bluuebunny/crossref_metadata_2025 huggingface dataset:
Classical and humanist works in the libraries of early modern Finland between the sixteenth and eighteenth centuries
Authors: Merisalo Outi
Published: March 2009

This article examines the presence of classical, humanist and neo‐humanist works in the libraries of the Magnus Ducatus of Finland between the sixteenth and eighteenth centuries. In this period, Sweden went from being a member of a Scandinavian union dominated by Denmark to an imperial power administering large areas of north‐central Europe, only to be subsequently demoted to the role of a regional player increasingly tossed about by her neighbours, especially Russia. Despite economic, political, religious and cultural turbulence, international trends seem to have reached the Magnus Ducatus Finlandiae, both through Finns studying at key centres of learning and culture, and through reading books purchased or borrowed. The establishment of the Academia Aboensis in 1640 ensured continuous contact with the rest of the Res publica litterarum. Members of the nobility, the officer class, the clergy and merchants gained access to older and more recent literature on a great variety of subjects, including work by ancient and humanist authors and scholars. Due to the rise of neo‐humanism, the Classics formed the back‐bone of school and university curricula until well into the nineteenth century, and seem to have been strongly represented in the standard stock of private libraries, if not in the original languages, then in French, German or Swedish translations.
Effect of hyponatraemia on outcomes following orthotopic liver transplantation
Authors: Hackworth William A. , Heuman Douglas M. , Sanyal Arun J. , Fisher Robert A. , Sterling Richard K. , Luketic Velimir A. , Shiffman Mitchell L. , Maluf Daniel G. , Cotterell Adrian H. , Posner Marc P. , Stravitz Richard T.
Published: March 2009

Background: Hyponatraemia increases risk of adverse outcomes following orthotopic liver transplantation (OLT), but it is unclear whether improvement of pretransplant hyponatraemia ameliorates post‐transplant complications.

Aims: To assess impact of pretransplant hyponatraemia on post‐transplant outcomes.

Methods: We performed a retrospective analysis of 213 patients with cirrhosis who underwent liver transplantation. Patients with serum sodium ≤130 mEq/L immediately before transplantation (‘hyponatraemia at OLT’; n=34) were compared with those who had experienced hyponatraemia but subsequently improved to a serum sodium >130 mEq/L at transplantation (‘resolved hyponatraemia’; n=56) and to those without history of hyponatraemia before transplantation (‘never hyponatraemic’; n=123). Primary endpoint was survival at 180 days post‐OLT. Secondary outcomes included time until discharge alive, complications during hospitalization, length of time ventilated and length of post‐transplant intensive care unit stay.

Results: There was no survival difference at 180 days post‐OLT between groups. After transplantation, patients with either hyponatraemia at OLT or resolved hyponatraemia had longer time until discharge alive and had higher rates of delirium, acute renal failure, acute cellular rejection and infection than those who were never hyponatraemic. As compared with patients with hyponatraemia at OLT, those with resolved hyponatraemia were more likely to be discharged alive within 3 weeks, but other outcomes, including survival, did not differ significantly.

Conclusions: We conclude that hyponatraemia at any time before liver transplantation is associated with adverse post‐transplant outcome, even when hyponatraemia has resolved.
Significance of antibodies to soluble liver antigen/liver pancreas: a large French study
Authors: Eyraud Violaine , Chazouilleres Olivier , Ballot Eric , Corpechot Christophe , Poupon Raoul , Johanet Catherine
Published: March 2009

Background: Antibodies to soluble liver antigen (SLA)/liver pancreas (LP) are generally considered as highly specific diagnostic markers of type 1 auto‐immune hepatitis (AIH‐1), and are particularly useful in patients without conventional antibodies. However, the presence of anti‐SLA/LP in type 2 auto‐immune hepatitis (AIH‐2), primary sclerosing cholangitis (PSC) and hepatitis C has recently been reported. The aim was thus to describe the characteristics of anti‐SLA/LP‐positive patients in the largest series reported to date.

Methods: Sera were selected from the period between 1998 and 2005, based on the presence of antibodies to SLA/LP detected by two methods. The clinical status of patients was determined from their medical records.

Results: Eighty‐one anti‐SLA/LP‐positive patients with available clinical data were included: 89% (72/81) had a diagnosis of AIH‐1, including 10 (12%) associated with cholestatic diseases (primary biliary cirrhosis in seven cases and PSC in three cases). Six patients (7%) suffered from another liver disease: hepatitis C (n=3) and drug‐induced hepatitis (n=3). No specific diagnosis was made in three patients.

Conclusions: Antibodies to SLA/LP are of a major diagnostic value for AIH‐1, including paediatric forms and overlap syndromes with cholestatic diseases, but are not found in association with anti‐liver/kidney/microsome type 1 or antibodies to liver cytosol type 1. They are rarely present in other liver diseases such as hepatitis C and drug‐induced hepatitis.
Association between angiotensin II type 1 receptor polymorphisms and the occurrence of nonalcoholic fatty liver disease
Authors: Yoneda Masato , Hotta Kikuko , Nozaki Yuichi , Endo Hiroki , Uchiyama Takashi , Mawatari Hironori , Iida Hiroshi , Kato Shingo , Fujita Koji , Takahashi Hirokazu , Kirikoshi Hiroyuki , Kobayashi Noritoshi , Inamori Masahiko , Abe Yasunobu , Kubota Kensuke , Saito Satoru , Maeyama Shiro , Wada Koichiro , Nakajima Atsushi
Published: March 2009

Background:Nonalcoholic fatty liver disease (NAFLD) is one of the most common causes of chronic liver injury in many countries. Genetic factors are important for the development of NAFLD, as well as environmental factors. Recently an angiotensin II type 1 receptor (AGTR1) has been recognized as important in the aetiology of fibrosis in the liver.

