bluuebunny/crossref_metadata_2025 huggingface dataset:
The prevalence of domestic violence in pregnant women
Authors: Johnson J.K. , Haider F. , Ellis K. , Hay D.M. , Lindow S.W.
Published: December 2003

Objective
To determine the prevalence of domestic violence in a population of pregnant women.

Design
Questionnaire survey.

Setting
Antenatal booking clinic in a north of England hospital.

Population
Five hundred consecutive women were included.

Methods
Anonymous confidential questionnaire to women who were not accompanied by their partners.

Main outcome measures
Disclosure of a past history of physical, emotional or sexual abuse.

Results
Four hundred and seventy‐five questionnaires were returned (95% response rate). The prevalence of domestic violence was 17%. Domestic violence was highest in the age group 26–30 years and boyfriends were the main perpetrators. Punching and slapping were the most common pattern of violence, and 10% of women experiencing domestic violence had had forced sexual activity.

Conclusion
The prevalence of domestic violence in a cohort of pregnant women in the north of England was 17%. Consideration should be given for routine screening for domestic violence in pregnancy to institute effective intervention strategies.
The use of lidocaine for fetocide in late termination of pregnancy
Authors: Senat M.V. , Fischer C. , Bernard J.P. , Ville Y.
Published: December 2003

Objective
To assess the use of lidocaine (1%) to induce permanent fetal cardiac asystole for fetocide in late termination of pregnancy.

Design
Prospective observational study.

Setting
One tertiary referral fetal medicine unit in France.

Sample
Fifty patients undergoing termination of pregnancy between 20 and 36 weeks of gestation for severe abnormalities or severe maternal conditions.

Methods
Fetocide was performed by umbilical vein puncture under ultrasound guidance with injection of sufentanil (5 μg) followed by 7 to 30 mL of lidocaine (1%).

Main outcome measures
Percentage of successful procedures to obtain permanent fetal cardiac asystole and maternal side effects.

Results
The procedure was successful in 92% of cases (46/50) with complete cessation of heart activity. The mean amount of lidocaine was 15.3 (6.5) mL. In three cases, fetocide was performed by cardiocentesis and in one case lidocaine was unsuccessful and fetocide was performed with KCl. There were no maternal side effects.

Conclusion
Lidocaine is an effective drug to perform fetocide with doses below the toxic dose for the mother.
Screening for chromosomal abnormalities in the first trimester using ultrasound and maternal serum biochemistry in a one‐stop clinic: a review of three years prospective experience
Authors: Spencer Kevin , Spencer Christine E. , Power Maureen , Dawson Carolynne , Nicolaides Kypros H.
Published: December 2003

Objective
To evaluate the performance of a one‐stop multidisciplinary clinic of screening for fetal chromosomal anomalies in the first trimester of pregnancy by a combination of maternal serum biochemistry and ultrasonography.

Design
Retrospective review of screening performance.

Setting
District General Hospital maternity unit.

Population
All women booked for routine antenatal care at Harold Wood Hospital between 1 June 1998 and 31 May 2001. The population included 12,339 women with singleton pregnancies presenting at 10–14 weeks of gestation.

Methods
Women were offered screening using a combination of maternal serum free β‐hCG and pregnancy associated plasma protein‐A (PAPP‐A) and fetal nuchal translucency thickness. Those with an estimated risk of ≥1 in 300 of carrying a fetus with trisomy 21 or trisomy 18 or trisomy 13 were offered the option of an invasive diagnostic test. Follow up of the outcome of all pregnancies was carried out.

Main outcome measures
Uptake of screening and invasive testing, detection rate for fetal chromosomal abnormalities and false positive rate.

Results
The uptake of first trimester screening was 97.5% and the uptake of invasive testing in the increased risk group was 77%. The rate of detection of trisomy 21 was 92% (23 of 25), of trisomy 13 or 18 was 100% (all 15) and of all aneuploidies was 96% (49 of 51). The false positive rate was 5.2%.

Conclusion
First trimester screening for trisomy 21 and other aneuploidies can be delivered in an efficient manner in a one‐stop multidisciplinary clinic. The detection rates are far better than can be achieved by second trimester serum screening.
Randomised controlled trial of nurse continence advisor therapy compared with standard urogynaecology regimen for conservative incontinence treatment: efficacy, costs and two year follow up
Authors: Moore K.H. , O'Sullivan R.J. , Simons A. , Prashar S. , Anderson P. , Louey M.
Published: December 2003

Objective
To compare the efficacy and labour costs of nurse continence advisors and urogynaecologists in conservative management of urinary incontinence.

Design
Single centre randomised controlled trial of patients with mild or moderate leakage.

Setting
Tertiary urogynaecology unit.

Sample
One hundred and forty‐five consecutive patients with stress and/or urge incontinence.

Methods
Standardised conservative therapy regimens, provided by nurse continence advisors and urogynaecologists.

Main outcome measures
One‐hour pad test, frequency volume charts, a 20‐point incontinence score and two quality of life tests, staff treatment times and costs.

