bluuebunny/crossref_metadata_2025 huggingface dataset:
Women's Perceptions of Midwifery Care: A Longitudinal Study to Shape Curriculum Development
Authors: Fraser Diane M
Published: March 2003

Background: Health and education services are increasingly expected to focus on the consumer. The perceptions of childbearing women should be incorporated into midwifery curricula, but often they are given minimal attention or not sought for this purpose. This study was designed to enable the views and experiences of local women to influence curriculum development in a large university in England. Methods: A descriptive, longitudinal, qualitative study was conducted using semistructured and unstructured interviews with women, and data from their maternity records. Forty‐one pregnant women were recruited and interviewed during pregnancy, in the early postpartum period in hospital, and in their homes 2 to 3 weeks after the birth. Results: Themes were clustered into three categories: the characteristics and qualities of the caregivers, the individualized nature of care, and the clinical competence of the caregivers. Continuity of caregiver was desired but accepted as probably unrealistic by many. Developing a “special” trusting relationship with a female midwife was perceived as essential to promoting a positive childbirth experience. Clinical competence was expected and largely experienced. Negative feelings related to individual caregivers more than the type of care given. Conclusions: Most women had positive experiences, finding midwives and doctors with good knowledge, interpersonal skills, and abilities. Examples of poor communication skills and interprofessional conflict indicated a need to give priority to developing and assessing students' interpersonal skills. Evidence of interprofessional conflict acted as the catalyst to merge midwifery with the department of obstetrics in the university to enhance interprofessional learning.
Does Parental Breastfeeding Knowledge Increase Breastfeeding Rates?
Authors: Susin Lulie R.O. , Giugliani Elsa R.J. , Kummer Suzane C. , Maciel Marileide , Simon Cristina , Da Silveira Letícia C.
Published: March 2003

Objective:
Although improving mothers' knowledge about breastfeeding can increase rates and duration of breastfeeding, little is known about the influence of fathers' knowledge. The purpose of this study was to assess the knowledge of mothers and fathers about breastfeeding before and after receiving postpartum advice and its relationship to the frequency of breastfeeding.
Methods:
A clinical trial was performed with mothers and fathers of normal children born at the Hospital de Clínicas de Porto Alegre, Brazil, between July 1994 and March 1995. The study intervention consisted of postpartum advice supplied by means of a video film discussing basic topics of breastfeeding, an explanatory leaflet, and open discussion after viewing the video. The first 208 couples comprised the control group, the next 197 comprised experimental group 1, and the remaining 196 comprised experimental group 2. Immediately after delivery, mothers and fathers in the three groups answered a test on breastfeeding knowledge; they completed the same test at the end of the first month. All families received home visits at the end of the first, second, fourth, and sixth months, or until breastfeeding ceased. Logistic regression was used to evaluate the association between the mothers' and fathers' knowledge and frequency of breastfeeding.
Results:
Postpartum advice increased the breastfeeding knowledge of mothers and fathers. The mothers with the highest level of knowledge had a 6.5 times higher chance of exclusively breastfeeding at the end of the third month, and 1.97 times higher chance of continuing breastfeeding to the end of the sixth month compared with other mothers. The fathers' knowledge also significantly influenced breastfeeding rates. The children whose fathers knew more had a 1.76 higher chance of being exclusively breastfed at the end of the first month, and 1.91 higher chance of receiving maternal milk at the end of the third month.
Conclusion:
A simple, inexpensive strategy can increase the level of breastfeeding knowledge of mothers and fathers and, consequently, have a positive impact on the frequency of breastfeeding.
Routine Use of External Cephalic Version in Three Hospitals
Authors: Regalia Anna Laura , Curiel Piero , Natale Nicola , Galluzzi Alfredo , Spinelli Giansenio , Ghezzi Gaia Valentina Limonta , Tampieri Antonio , Terzian Emanuela
Published: March 2003

Background:
External cephalic version has been advocated as a safe alternative to vaginal breech delivery or cesarean birth. The purpose of this study was to determine the efficacy of routine use of external cephalic version at 36 weeks or more of gestation in three different levels of hospitals. Methods:External cephalic version was performed on 923 women with a single breech fetus at three hospitals in Italy. The procedure was attempted with a tocolytic agent for uterine relaxation and with no maternal analgesia. The version technique adopted was the “forward roll.”Results:Version was successfully performed on 579 fetuses (62.7%); each hospital had a similar success rate, and 56.9 percent of the women delivered vaginally. The procedure was more successful in multiparas and in women with an incomplete type of breech, polyhydramnios, and posterior localization of the placenta. Vaginal bleeding was experienced by 14 women; eight cesarean sections were performed for suspected abruptio placentae, confirmed in four cases. Two cephalic‐turned fetuses experienced an episode of persistent bradycardia and were turned again to breech; in five cases a nonstress test recorded after the version showed repeated variable decelerations and in one case a cesarean section was performed. Neonatal outcomes were good in 922 infants. A fracture of the femur attributable to the version was observed in one newborn. Conclusions:External cephalic version is effective in reducing the number of cesarean deliveries in term breech infants in different obstetric settings, with no major neonatal adverse outcomes.
Commercial Hospital Discharge Packs for Breastfeeding Women
Authors: Gupta J. K. , Nikodem V. C.
Published: March 2003

A substantive amendment to this systematic review was last made on 23 March 1999. Cochrane reviews are regularly checked and updated if necessary.