Objective:In this study we investigated the association between angiotensin II type 1 receptor gene polymorphism (ATGR1) and NAFLD.

Methods:One hundred and sixty‐seven NAFLD patients [106 with nonalcoholic steatohepatitis (NASH) and 61 with simple steatosis] with a positive diagnosis by liver biopsy and 435 healthy control subjects were recruited in this study.

Results:We investigated 12 single nucleotide polymorphisms (SNPs) of theATGR1gene, among which rs3772622 showed the lowestP‐value of allele frequency model (P=0.0000012) with an odds ratio (95% confidence interval) of 1.95 (1.49–2.55). Five SNPs (rs3772622, rs3772633, rs2276736, rs3772630 and rs3772627) were significantly associated with NAFLD, even when the most conservative Bonferroni's correction was applied. Linkage disequilibrium analysis revealed that SNP rs3772622 and another four SNPs (rs3772633, rs2276736, rs3772630 and rs3772627) were in the same block. We investigated the association between rs3772622 genotypes and the fibrosis index. The results of the analysis revealed an additive increase of the fibrosis index in the patients with the A allele of rs3772622.

Conclusions:This is the first report to demonstrate the genetic variations inATGR1that may influence the risk of NAFLD and liver fibrosis in NAFLD.
Association of inflammatory and anti‐inflammatory cytokines with insulin resistance in chronic hepatitis C
Authors: Hung Chao‐Hung , Lee Chuan‐Mo , Chen Chien‐Hung , Hu Tsung‐Hui , Jiang Shu‐Rong , Wang Jing‐Houng , Lu Sheng‐Nan , Wang Pei‐Wei
Published: March 2009

Background: The pathogenetic basis for the association between hepatitis C virus (HCV) infection and type‐2 diabetes remains uncertain. It has been reported that insulin resistance (IR) plays an essential role. We investigated the association of inflammatory [tumour necrosis factor (TNF)‐α, interleukin (IL)‐6] and anti‐inflammatory cytokines (adiponectin and IL‐10) with IR in chronic HCV infection.

Methods: Eighty‐one consecutive non‐diabetic chronic hepatitis C patients (37 men and 44 women, mean age of 51.9±12.2 years) and 40 age, sex and body mass index (BMI)‐matched healthy individuals were collected. IR was evaluated by the homoeostasis model assessment (HOMA). Serum levels of cytokines were measured by enzyme‐linked immunosorbent assay.

Results: Patients with chronic hepatitis C have a higher HOMA‐IR, TNF‐α, IL‐6, adiponectin and IL‐10, as compared with controls. By multiple linear regression analysis, moderate/severe steatosis grade, total cholesterol level and adiponectin was significantly associated with HOMA‐IR, whereas, TNF‐α, IL‐6 and IL‐10 was not. Male gender, BMI and HOMA‐IR was inversely correlated with the serum adiponectin level. Serum adiponectin was positively correlated with TNF‐α level, which was significantly associated with higher degree of hepatic necroinflammation.

Conclusion: Our data suggest that chronic HCV infection is associated with increased IR, which is correlated inversely with the serum adiponectin level. The complex role of adiponectin in the pathogenesis of IR and hepatic necroinflammation in chronic HCV infection merit further investigation.
Eradication of hepatitis C virus by interferon improves whole‐body insulin resistance and hyperinsulinaemia in patients with chronic hepatitis C
Authors: Kawaguchi Yasunori , Mizuta Toshihiko , Oza Noriko , Takahashi Hirokazu , Ario Keisuke , Yoshimura Toru , Eguchi Yuichiro , Ozaki Iwata , Hisatomi Akitaka , Fujimoto Kazuma
Published: March 2009

Background/Aims: To investigate whether eradication of hepatitis C virus (HCV) by interferon (IFN) therapy influences systemic glucose metabolism.

Methods: Seventy‐two patients with chronic hepatitis C were enrolled in this study. Patients received IFN therapy and were classified into two groups: sustained responders (n=48) and nonsustained responders (n=24). We analysed systemic glucose metabolism in terms of the following indices: homeostasis model assessment for insulin resistance (HOMA‐IR) and β‐cell function (HOMA‐β), insulinogenic index (II), composite insulin sensitivity index (ISI composite) and the area under the curve of plasma glucose (PG‐AUC) and serum insulin (SI‐AUC) in oral glucose tolerance tests. In 28 sustained responders and 16 nonsustained responders, serum levels of soluble tumour necrosis factor receptor 2 (sTNFR2) were measured. Indices were determined before and 6 months after therapy.

Results: In the sustained responders, HOMA‐β (P=0.0004) and SI‐AUC (P=0.002) were significantly decreased and the ISI composite was increased (P=0.009), although there were no significant changes in HOMA‐IR, II or PG‐AUC. Serum sTNFR2 levels decreased significantly after therapy in sustained responders (P=0.001). In the nonsustained responders, there were no changes in any index.

