bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing and Restoring the Health of Urban Streams in the Puget Sound Basin
Authors: Morley Sarah A. , Karr James R.
Published: March 2003

Abstract: Rapid urbanization threatens the biota of streams and rivers around the globe. Efforts to manage urban streams traditionally take an engineering approach focused on stormwater runoff, physical channel condition, and chemical water quality. Our objective was to use the biology of streams—measured with the multimetric benthic index of biological integrity ( B‐IBI) based on benthic macroinvertebrates—to assess stream health. From 1997 to 1999, we sampled invertebrates at 45 sites in second‐ and third‐order streams in the Puget Sound lowlands of Washington State. Land cover upstream of each site was characterized by analysis of a 1998 satellite image. We evaluated associations between five land cover categories and biological condition across three spatial scales. The relationships between B‐IBI (and its component metrics) and stream substrate and hydrologic features were also analyzed at a subset of sites. Across all study sites, B‐IBI declined as the percentage of urban land cover increased (r < −0.71, p < 0.001, n> 31). Most metrics were better predicted by sub‐basin rather than local‐scale urbanization. Within individual basins, however, local land‐cover urbanization and B‐IBI were strongly correlated (r = −0.91, p < 0.001, n = 9). The biological condition of a site was also related to measures of hydrologic alteration and stream substrate. The aquatic biota is sensitive to a variety of urban effects, expressed at both large and small spatial scales. Biological assessment tools such as B‐IBI can identify areas of excellent biological condition for conservation and guide the design and evaluation of efforts to restore the biota of degraded streams.
Lying in Wait for Extinction: Ecological Correlates of Conservation Status among Australian Elapid Snakes
Authors: Reed Robert N. , Shine Richard
Published: March 2003

Abstract:Why do some species decline rapidly with anthropogenic disturbance, whereas others readily exploit disturbed habitats? It is possible that the ecological characteristics of some species render them especially vulnerable to extinction. Previous analyses of a diverse array of taxa have identified a number of intrinsic ecological predictors of vulnerability, but snakes have not been studied in this respect. We collated ecological data on Australian venomous snake species in the family Elapidae, based primarily on examination of preserved specimens in museums, to investigate possible differences between threatened and nonthreatened taxa. We also used comparative (  phylogenetically based) analyses to identify functional associations with endangerment. Correlates of conservation vulnerability identified in previous studies did not discriminate successfully between threatened and nonthreatened elapid species. However, threatened and nonthreatened elapids differed significantly in two main respects. First, threatened species tended to rely on ambush foraging rather than actively searching for prey. Sit‐and‐wait foragers may be vulnerable because (1) they rely on sites with specific types of ground cover, and anthropogenic activities disrupt these habitat features, and (2) ambush foraging is associated with a suite of life‐history traits that involve low rates of feeding, growth, and reproduction. The second major correlate of endangerment involves the mating system. Endangered species typically lacked male‐male combat: In such taxa, females grow larger than males and are more vulnerable to human predation (as judged by the composition of museum collections). Our analysis also identified taxa that, although not currently listed as threatened, share many of the ecological traits of the endangered group. Our results may facilitate future attempts to prioritize conservation actions for Australian snakes.
Demographic Trends and Community Stability in a Montane Amphibian Assemblage
Authors: Martínez‐Solano Iñigo , Bosch Jaime , García‐París Mario
Published: March 2003

Abstract: We conducted a long‐term study of a montane amphibian community in Peñalara Natural Park ( central Spain ) to analyze population trends. We recorded larval density and number of ponds used for reproduction for nine species in two time periods: 1982–1986 and 1999. We used chi‐square analysis to compare the observed ratio of extinctions to colonizations to an expected ratio of 1:1 at the ponds used for reproduction for each species. We also compared larval densities of six species in both time periods. Overall, we found no differences in species composition. However, separate analyses for each of the nine species inhabiting the study area showed that underlying this apparent stability were significant opposite population trends in six species. Three species expanded their ranges, whereas three suffered severe range reductions and population decreases. A chytrid infection was responsible for the decline of Alytes obstetricans, almost extirpated from the surveyed area, whereas less dramatic decreases were observed for Salamandra salamandra and Bufo calamita. Our study emphasizes the need to analyze each species separately to assess the conservation status of amphibian assemblages. In this context, the conservation of endemic species with restricted distribution areas should be considered a priority.
Stakeholders' Perceptions of a Wading Bird Colony as a Community Resource in the Brazilian Pantanal
Authors: Bouton Shannon N. , Frederick Peter C.
Published: March 2003