Results
Of 110 women who completed 12‐week treatments, 64% of the women in the nurse continence advisor group (n= 58) and 52% of women treated by urogynaecologists (n= 52) were asymptomatic (dry pad test; OR 1.63, 95% CI 0.71–3.75). There was no significant difference between clinician groups for change in pad test result (P= 0.71), voids/day (0.43), incontinence score (P= 0.57) or quality of life scores (urogenital distress inventory, P= 0.27; Incontinence Impact Questionnaire, P= 0.41). Despite the expected longer consultation times for the advisor group (median 160 min, interquartile range [IQR] 130–210) versus the urogynaecologist group (median 90 min, IQR 60–120), the per capita labour cost for advisor treatment (median AU$59.20, IQR 48.10–77.70) was lower than for treatment given by urogynaecologists (median cost AU$ 189.70, IQR 120.60–250.70, Mann–Whitney U test, P < 0.0001). At 2.5 years, 23/58 patients (40%) treated by advisor and 27/52 patients (52%) treated by urogynaecologist group, who had been cured and discharged, were available for contact. Of these, 29% of women in the nurse continence advisor group and 41% of those treated by urogynaecologists remained continent (on 20‐point score). Quality of life improvement persisted equally in both groups. These data should be interpreted cautiously due to a 24% dropout rate.

Conclusions
The reduction in urine leakage and improvement in quality of life observed in patients treated by nurse continence advisors and urogynaecologists were similar at 12 weeks and 2 years, but lower costs arose from treatment provided by nurse advisors. We suggest that conservative treatment by the nurse continence advisor could be used more widely in mild to moderate incontinence.
The role of frozen section examination of conisations in the management of women with cervical intraepithelial neoplasia
Authors: Bretelle Florence , Agostini Aubert , Rojat‐Habib Marie‐Christine , Cravello Ludovic , Roger Valérie , Blanc Bernard
Published: December 2003

Objective
To determine whether frozen section in conisation improves the management of cervical intraepithelial neoplasia.

Design
Randomised trial.

Setting
Department of Obstetrics and Gynaecology, Conception Hospital, Marseille, France.

Population
Patients referred for treatment or diagnosis of cervical intraepithelial neoplasia.

Methods
Two hundred and three patients requiring conisation for diagnosis or treatment of cervical pathology were randomly assigned to have (n= 102) or not (n= 101) a frozen section of the endocervical margin of the cone specimen.

Main outcome measures
The principal criterion was the 12 month residual or recurrent high grade disease rate.

Results
At 12 months, the residual or recurrent disease rate of high grade lesions was 12.6% in the group that did not have frozen sections and 1% in the group that did (relative risk, RR, 11.9, 95% CI 1.6–89.5, P= 0.0025). The corresponding rates of margin involvement were 18.9% and 1%, respectively (RR 15.13, 95% CI 2.06–111.27, P= 0.0002). The groups did not differ as to the height of the cone (13.6 [5.6] mm vs 13.7 [4.7] mm, P= 0.75) or post‐operative morbidity (6% vs 7%, RR 1.01, 95% CI 0.94–1.09, P= 0.8). The rate of patients lost to follow up was similar in both groups 17% vs 12% (RR 1.42, 95% CI 0.71–2.81, P= 0.31).

Conclusion
Frozen section is effective in conisation and significantly reduces residual or recurrent high grade disease. This finding improves the management of cervical pathology achieving immediate clear margins in most of conisations. This is of great interest because high rates of patients are lost to follow up as we and others authors have found.
Dexamethasone and ursodeoxycholic acid protect against the arrhythmogenic effect of taurocholate in an in vitro study of rat cardiomyocytes
Authors: Gorelik J. , Shevchuk A.I. , Diakonov I. , de Swiet M. , Lab M. , Korchev Y. , Williamson C.
Published: December 2003

Objective
To establish whether the therapeutic agents ursodeoxycholic acid and dexamethasone protect cardiomyocytes from taurocholate‐induced arrhythmias in an in vitro model.

Design
Laboratory study.

Setting
Imperial College London, Hammersmith Campus.

Sample
Neonatal rat cardiomyocytes.

Methods
Using scanning ion conductance microscopy, we measured the rate, rhythm, amplitude of contraction and calcium dynamics of ventricular myocytes from one to two day old rats. Cells were pre‐incubated for 16 hours in dexamethasone (80 or 800 nM) or 0.1 mM ursodeoxycholic acid before adding taurocholate at different concentrations (0.3–4.5 mM).

Main outcome measures
Changes in rate and amplitude of contraction, calcium dynamics and rhythm.

Results
Taurocholate at concentrations of up to 3 mM induces abnormal changes including reductions in rate, amplitude of contraction, abnormal calcium dynamics and dysrhythmias. Although dexamethasone had no immediate protective effect on these changes, pre‐incubation with dexamethasone was protective. Ursodeoxycholic acid pre‐incubation was protective at taurocholate concentrations up to 1 mM.

Conclusion
The therapeutic agents dexamethasone and ursodeoxycholic acid appear protective against the arrhythmogenic effect of taurocholate on cardiomyocytes.
Laparoscopic restaging of borderline ovarian tumours: results of 30 cases initially presumed as stage IA borderline ovarian tumours
Authors: Querleu D. , Papageorgiou Th. , Lambaudie E. , Sonoda Y. , Narducci F. , LeBlanc E.
Published: December 2003

Objectives
To review our experience with the laparoscopic restaging procedure of presumed early stage borderline ovarian tumours.

Design
Retrospective study.

Setting
Cancer centre.