Conclusions: Eradication of HCV by IFN therapy could improve whole‐body insulin resistance and insulin hypersecretion with reduced serum TNF‐α levels.
Antenatal screening practice for infectious diseases by general practitioners in Australia
Authors: GILES Michelle L. , PEDRANA Alisa , JONES Cheryl , GARLAND Suzanne , HELLARD Margaret , LEWIN Sharon R.
Published: March 2009

Introduction:  This study aimed to assess self‐reported screening practice in the antenatal setting, factors associated with screening, barriers to universal testing for HIV and follow‐up for infants born to hepatitis C virus (HCV)‐infected women.

Methods:  A total of 3100 general practitioners (GPs) were mailed the survey. The half from Victoria was randomised to receive their questionnaire by registered post or regular post. All GPs from New South Wales (NSW) received their questionnaire via regular post.

Results:  The overall response rate was 70%. Registered post resulted in a higher cumulative response rate compared with regular post (86% vs. 67%P < 0.001). Greater than 90% of respondents always screened for syphilis, rubella and hepatitis B virus. Testing for HIV and HCV approached 66% in NSW. In Victoria more respondents always screen for HCV (72%) compared with HIV‐1 (64%). Respondents from NSW were less likely to screen for toxoplasmosis (adjusted odds ratio (AOR) 0.64 (0.43, 0.94) P = 0.02) or HCV (AOR 0.75 (0.61, 0.92) P = 0.005) compared with Victoria. Older respondents were more likely to screen for toxoplasmosis (AOR 1.54 (1.05, 2.27) P = 0.03), cytomegalovirus (OR 1.5 (1.0, 2.1) P = 0.05) and chlamydia (AOR 1.88 (1.27, 2.77) P = 0.002). Of respondents who have managed a pregnant woman with HCV 25% inappropriately test infants for infection before one month of age.

Conclusion:  This study highlights the need for more education and resources to increase HIV testing rates and to improve follow‐up of an HCV‐exposed infant.
Survey of surgical skills of RANZCOG trainees
Authors: OBERMAIR Andreas , TANG Amy , CHARTERS Deryck , WEAVER Edward , HAMMOND Ian
Published: March 2009

Background: In Australia, the Integrated Training Program (ITP) of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) offers training in obstetrics and gynaecology. There is anecdotal concern among trainees and Fellows that the surgical component of training is inadequate, with new specialists lacking the confidence and competence to perform many ‘standard’ surgical procedures. These concerns have not previously been quantified in Australia and New Zealand.

Aim: To determine trainees’ subjective competence and confidence with surgical procedures and trainees’ satisfaction with their surgical training.

Methods: All 430 active RANZCOG trainees and 108 Fellows elevated within the previous two years were invited to complete a self‐administered questionnaire (65% response rate), which assessed details of procedures performed and confidence to perform them; satisfaction with the surgical training; and perceived teaching ability of the supervising consultants.

Results: Those in ITP year 6 rated their confidence high (≥ 4 of 5) for procedures performed very frequently, but lower for other procedures. No procedure regarding the management of complications reached a confidence score of ≥ 4. Teaching abilities were rated best for obstetric procedures, with 54% rating their consultants’ teaching ability as ‘excellent’; but for laparoscopic procedures and procedures dealing with complications, 21.2% and 23.4% of respondents rated their consultants’ teaching ability as ‘poor’, respectively.

Conclusions: Advanced trainees lacked confidence in a range of surgical procedures; and possible weaker areas were identified in the teaching experience of trainers. These limitations must be addressed by medical educators and training program coordinators.
Uterine compression sutures for post‐partum bleeding with atony; modification of the B‐Lynch suture
Authors: MARASINGHE Jeevan Prasanga , CONDOUS George
Published: March 2009

We have described a modification of the B‐Lynch uterine compression suture which is simple and effective. This technique apposes the anterior and posterior uterine walls, obliterating the cavity and thereby provides effective control of post‐partum haemorrhage as a result of uterine atony. It comprises of vertical compression sutures and is distinct from B‐Lynch and Haymen's suture by having an additional firm puncture just below the uterine fundus. This means that the suture is transfixed at the uterine fundus, thus eliminating the risk of the sutures sliding off at the uterine fundus.
HuR expression in the nucleus correlates with high histological grade and poor disease‐free survival in ovarian cancer
Authors: YI Xiaofang , ZHOU Yi , ZHENG Wenxin , CHAMBERS Setsuko K.
Published: March 2009

Background: HuR, a nucleo‐cytoplasmic shuttling protein, plays an important role in mRNA stability as well as cellular differentiation. Recently, HuR expression, particularly in the cytoplasm, was thought to be associated with the prognosis of several cancers including ovarian cancer.

Aims: To study the clinical significance of nuclear HuR expression in ovarian cancer.

Methods: Primary epithelial ovarian carcinomas (102) and ovarian low malignant potential tumours (11) were assessed for HuR protein expression by immunohistochemistry. HuR scoring accounted for both intensity and percentage of cells stained, and ranged from 0 to 300.