Abstract: In the Brazilian Pantanal, large breeding colonies of ciconiiform wading birds ( 200–10,000 pairs ) have recently become important as tourist attractions, although there is good evidence of detrimental effects of tourism on breeding behavior and success. We sought to understand the possible amelioration of the effects of tourists on colonies by identifying human users of the colony and their control over changes in the way colonies are used. We conducted a stakeholder analysis, consisting of interviews with local interest groups made up of tourist guides, boat drivers, hotel owners and landowners, local fishermen, and tourists. The analysis revealed a series of human activities that potentially perturb nesting birds, including tourism, the collection of eggs and chicks for human consumption, camping, and sport and bait fishing close to colonies. There was a strong conservation ethic among stakeholders and an awareness of the consequences of human disturbance. In addition, tourism provided an economic incentive for conservation, which potentially outweighed the importance of consumptive uses of the colony. Results of questionnaires given to tourists offered insights into alternative management ideas for improving satisfaction with visits to the colony. Future development of tourism in Pantanal nesting colonies appears to be a realistic objective from the human community perspective but will require a strong, well‐enforced management plan and continued education of locals, tourists, and the tourist industry.
Integrating Economics into Priority Setting and Evaluation in Conservation Management
Authors: Hughey Kenneth F. D. , Cullen Ross , Moran Emma
Published: March 2003

Abstract: To protect the world's threatened and endangered species, it is necessary that appropriate tools be available to assist decision‐makers in achieving their conservation management goals. We examine the range of approaches used in priority setting and evaluation in conservation management by reviewing the conservation, economic, and environmental policy literature on the evaluation of conservation efforts. We then identify the circumstances under which these approaches are applied, assess the strengths and weaknesses of their use, and make suggestions for the further inclusion of economic factors in priority setting and evaluation. We found two major areas where evaluation and prioritization occur in conservation management: the initial prioritization for conservation action and the eventual evaluation of project and program effectiveness. The two main questions considered to date are (1) What and where are the priority areas or species that require conservation management? and (2) How effective are different management interventions and techniques in the conservation of areas and species? Because neither question addresses the need for measures that compare outputs or considers the costs of management, the full range of costs involved in making informed choices is not considered properly. We argue that decision‐makers need to ask (1) Where should scarce resources be invested in conservation management? and (2) Which investments in conservation management have been the most successful? To answer these questions, decision‐makers need to use cost‐effectiveness analysis and cost‐utility analysis to improve the conservation of threatened and endangered species.
Transfer from Home to Hospital: What Is Its Effect on the Experience of Childbirth?
Authors: Wiegers Therese A. , Zee Jouke van der , Keirse Marc J. N. C.
Published: March 2003

Background:

In the Netherlands women with low‐risk pregnancies are free to choose where to give birth, at home or in hospital, attended by an independent midwife or general practitioner. On average one of five women who remains in the care of a midwife at the onset of labor will be referred to an obstetrician during or shortly after childbirth. If women had planned to give birth at home, they would then have to be transferred to the hospital.

Methods:

Postal questionnaires were sent to 2301 pregnant women before and after birth to measure the experience of childbirth, appropriateness of the chosen place of birth, satisfaction with the birth, midwife's care, and first days postpartum of women planning to give birth at home or in hospital. The response rate for both questionnaires was 89.3 percent.

Results:

Of 745 nulliparous women and 895 multiparous women, 39.3 and 10.3 percent, respectively, experienced referral to an obstetrician during labor. Of these women, the ones who wanted to give birth at home but were transferred to hospital because of the referral were as positive about the birth, early puerperium, and attendance of the midwife as the women who wanted to give birth in hospital.

Conclusion:

Our research showed, contrary to expectations, that an unplanned transfer from a planned home birth to hospital has little influence on the experience of childbirth. (BIRTH 25:1, March 1998)
Maternal Hospital Charges Associated with Trial of Labor Versus Elective Repeat Cesarean Section
Authors: Traynor Jeffrey D. , Peaceman Alan M.
Published: March 2003

Background:

Although cesarean section is known to be associated with higher hospital charges than vaginal delivery, cost comparisons require further investigation. This study compared maternal hospital charges of women with one previous cesarean section undergoing a trial of labor with the charges of women who underwent an elective repeat cesarean section. Hospital charges for the trial of labor group were also compared with charges of women with a previous vaginal delivery but no previous cesarean section.

Methods:

A retrospective analysis of three primiparous privately insured patient groups who gave birth from July 1992 to October 1993 was conducted. Hospital charges for 50 primiparas with previous cesarean births who underwent a trial of labor were compared with those of 50 contemporaneous primiparas who underwent elective repeat cesarean section, and with those of 50 primiparas without a past history of cesarean birth.

Results:

Trial of labor was associated with a mean maternal hospital charge of $5820 ±$1609 compared with $6785 ±$771 for elective repeat cesarean section (p < 0.001). Trial of labor was also associated with a decreased length of stay when compared with elective cesarean section (2.48 ± 0.88 days vs 3.62 ± 0.57 days, p < 0.001). The difference in charges between these two groups was primarily due to charges associated with length of stay and the operating room, but was partly offset by charges associated with labor. The group of women without a past history of cesarean birth had a mean maternal hospital charge of $4685 ±$966 and a mean length of stay of 1.96 ± 0.63 days.