Population
Thirty patients with presumed stage I borderline ovarian tumours after limited initial surgery

Methods
From April 1991 to May 2001, the patients were laparoscopically reassessed. The procedure involved peritoneal cytology, exploration of the peritoneal cavity, infracolic omentectomy, directed or random peritoneal biopsies, and when appropriate, contralateral oophorectomy and hysterectomy and appendectomy. Medical records were reviewed for patients' age, interval time between procedures, tumour stage, histological type, operative time, hospital stay, peri‐operative complications and follow up.

Main outcome measures
Seroperative and postoperative data, pathology and clinical follow up.

Results
Laparoscopic restaging was completed in all 30 (100%) identified patients. The mean age was 34.8 (10.5) years; the delay between initial operation and restaging laparoscopy averaged 9.8 (6.6) weeks. The mean operative time was 165.4 (53.8) minutes, and the mean hospital stay was 2.7 (1.3) days. There were two (7.0%) major complications related directly to the procedure. Eight (26.6%) patients were upstaged. Mean follow up was 29.1 (6.6) months, all patients are alive and one (3.2%) recurrence was observed.

Conclusions
Laparoscopic approach of restaging for borderline ovarian tumours is an accurate safe procedure. It is associated with an acceptable rate of minor complications, it has similar morbidity associated with laparotomy and it minimises the incidence of infertility in the young patients. Whenever staging of borderline ovarian tumours is to be considered in an individual patient, laparoscopy provides a suitable alternative approach.
Aggressive or expectant management of labour: a randomised clinical trial
Authors: Pattinson R.C. , Howarth G.R. , Mdluli W. , MacDonald A.P. , Makin J.D. , Funk M.
Published: December 2003

Objective
To compare labour outcomes using aggressive or expectant management protocols.

Design
Randomised trial.

Setting
Pretoria Academic Complex, South Africa. It serves an indigent urban population.

Population
Healthy nulliparous women in active labour, at term, with a health singleton pregnancy and cephalic presentation.

Methods
The women were randomised to either aggressive (n= 344) or expectant (n= 350) management protocols. Aggressive management entailed using a single line partogram, a vaginal examination every two hours and use of an oxytocin infusion if the line was crossed. Expectant management entailed using a two line partogram, with the alert line and a parallel action line four hours to the right, with a vaginal examination every four hours. If the action line was reached, oxytocin was started. The women were reassessed every two hours thereafter. Analgesia was prescribed on request.

Main outcome measures
Mode of birth, use of oxytocin and analgesia and neonatal outcome.

Results
The groups were similar with respect to maternal age, cervical dilation at trial entry, number crossing the alert line and birthweight of the infants. Significantly fewer women managed aggressively had caesarean sections (16.0%) than those managed expectantly (23.4%) (relative risk [RR] 0.68, 95% confidence intervals [CI] 0.50, 0.93). Significantly more oxytocin was used in the aggressive management group, but there was no difference with respect to the use of analgesia or episiotomy or in neonatal outcome with respect to the Apgar score at 1 or 10 minutes. There were three perinatal deaths. One woman was found to have an intrauterine death before trial entry and the other two were in the aggressive management group but did not receive oxytocin. Compliance by staff was poor in the aggressive management group.

Conclusions
Aggressive management of labour reduces the caesarean section rate in nulliparous women but requires more intensive nursing.
Laparoscopic gonadectomy in paediatric and adolescent girls with intersex disorders
Authors: Esegbona Gloria , Cutner Alfred , Cuckow Peter , Creighton Sarah
Published: December 2003

Gonadectomy is indicated in some children and teenagers with intersex disorders. Traditionally, this has been performed by laparotomy. This paper is a retrospective evaluation of laparoscopic gonadectomy in 10 girls (age range 8 to 17 years). Clinical records were reviewed for diagnosis, indication for surgery, complications and recovery period. Operative notes were reviewed for details of technique and complications. In all cases, the procedure was uncomplicated and the maximum hospital stay was two days. Laparoscopic gonadectomy is an effective and safe procedure for children and teenagers with these rare conditions.
Are smoking and other lifestyle factors associated with female urinary incontinence? The Norwegian EPINCONT Study
Authors: Hannestad Yngvild S. , Rortveit Guri , Daltveit Anne Kjersti , Hunskaar Steinar
Published: December 2003

Objective
To examine whether modifiable lifestyle factors such as smoking, obesity, physical activity and intake of alcohol or caffeinated drinks were associated with urinary incontinence in women.

Design
Cross sectional population‐based study.

Setting
The Norwegian Epidemiology of Incontinence in the County of Nord‐Trøndelag (EPINCONT) Study is part of a large survey performed in a county in Norway during 1995–1997.

Population
Women ≥20 years (n= 34,755, 75% of the invited) attended the first part of the survey and received the questionnaire. There were 27,936 (80% of source population) women who completed the incontinence part of the questionnaire.

Methods
Questionnaire covering several health topics including urinary incontinence was received at a screening station. Logistic regression analysis was used to adjust for confounding and to establish associations with the different outcomes under investigation: any incontinence, severe incontinence and stress, urge and mixed subtypes.

Main outcome measures
Effect measure were odds ratios with corresponding 95% confidence intervals.

Results
Former and current smoking was associated with incontinence, but only for those who smoked more than 20 cigarettes per day. Severe incontinence was weakly associated with smoking regardless of number of cigarettes. The association between increasing body mass index and incontinence was strong and present for all subtypes. Increasing levels of low intensity physical activity had a weak and negative association with incontinence. Tea drinkers were at slightly higher risk for all types of incontinence. We found no important effects of high intensity physical activity, intake of alcohol or coffee.