Background: For centuries, there has been controversy around whether being upright (sitting, birthing stools, chairs, squatting) or lying down has advantages for women delivering their babies.

Objectives: The objective of this review was to assess the benefits and risks of the use of different positions during the second stage of labour (i.e., from full dilatation of the cervix).

Search strategy: Relevant trials are identified from the register of trials maintained by the Cochrane Pregnancy and Childbirth Group, and from the Cochrane Controlled Trials Register.

Selection criteria: Trials were included which compared various positions assumed by pregnant women during the second stage of labour. Randomised and quasi‐randomised trials with appropriate follow‐up were included.

Data collection and analysis: Trials were independently assessed for inclusion, and data extracted by the two authors. Disagreements would have been resolved by consensus with an editor. Meta‐analysis of data is performed using the RevMan software.

Main results: Results should be interpreted with caution as the methodological quality of the 18 trials was variable. Use of any upright or lateral position, compared with supine or lithotomy positions, was associated with:

Reduced duration of second stage of labour (12 trials—mean 5.4 minutes, 95% confidence interval (CI) 3.9–6.9 minutes). This was largely due to a considerable reduction in women allocated to use of the birth cushion.

A small reduction in assisted deliveries (17 trials—odds ratio (OR) 0.82, 95% CI 0.69–0.98).

A reduction in episiotomies (11 trials—OR 0.73, 95% CI 0.64–0.84).

A smaller increase in second degree perineal tears (10 trials—OR 1.30, 95% CI 1.09–1.54).

Increased estimated risk of blood loss > 500ml (10 trials—OR 1.76, 95% CI 1.34–3.32).

Reduced reporting of severe pain during second stage of labour (1 trial—OR 0.59, 95% CI 0.41–0.83).

Fewer abnormal fetal heart rate patterns (1 trial—OR 0.31, 95% CI 0.11–0.91).

Reviewers' conclusions: The tentative findings of this review suggest several possible benefits for upright posture, with the possibility of increased risk of blood loss > 500 mL.

Women should be encouraged to give birth in the position they find most comfortable. Until such time the benefits and risks of various delivery positions are estimated with greater certainty when methodologically stringent trials data are available, then women should be allowed to make informed choices about the birth positions in which they might wish to assume for delivery of their babies.

Citation: Gupta JK, Nikodem VC. Women's position during second stage of labour (Cochrane Review). In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software.
Hospitalization for Early Bonding of the Genetic Mother After a Surrogate Pregnancy: Report of Two Cases
Authors: Sharan Haviva , Yahav Jacob , Peleg Dan , Ben‐Rafael Zion , Merlob Paul
Published: March 2003

Background:
In surrogate pregnancies the genetic parents have little opportunity for early bonding to their infant, either prenatally (in utero) or in the immediate postnatal period. The purpose of this article is to describe a new method for encouraging early parent‐infant bonding after surrogate pregnancy by hospitalizing the genetic mother in the maternity ward immediately after the delivery.
Methods:
Two genetic mothers were hospitalized in the maternity ward (rooming‐in system) at the Rabin Medical Center in Israel immediately after delivery of their infants by surrogate arrangement. The first birth was a singleton pregnancy with vaginal delivery and the second, a twin pregnancy with delivery by cesarean section. The genetic parents were counseled by a social worker from the adoption agency, starting 3 months before the estimated date of delivery. The parents were referred to the hospital social worker before the delivery. To assess attachment, we observed the parents' behavior toward their children during two daily 15‐minute periods of free, unstructured interaction.
Results:
The parents showed good primary caregiving functions and established affective verbal and physical contact with the infants. They began to recognize the infants' needs and temperament, and exhibited an aura of self‐confidence during their interactions. All expressed satisfaction with the method at discharge and reported on reduction of their fears about returning home with the infants.
Conclusions:
We believe that early hospitalization of the genetic mother in a surrogate delivery may be desirable to establish good and safe early mother‐infant bonding, and that it should be considered for adoption as regular hospital policy. Further randomized studies with larger samples over the long term are warranted.
Breastfeeding Rates in Hong Kong: A Comparison of the 1987 and 1997 Birth Cohorts
Authors: Leung Gabriel M. , Ho Lai‐Ming , Lam Tai‐Hing
Published: March 2003

ABSTRACT: Background: Low breastfeeding rates are an issue of international public health concern. Anecdotal reports suggest very low breastfeeding rates in Asia, but no population‐based studies have been conducted in the region. To determine the secular trend in breastfeeding practice in an Asian postindustrialized metropolitan community, we examined data from two population‐based birth cohorts of Hong Kong infants in 1987 and 1997.