Conclusions:

Trial of labor is associated with an overall 14 percent reduction in maternal hospital charges and a 31 percent reduction in length of stay compared with elective repeat cesarean section. (BIRTH 25:2 June 1998)
Intention to Breastfeed in Low‐Income Pregnant Women: The Role of Social Support and Previous Experience
Authors: Humphreys Amy S. , Thompson Nancy J. , Miner Kathleen R.
Published: March 2003

Background:
The purpose of this study was to describe the relationship between breastfeeding intention among socioeconomically disadvantaged pregnant women and maternal demographics, previous breastfeeding experience, and social support.
Methods:
A cross‐sectional, convenience sampling strategy was employed for data collection. Low‐income women (n= 1001) in a public hospital completed a six‐page questionnaire about their infant feeding plans, demographics, and social support. Simple regression analyses were conducted to compare maternal breastfeeding intention with the hypothesized correlates. Results:Breastfeeding intention was positively correlated with older maternal age, higher education, more breastfeeding experience, Hispanic ethnicity, and hearing about breastfeeding benefits from family members, the baby's father, and lactation consultants, but not from other health professionals. Health professionals' attitudes were less influential on women's infant feeding decisions than the attitudes and beliefs of members of women's social support networks. When controlling for breastfeeding experience (none vs any), some findings varied, indicating a need for breastfeeding interventions tailored to women's level of experience. Conclusion: Use of peer counselors and lactation consultants, inclusion of a woman's family members in breastfeeding educational contacts, and creation of breastfeeding classes tailored to influential members of women's social support networks may improve breastfeeding rates among low‐income women, especially those with no breastfeeding experience, more effectively than breastfeeding education to pregnant women that is solely conducted by health professionals. (BIRTH 25:3 September 1998)
First Stage Labor Management: An Examination of Patterned Breathing and Fatigue
Authors: Pugh Linda C. , Milligan Renee A. , Gray Sarah , Strickland Ora L. ,   Linda C. Pugh is Director, Center for Nursing Research, Penn State Geisinger Health System, The Milton S. Hershey Medical Center, and Associate Professor, Department of Health Evaluation Sciences College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania; Renee A. Milligan is Associate Professor at Georgetown University, School of Nursing, Washington, DC; Sarah Gray is a graduate student, Biostatistics Department, The Johns Hopkins University School of Hygiene and Public Health, Baltimor
Published: March 2003

Background:
Patterned breathing is one way that women cope with labor. Fatigue is a frequently reported symptom over which women and caregivers have little control. The purpose of this study was to examine the relationship between the use of patterned breathing, a traditional intervention, and the level of fatigue reported during the first stage of labor.
Method:
A secondary analysis was conducted on a subset (n= 56) of a prospective longitudinal study of fatigue during the intrapartum period. The sample comprised primiparous women in labor whose fatigue was measured every two hours for six hours after admission. At each data point the investigator evaluated the method of breathing that participants used.Results:During the latent phase of labor, women using patterned breathing exhibited significantly more fatigue. In the active phase, differences between groups were not significant. Controlling for age, education, and marital status of participants did not change the results.Conclusions:It is appropriate for nurses, midwives, physicians, and doulas to encourage the use of patterned breathing as an intervention in active labor; however, patterned breathing may increase the mother's fatigue level if begun too early. (BIRTH 25:4 December 1998)
Severity of Nausea and Vomiting During Pregnancy: What Does It Predict?
Authors: Zhou Qiuping , O'brien Beverley , Relyea Joyce
Published: March 2003

Background: Relationships between the severity of nausea and vomiting during pregnancy and selected demographic (employment status, parity, age, smoking) and pregnancy outcome (birthweight, gender) variables are described. Methods: Women who volunteered for a community‐based clinical trial were eligible for inclusion in this study. On three occasions, 12 hours apart, during early pregnancy using a continuous measure of nausea, vomiting, and retching, women assessed the amount, duration, and severity of symptoms as they occurred. After the birth of their infants, they provided information about the duration of nausea, vomiting, and retching as well pregnancy outcome information by responding to a mailed questionnaire. Multivariate methods were used to analyze data. Results: More severe vomiting in early pregnancy was likely to continue for a longer period of time and was related to decreased infant birthweight. Gestational age, parity status, and severity of vomiting were predictors of infant birthweight and together explained 22 percent of the variance in birthweight. A significant relationship between fetal gender and severity of nausea and vomiting was not found. Conclusions: It may be possible to identify women at risk for third trimester vomiting and to provide appropriate nutritional support and counseling so that their risk of having a low‐birthweight infant is reduced. A larger sample would be required to assess the relationship between fetal gender and severity of nausea, vomiting, and retching.
Perinatal Outcome in 41 Sets of Triplets in Jordan
Authors: Ziadeh Saed M
Published: March 2003

Background:
Triplet births, which have increased greatly throughout the world in recent years, have a much greater risk of poor birth outcome than singleton births. The purpose of this study was to determine the perinatal outcome associated with triplet pregnancies and to compare abdominal delivery with vaginal delivery.
Methods:
We conducted a retrospective study of 41 sets of triplets born between January 1, 1994, and June 30, 1999, at the Princess Badee'a Teaching Hospital in Amman, Jordan. The primary outcome measures were perinatal mortality and early neonatal complications.
Results:
Of these sets, 21 triplets were delivered vaginally and 20 triplets were delivered by cesarean section. The perinatal mortality rate was 260 per 1000 live births in this series, primarily due to respiratory distress syndrome. The perinatal deaths occurred to infants whose birthweights were primarily 500 to 1500 g (90.6%). Breech presentation was associated with a significantly higher perinatal mortality rate than vertex presentation (62.5% vs 37.5%). Cesarean delivery was associated with a higher perinatal mortality rate than vaginal delivery (30.0% vs 22.2%).
Conclusions:
These results suggested that cesarean delivery in triplets is not superior to vaginal delivery in terms of fetal and early neonatal outcome. The perinatal mortality rate was significantly higher than that in other recent series due to limited resources in Jordan.
Reducing Postnatal Pain from Perineal Tears by Using Lignocaine Gel: A Double‐Blind Randomized Trial
Authors: Corkill Anna , Lavender Tina , Walkinshaw Stephen A , Alfirevic Zarko
Published: March 2003