Conclusions
Several potentially modifiable lifestyle factors are associated with urinary incontinence. Highest odds ratios were found for body mass index, heavy smoking and tea drinking.
The contribution of assisted conception, chorionicity and other risk factors to very low birthweight in a twin cohort
Authors: Lynch Anne , McDuffie Robert , Stephens Janet , Murphy James , Faber Kenneth , Orleans Miriam
Published: December 2003

Objectives
To investigate the contribution of assisted conception (assisted reproductive technology and ovulation induction), chorionicity and selected maternal risk factors for very low birthweight.

Design
Retrospective twin cohort study.

Setting
Staff model Colorado Health Maintenance Organization.

Sample
Five hundred and sixty‐two twin gestations [assisted = 193 (34%); unassisted = 369 (66%)].

Methods
Data were collected from a perinatal database and medical record review. Data were analysed using univariate and multivariable logistic regression analysis.

Main outcome measure
Very low birthweight.

Results
Women with assisted twin gestation were more likely to be older, nulliparous, non‐smokers, married, have a prior history of a miscarriage and a dichorionic placentation. There was no difference in the distribution of low and very low birthweight, discordant growth or preterm delivery between assisted and unassisted twin gestations. Significant risk factors for very low birthweight were: a prior preterm birth (odds ratio, OR, 3.8, 95% confidence interval, CI, 2, 7), monochorionicity (OR 3, 95% CI 2, 4.7), nulliparity (OR 2, 95% CI 1.3, 3), cigarette smoking (OR 1.8, 95% CI 1, 3) and prior miscarriage (OR 1.6, 95% CI 1, 2). Monochorionicity was significantly associated with adverse perinatal outcomes.

Conclusion
Assisted conception did not play a significant role in the occurrence of very low birthweight in this cohort. A history of preterm birth and a monochorionic twin gestation were the leading risk factors for very low birthweight. Associated risk factors for very low birthweight were nulliparity, cigarette smoking and a prior miscarriage.
Unexpected reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period: was this the Hawthorne effect?
Authors: Leung W.C. , Lam H.S.W. , Lam K.W. , To M. , Lee C.P.
Published: December 2003

Objective
The study was originally designed to identify the risk factors that could predict those difficult instrumental deliveries resulting in birth trauma and birth asphyxia.

Design
A prospective study on all singleton deliveries in cephalic presentation with an attempt of instrumental delivery over a 12‐month period (13 March 2000 to 12 March 2001).

Setting
A local teaching hospital.

Sample
Six hundred and seventy deliveries.

Methods
A codesheet was designed to record the demographic data, characteristics of first and second stages of labour and neonatal outcome. In particular, the doctor had to enter the pelvic examination findings before the attempt of instrumental delivery.

Main outcome measures
Birth trauma and birth asphyxia.

Results
There was a significant reduction in the incidence of birth trauma and birth asphyxia related to instrumental deliveries during the study period (0.6%) when compared with that (2.8%) in the pre‐study period (1998 and 1999) (RR 0.27, 95% CI 0.11–0.70). There was more trial of instrumental deliveries in the operating theatre although this was not statistically significant (RR 1.19, 95% CI 0.88–1.60). The instrumental delivery rate decreased during the study period (RR 0.88, 95% CI 0.82–0.94). The caesarean section rate for no progress of labour, the incidence of direct second stage caesarean section and the incidence of failed instrumental delivery did not increase during the study period.

Conclusions
Apart from the merits of regular audit exercise and increasing experience of the staff, the Hawthorne effect might be the major contributing factor in the reduction of birth trauma and birth asphyxia related to instrumental deliveries during the study period.
The pre‐operative assessment of the adnexal mass: the accuracy of clinical estimates versus clinical prediction rules
Authors: Boll Dorry , Geomini Peggy M.A.J. , Brölmann Hans A.M. , Sijmons Edith A. , Heintz Peter M. , Mol Ben W.J.
Published: December 2003

Objective
To evaluate the reproducibility of the clinical judgement of gynaecologists, gynaecologists in training and gynaecologic oncologists and to compare the predictive performance of the offhand assessment with the predictive performance of existing mathematical models for the pre‐operative assessment of the adnexal mass.

Design
Questionnaire with paper cases of women operated on for an adnexal mass.

Setting
Gynaecological unit in a teaching hospital in the South of The Netherlands.

Population
Women who underwent surgery for adnexal mass between January 1991 and December 1998.

Methods
We offered 45 gynaecologists five different sets of 34 cases, with data on female age and menopausal status, a written description of the sonography, Doppler flow measurement and serum CA125 measurement. Nine observers for every set were asked to estimate the probability of malignancy.

Main outcome measures
The reproducibility of the risk estimates as made by the participants was expressed with an intraclass correlation coefficients. The accuracy of the judgement of the clinicians and the result of mathematical models in the prediction of malignancy were expressed with sensitivity, specificity, and receiver‐operating characteristic curves.

Results
Neither clinically relevant nor statistically significant differences could be found between the accuracy of the risk assessments made by the clinicians and the accuracy of the risk assessments made by prediction models.