Methods: Annual population rates of breastfeeding initiation and duration were estimated from the birth cohorts, considering the change in breastfeeding rates over 10 years with correction for sociodemographic and birth characteristics. Factors associated with breastfeeding practice were identified using multivariate logistic regression modeling in a pooled analysis of individual data of both cohorts.

Results: Overall, 26.8 percent of mothers initiated breastfeeding in 1987, and the rate increased to 33.5 percent in 1997. The rate would have been 27.4 percent in 1987 if the distributions of method of delivery, birthweight, birth order, maternal age, education, and employment status had been the same as in 1997. Only 7.6 percent of infants remained on the breast for more than 1 month in 1987 compared with 20.4 percent a decade later. Similarly, the rate for breastfeeding more than 3 months increased from 3.9 to 10.3 percent. Total breastfeeding duration was significantly longer in 1997 than 10 years earlier.

Conclusions: This is the first systematic report of secular variations of breastfeeding rates in Asia. Hong Kong should set higher but realistic goals for breastfeeding that emphasize both initiation and maintenance. Given the wide latitude for improvement in terms of readily modifiable risk factors, such as smoking and cesarean section, these new goals should focus on improving rates in these targeted groups where breastfeeding rates are lowest. (BIRTH 29:3 September 2002)
Satisfaction with Team Midwifery Care for Low‐ and High‐Risk Women: A Randomized Controlled Trial
Authors: Biró Mary Anne , Waldenström Ulla , Brown Stephanie , Pannifex Jan H.
Published: March 2003

ABSTRACT:Background: In 1996 a new model of maternity care characterized by continuity of midwifery care from early pregnancy through the postpartum period was implemented for women attending Monash Medical Centre, a tertiary level obstetric service, in Melbourne, Australia. This study's purpose was to assess the impact of this model on women's views and experiences of care during the antenatal, intrapartum, and postpartum periods compared with views of women receiving standard maternity care.

Methods: One thousand low‐ and high‐risk women who booked at the antenatal clinic and met the eligibility criteria were randomly allocated to continuity of midwifery care from a group of seven midwives in collaboration with medical staff, or to standard care from a variety of midwives and medical staff. Women's views of care were measured by means of a postal questionnaire at four months after the birth.

Results: Team midwifery care was associated with increased satisfaction with antenatal, intrapartum, and some aspects of postpartum care. The differences were most obvious for antenatal care.

Conclusions: Continuity of midwifery care is realistically achievable in a tertiary obstetric referral service and is associated with increased satisfaction. (BIRTH 30:1 March 2003)
Swedish Women's Interest in Home Birth and In‐Hospital Birth Center Care
Authors: Hildingsson Ingegerd , Waldenström Ulla , Rådestad Ingela
Published: March 2003

ABSTRACT:Background: In Sweden, few alternatives to a hospital birth are available, and little is known about consumer interest in alternative birth care. The aim of this study was to determine women's interest in home birth and in‐hospital birth center care in Sweden, and to describe the characteristics of these women.

Methods: All Swedish‐speaking women booked for antenatal care during 3 weeks during 1 year were invited to participate in the study. Three questionnaires, completed after the first booking visit in early pregnancy, at 2 months, and 1 year after the birth, asked about the women's interest in two alternative birth options and a wide range of possible explanatory variables.

Results: Consent to participate in the study was given by 3283 women (71% of all women eligible). The rates of response to the three questionnaires were 94, 88, and 88 percent, respectively. One percent of participants consistently expressed an interest in home birth on all three occasions, and 8 percent expressed an interest in birth center care. A regression analysis showed five factors that were associated with an interest in home birth: a wish to have the baby's siblings (OR 20.2; 95% CI 6.2–66.5) and a female friend (OR 15.2; 95% CI 6.2–37.4) present at the birth, not wanting pharmacological pain relief during labor and birth (OR 4.7; 95% CI 1.4–15.3), low level of education (OR 4.5; 95% CI 1.8–11.4), and dissatisfaction with medical aspects of intrapartum care (OR 3.6; 95% CI 1.4–9.2). An interest in birth center care was associated with experience of being in control during labor and birth (OR 8.3; 95% CI 3.2–21.6), not wanting pharmacological pain relief (OR 2.3; 95% CI 1.3–4.1), and a preference to have a known midwife at the birth (OR 2.2; 95% CI 1.6–2.9).

Conclusion: If Swedish women were offered free choice of place of birth, the home birth rate would be 10 times higher, and the 20 largest hospitals would need to have a birth center. Women interested in alternative models of care view childbirth as a social and natural event, and their needs should be considered. (BIRTH 30:1 March 2003)
Relationship of vacA Genotypes of Helicobacter pylori to cagA Status, Cytotoxin Production, and Clinical Outcome
Authors: Yamaoka Yoshio , Kodama Tadashi , Kita Masakazu , Imanishi Jiro , Kashima Kei , Graham David Y.
Published: March 2003

Background.