Results: HuR was found to be present predominantly in the nucleus, where it was expressed in 85.8% of cases. Nuclear HuR was associated with the invasive cancers (P = 0.004), high grade (P < 0.0001), large residual disease (P = 0.045) and poor disease‐free survival (P = 0.0009). Among those 91 specimens with high grade, 76.9% had a high nuclear HuR score, while in those 22 cases with low grade, only 31.8% had a high HuR score (P < 0.0001). Multivariate analysis showed that nuclear HuR intensity was an independent prognostic factor for poor disease‐free survival (P = 0.0484). When the invasive cancers were analysed separately, only the association between nuclear HuR and high grade remained (P = 0.0089).

Conclusions: Our results support the clinical significance of nuclear HuR in ovarian carcinoma and suggest that nuclear HuR may also play a role in the biology of ovarian cancer. These data suggest a more complex model for HuR in ovarian cancer than one limited to cytoplasmic localisation.
An overview of the literature on congenital lower urinary tract obstruction and introduction to the PLUTO trial: Percutaneous shunting in lower urinary tract obstruction
Authors: MORRIS R. Katie , KILBY Mark D.
Published: March 2009

Congenital lower urinary tract obstruction (LUTO) comprises a heterogeneous group of pathologies causing obstruction to the urethra, the most common being posterior urethral valves. Such pathology is often associated with high perinatal mortality and varying degrees of perinatal and infant morbidity. A high proportion of LUTO may be visualised during routine second trimester (and first trimester) ultrasound giving rise to the possibility of determining individual fetal prognosis and treatments such as vesico‐amniotic shunting, with a view to altering pathogenesis. The aims of the percutaneous shunting in low urinary tract obstruction (PLUTO) trial are to determine the effectiveness of these treatments and accuracy of the investigations with the primary outcome measures being perinatal mortality and postnatal renal function.
Selective fetoscopic laser ablation in 100 consecutive pregnancies with severe twin–twin transfusion syndrome
Authors: CINCOTTA Robert B. , GRAY Peter H. , GARDENER Glenn , SOONG Barbara , CHAN Fung Yee
Published: March 2009

Aims: To report the perinatal outcomes of a large series of twin pregnancies with severe twin–twin transfusion syndrome (TTTS) managed with laser ablation surgery in an Australian tertiary perinatal centre and to compare the outcome with other large cohorts.

Methods: The outcomes of 100 consecutive pregnancies with severe TTTS managed with selective fetoscopic laser ablation from March 2002 to June 2007 were examined. Survival and neonatal morbidity were analysed. Comparisons were made with the results from other studies of laser surgery with at least 100 pregnancies.

Results: There were 100 women with TTTS treated with laser ablation; 34 stage II, 44 stage III and 22 at stage IV. Median gestation at time of laser was 21 weeks (range 18–28) and median gestation at delivery was 31 weeks (range 20–39). Overall perinatal survival rate was 151 of 200 (75.5%). Eighty five per cent had one or more surviving twins. The survival rate for stage IV TTTS was 88.6%, significantly better than for stage II (69.1%) and stage III (73.9%) pregnancies. The perinatal mortality rate for donors (30%) was not significantly different from recipients (19%), but the fetal death rate for donors was significantly greater than that for recipients (P = 0.03). Severe cerebral abnormalities were present in only 2.8% of newborns. The overall survival rate was comparable to other large series.

Conclusions: These results for the management of severe TTTS are comparable to the best reported international series. Long‐term follow‐up is required and more research needs to be undertaken to further improve these results.
The early pregnancy assessment project: The effect of cooperative care in the emergency department for management of early pregnancy complications
Authors: O’ROURKE David , WOOD Stephen
Published: March 2009

Background: Early pregnancy assessment clinics (EPAC) have been introduced and accepted as the gold standard for management of early pregnancy problems (EPP). However, EPAC are not universally available and management of EPP within the emergency department (ED) can result in prolonged waiting times, inappropriate use of resources and no clear treatment or follow‐up plan being implemented.

Aim: To assess the effect of an early pregnancy assessment protocol (EPAP) in the ED, designed to create a cultural change among doctors in relation to EPP in order to minimise use of resources, improve treatment times for patients and establish a clear management plan where dedicated EPAC services are not available.

Methods: An intervention, the EPAP was introduced to the ED and retrospective and prospective audits of the patients were carried out to assess the effect.

Results: Implementation of the EPAP decreased treatment time by 55%, representations by 48%, pathology blood tests by 56% and formal imaging services by 85%. Gynaecological consultation increased by 37% for each patient visit to the ED and by 9% for each EPP. Total direct cost saving was 63% per patient and no adverse outcomes were recorded.

Conclusion: Introduction of the EPAP was successful in creating cultural change and delivering clinical and financial benefits to the hospital, patients and staff. Early gynaecological consultation and bedside ultrasound scanning within the ED were key factors. Similar benefits could be reproduced in other institutions and for other clinical scenarios where a need has been identified.
Prevalence of menopausal symptoms and quality of life after menopause in women from South India
Authors: BAIRY Laxminarayana , ADIGA Shalini , BHAT Parvathi , BHAT Rajeshwari
Published: March 2009

Objectives: This study was carried out to establish the age at onset of menopause and the prevalence of menopause and menopausal symptoms in South Indian women.

Materials and methods: Three hundred and fifty‐two postmenopausal women attending the outpatient clinics of obstetrics and gynaecology department of Dr TMA Pai Hospital, a tertiary care Hospital in South India, were included in the study. The Menopause‐Specific Quality of Life (MENQOL) questionnaire was used in the study. Data were presented as percentages for qualitative variable.