Conclusion
This study demonstrates that at this moment there is no need to introduce complicated predictive scoring systems such as neural networks or logistic regression models for the pre‐operative assessment of the adnexal masses.
Factor V Leiden in pregnancies complicated by placental abruption
Authors: Procházka Martin , Happach Catharina , Maršál Karel , Dahlbäck Björn , Lindqvist Pelle G.
Published: December 2003

Objective
Recent studies suggest an increased prevalence of obstetric complications in female carriers of hereditary or acquired thrombophilias. The aim of the study was to determine if carriership of the factor V (FV) Leiden mutation (activated protein C [APC] resistance) is higher in women who have had of placental abruption during pregnancy.

Design
A retrospective case–control study.

Setting
University Hospital MAS, Malmö, Sweden.

Methods
A comparison of 102 women with placental abruption with 2371 prospectively collected controls. Carriership of FV Leiden was determined and the women were interviewed.

Main outcome measures
Proportion of FV Leiden carriership, first degree heritage of thrombosis and previous placental abruption in cases and controls.

Results
Carriage of FV Leiden was found in 15.7% of women who have had placental abruption as compared with 10.8% of controls (P= 0.12, odds ratio [OR] = 1.5, 95% confidence interval [CI] = 0.9–2.7). Around 20% of women with placental abruption reported first degree heritage for venous thrombosis, as compared with 6.7% of controls (P≤ 0.001).

Conclusions
FV Leiden carriership was not significantly different in women with placental abruption. However, there was an increased prevalence of first degree heritage for venous thrombosis in women with placental abruption, indicating a higher prevalence of thrombophilia among women with placental abruption.
Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy
Authors: Sebire N.J. , Fisher R.A. , Foskett M. , Rees H. , Seckl M.J. , Newlands E.S.
Published: December 2003

Objective
To determine pregnancy outcome, including the rate of repeat molar pregnancy, following histologically confirmed complete or partial hydatidiform mole.

Design
Retrospective review of a large supraregional database of registrations for gestational trophoblastic disease.

Setting
Supraregional Trophoblastic Disease Unit, London.

Sample
Women with pregnancies affected by complete or partial hydatidiform mole registered between 1992 and 1998.

Methods
All patients with a diagnosis of histologically confirmed complete or partial hydatidiform mole were identified and data on subsequent pregnancies compared between groups using comparison of proportion test.

Main outcome measures
Pregnancy outcome by partial or complete mole subtype, with particular regard to risk of subsequent molar pregnancy.

Results
Of 2578 complete moles, the subsequent pregnancy was affected by hydatidiform mole in 27 (1.9%) cases, including 22 (81%) complete moles and 5 (19%) partial moles. Of 2627 partial moles, the subsequent pregnancy was also molar in 25 (1.7%) cases, including 17 (68%) partial moles and 8 (32%) complete moles. Overall recurrence risk for molar pregnancy was 1.8% (1 in 55), or a 20‐fold increase compared with the background risk. Of 27 cases with repeat complete moles, three had further complete moles, suggesting the recurrence risk following two previous complete moles is approximately 10%. There were no other significant differences in pregnancy outcome between cases with previous complete or partial hydatidiform mole and that expected in an unselected obstetric population.

Conclusions
Women having a pregnancy affected by a histologically confirmed complete or partial hydatidiform mole may be counselled that the risk of repeat mole in a subsequent pregnancy is about 1 in 60 and if this were to occur, the majority of cases will be of the same type of mole as the preceding pregnancy. However, >98% of women who become pregnant following a molar conception will not have a further hydatidiform mole and these pregnancies are at no increased risk of other obstetric complications.
Choices about abortion method: assessing the quality of patient information leaflets in England and Wales
Authors: Wong Sandra S.M. , Bekker Hilary L. , Thornton Jim G. , Gbolade Babatunde A.
Published: December 2003

ObjectiveTo assess the quality of patient leaflets regarding the choice between medical and surgical abortions.

DesignCross sectional survey.

SettingNHS and private providers of abortion services in England and Wales.

SampleLeaflets from three private providers, all teaching hospitals (n= 14) and a representative sample of NHS district hospitals (n= 27), accessed by approximately 100,000 women per year.

MethodsOn telephoning the above abortion services, the leaflets provided to women choosing to have medical or surgical abortions were requested. Content analysis of leaflets included: application of a coding frame assessing adequacy of information about options, risks and procedures; the Flesch Readability Ease scale.

Main outcome measuresProvision of leaflet, adequacy of information and ease of readability.

ResultsSeventy‐three percent (44/60) of contacted providers offered women a leaflet. Of these 44 leaflets, one mentioned medical and 15 surgical abortion methods only. Adequacy of information provision was low, with on average 10/23 points covered about the surgical method, 12/21 points about the medical method and 7/11 points about aftercare. Readability scores were poor with 24/44 (55%) rated as ‘difficult’ or ‘fairly difficult’. Among NHS providers, scores were slightly higher in the teaching than in the district hospitals.

ConclusionsOn average, leaflets provided half the information possible about the risks and procedures of medical and surgical methods. In addition, readability was rated as difficult in over half the leaflets. It seems unlikely that these leaflets enable women to make informed choices between abortion methods and, therefore, do not meet the requirements of current guidelines.
Do bladder neck position and amount of elevation influence the outcome of colposuspension?
Authors: Bombieri L. , Freeman R.M.
Published: December 2003

Objective
To determine whether the amount of bladder neck elevation and the position of the bladder neck after surgery influence the cure rate after colposuspension.