Background:
Perineal pain is one of the most common causes of maternal morbidity in the early puerperium.
Several randomized trials have shown that topical application of local anesthetics is effective in reducing postepisiotomy pain, but no randomized study has assessed the efficacy of local anesthetics for other perineal trauma. This study investigated if topically applied 2 percent lignocaine gel was an effective treatment for this group of women.
Methods:
A double‐blind placebo controlled trial was conducted in a regional teaching hospital in the northwest of England. One hundred and forty‐nine women who had sustained a first‐ or second‐degree tear were allocated by sealed envelopes to the lignocaine gel or placebo group. The primary outcome was self‐reported pain at 24 hours postdelivery as measured on a numerical rating scale (pain score). Secondary outcomes included pain scores at 48 hours, the need for oral analgesia, and maternal satisfaction. Based on a pilot study, we calculated that 128 women were required to detect a 25 percent difference in pain scores between the two groups with 80 percent power (alpha = 0.05). The pain scores of women in each trial arm were compared using the unpaired t test and 95 percent confidence intervals.Results:Women using lignocaine gel had lower average pain scores, although this only reached statistical significance at 48 hours after delivery (p =0.023). In general, women liked using the study gel. No difference was found in consumption of oral analgesia.Conclusions:This study suggested that lignocaine gel may be effective on the second postnatal day. Further research is required to assess the optimum timing of this intervention and the population that would most benefit from its use.
Effective Care in Pregnancy and Childbirth: A Synopsis
Authors: Enkin Murray , Keirse Marc J.N.C. , Neilson James , Crowther Caroline , Duley Lelia , Hodnett Ellen , Hofmeyr G. Justus
Published: March 2003

EDITOR'S NOTE:

This article is the text and six tables from the final chapter (Chapter 50) of the new third edition of A Guide to Effective Care in Pregnancy and Childbirth. It summarizes the authors' conclusions and recommendations, based on the information they have compiled in the book about the beneficial or harmful effects of the various elements of care used during pregnancy and childbirth. The chapter numbers refer the reader to the relevant chapter of the book.
Immersion in Water in the First Stage of Labor: A Randomized Controlled Trial
Authors: Eckert Kerena , Turnbull Deborah , MacLennan Alastair
Published: March 2003

Background:
Current forms of analgesia often have significant side effects for women in labor. Bathing in warm water during labor has been reported to increase a woman's comfort level and cause a reduction in painful contractions. The objective of this trial was to compare immersion in warm water during labor with traditional pain management for a range of clinical and psychological outcomes.
Methods:
A prospective randomized controlled trial of 274 pregnant women, who were free from medical and obstetric complications and expecting a singleton pregnancy at term, was conducted at the Women's and Children's Hospital, a maternity tertiary referral center in Adelaide, South Australia. Women in labor were randomized to an experimental group who received immersion in a bath or to a nonbath group who received routine care. Pharmacological pain relief was the primary outcome that was measured, and secondary outcomes included maternal and neonatal clinical outcomes, factors relating to maternal and neonatal infectious morbidity, psychological outcomes, and satisfaction with care.
Results:
The use of pharmacological analgesia was similar for both the experimental and control groups; 85 and 77 percent, respectively, used major analgesia. No statistical differences were observed in the proportion of women requiring induction and augmentation of labor or in rates of perineal trauma, length of labor, mode of delivery, or frequency of cardiotocographic trace abnormalities. Neonatal outcomes (birthweight, Apgar score, nursery care, meconium‐stained liquor, cord pH estimations) revealed no statistically significant differences. Infants of bath group women required significantly more resuscitation than routine group women. Routine group women rated their overall experience of childbirth more positively than bath group women. Psychological outcomes, such as satisfaction with care or postnatal distress, were the same for both groups.
Conclusion:
Bathing in labor confers no clear benefits for the laboring woman but may contribute to adverse effects in the neonate.
Single Room Maternity Care: The Nursing Response
Authors: Janssen Patricia A. , Harris Susan J. , Soolsma Jetty , Klein Michael C. , Seymour Laurie C.
Published: March 2003