Mosaicism in vacA alleles with three distinct families of vacA signal sequences (s1a, s1b and s2) and two distinct families of middle region alleles (m1 and m2) has been reported. It was suggested that the vacA s1a genotype was closely associated with duodenal ulcer disease and with high cytotoxin production. The aim of this study was to evaluate the role of vacA genotyping with respect to gastric inflammation and injury, cytotoxin activity, and clinical presentation.

Methods.

H. pylori from patients with gastritis, peptic ulcer disease, or gastric cancer were characterized by vacA typing by polymerase chain reaction (PCR) and DNA sequencing. In vitro cytotoxin activity was assessed by vacuolation assay using Vero cells as well as with Hela cells.

Results.

Four hundred ninety‐one strains were tested. vacA genotype s1a/m1 was present in more than 95% of strains independent of presentation with gastritis, peptic ulcer, or gastric cancer. No vacA genotype was associated with high average cytotoxin activity. The s2/m2 isolates had low or absent cytotoxin activity. All cagA negative strains (n = 18) were s1a strains and both s2/m2 strains were cagA positive. One strain that was a recombinant of m1 and m2 strains was identified and had low cytotoxin activity. The nucleotide and amino acid sequences between original m1 strains and Japanese m1 strains (new m1 strains) were about 85% and 81%, respectively. Strains with the new m1 genotype had nucleotide and amino acid sequences similarity of more than 96%. There was no difference in cytotoxin activity between strains with the Western type m1 and the new type m1 genotype.

Conclusion.

In this as in other reported studies (≈ 1500 patients overall) vacA genotype was strongly but not exclusively associated with the presence of cagA. Overall, the studies did not support a role for vacA genotyping in relation to cytotoxin activity, virulence, histologic finding, or risk of a particular H. pylori disease. vacA genotype s1 is likely to be a surrogate marker for the presence of the cag pathogenicity island.
Heterogeneity of Protein Profiles of Helicobacter pylori Isolated from Individual Patients
Authors: Kitamoto Noritoshi , Nakamoto Hiromichi , Katai Atsuo , Takahara Nobuaki , Nakata Hiroya , Tamaki Hidehito , Tanaka Tomoyuki
Published: March 2003

Background.

In order to characterize the diversity of Helicobacter pylori (H. pylori) in infected individuals, 10 colonies of H. pylori were isolated from the gastric juice of 25 patients with gastroduodenal diseases (total 250 isolates).

Methods.

Protein profiles of isolates were compared by sodium dodecyl sulfate‐polyacrylamide gel electrophoresis (SDS‐PAGE). Results were confirmed by Western blotting (immunoblotting) test using rabbit antisera against three different strains of H. pylori.

Results.

The protein profiles of 18 of 25 cases (72%) showed a single type of H. pylori with the same polypeptide pattern. In contrast, heterogeneity in the protein profiles was seen in isolates from seven cases (28%). Two differing H. pylori types with two very different polypeptide patterns were found in 10 isolates from one case. In six patients, the protein profiles of isolates were found to have variations in their polypeptides between molecular weights of 30,000 (30K) and 14K, which are thought to be associated with bacterial membrane protein. In some isolates, a polypeptide band of the 16K was missing. Each of three different antisera confirmed differences among the distinct isolates from individual patients.

Conclusions.

These findings suggest that more than one antigenically different strain of H. pylori may exist in same infected individuals.
CagA and Cytotoxicity of Helicobacter pylori Are Not Markers of Peptic Ulcer in Japanese Patients
Authors: Tokumaru Kenkichi , Kimura Ken , Saifuku Kouji , Kojima Toshichika , Satoh Kiichi , Kihira Ken , Ido Kenichi
Published: March 2003

Background.

The infection with cagA‐positive Helicobacter pylori strains is reported to be associated with peptic ulcer disease in developed countries, but it is controversial in Asia. To investigate the relationship between the virulence factors of H. pylori and peptic ulcer disease in Japan, we compared these between ulcer and nonulcer patients.

Materials and Methods.

Seventy‐four strains of clinically isolated H. pylori obtained from 22 gastric ulcer (GU), 23 duodenal ulcer (DU), and 29 chronic gastritis (CG) patients were studied. The presence of vacA and cagA gene was examined by polymerase chain reaction method using two different primer sets. We evaluated the proliferation‐inhibiting and lethal cytotoxicity of culture supernatants using the alamarBlue assay.

Results.

The vacA gene was identified in all strains by the original primers. S1 strains were found in 90.9% (20/22) from GU, 95.7% (22/23) from DU, and 96.6% (28/29) from CG patients. The prevalence of cagA gene determined by the first, and second primers was 90.9% (20/22), 90.9% (20/22) in strains from GU, 87.0% (20/23), 91.3% (21/23) from DU, and 86.2% (25/29), 89.7% (26/29) from CG patients, respectively. The supernatant showed cytolethal effect in 95.5% (21/22) of strains from GU, in 100% (23/23) from DU, and in 93.1% (27/29) from CG patients. There was no significant difference in the prevalence of the virulence factors between H. pylori strains isolated from patients with peptic ulcers and those with chronic gastritis.