Design
Prospective, observational study.

Setting
Urogynaecology unit, district general hospital.

Population
Seventy‐seven women undergoing colposuspension for urodynamic stress incontinence.

Methods
The bladder neck was imaged pre‐operatively and one week after surgery using magnetic resonance imaging. The position of the bladder neck after surgery and the amount of elevation were correlated to continence outcome one year after surgery (subjective and objective evidence of stress incontinence).

Main outcome measures
Subjective and urodynamic stress incontinence one year after surgery.

Results
At one year the subjective and objective failure rates were 11.6% and 10.5%, respectively. Measures using magnetic resonance imaging were obtained in 73 women. No association was found between continence outcome and post‐operative bladder neck position and elevation.

Conclusion
The post‐operative position of the bladder neck and the amount of elevation do not influence continence outcome. Post‐operative morbidity (voiding dysfunction and detrusor instability) might be preventable by avoiding excessive bladder neck elevation and compression, without compromising the success of the procedure.
Increased vaginal bleeding and psychological distress: a longitudinal study of their relationship in the community
Authors: Shapley Mark , Jordan Kelvin , Croft Peter R.
Published: December 2003

Objective
To explore the temporal relationship between the development of self‐reported symptoms of vaginal bleeding and the development of psychological distress among women in the community.

Design
Prospective cohort study using postal surveys at baseline and at 6 and 12 months.

Setting
An urban four‐partner general practice with 10,000 registered patients.

Population
All women aged 18–54 years on the practice age–sex register.

Methods
Baseline postal questionnaire with follow up questionnaires sent at 6 and 12 months.

Main outcome measures
The associations between the development of heavy periods and psychological distress.

Results
Two thousand and four hundred and thirty‐five baseline questionnaires were sent out with an initial response rate of 76%. One thousand and five hundred and thirteen women (62%) responded to all three questionnaires. Women with psychological distress at baseline were more likely to develop heavy periods 6 months later than women without distress (adjusted odds ratio 1.87, 95% CI 1.15, 3.02). Women with heavy periods at baseline were no more likely to develop psychological distress 6 months later than women with non‐heavy periods (adjusted odds ratio 1.09, 95% CI 0.73, 1.63). Similar findings existed with respect to intermenstrual bleeding and postcoital bleeding. Results of the 12‐month analysis were similar.

Conclusion
In the community, psychological distress appears to influence the future self‐reporting of heavy periods and other symptoms of vaginal bleeding.
Management of incomplete abortion in South African public hospitals
Authors: Brown H.C. , Jewkes R. , Levin J. , Dickson‐Tetteh K. , Rees H.
Published: December 2003

Objective
To describe the current management of incomplete abortion in South African public hospitals and to discuss the extent to which management is clinically appropriate.

Design
A multicentre, prospective descriptive study.

Setting
South African public hospitals that manage gynaecological emergencies.

Sample
Hospitals were selected using a stratified random sampling method. All women who presented to the above sampled hospitals with incomplete abortion during the three week data collection period in 2000 were included.

Methods
A data collection sheet was completed at the time of discharge for each woman admitted with a diagnosis of incomplete, complete, missed or inevitable abortion during the study period. Information gathered included demographic data, clinical signs and symptoms at admission, medical management, surgical management, anaestetic management, use of blood products and antibiotics and complications. Three clinical severity categories were used for the purpose of data analysis and interpretation.

Main outcome measures
Detail of medical management, detail of surgical management, use of blood products and antibiotics, methods of analgesia and anaesthesia used, and use of abortifacients.

Results
There is a trend towards low cost technology such as the use of manual vacuum aspiration and sedation anaesthesia; however, this is mainly limited to the better resourced tertiary hospitals linked to academic units. The use of antibiotics and blood products has decreased but much of the use is inappropriate. The use of abortifacients does include some use of misoprostol but merely as an adjunct to surgical evacuation.

Conclusions
The management of incomplete abortion remains a problem in South Africa, a low income country that is still managing a common clinical problem with costly interventions. The evidence of a trend towards low cost technology is promising, albeit limited to tertiary centres. This study has given us information as how to best address this problem. More training in low cost methods is needed, targeting in particular the district and regional hospitals, and reinforced by skills training focussed mainly on undergraduates and midwife post‐abortion care programmes.
Inter‐observer variation in assessment of 845 labour admission tests: comparison between midwives and obstetricians in the clinical setting and two experts
Authors: Blix Ellen , Sviggum Oddvar , Koss Karen Sofie , Øian Pål
Published: December 2003

Objective
To assess the inter‐observer agreement in assessment of the labour admission test between midwives and obstetricians in the clinical setting and two experts in the non‐clinical setting, the inter‐observer agreement between two experts in the non‐clinical setting and to what degree fetal distress in labour could be predicted by the two experts.

Design
Observational study.

Setting
The maternity unit of Hammerfest Hospital, Norway.

Population
Eight hundred and forty‐five high and low risk women.

Method
The labour admission test was first assessed by the midwife or obstetrician in the clinical setting, and was later assessed by two experts. The traces were assessed as normal, equivocal or ominous. Weighted kappa (κw), proportion of agreement (Pa) and predictive values were calculated.

Main outcome measures
Weighted kappa, proportion of agreement, sensitivity, positive predictive value and likelihood ratios.