Background: The introduction of single room maternity care in the 1990s necessitated a new approach to nursing education and practice. A focus on perinatal nursing requires competence across the spectrum of labor, delivery, postpartum and newborn care. We sought to evaluate the nursing response to this change by comparing satisfaction with the workplace environment among single room maternity care nurses before and after they worked in the setting and among nurses working in traditional birth settings. Methods: Six months before the opening of a pilot seven‐bed single room maternity care unit, nurses who planned to work in the new unit completed a survey about their satisfaction with aspects of their work environment. Three months after the new unit opened the survey was repeated with this study group and also by a sample of nurses working in the delivery and postpartum areas. Results: Responses indicated that single room maternity care nurses before and after working in the unit were significantly more satisfied with the physical setting, their ability to respond to patients' needs, their opportunity for teaching families, the nursing practice environment, peer support, and their perceived level of competency. They rated their satisfaction significantly higher than that of their colleagues in the traditional delivery and postpartum settings. Conclusions: The positive transition to single room maternity care by obstetrical nurses was demonstrated by their improved overall satisfaction with the work environment. Evaluation of the nurses' responses to changes in health care delivery has important implications for justifying new clinical approaches and planning for future changes.
Attitudes and Beliefs About Childbirth Among College Students: Results of an Educational Intervention
Authors: Cleeton Elaine R.
Published: March 2003

Background: Research on knowledge of childbirth has focused primarily on expectant mothers. The purpose of this study was to investigate college student beliefs, knowledge of, and interest in learning more about childbirth. Methods: Qualitative research methods were used to analyze college students' written responses to a childbirth video as the first stage in a research project aimed at understanding nulliparous and prepaternity knowledge of childbirth among adolescents and young adults. Participants were 65 students at a liberal arts college in upstate New York. Results: The findings demonstrated a range of levels of awareness, interest, and knowledge. In their responses, students described childbirth as a miraculous event associated with fear of pain; students primarily knew that childbirth takes place in the hospital, where “safe and effective” pain medication is administered; students liked seeing the experiential aspect of birth; and students wanted to know about the risks and benefits of various hospital procedures, and the “spiritual” emotional aspects of giving birth. Conclusion: The findings contribute insights into how college students think about pain in childbirth, suggesting that their fear is associated with a lack of knowledge. Teaching high school students specifics about pregnancy and childbirth practices and procedures holds promise for reducing anxiety, increasing maternal control, and supporting positive birth experiences.
Survey of Folk Beliefs About Induction of Labor
Authors: Schaffir Jonathan
Published: March 2003

Background:
Many folk beliefs concerning the induction of labor are circulated among women in their final months of pregnancy. This study sought to identify the prevalence of some of these beliefs and whether or not they were more commonly shared in certain subsets of the community.
Method:
A survey was conducted of women receiving prenatal care at a group of Midwestern urban prenatal clinics. Women were asked about exposure to certain recommendations about inducing labor and to what extent each recommendation was believed.
Results:
One hundred and two women responded to the survey. Walking and having sex were the activities most commonly believed to hasten labor. These beliefs were equally prevalent across ages, parities, and levels of education.
Conclusions:
Folk beliefs about the induction of labor are varied and pervasive in an urban community. A review of scientific evidence relating to these beliefs can alert perinatal caregivers to potential benefit and harm that could ensue if certain recommendations are followed.
Hospital Variation in Episiotomy Use and the Risk of Perineal Trauma During Childbirth
Authors: Webb David A. , Culhane Jennifer
Published: March 2003

Background: Episiotomies are the most frequently performed surgical procedure among United States women, but there are no published epidemiological studies of the extent of variation in episiotomy use among different obstetrical providers, or the outcomes associated with different levels of use. The objective of this study was to assess the extent of hospital variation in the use of episiotomy and the relationship between hospital episiotomy use and the incidence and risk of perineal trauma among women residing in a large urban area in the United States.

Methods: Linked birth certificate and hospital discharge data pertaining to births to nulliparous women without prolonged labor or obstructed deliveries, and with infants weighing between 2500 and 4000 g, were analyzed for 18 major maternity hospitals. The relationship between episiotomy use and perineal trauma at the hospital level was examined using regression analysis.

Results: Hospital episiotomy rates ranged from approximately 20 to 73 percent. The rate of third or fourth degree perineal lacerations varied from a low of 4 percent to a high of more than 13 percent among hospitals. Rates of episiotomy were significantly correlated with rates of a third or fourth degree perineal laceration (r = 0.70; p < 0.01), and with the hospital‐specific, adjusted odds ratios for such lacerations (r = 0.65; p < 0.01).

Conclusions: Findings from the analysis of epidemiological data for this study population were consistent with those from clinical studies, indicating that liberal as opposed to restrictive use of episiotomy is unwarranted, and probably even harmful. Hospital episiotomy rates exceeded 20 percent in all cases, but such rates appear difficult to justify in face of the evidence. (BIRTH 29:2 June 2002)
Both Empowered and Powerless: Mothers’ Experiences of Professional Care When Their Newborn Dies
Authors: Lundqvist Anita , Nilstun Tore , Dykes Anna‐Karin
Published: March 2003

ABSTRACT: Background: The death of a newborn is a complex and tragic situation, the uncertain and stressful nature of which places emotional burdens on the parents. The aim of this study was to examine and illuminate mothers’ experiences and perceptions of the care given to them at neonatal clinics while facing the threat and the reality of losing their baby.