Conclusions.

These results indicate that cagA gene status and the proliferation‐inhibiting and lethal cytotoxicity of supernatant are not reliable markers of ulcerogenicity of H. pylori in Japanese patients.
Twice‐Daily Versus Thrice‐Daily Clarithromycin in Combination with Ranitidine Bismuth Citrate in the Eradication of Helicobacter pylori
Authors: Schwartz Howard I. , Perschy Teresa B. , McSorley David J. , Sorrells Susan C.
Published: March 2003

Background. Ranitidine bismuth citrate (RBC), 400 mg bid for 4 weeks, plus clarithromycin, 500 mg tid, is a regimen approved by the US Food and Drug Administration for the eradication of Helicobacter pylori in patients with duodenal ulcers. Proof that the clarithromycin portion of the regimen could be given twice daily without loss of efficacy would reduce cost and improve patient compliance. The objective of this study was to compare the H. pylori eradication rates in patients who had duodenal ulcer and were randomly assigned to 4 weeks of treatment with RBC, 400 mg bid, in conjunction with 2 weeks of therapy with either clarithromycin, 500 mg tid, or clarithromycin, 500 mg bid.

Patients and Methods. Patients who had a duodenal ulcer and were H. pylori–positive by at least two tests were randomly assigned to (1) RBC, 400 mg bid for 4 weeks, plus clarithromycin, 500 mg tid for 2 weeks, or (2) RBC, 400 mg bid for 4 weeks, plus clarithromycin, 500 mg bid for 2 weeks. H. pylori eradication was assessed 4 weeks after completion of RBC plus clarithromycin.

Results. Three hundred eighty‐three patients from 78 centers had a duodenal ulcer and were H. pylori–positive. The modified intent‐to‐treat (MITT) and the per‐protocol (PP) eradication rates were statistically equivalent between the twice‐daily (65% MITT, 74% PP) and thrice‐daily (63% MITT, 73% PP) clarithromycin treatment regimens. Incidence and types of adverse events did not differ between the two groups.

Conclusions. For eradicating H. pylori in patients with duodenal ulcer, clarithromycin, 500 mg bid for 2 weeks, with RBC, 400 mg bid for 4 weeks, is equivalent to clarithromycin, 500 mg tid with RBC. The potential enhancement of patient compliance, reduced cost of clarithromycin, and equivalent efficacy would support the use of twice‐daily clarithromycin in triple‐therapy regimens with RBC.
Efficacy of Conventional Endoscopic Disinfection and Sterilization Methods Against Helicobacter pylori Contamination
Authors: Cronmiller James R. , Nelson Daniel K. , Jackson Dana K. , Kim Chung H.
Published: March 2003

Background. Iatrogenic transmission of Helicobacter pylori via contaminated endoscopic devices is well documented. Despite the prevalence of this infectious agent, few controlled studies have investigated the major factors that impact on reprocessing of endoscopes contaminated with H. pylori.

Materials and Methods. An endoscope (Pentax) was contaminated with 108 cfu/ml of H. pylori in 5% bovine calf serum as standardized inoculum. The endoscope then was passed through one of eight arms (five repetitions per arm = 40 total runs), as follows: 1, recovery control (no cleaning or disinfection); 2, manual cleaning alone; 3–5, manual precleaning followed by either 10‐, 20‐, or 45‐minute exposure to 2% glutaraldehyde and ethanol (ETOH) drying; 6, manual cleaning followed by automated reprocessing by STERIS System; 7 and 8, automated reprocessing by STERIS with and without active peracetic acid sterilant (wash‐off control). Suction‐biopsy channels and air‐water channels were harvested for microbiological culture.

Results. Control runs recovered more than 1 × 106 cfu per site, confirming the viability of the test organism and the adequacy of the biological burden for challenge. When instruments underwent manual cleaning alone (without subsequent disinfection), test organisms remained in 40% of runs at the air‐water site. Manual cleaning followed by 10‐, 20‐, or 45‐minute glutaraldehyde exposure and ETOH drying removed all test organisms from all sites in all runs (i.e., 100% disinfection). The automated STERIS system with or without active peracetic acid sterilant also removed all test organisms from all sites in all runs, as did manual cleaning followed by STERIS use.

Conclusion. Manual cleaning alone does not effectively remove H. pylori from an endoscope. Current joint association recommendations for minimal disinfection (manual cleaning followed by at least 20 minutes of immersion in glutaraldehyde and ETOH drying) are effective in preventing cross‐transmission of H. pylori. Reprocessing using the automated STERIS system according to manufacturer's recommendations also is highly effective in sterilizing endoscopes contaminated with H. pylori.
Different Penicillin‐Binding Protein Profiles in Amoxicillin‐Resistant Helicobacter pylori
Authors: Dore Maria P. , Graham David Y. , Sepulveda Antonia R.
Published: March 2003

Background. The β‐lactam group of antibiotics kills bacteria by inhibiting the terminal stages of peptidoglycan metabolism. We have recently identified amoxicillin‐resistant Helicobacter pylori, none of which expressed β‐lactamase. Penicillin‐binding proteins (PBPs) represent a group of target enzymes for the β‐lactam antibiotic family, and alterations in PBPs have been described in other penicillin‐resistant bacteria. The amoxicillin‐resistant phenotype characteristically was lost after freezing but could be restored by consecutive transfers into gradient plates.