Results
Inter‐observer agreement between Expert 1 and Expert 2: κw 0.38 (CI 0.31–0.46), Pa for reactive labour admission test 0.86 (CI 0.83–0.88) and Pa for equivocal/ominous test 0.33 (CI 0.26–0.40). Agreement between Expert 1 and midwives/obstetricians: κw 0.25 (CI 0.15–0.36), Pa for reactive labour admission test 0.89 (CI 0.87–0.91) and Pa for equivocal/ominous labour admission test 0.18 (CI 0.11–0.25). Agreement between Expert 2 and midwives/obstetricians: κw 0.28 (CI 0.20–0.37), Pa for reactive labour admission test 0.85 (CI 0.82–0.88) and Pa for equivocal/ominous test 0.20 (CI 0.14–0.26). Totally 5.9% of the newborns had fetal distress. At cutoff equivocal test, sensitivity was 0.22 and 0.31 in the two observers. Positive predictive values were 0.13 and 0.11. Likelihood ratio for a positive test was 2.30 and 1.92 and likelihood ratio for a negative test 0.86 and 0.83.

Conclusion
A labour admission test is still routine practice in most obstetric units in the Western world when there is little evidence on its benefits. The results from this study may provide some reconsideration for such practice, and for more research.
Longitudinal quantification of uterine artery blood volume flow changes during gestation in pregnancies complicated by intrauterine growth restriction
Authors: Konje Justin C. , Howarth Edmund S. , Kaufmann Peter , Taylor David J.
Published: December 2003

Objective
To quantify and compare longitudinal uterine artery volume flow changes in appropriate for gestational age (AGA) pregnancies and those complicated by intrauterine growth restriction (IUGR).

Design
Serial longitudinal study.

Setting
Large UK Teaching Hospital Obstetrics and Gynaecology Department and Institute of Anatomy, RWTH Aachen, Germany.

Population
Pregnant women with accurately dated singleton pregnancies.

Methods
Quantified uterine volume flow was prospectively measured by colour power angiography in (a) 32 women with abnormal uterine artery Doppler velocimetry at 20 and 24 weeks of gestation and with risk factors for IUGR (IUGR group) and (b) 25 women with normal uterine artery Doppler velocimetry and no risk factors for IUGR (AGA group) between 20 and 38 weeks of gestation. Values obtained from each gestation were compared using unpaired t test.

Main outcome measures
Gestational age at delivery, birthweight and total quantified volume flow (mL/min) per gestation in IUGR and AGA pregnancies.

Results
Twenty of the 32 women recruited into the IUGR group and 18 of the 25 controls fulfilled the criteria for inclusion in the analyses. The mean birthweight [SD] and gestational age [SD] at delivery in the IUGR and AGA groups were 2634 [277] versus 3429 [349] g and 39.5 [1.2] and 41.1 [2.3] weeks, respectively. The diameter of the proximal uterine artery just after it crosses the external iliac artery was smaller in the IUGR group from as early as 20 weeks of gestation but this difference only became statistically significant from 24 weeks of gestation and widened as pregnancy advanced. The quantified volume flow in the IUGR group was significantly less than that in the AGA throughout the study period (287 [117] versus 328 [159] mL/min at 20 weeks (P < 0.05), 334 [169] versus 538 [181] mL/min at 24 weeks [P < 0.004] and 534 [332] versus 830 [284] mL/min at 38 weeks of gestation [P < 0.002]). Volume flow in the IUGR group was 12.5% and 36.7% less than that in the AGA group at 20 and 28 weeks of gestation, respectively.

Conclusion
Proximal uterine artery diameter and quantified volume flow change with gestation and show significant differences between AGA pregnancies and those complicated by IUGR. These changes occur early and become more marked as pregnancy advances. Early use of these measurements may identify pregnancies at risk of complications.
The relationship between intraocular pressure and refractive error adjusting for age and central corneal thickness
Authors: Nomura Hideki , Ando Fujiko , Niino Naoakira , Shimokata Hiroshi , Miyake Yozo
Published: December 2003

Purpose:  To investigate the relationship between intraocular pressure (IOP) and refractive errors after adjusting for age, central corneal thickness (CCT), and other related factors.

Methods:  IOP, CCT and refractive errors were measured in the right eyes of 1855 subjects, aged 40–82 years, in a cross‐sectional study design. Subjects were divided into groups by refractive status: hyperopia, emmetropia, mild myopia, moderate myopia, or high myopia. With adjustments for age, CCT, blood pressure, obesity, education, hypertension, diabetes, and smoking status, IOP was estimated for each refractive status using a general linear model.

Results:  IOP increased with advancing degrees of myopia, even after adjustment for age, CCT, and other related factors (p = 0.011). Estimated IOP of moderate myopia was significantly higher than that of emmetropia (p = 0.022).

Conclusions:  Our results confirm the positive association between IOP and increasing degrees of myopia. This finding would support the hypothesis that the relationship between glaucoma and myopia might be pressure mediated.
Visualisation of ‘Marx's line’ along the marginal eyelid conjunctiva of human subjects with lissamine green dye
Authors: Doughty Michael J. , Naase Taher , Donald Claire , Hamilton Leona , Button Norman F.
Published: December 2003

Purpose:  To qualitatively assess the frequency and intensity of the staining of Marx's line with lissamine green dye.