Method: Interviews were performed, in the form of conversations, with 16 mothers approximately 2 years after the death of their newborns. The interviews were analyzed using a hermeneutic phenomenological method.

Results: The primary themes identified were feeling empowered and feeling powerless. Three related themes to feeling empowered were a sense of nearness—supporting confidence; a sense of encouragement—supporting self‐esteem; and a sense of empathy—supporting comfort. Three related themes to feeling powerless were a sense of distance—leading to strength or adjustment; a sense of violation—leading to helplessness and despondency; and a sense of disconnection—leading to insecurity and discouragement. All mothers felt both empowered and powerless. When experiencing empowering care, they had a feeling of encountering benevolence, with respect to their individual desires. Experiencing competent care without humane treatment madethemfeel powerless, and they were neither respected as a mother nor a person.

Conclusions: Feelings of empowerment emerged when the health care professionals not only saw the mother as an individual but also ‘‘saw through the mothers’ eyes’’ and ‘‘felt with the mother's feelings’’.Feelings of powerlessness emerged when the similarity in the lifeworld (i.e., the world of lived experiences) differed, and the perspectives of the mothers and the health care professionals did not correspond. (BIRTH 29:3 September 2002)
Colloidal Bismuth Pectin: An Alternative to Bismuth Subcitrate for the Treatment of Helicobacter pylori– Positive Duodenal Ulcer
Authors: Nie Yuqiang , Li Yuyuan , Wu Huisheng , Sha Weihong , Du Hong , Dai Shoujun , Wang Hong , Li Qinglin
Published: March 2003

Background. Bismuth triple therapy provides consistently good results in Helicobacter pylori eradication worldwide, whereas quadruple therapy using a combination of omeprazole and bismuth triple regimen has produced cure rates in excess of 90%. The prevalence of metronidazole‐resistant strains was 26.8% in our area. Colloidal bismuth pectin (CBP) is a new, lower‐priced bismuth salt made in China. The purpose of this study was to investigate the efficacy and safety of CBP triple and quadruple regimens in the treatment of H. pylori–positive duodenal ulcer.

Materials and Methods. In this prospective trial, 205 patients with H. pylori–positive duodenal ulcer were allocated randomly to receive one of four regimens: metronidazole, 200 mg; amoxicillin, 250 mg; and colloidal bismuth subcitrate (CBS), 120 mg (group 1), or CBP, 100 mg qid (group 2) for 2 weeks, then continued CBS, 240 mg, or CBP, 200 mg bid for a further 2 weeks. A quadruple regimen using a combination of omeprazole, 20 mg bid, and CBS triple therapy (group 3) or CBP triple therapy (group 4), respectively, was given to patients for 1 week, followed by omeprazole, 20 mg once daily for a further 3 weeks. Further endoscopy was performed at least 4 weeks after cessation of the treatment. H. pylori status was determined by histology, a 14C urea breath test, and a urease test.

Results. The per‐protocol H. pylori cure rates were 85% (22 of 26 patients), 90% (35 of 39), 96% (46 of 48), and 95% (75 of 79) for groups 1 through 4. In the intention‐to‐treat analysis, cure rates were 79% (22 of 28), 83% (35 of 42), 90% (46 of 51), and 89% (75 of 84), respectively. The cure rates of quadruple therapy were higher than those of triple therapy; an 8.2% difference was not statistically significant (95% confidence interval [CI], 2.3–18.7%). The ulcer‐healing rates were 88%, 87%, 98%, and 97%, respectively, for groups 1 through 4. The ulcer pain was relieved more rapidly in quadruple‐ than in triple‐therapy regimens. Two patients discontinued treatment prematurely owing to drug‐related side effects.

Conclusion. One‐week quadruple therapy is highly effective and safe in H. pylori eradication in Chinese patients. CBP is as effective as CBS.
Invasiveness of Helicobacter pylori into Human Gastric Mucosa
Authors: Ko Gyung Hyuck , Kang Soo Min , Kim You Kyung , Lee Jeong Hee , Park Cheol Keun , Youn Hee Shang , Baik Seung Chul , Cho Myung Je , Lee Woo Kon , Rhee Kwang Ho
Published: March 2003

Background. Helicobacter pylori has generally been observed only in the gastric mucous layer or in the spaces between gastric mucus‐secreting cells and not in the gastric epithelial cells or in the lamina propria. The purpose of this study is to determine whether H. pylori invades the gastric mucosa, using an immunoelectron microscopical examination of human gastric mucosa infected with H. pylori.

Materials and Methods. Five hundred gastric antral biopsy specimens were fixed in a periodate‐lysin‐paraformaldehyde solution, embedded in Lowicryl, sectioned, and examined with a light microscope. One hundred specimens moderately or severely infected with H. pylori were selected and were incubated with polyclonal rabbit anti–H. pylori antibody. The specimens were washed, incubated with 20 nm of colloidal gold–conjugated goat anti–rabbit IgG, stained with uranyl acetate and lead citrate, and observed with a transmission electron microscope.

Results. In one case, a bacterium was observed within the cytoplasm of a gastric mucus‐secreting cell; in another case, a few bacteria were observed within the cytoplasm of a stromal cell in the lamina propria. The bacteria could be differentiated from degenerated intracellular organelles by gold particles attached to the bacteria.