Results: The mean age at menopause was 48.7 years. Most frequent menopausal symptoms were aching in muscle and joints, feeling tired, poor memory, lower backache and difficulty in sleeping. The vasomotor and sexual domains were less frequently complained when compared to physical and psychological domains.

Conclusion: The age at onset of menopause in southern Karnataka (India) is 48.7 years which is four years more than the mean menopause age for Indian women. This could be attributed to better socioeconomic and health‐care facility in this region.
Use of Routine Interventions in Vaginal Labor and Birth: Findings from the Maternity Experiences Survey
Authors: Chalmers Beverley , Kaczorowski Janusz , Levitt Cheryl , Dzakpasu Susie , O’Brien Beverley , Lee Lily , Boscoe Madeline , Young David ,   Maternity Experiences Study Group of the Canadian Perinatal Surveillance System,   Public Health Agency of Canada
Published: March 2009

ABSTRACT:  Background:
Intervention rates in maternity practices vary considerably across Canadian provinces and territories. The objective of this study was to describe the use of routine interventions and practices in labor and birth as reported by women in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Rates of interventions and practices are considered in the light of current evidence and both Canadian and international recommendations.
Methods:
A sample of 8,244 estimated eligible women was identified from a randomly selected sample of recently born infants drawn from the May 2006 Canadian Census and stratified primarily by province and territory. Birth mothers living with their infants at the time of interview were invited to participate in a computer‐assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews averaged 45 minutes long and were completed when infants were between 5 and 10 months old (9–14 mo in the territories). Completed responses were obtained from 6,421 women (78%).
Results:
Women frequently reported electronic fetal monitoring, a health care practitioner starting or speeding up their labor (or trying to do so), epidural anesthesia, episiotomy, and a supine position for birth. Some women also reported pubic or perineal shaves, enemas, and pushing on the top of their abdomen.
Conclusions:
Several practices and interventions were commonly reported in labor and birth in Canada, although evidence and Canadian and international guidelines recommend against their routine use. Practices not recommended for use at all, such as shaving, were also reported. (BIRTH 36:1 March 2009)
Impact of Cesarean Section on Intermediate and Late Preterm Births: United States, 2000–2003
Authors: Malloy Michael H.
Published: March 2009

ABSTRACT:  Background:
Cesarean section appears to be associated with increased risk of neonatal mortality among infants of low‐risk term pregnancies, but it may offer some survival advantage among the most extremely preterm infants. The impact on intermediate (32–33 wk) and late preterm (34–36 wk) deliveries remains uncertain. The objective of this analysis was to compare the neonatal mortality rate (death at 0–27 days), the mechanical ventilation usage rate, and the incidence of hyaline membrane disease among intermediate and late preterm infants delivered by primary cesarean section compared with those delivered vaginally.
Methods:
United States Linked Birth and Infant Death Certificate files from the years 2000 to 2003 were used. Maternal demographic characteristics, medical complications, and labor and delivery complications were abstracted from the files along with infant information. Because of concern for misclassification of gestational age, a procedure was used to trim away births in which the birthweight of an infant for a specific gestational age was inconsistent. Adjusted odds ratios were calculated using logistic regression for the risk of the three outcomes of interest relative to the mode of delivery.
Results:
A total of 422,001 live births were available with complete data from the trimmed data set (60% of untrimmed data). After adjustment by logistic regression for infant size at birth, birthweight, sex, Apgar score at 5 minutes less than 4, multiple births, breech presentation, presence of an anomaly, the presence of any maternal medical condition or complication of labor and delivery, labor induction, maternal race, age, education, and gravidity, the adjusted odds ratios (95% CI for neonatal mortality at gestational ages of 32, 33, 34, 35, and 36 wk) were, respectively, 1.69 (1.31–2.20), 1.79 (1.40–2.29), 1.08 (0.83–1.40), 2.31 (1.78–3.00), and 1.98 (1.50–2.62).
Conclusions:
These data suggest that for low‐risk preterm infants at 32 to 36 weeks’ gestation, independent of any reported risk factors, primary cesarean section may pose an increased risk of neonatal mortality and morbidity. (BIRTH 36:1 March 2009)
How Are Effective Breastfeeding Technique and Pacifier Use Related to Breastfeeding Problems and Breastfeeding Duration?
Authors: Kronborg Hanne , Væth Michael
Published: March 2009

Abstract:  Background:
Inconsistent findings leave uncertainty about the impact of pacifier use on effective breastfeeding technique. The purpose of this study was to investigate how breastfeeding technique and pacifier use were related to breastfeeding problems and duration of breastfeeding.
Methods:
Data were collected from the intervention group of a randomized trial in which health visitors followed up with mothers for 6 months after childbirth. The health visitors classified the breastfeeding technique at approximately 1 week after birth and repeated the observation if a correction was necessary. Effective technique included positioning, latch, sucking, and milk transfer. Data on breastfeeding problems and pacifier use were obtained from self‐reported questionnaires. The study population included 570 mother‐baby pairs with complete information on breastfeeding technique and pacifier use. The primary outcome was duration of exclusive breastfeeding.
Results:
One‐half of the mothers showed ineffective breastfeeding technique at the first\ observation, most frequently ineffective position (61%) and latch (52%). In the unadjusted analysis, only sucking and milk transfer were associated with breastfeeding duration. In the adjusted analysis, ineffective technique was significantly associated with mothers reporting early breastfeeding problems, which thereby influenced the breastfeeding duration. Pacifier use had an independent negative impact on duration of breastfeeding. A single correction of the breastfeeding technique was not associated with duration or occurrence of problems.
Conclusions:
Observation of breastfeeding technique may help mothers in the stage of when they are establishing breastfeeding to avoid early and later problems, but breastfeeding technique is less useful in predicting breastfeeding duration. Use of a pacifier should be avoided in the first weeks after birth. (BIRTH 36:1 March 2009)
Using Emergency Obstetric Drills in Maternity Units as a Performance Improvement Tool
Authors: Osman Hibah , Campbell Oona M. R , Nassar Anwar H
Published: March 2009