Materials and Methods. To determine whether amoxicillin resistance in H. pylori was related to alterations in any of the H. pylori PBPs, five H. pylori strains resistant to amoxicillin and three amoxicillin‐sensitive strains were tested. PBPs were extracted from bacteria grown to logarithmic phase, labeled in vivo with 3H‐benzylpenicillin, and analyzed by sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS‐PAGE) and fluorography. Four main PBPs were separated from all amoxicillin‐sensitive H. pylori strains.

Results. Only three of the four main PBPs were found in the amoxicillin‐resistant H. pylori strains. The differentially detectable PBP (PBP D) had an apparent molecular weight of 30 to 32 kD.

Conclusion. These results suggest that PBP D might play a role in the amoxicillin‐resistant phenotype of H. pylori strains lacking β‐lactamase activity.
A New Rapid Test for Detecting Anti–Helicobacter pylori Antibody Excreted into Urine
Authors: Yamamoto Soichiro , Uemura Naomi , Okamoto Shiro , Yamaguchi Shuji , Mashiba Hiroto , Tachikawa Tetsuya
Published: March 2003

Background. Helicobacter pylori infection has been one of the most common infectious diseases in the world, whereas a gold standard for identifying its infection has not yet been established. The specific test will depend on the particular clinical, epidemiological, and scientific requirements. We recently developed a new type of rapid test to detect H. pylori antibody excreted into urine; the test requires only 20 minutes. The purpose of this study was to examine the accuracy of this rapid test.

Methods. The performance of the rapid test was compared with those of a histological search through Giemsa staining and of an assay for detecting antibodies in serum by a commercially available ELISA kit. The patients, totaling 117 (male, 62, female, 55; average age, 51.6 years), included those with peptic ulcer endoscopically diagnosed and excluded cases that were subjected to eradication therapy in the past.

Results. With respect to the determinations of H. pylori identified by the microscopical test and the serum antibody assay, our kit had a sensitivity of 92.0% and a specificity of 93.1%, and the agreement of determination of H. pylori infection was as high as 91.5% and 92.3%, respectively.

Conclusions. The rapid test for antibodies to H. pylori in urine could detect H. pylori infection easily, rapidly, and noninvasively and would be useful in general practice for screening patients with dyspeptic symptoms.
The 26‐Kilodalton, AhpC Homologue, of Helicobacter pylori is also Produced by Other Helicobacter Species
Authors: Lundström Anneli M. , Sundaeus Vivianne , Bölin Ingrid
Published: March 2003

Background.

The 26 kDa protein, which is an alkyl hydroperoxide reductase (AhpC) homologue, has earlier been described as specific for Helicobacter pylori. The aims of this study were to analyse whether this protein, or the corresponding gene, could be identified in other Helicobacter species.

Materials and Methods.

Two different monoclonal antibodies (Mabs), which recognise the 26 kDa protein in H. pylori, were used in immunoblots to determine the presence of the protein in 10 Helicobacter species. PCR was performed in order to analyse whether the gene was detectable and the PCR products were sequenced. Southern and Northern blot analyses were done on chromosomal DNA and total RNA, respectively, isolated from some selected Helicobacter species in order to compare the genes and mRNA transcripts to H. pylori.

Results.

The 26 kDa protein was identified in H. nemestrinae (primate), H. acinonychis (cheetah), H. bilis (mouse), H. felis (cat) and H.salomonis (dog) but not in H. mustelae (ferret), H. cinaedi (human), H. canis (dog), H. fennelliae (human) or H. pullorum (poultry). By PCR the gene was also recognised in H. mustelae, H. cinaedi and H. pullorum. The PCR products showed high sequence homology (66–98%) compared to H. pylori. The gene was also highly conserved in four H. pylori strains (94–99% homology). Southern blot showed that the H. nemestrinae and H. acinonychis chromosomal DNA contained a single copy of the gene and the Northern blot analyses indicated mono‐cistronic transcription of the gene in these two species, as has been found in H. pylori.

Conclusions.

A gene similar to ahpC was found in eight out of 10 Helicobacter species analysed.
Is Eradication of Helicobacter pylori With Colloidal Bismuth Subcitrate Quadruple Therapy Safe?
Authors: Phillips Rosemary H. , Whitehead Mark W. , Doig Laura A. , Sieniawska Christine E. , Delves H. Trevor , Thompson Richard P. H. , Powell Jonathan J.
Published: March 2003

Background.