Conclusion. H. pylori rarely invade the lamina propria and gastric cells.
Negative Association Between Helicobacter pylori Infection and Reflux Esophagitis in Older Patients: Case‐Control Study in Japan
Authors: Haruma Ken , Hamada Hiroshige , Mihara Mitsuhiro , Kamada Tomoari , Yoshihara Masaharu , Sumii Koji , Kajiyama Goro , Kawanishi Masahiro
Published: March 2003

Background. Recent studies have clarified a close association between H. pylori infection and gastritis, peptic ulcer disease, and gastric cancer, but there is little information concerning the relationship between H. pylori infection and reflux esophagitis (RE). We investigated the relationship between H. pylori, RE, and corpus gastritis.

Subjects and Methods. Ninety‐five patients with RE and 190 sex‐ and age‐matched asymptomatic healthy controls demonstrating no localized lesions in the upper GI tract were studied and evaluated for H. pylori infection, histologic gastritis, serum gastrin, and pepsinogens (PGs).

Results. H. pylori infection was significantly lower in RE patients than in asymptomatic controls (41% vs. 76%, p < .01). Histologic gastritis of both the antrum and corpus was significantly less frequent (antrum; p < .01, corpus; p < .01), and serum levels of PGI and the PG I/II ratio were significantly higher in RE patients than in controls (PGI; p < .05, PG I/II ratio; p < .01). When the subjects were divided into two age groups (59 years of age and younger and 60 years of age and older), a significant difference was found only among patients over 60 years of age (29% vs. 85%, p < .01). Among subjects in this age group, gastritis in both the antrum and corpus were significantly milder in RE patients than in controls. Although the prevalence of H. pylori infection was similar between the two groups of patients under 59 years of age, corpus gastritis was significantly milder in patients than in controls (p < .05).

Conclusions. A significantly low prevalence of H. pylori infection was found in RE patients over 60 years of age but not in those under 59 in comparison with sex‐ and age‐matched controls. The relative lack of corpus gastritis might play a role in the pathogenesis of RE in our population through preservation of the acid secretion area.
13C Urea Breath Test with Nondispersive Isotope‐Selective Infrared Spectrometry: Reproducibility and Importance of the Fasting Status
Authors: Mana Fazia , Franken Philippe R. , Ham Hamphrey R. , Reynaert Hendrik , Urbain Daniel
Published: March 2003

Background. The 13C urea breath test (13C‐UBT) is the most convenient method for diagnosing Helicobacter pylori infection noninvasively. Nondispersive isotope‐selective infrared spectrometry (NDIRS) is an inexpensive and easy alternative to mass spectrometry. The objective of this study was to evaluate: (1) the reproducibility of the 13C‐UBT as performed by using the NDIRS method; (2) the repeatability of bags analysis and the impact of delayed analysis; and (3) the need for fasting status for the 13C‐UBT.

Methods. The 13C‐UBT was performed with 75 mg urea labeled with 13C, with breath samples collected at times 0 and 30 minutes. Results are expressed as delta over baseline (0/00). Fifty‐three patients underwent two successive 13C‐UBTs with an interval of 48 to 72 hours. The 106 collected bags were randomly reanalyzed immediately or 72 hours later. In 26 volunteer subjects, the 13C‐UBT was performed both in a fasting condition and after a nonstandardized meal. The reproducibility was assessed by the method of Bland and Altman.

Results. The mean of difference between two successive tests was 0.14 0/00 (standard deviation, 0.90), and the coefficient of repeatability was 1.80 (confidence interval, 95%). The difference between two successive analyses was always less than 2.2% of the initial value. The coefficient of variation between two successive tests for the influence of a meal was 11.24.

Conclusion. The 13C‐UBT as performed by using NDIRS is reproducible, analyses can be delayed up to 72 hours, and the test must be performed in fasting conditions.
Double‐Blind Comparison of Absorbable Colloidal Bismuth Subcitrate and Nonabsorbable Bismuth Subnitrate in the Eradication of Helicobacter pylori and the Relief of Nonulcer Dyspepsia
Authors: Whitehead Mark W. , Phillips Rosemary H. , Sieniawska Christine E. , Delves H. Trevor , Seed Paul T. , Thompson Richard P.H. , Powell Jonathan J.
Published: March 2003

Background. Bismuth is widely used for the eradication of H. pylori, especially in developing countries, although there are concerns over its neurotoxicity. Whether bismuth has to be absorbed in humans to act against H. pylori is not known. In this study, we compared “absorbable” (colloidal bismuth subcitrate) and “nonabsorbable” (bismuth subnitrate) bismuth as part of triple therapy in the eradication of H. pylori.

Materials and Methods. A double‐blind, randomized, placebo‐controlled trial was carried out with 120 H. pylori–positive patients with nonulcer dyspepsia. Group CBS + Ab (n = 35) received colloidal bismuth subcitrate (one tablet qds), amoxicillin (500 mg qds), and metronidazole (400 mg tds). Group BSN + Ab (n = 35) received bismuth subnitrate (two tablets tds) and the same antibiotics. Group Ab (n = 35) received placebo bismuth (two tablets tds) and the antibiotics. Group BSN (n = 15) received bismuth subnitrate (two tablets tds) and placebo antibiotics. Bismuth was taken for 4 weeks and the antibiotics for the first 2 weeks. H. pylori eradication, side effects, compliance, pre‐ and post‐treatment symptom scores, and bismuth absorption were assessed.