ABSTRACT:  Background:
Obstetric drills are being used increasingly to test, improve, and maintain knowledge and skills related to obstetric emergencies as a means to improve proficiency and efficiency of practitioners. The purpose of this study was to assess the feasibility and usefulness of conducting drills to evaluate the response to obstetric emergencies using a holistic approach that tested the hospital system.
Methods:
A prospective trial was conducted at three hospitals (two tertiary referral centers and one small community hospital) in Beirut, Lebanon. Two different emergency obstetric drills at two points in time were conducted between April and May 2006 either in the emergency room or on the labor floor. The drills included medical and paramedical staff, a female actor (simulating a pregnant woman), a research assistant (acting as her companion), and a physician trained in obstetrics (the drill leader). Responses were recorded and critically analyzed.
Results:
Although overall quality of care was within standards of care, problems were identified related to hospital policies, supplies and equipment, communication, and clinical management. Some technical problems related to administration of the drills were identified. Most drill participants appreciated the exercise and found it beneficial.
Conclusions:
Obstetric drills provide a useful tool to identify and address deficiencies in the hospital system. This finding could have implications on improving quality of care provided to obstetric patients. (BIRTH 36:1 March 2009)
Hospital Education in Lactation Practices (Project HELP): Does Clinician Education Affect Breastfeeding Initiation and Exclusivity in the Hospital?
Authors: Grossman Xena , Chaudhuri Jana , Feldman‐Winter Lori , Abrams Jessica , Newton Kimberly Niles , Philipp Barbara L. , Merewood Anne
Published: March 2009

ABSTRACT:  Background:
A woman’s decision to breastfeed may be influenced by her health care practitioners, but breastfeeding knowledge among clinicians is often lacking. Project HELP (Hospital Education in Lactation Practices) was an intensive education program designed to increase breastfeeding knowledge among health care practitioners. The purpose of this study was to determine whether educating practitioners affected breastfeeding initiation and exclusivity rates at hospitals with low breastfeeding rates.
Methods:
Between March 31, 2005, and April 24, 2006, we taught courses at four Massachusetts hospitals with low breastfeeding rates. Each course consisted of three, 4‐hour teaching sessions and was offered nine times. The training, taught by public health professionals, perinatal clinicians, and peer counselors, covered a broad range of breastfeeding‐related topics, from managing hyperbilirubinemia to providing culturally competent care. Medical records of infants born before and after the intervention were reviewed to determine demographics and infant feeding patterns.
Results:
Combining data from all hospitals, breastfeeding initiation increased postintervention from 58.5 to 64.7 percent (p = 0.02). An overall increase in exclusive breastfeeding rates was not statistically significant. In multivariate logistic regression for all hospitals combined, infants born postintervention were significantly more likely to initiate breastfeeding than infants born preintervention (adjusted OR 1.32, 95% CI 1.03–1.69).Conclusions: Intensive breastfeeding education for health care practitioners can increase breastfeeding initiation rates. (BIRTH 36:1 March 2009)
Women’s Attitudes, Preferences, and Perceived Barriers to Treatment for Perinatal Depression
Authors: Goodman Janice H.
Published: March 2009

ABSTRACT:  Background:
Perinatal depression is associated with potential negative consequences for the mother and infant, and therefore efforts to improve treatment access and efficacy are warranted. The purpose of this study was to examine pregnant women’s preferences and attitudes about treatment for depression, and perceived potential barriers to accessing treatment.
Methods:
Data were collected by means of a questionnaire from a convenience sample of 509 predominantly well‐educated, high‐income, married women in the northeastern United States during the last trimester of pregnancy. Participants were queried as to treatment modalities in which they would most likely participate if they wanted help for depression, their attitudes toward psychotherapeutic and pharmacological treatments, and perceived barriers to receiving help. Results: Most women (92%) indicated that would likely participate in individual therapy if help was needed. Only 35 percent stated that they would likely take medication if recommended, and 14 percent indicated that they would participate in group therapy. The greatest perceived potential barriers to treatment were lack of time (65%), stigma (43%), and childcare issues (33%). Most women indicated a preference to receive mental health care at the obstetrics clinic, either from their obstetrics practitioner or from a mental health practitioner located at the clinic. Factors associated with acceptability of various depression treatments are presented.Conclusions: Understanding what prevents women from seeking or obtaining help for depression and determining what they prefer in the way of treatment may lead to improved depression treatment rates and hold promise for improving the overall health of childbearing women. (BIRTH 36:1 March 2009)
Determinants of Early Medical Management of Nausea and Vomiting of Pregnancy
Authors: Lacasse Anaïs , Rey Evelyne , Ferreira Ema , Morin Caroline , Bérard Anick
Published: March 2009

