylori status was evaluated by urease test, histology, culture, and urea breath test. Susceptibility to amoxicillin, clarithromycin, and metronidazole was studied by E‐test. Cure of infection was defined as negative results from endoscopy‐based tests 1 month after treatment and negative results from a urea breath test at 2 months. Treatment consisted of a 1‐week combination of lansoprazole (30 mg bid), tetracycline (500 mg qid), metronidazole (500 mg tid), and bismuth subcitrate (120 mg qid).

Results. H. pylori was resistant to metronidazole in three cases, to clarithromycin in three cases, and to both clarithromycin and metroinidazole in an additional three patients. No resistance to amoxicillin was found. Eradication was obtained in 20 cases (95.2% confidence interval [CI], 76.2–99.9). The only patient in whom infection was not eradicated harbored a metronidazole‐resistant (minimum inhibitory concentration> 32 μg/ml) strain. No significant side effects were reported.

Conclusion. Quadruple therapy obtains a high eradication rate even in patients with clarithromycin‐ and metronidazole‐resistant strains. Further randomized and controlled studies are warranted and are urgently needed.
Addition of Metronidazole to Rabeprazole‐Amoxicillin‐Clarithromycin Regimen for Helicobacter pylori Infection Provides an Excellent Cure Rate with Five‐Day Therapy
Authors: Nagahara Akihito , Miwa Hiroto , Ogawa Kaoru , Kurosawa Akihiko , Ohkura Ryuichi , Iida Noboru , Sato Nobuhiro
Published: March 2003

Background. New triple therapy for eradication of Helicobacter pylori based on a proton pump inhibitor (PPI) provides a cure rate of approximately 90% with few adverse effects. Recently, a PPI‐based quadruple therapy, which consists of a PPI plus bismuth‐based triple therapy for 7 days, has been studied, and a sufficient eradication rate has been achieved. However, a shorter duration results in improved compliance. In this study, newly developed short‐term, simple twice‐daily quadruple therapy consisting of rabeprazole, amoxicillin, clarithromycin, and metronidazole (RACM) was compared with a PPI‐based triple‐therapy regimen for eradication of H. pylori.

Patients and Methods. This study was designed as a randomized open, prospective single‐center study. Of a total of 105 H. pylori–positive patients, 55 received the RACM regimen for 5 days (rabeprazole, 10 mg bid; amoxicillin, 750 mg bid; clarithromycin, 200 mg bid; and metronidazole, 250 mg bid), and 50 received the RAC regimen for 5 days (rabeprazole, 10 mg bid; amoxicillin, 750 mg bid; and clarithromycin, 200 mg bid). Cure of the infection was assessed by HpSA (H. pylori stool antigen immunoassay) 1 month after completion of therapy.

Results. The rates of eradication of H. pylori by RACM versus RAC were 94.5% (95% CI, 85–99) versus 80.0% (95% CI, 66–90) by intention‐to‐treat analysis; 98.1% (95% CI, 90–100) versus 87.0% (95% CI, 74–95) by all‐patients‐treated analysis; and 98.1% (95% CI, 90–100) versus 86.7% (95% CI, 73–95) by per‐protocol analysis. No major adverse effects were reported, and 98.0% of patients reported complete compliance.

Conclusions. The simple twice‐daily and short‐term quadruple regimen for only 5 days provided an excellent eradication rate. Compliance with the regimen was high, and serious adverse effects were few. Therefore, the RACM regimen can be considered as safe and effective.
Identif ication of Enterohepatic Helicobacter Species by Restriction Fragment‐Length Polymorphism Analysis of the 16S rRNA Gene
Authors: Shen Zeli , Feng Yan , Fox James G.
Published: March 2003

Background. Restriction fragment‐length polymorphism (RFLP) analysis of a 1,200‐bp polymerase chain reaction–amplified DNA fragment of gene coding for 16S rRNA was used to generate restriction profiles of 11 enterohepatic Helicobacter spp. isolated from various animals and humans.

Methods. The amplicon from each Helicobacter sp. was digested with four restriction endonucleases: Alu I, Hinf I, Hha I, and Dde I. Alu I digestion produced five patterns that were useful for initial differentiation.