When standard triple therapy fails to eradicate Helicobacter pylori, quadruple ‘rescue’ therapy is often used which, in Europe, generally comprises colloidal bismuth subcitrate (CBS) based triple therapy and a proton pump inhibitor. Since hypochlorhydria could greatly increase absorption of the toxic bismuth ion from CBS, we investigated the bismuth status of patients receiving anti‐H. pylori quadruple therapy.

Materials and Methods.

In a prospective open label study 34 patients with nonulcer dyspepsia or peptic ulcer disease, who had failed to eradicate H. pylori with standard triple therapy, were subsequently treated with CBS, omeprazole, amoxycillin and metronidazole (BOAM). A further 35 patients received triple therapy for the eradication of H. pylori: CBS, amoxycillin and metronidazole (BAM) (n = 18); placebo bismuth, amoxycillin and metronidazole (AM) (n = 9); or omeprazole, amoxycillin and metronidazole (OAM) (n = 8). Whole blood bismuth levels were determined before and within 24 hours of completing treatment. Analysis of bismuth was by inductively coupled plasma mass spectrometry, and concentrations were compared between groups and with the Hillemand ‘alarm level’ for blood bismuth (50–100 µg/l).

Results.

BOAM gave higher blood bismuth levels than BAM (difference in means 13.1, CI 6.0–20.2, p < .001); three (8.8%) patients taking BOAM had concentrations within the Hillemand alarm level at 54.2, 64.7 and 91.8 µg/l. OAM and AM did not alter baseline blood bismuth levels.

Conclusions.

Caution should be observed in prescribing CBS with gastric acid suppression, and alternative bismuth preparations should be considered.
Helicobacter pylori Infection Increases Serum Nitrate and Nitrite More Prominently Than Serum Pepsinogens
Authors: Kodama Kanji , Sumii Koji , Kawano Masanori , Kido Tamako , Nojima Keiko , Sumii Masaharu , Haruma Ken , Yoshihara Masaharu , Chayama Kazuaki
Published: March 2003

Background. Helicobacter pylori infection causes chronic gastritis and results in increased serum concentrations of pepsinogens I and II as well as gastrin, while the ratio of pepsinogen I to II (I : II) is decreased. Inducible nitric oxide synthase (iNOS) is induced in H. pylori‐associated gastritis and may modulate inflammation. However serum nitrate and nitrite (NOx) concentrations in patients with H. pylori‐induced chronic gastritis have not been reported. We examined differences in serum NOx between H. pylori‐negative and positive volunteers relative to differences in pepsinogens and gastrin.

Materials and methods. Sera from 80 healthy asymptomatic volunteers younger than 36 years were analyzed for anti‐H. pylori antibody, NOx, gastrin and pepsinogens.

Results. In H. pylori antibody‐positive subjects serum NOx concentrations were higher than in negative subjects (p < .005). In H. pylori‐negative subjects, NOx correlated with pepsinogen II (r = .405, p < .05). In subjects with low pepsinogen I or II, NOx was higher in H. pylori‐positive than negative subjects (p < .001). In subjects with high pepsinogen I : II (6 or higher), serum NOx was higher in H. pylori‐positive than in negative subjects.

Conclusions. H. pylori‐induced gastritis increases serum NOx concentrations more prominently than those of pepsinogen. In H. pylori‐negative subjects, serum correlates with serum pepsinogen II.
Increased Primary Resistance to Recommended Antibiotics Negatively Affects Helicobacter pylori Eradication
Authors: Ecclissato C. , Marchioretto M.A.M. , Mendonça S. , Godoy A.P.O. , Guersoni R.A. , Deguer M. , Piovesan H. , Ferraz J.G.P. , Pedrazzoli J.
Published: March 2003

Objective. To evaluate the efficacy of two commonly employed treatments for Helicobacter pylori infection and the impact of bacterial resistance to antibiotics on eradication rate.

Methods. Ninety‐two consecutive H. pylori‐positive patients with active peptic ulcer disease were randomly enrolled to receive a 7‐day treatment with either lansoprazole 30 mg plus amoxicillin 1 g and clarithromycin 500 mg [all twice a day (b.i.d.), Group A, n = 46]; or bismuth subcitrate 125 mg four times a day (q.i.d.) plus tetracycline 500 mg q.i.d and furazolidone 200 mg b.i.d. (Group B, n = 46) H. pylori status was reassessed 30 days after completion of the therapy and bacterial resistance to the antibiotics was investigated using an in vitro assay.

Results. Five patients from each study group were lost to follow up. Both treatments resulted in similar H. pylori eradication rate: 66–60% (per protocol), 59–52% (intention‐to‐treat) in Groups A and B, respectively (non significant). However, eradication improved to 79% in the absence of H. pylori resistance to clarithromycin or amoxicillin.