Results. H. pylori eradication was 69%, 83%, 31%, and 0% in CBS + Ab, BSN + Ab, Ab, and BSN, respectively. Side effects, compliance, and symptom relief were similar in all groups, but blood bismuth levels were significantly greater in CBS + Ab than the other three groups.

Conclusion. The efficacy of bismuth‐based therapies as part of triple therapy in the eradication of H. pylori is unrelated to absorption. Hence, the use of effective but poorly absorbed bismuth preparations should be encouraged for bismuth‐based eradication therapies.
pH‐Dependent Protein Profiles of Helicobacter pylori Analyzed by Two‐Dimensional Gels
Authors: Slonczewski Joan L. , McGee David J. , Phillips Judith , Kirkpatrick Christopher , Mobley Harry L. T.
Published: March 2003

Background. Helicobacter pylori survives transient exposure to extreme acid prior to adherence and growth on the gastric epithelium at neutral pH.

Materials and Methods. The effect of pH stress on protein profiles of H. pylori was observed using two‐dimensional gel electrophoresis (2‐D gels). H. pylori 26695 was grown microaerobically in tryptone‐yeast extract broth, 3% fetal bovine serum. Growth in acid alkalinized the medium, whereas growth in base caused acidification. For 2‐D gel analysis of protein profiles, cultures were grown in media buffered at pH 5.7 and at pH 7.5.

Results. Under all pH conditions, the most abundant proteins observed were the urease structural subunit UreB and the chaperonin GroEL. Growth in acid significantly increased the abundance of UreB. Thus, urease expression is not completely constitutive, as reported previously, but shows regulation by pH. Another protein observed only at low pH was identified as mammalian apolipoprotein A‐I, possibly taken up by H. pylori from bovine serum in the growth medium. This finding, if confirmed, suggests that uptake of high‐density lipoprotein from the human host may facilitate acquisition of cholesterol, required for formation of the unique cholesteryl glucosides in the membrane of H. pylori. In growth above pH 7, three stress proteins were induced: GroES (HspA), GroEL (HspB), and the antioxidant AhpC homolog TsaA. In addition, N‐terminal sequence analysis identified five additional proteins that had not previously been reported on 2‐D gels of H. pylori (FMN, SodB, TrxB, TsaA, and Tsr).

Conclusions. In summary, our 2‐D gel study reveals expression of several proteins dependent on growth pH.
High Efficacy of Ranitidine Bismuth Citrate, Amoxicillin, Clarithromycin and Metronidazole Twice Daily for Only Five Days in Helicobacter pylori Eradication
Authors: Gisbert Javier P. , Marcos Santiago , Gisbert Jose Luis , Pajares Jose Maria
Published: March 2003

Aim.

The combination of a proton pump inhibitor (PPI) or ranitidine‐bismuth‐citrate (Rbc) and two antibiotics for 7–10 days are, at present, the preferred treatments in Helicobacter pylori eradication. However, therapies for fewer than 7 days have been scarcely evaluated and it is unknown whether the length of treatment can be shortened, without a lost of efficacy, if three instead of two antibiotics are used. The aim of our study was to evaluate the efficacy of Rbc plus three antibiotics for only 5 days in H. pylori eradication.

Methods.

We prospectively studied 80 patients (34% duodenal ulcer, 66% functional dyspepsia) infected by H. pylori. At endoscopy, biopsies were obtained for histological study and rapid urease test, and a 13C‐urea breath test was carried out. Urea breath test was repeated 4 weeks after completing eradication treatment with Rbc [400 mg twice a day (bid)], amoxicillin (1 g bid), clarithromycin (500 mg bid) and metronidazole (500 mg bid). All drugs were administered together after breakfast and dinner for 5 days only, and no treatment was administered thereafter. Compliance with therapy was determined from the interrogatory and the recovery of empty envelopes of medications.

Results.

In 79 out of the 80 patients, H. pylori eradication success or failure was assessed after therapy (one patient was lost from follow‐up). All but one of these 79 patients took all the medications (one patient stopped treatment on the day 3 due to nausea/vomiting). Per protocol eradication was achieved in 72/78 (92%; 95% CI, 84–96%) and in 72/80 (90%; 81–95%) by intention‐to‐treat. Therapy was more effective in patients with duodenal ulcer than in those with functional dyspepsia [100% (87–100%) vs. 85% (73–92%) by intention‐to‐treat; p < .05]. Adverse effects were described in ten patients (12%), and included the perception of a metallic taste (eight patients), nausea/vomiting (two patients, one of them abandoned the treatment due to this), and diarrhea (two patients).

Conclusion.

The combination of Rbc, amoxicillin, clarithromycin and metronidazole for only 5 days represents a promising therapy for H. pylori infection, due to its high efficacy, simple posology, low cost and excellent tolerance.