Results. Most Helicobacter spp. isolated from rodents had the same RFLP profiles by Alu I digestion (except H. rodentium and H. cholecystus), but they had different RFLP profiles by Hha I digestion. Only H. bilis and “H. rappini” mouse isolates could not be readily distinguished by the polymerase chain reaction‐RFLP method. However, these two species can be distinguished using H. bilis specific primers. Some of the Helicobacter spp. have an intervening sequence in their 16S rRNA gene, which changes the RFLP patterns; in these cases, sequencing is the preferred method to make an appropriate diagnosis.

Conclusions. The RFLP method used in this study was straightforward and rapid and should prove useful as an adjunct for identification and classification of multiple enterohepatic Helicobacter spp.
Where Are We With Current Therapy?
Authors: Sung Joseph J.Y.
Published: March 2003

Despite intensive research and widely publicized recommendations from consensus meetings in different continents, the public and primary care physicians are relatively slow in picking up the impact of Helicobacter pylori infection and identifying optimal therapies. The treatment of H. pylori infection has evolved from bismuth‐containing regimens, 2‐week proton pump inhibitor (PPI)‐dual therapies, and now, the widely accepted PPI/ranitidine bismuth citrate (RBC) single week triple therapies. There is a wealth of evidence showing that these regimens are highly efficacious and well tolerated by patients. The MACH‐2 studies have confirmed that the addition of a PPI to two antimicrobials has significantly improved the cure rate of H. pylori infection and reduced the impact of antimicrobial resistance. Attempts to use shorter regimens ranging from 1 to 3 days should be resisted because of their unacceptably low therapeutic efficacy. In the United States, there are some indications that 10–14 days of treatment may be required. While the first‐line therapies for H. pylori infection is well established, we are still struggling with the choice of optimal regimen in retreatment after the first attempt fails. Quadruple therapy combining PPI with bismuth, metronidazole and tetracycline has achieved a respectable success of around 85%. Switching between metronidazole and clarithromycin seems to be a sensible strategy as these two are the most effective anti‐Helicobacter agents. Changing between PPI and RBC in the triple therapy would not make much difference without replacing some of the antimicrobials. Rifabutin‐containing regimens and high‐dose PPI‐amoxicillin dual therapy deserve more studies with large‐scale studies. Data on anti‐Helicobacter therapy for children are few. Most studies based on bismuth derivatives in combination with amoxicillin or tinidazole and were limited by the small number of cases. Recent studies showed 1‐week bismuth‐based triple therapy and 2‐week PPI‐based triple therapy are highly efficacious. Reinfection in children > 5 years of age after successful cure is rare. It is worthwhile to refine the optimal therapy for children as the treatment of this group would, theoretically, prevent the development gastric cancer in the long term.
Helicobacter pylori Induces Apoptosis in Human Epithelial Gastric Cells by Stress Activated Protein Kinase Pathway
Authors: Domek Matthew J. , Netzer Peter , Prins Bruce , Nguyen Trang , Liang Dan , Wyle Frederic A. , Warner Alberta
Published: March 2003

Background.

The pathway by which Helicobacter pylori induces apoptosis in gastric epithelial cells is not known. The aim of this study was to determine whether H. pylori‐induced apoptosis is associated with SAPK/JNK activity in human gastric cancer KATO III cells.

Materials and Methods.

H. pylori VacA toxin positive strain was incubated with KATO III cells for 0.5, 1, 2 or 24 hours. The SAPK/JNK protein was harvested from the KATO III cell lysate by precipitation with a C‐jun fusion protein and its activity was measured by C‐jun phosphorylation utilizing transblotting and phosphoserine antibody. Cellular apoptosis was demonstrated by DNA fragmentation. In addition, cell growth in coculture with H. pylori was determined over 72 hours.

Results.

H. pylori significantly stimulated SAPK/JNK activity in KATO III cells with a peak at the 0.5 hour time point (3.6‐fold vs. control, p < .05), but a return to basal levels by 2 hours. In addition, significant DNA fragmentation was observed after 24 hours in these cells but not in the control KATO III cells. Cell growth was inhibited in a dose dependent fashion in coculture with H. pylori.

Conclusion.

These results show that H. pylori triggers an increase in apoptosis in KATO III cells as reflected by DNA fragmentation. This effect was preceded and correlated with an increase in SAPK/JNK activity suggesting that the H. pylori‐induced apoptosis in human gastric epithelial cells may be mediated by the SAPK/JNK pathway.