ABSTRACT:  Background:
Early medical management of nausea and vomiting during pregnancy is desirable but less than optimal. The aims of this study were to describe the management of nausea and vomiting during the first prenatal visit and to identify the determinants of 1) addressing the subject of nausea and vomiting during pregnancy with the health practitioner and 2) receiving an antiemetic prescription.
Methods:
A prospective study was conducted of 283 women who reported nausea and vomiting during the first trimester of pregnancy. Women were eligible if they were at least 18 years of age and ≤ 16 weeks’ gestation at the time of their first prenatal visit. Participants completed a questionnaire to determine their maternal characteristics, the presence of nausea and vomiting during pregnancy, and its management.
Results:
Of the 283 study participants, 79 percent reported that the condition was addressed during their first prenatal visit, 52 percent reported being asked about the intensity and severity of their symptoms, and 22 percent reported being questioned about the extent to which it disrupted their daily tasks. Health practitioners prescribed an antiemetic for 27 percent of women and recommended a nonpharmacological method for 14 percent. Multivariate models showed that the severity of the nausea and vomiting, previous use of an antiemetic, and smoking before pregnancy were significantly associated with an increased likelihood of addressing the subject of nausea and vomiting during pregnancy. Variables associated with an increased likelihood of women receiving an antiemetic prescription included nausea and vomiting severity, excessive salivation, previous antiemetic use, and work status.
Conclusions:
Health practitioners can improve their management of nausea and vomiting during pregnancy based on the available guidelines for treatment and they should address important factors such as symptom severity and work status at the first prenatal visit to assess women’s need for antiemetic treatment. (BIRTH 36:1 March 2009)
Preventive Labor Induction‐AMOR‐IPAT: Much Promise, Not Yet Realized
Authors: Klein Michael C.
Published: March 2009

ABSTRACT:  “Preventive Labor Induction‐AMOR‐IPAT” is a method designed to time induction before the fetus becomes too large or the placenta dysfunctional. In two retrospective cohort studies and one randomized trial, the developers claim to have reduced cesarean section rates and improved newborn outcomes. These claims have yet to be substantiated in an adequately powered trial, but having decided on the need for an induction, the investigators do manage inductions in a woman‐centered and intimate style that has merit. (BIRTH 36:1 March 2009)
Where in the World Are We? Generalizing the Results of Status Epilepticus Trials
Authors: Herman Susan T.
Published: March 2009

Comparison of Buccal Midazolam with Rectal Diazepam in the Treatment of Prolonged Seizures in Ugandan Children: A Randomized Clinical Trial. Mpimbaza A, Ndeezi G, Staedke S, Rosenthal PJ, Byarugaba J. Pediatrics 2008; 121(1):e58–64.

Objective

Our goal was to compare the efficacy and safety of buccal midazolam with rectal diazepam in the treatment of prolonged seizures in Ugandan children.

Methods

This was a single-blind, randomized clinical trial in which 330 patients were randomly assigned to receive buccal midazolam or rectal diazepam. The trial was conducted in the pediatric emergency unit of the national referral hospital of Uganda. Consecutive patients who were aged 3 months to 12 years and presented while convulsing or who experienced a seizure that lasted >5 minutes were randomly assigned to receive buccal midazolam plus rectal placebo or rectal diazepam plus buccal placebo. The primary outcome of this study was cessation of visible seizure activity within 10 minutes without recurrence in the subsequent hour.

Results

Treatment failures occurred in 71 (43.0%) of 165 patients who received rectal diazepam compared with 50 (30.3%) of 165 patients who received buccal midazolam. Malaria was the most common underlying diagnosis (67.3%), although the risk for failure of treatment for malaria-related seizures was similar: 35.8% for rectal diazepam compared with 31.8% for buccal midazolam. For children without malaria, buccal midazolam was superior (55.9% vs 26.5%). Respiratory depression occurred uncommonly in both of the treatment arms.

Conclusion

Buccal midazolam was as safe as and more effective than rectal diazepam for the treatment of seizures in Ugandan children, although benefits were limited to children without malaria.
Cytokines and Strokes of Ill Fortune
Authors: Blume Warren T.
Published: March 2009

Incidence of Seizures in the Acute Phase of Stroke: A Population-based Study. Szaflarski JP, Rackley AY, Kleindorfer DO, Khoury J, Woo D, Miller R, Alwell K, Broderick JP, Kissela BM. Epilepsia 2008;49(6):974–981.

Purpose

The incidence of seizures within 24 h of acute stroke has not been studied extensively. We aimed to establish the incidence of acute poststroke seizures in a biracial cohort and to determine whether acute seizure occurrence differs by race/ethnicity, stroke subtype, and/or stroke localization.

Methods

We identified all stroke cases between July 1993 and June 1994 and in 1999 within the population of the Greater Cincinnati metropolitan region. Patients with a prior history of seizures/epilepsy were excluded from analysis.

Results

A total of 6044 strokes without a history of seizure(s) were identified; 190 (3.1%) had seizures within the first 24 h of stroke onset. Of ICH/SAH patients, 8.4% had a seizure within the first 24 h of stroke onset ( p ≤ 0.0001 vs all other stroke subtype). Of the patients with ischemic stroke, we observed higher incidence of seizures in cardioembolic versus small or large vessel ischemic ( p = 0.02) strokes. Patients with seizures experienced higher mortality than patients without seizures ( p < 0.001) but seizures were not an independent risk factor of mortality at 30 days after stroke. Independent risk factors for seizure development included hemorrhagic stroke, younger age, and prestroke Rankin score of ≥1. Race/ethnicity or localization of the ischemic stroke did not influence the risk for seizure development in the studied population.