Methods:  Eighty‐five non‐contact lens wearers, aged 18–78 years and of white (European) or Arabic origin, were assessed. The subjects had no major eye disease, although some had mild‐to‐moderate congestion of the main tarsal (Meibomian) glands and/or anterior blepharitis. Lissamine green dye strips were used to stain the marginal zone of the palpebral conjunctiva, and then high magnification photo slitlamp images were taken.

Results:  A lissamine green staining line was unmistakable in 83 of the subjects, and just evident in the other two. The line extends along the entire length of the upper and lower lid margins, and the staining broadens and extends over the puncta. In most subjects, the lissamine green‐stained line was posterior to the main tarsal gland orifices, but in five subjects it was distinctly anterior to the orifices. In over two‐thirds of the subjects, the width of line was much less than the distance between the gland orifices, and was at a similar distance to its width from the orifices. However, in one‐third of the subjects, the width of the line was around half that of the distance between the orifices or slightly greater (i.e. approximately 0.5 mm), and this feature was more commonly present in those of non‐European origin.

Conclusion:  Lissamine green dye highlights a very distinct line of cells along the marginal zone, and should be a useful tool to visualise this feature. This line of cells is thought to be the natural site of contact between the eyelid margin and the surfaces of the bulbar conjunctiva and cornea.
Prevalence of refractive errors in teenage high school students in Singapore
Authors: Quek Timothy P. L. , Chua Choon Guan , Chong Choon Seng , Chong Jin Ho , Hey Hwee Weng , Lee June , Lim Yee Fei , Saw Seang‐Mei
Published: December 2003

We aimed to study the prevalence of refractive conditions in Singapore teenagers. Grade 9 and 10 students (n = 946) aged 15–19 years from two secondary schools in Singapore were recruited. The refractive errors of the students’ eyes were measured using non‐cycloplegic autorefraction. Sociodemographic data and information on risk factors for myopia (such as reading and writing) were also obtained using an interviewer‐administered questionnaire. The prevalence of refractive conditions was found to be: myopia [spherical equivalent (SE) at least −0.50 D] – 73.9%, hyperopia (SE at least +0.50 D) – 1.5%, astigmatism (cylinder at least −0.50 D) – 58.7% and anisometropia (SE difference at least 1.00 D) – 11.2%. After adjusting for age and gender, currently doing more than 20.5 h of reading and writing a week was found to be positively associated with myopia [odds ratio 1.12 (95% CI 1.04–1.20, p = 0.003)], as was reading and writing at a close distance and a better educational stream. The prevalence of myopia (73.9%) in Singapore teenagers is high. Current reading and writing habits, reading at close distances and a better educational stream are possible risk factors for myopia.
The Weyl–Lanczos relations and the four-dimensional Lanczos tensor wave equation and some symmetry generators
Authors: Dolan P. , Gerber A.
Published: December 2003

We examine symmetry generators for exterior differential systems and for systems of partial differential equations and apply the Cartan theory of exterior differential systems to the Weyl–Lanczos equations and to the Lanczos wave equation in four dimensions. We look at a number of examples of symmetries for the Weyl–Lanczos equations in four dimensions and give examples of isovectors when the solution manifold is the Schwarzschild, Kasner or Gödel space–time. Solutions of the Weyl–Lanczos system are automatically solutions of the Lanczos wave equation. We give examples of symmetry generators for the Lanczos wave equation and find that they are not automatically symmetry generators for the Weyl–Lanczos equations.
Asymptotic, closed integral solutions for the reconstruction of Grad–Shafranov equilibria in axisymmetric, large-aspect-ratio toroidal plasmas
Authors: Rodrigues Paulo , Bizarro João P. S.
Published: December 2003

A method for magnetic-equilibria reconstruction in axisymmetric, large-aspect-ratio toroidal plasmas is presented, which takes as input the plasma-pressure and the reduced poloidalmagnetic-field profiles, measured in laboratory coordinates along any chord crossing the magnetic axis, together with suitable boundary conditions. Besides yielding solutions in a closed integral form, with concomitant advantages over the usual sets of nonlinearly coupled differential equations, either for analytical or numerical work, the proposed approach circumvents the need to assume beforehand any relationship between the plasma pressure, the toroidal-magnetic-field pressure, and the poloidal-flux function. This enables magnetic equilibria to be reconstructed directly from experimental data, departing from the accustomed practice of fitting such data over a predefined model by iteratively solving the Grad–Shafranov equation, and therefore reduces the computational effort involved.
Self-consistent problem of electron cyclotron resonance heating of plasma in a magnetic trap
Authors: Erukhimov V. L. , Semenov V. E.
Published: December 2003

The one-dimensional linear problem of the electron cyclotron resonance (ECR) absorption of a right-hand polarized wave, propagating along inhomogeneous magnetic field in warm plasma with nonrelativistic electrons component is considered. The numerical modelling of Maxwell equations together with the kinetic equation for electron distribution function is carried out. The profiles of the wave fields near the ECR zone and the distribution of the absorbed power over electrons have been found for a wide range of parameters of practical interest.
Expansions about free-fermion models
Authors: Mitra Saibal
Published: December 2003

A simple technique for expanding the free energy of general six-vertex models about free-fermion points is introduced. This technique is used to verify a Coulomb gas prediction about the behavior of the leading singularity in the free energy of the staggered F-model at zero staggered field.