Discussion

The overall incidence of acute seizures after stroke was 3.1%, with a higher incidence seen in hemorrhagic stroke, younger patients, and those presenting with higher prestroke Rankin scores. Acute seizures were associated with a higher mortality at 30 days after stroke.
New Developments in Antiepileptic Drug Resistance: An Integrative View
Authors: Schmidt Dieter , Löscher Wolfgang
Published: March 2009

Current theories on drug resistance in epilepsy include the drug transporter hypothesis, the drug target hypothesis, and a novel approach called the inherent severity model of epilepsy, which posits that the severity of the disease determines its relative response to medication. Valuable as each of these hypotheses is, none is currently a stand-alone theory that is able to convincingly explain drug resistance in human epilepsy. As a consequence, it may be of interest to update and integrate the various hypotheses of drug resistance and to explore possible links to the severity of epilepsy. The observation that a high frequency of seizures prior to onset of treatment is a prognostic signal of increased severity and future drug failure suggests that common neurobiological factors may underlie both disease severity and pharmacoresistance. Such a link has been proposed for depression; however, the evidence for a direct mechanistic link, genetic or otherwise, between drug response and disease severity of human epilepsy is still elusive. Although emerging data from experimental studies suggest that alterations in GABAA receptors may present one example of a mechanistic link, clearly more work is needed to explore whether common neurobiological factors may underlie both epilepsy severity and drug failure.
Arresting a Seizure by Dropping a Little Acid
Authors: Rho Jong M.
Published: March 2009

Seizure Termination by Acidosis Depends on ASIC1a. Ziemann AE, Schnizler MK, Albert GW, Severson MA, Howard MA 3rd, Welsh MJ, Wemmie JA. Nat Neurosci 2008;11(7):816–822. Most seizures stop spontaneously; however, the molecular mechanisms that terminate seizures remain unknown. Observations that seizures reduced brain pH and that acidosis inhibited seizures indicate that acidosis halts epileptic activity. Because acid-sensing ion channel 1a (ASIC1a) is exquisitely sensitive to extracellular pH and regulates neuron excitability, we hypothesized that acidosis might activate ASIC1a, which would terminate seizures. Disrupting mouse ASIC1a increased the severity of chemoconvulsant-induced seizures, whereas overexpressing ASIC1a had the opposite effect. ASIC1a did not affect seizure threshold or onset, but shortened seizure duration and prevented seizure progression. CO2 inhalation, long known to lower brain pH and inhibit seizures, required ASIC1a to interrupt tonic-clonic seizures. Acidosis activated inhibitory interneurons through ASIC1a, suggesting that ASIC1a might limit seizures by increasing inhibitory tone. Our results identify ASIC1a as an important element in seizure termination when brain pH falls and suggest both a molecular mechanism for how the brain stops seizures and new therapeutic strategies.
Managing Societal and Institutional Risk in Child Protection
Authors: Munro Eileen
Published: March 2009

Public sector services have been reshaped by two interacting factors: the growing dominance of risk management and the growing demands for transparency and accountability. For the caring professions, these have provoked radical reform. Using the child protection service as a case study, this article explores the impact of the changes on a service that deals with conflicting risks and has a poorly articulated knowledge base. Drawing on Rothstein et al.'s distinction between societal and institutional risks, it is argued that difficulties in managing societal risks are creating serious institutional risks. The latter are then being prioritized in the way the system operates. The preoccupation with such risks has been translated into concerted efforts to formalize the work of front line practitioners to make it transparent and auditable. Although done, in part, with the good intention of spreading good practice standards, this formalization has gone beyond the evidenced knowledge base to the extent that it is creating a new picture of “good practice” that omits significant dimensions of work and is distinct from measures of children's safety or welfare. Moreover, the process of formalization acts as an impediment to knowledge development in disciplines where such learning is urgently needed.
The Influence of Weather Conditions on the Relative Incident Rate of Fishing Vessels
Authors: Wu Yue , Pelot Ronald P. , Hilliard Casey
Published: March 2009

There is a long history of studying the relationship between weather and maritime activities. This article analyzes the link between relative incident rate (RIR) and general weather factors within certain gridded areas and time periods. The study area, which encompasses a broad extent of Atlantic Canadian waters, includes fishing incidents recorded by the Canadian Coast Guard from 1997 to 1999. Methodologies used for traffic track generation in a geographical information system and aggregation of all relevant weather data needed for the statistical analyses are presented. Ultimately, a regression tree was built to illustrate the relationship between incident rate and the following six weather factors: wave height; sea surface temperature; air temperature; ice concentration; fog presence; and precipitation. Results from the regression tree reveal that the RIR defined as (incident number per area‐day)/(traffic amount per area‐day) across grid cells with incidents, increases as the weather conditions deteriorate in a general way, and the concentration of ice has the biggest influence on the magnitude of incident rates for a given level of traffic exposure. The results from this analysis may assist administrators of maritime traffic, especially those associated with fishing activities, through a better understanding of the influence on RIR of certain weather conditions within given areas in specific time periods.