Conclusion. Primary resistance to clarithromycin or amoxicillin may underscore a potentially serious problem for the eradication of H. pylori infection. Testing for bacterial resistance may become necessary to improve therapeutic efficacy.
The Presence of Immunoglobulins in the Gastric Juice of Patients Infected With Helicobacter pylori is Related to a Reduced Secretion of Acid
Authors: Meining Alexander , Wick Manfred , Miehlke Stephan , Bayerdörffer Ekkehard , Stolte Manfred , Sackmann Michael , Ochsenkühn Thomas
Published: March 2003

Background. It has been reported that treatment with proton pump inhibitors (PPI) leads to partial elimination and suppression of Helicobacter pylori. In theory, since acid is known to denature immunoglobulins, this antibacterial activity of PPI may be due to a reduction in the acid output favouring humoral immunity.

Materials and methods. We analysed prospectively fasting gastric juice in 54 consecutive patients attending upper endoscopy for pH and levels of IgG, IgA and IgM. In addition, two antral and two corpus biopsies were obtained and histologically examined for the presence of H. pylori.

Results. 41/54 patients were infected with H. pylori. Immunoglobulines in the gastric juice of these patients were found in 25/41 (IgG), 27/41 (IgA), and 29/41 (IgM) patients. There was a highly significant difference in the gastric pH when H. pylori infected patients with measurable IgG, IgA, or IgM were compared with those in whom no immunoglobulines were found (median pH: 6 vs. 2 in each group; p < .001)

Conclusions. There is a close correlation between a high gastric pH and the presence of IgG, IgA, and IgM antibodies. Hence, it may be speculated that the efficacy of humoral immunity following H. pylori infection depends on a high pH such as resulting from PPI treatment.
Vitamin C and E Supplements to Lansoprazole‐Amoxicillin‐Metronidazole Triple Therapy May Reduce the Eradication Rate of Metronidazole‐Susceptible Helicobacter pylori Infection
Authors: Chuang Chiao‐Hsiung , Sheu Bor‐Shyang , Huang Ay‐Huey , Yang Hsiao‐Bai , Wu Jiunn‐Jong
Published: March 2003

Aim. To test whether vitamin C and E supplements to triple therapy can improve the Helicobacter pylori eradication rate and gastric inflammation.

Methods. A total of 104 H. pylori‐infected patients were randomized to receive: either lansoprazole, amoxicillin, and metronidazole twice daily for 1 week (triple‐only group) or lansoprazole, amoxicillin, metronidazole plus vitamin C (250 mg) and vitamin E (200 mg) twice daily for 1 week, followed immediately by vitamin C and E once daily for 6 consecutive weeks (triple‐plus‐vitamin group). Eight weeks after the completion of triple therapy, patients were assessed for the effectiveness of H. pylori eradication. The severity of gastric inflammation in histology was assessed for the acute and chronic inflammation scores.

Results. Intention‐to‐treat and per‐protocol eradication rates were 59.1% and 64.4% in the triple‐only group, and 40% and 44% in the triple‐plus‐vitamin group. In the patients infected with metronidazole susceptible isolates, the triple‐only group had a higher intention‐to‐treat eradication rate than those in the triple‐plus‐vitamin group (80% vs. 53.1%, p < .01). However, for the metronidazole resistance isolates, the intention‐to‐treat eradication rates between the two groups were not different (26.3% vs. 21.7%, p = NS). The improvements of both acute and chronic inflammation scores in histology were not different between the two groups.

Conclusion. Adding vitamin C and E to triple therapy cannot improve the H. pylori eradication rate and gastric inflammation. For patients with metronidazole susceptible strain infection, adding these vitamins may even reduce the eradication rate of triple therapy.
A Group‐Specific PCR Assay for the Detection of Helicobacteraceae in Human Gut
Authors: Bohr Ulrich R. M. , Primus Anett , Zagoura Alexandra , Glasbrenner Bernd , Wex Thomas , Malfertheiner Peter
Published: March 2003

Background. Enterohepatic Helicobacter species are emerging pathogens, which are increasingly isolated from humans with enteric diseases. Nevertheless, current methods to detect Helicobacteraceae in the human gut have significant limitations.

Methods. Based on 16S‐rRNA gene alignments and computer aided primer analysis a set of group‐specific PCR primers was designed. The evaluation of the PCR assay was performed using 36 ATCC reference strains and intestinal biopsies from 10 patients with defined gastric Helicobacter pylori status. The amplification products derived from clinical samples were cloned and subsequently analyzed by DNA sequencing. Sensitivity of the PCR‐assay was determined by spiking previously negative tested samples with decreasing amounts of Helicobacter DNA.

Results. The analysis of the ATCC reference strains revealed amplification products in all 14 Helicobacter strains and Wolinella succinogenes, 21 other microorganisms representing negative controls did not produce PCR fragments. Four out of the 10 patient‐derived samples were positive. Three of them represented H. pylori‐derived DNA confirming the gastric H. pylori infection in these patients. In the fourth patient, who was suffering from Crohn's disease, H. pullorum was identified. The sensitivity of the PCR assay was 0.1 pg of Helicobacter‐derived DNA representing about 40 bacteria.

Conclusion. The novel PCR assay described here is an important new tool in rapid and sensitive assessment for the presence of Helicobacteraceae in human gut.
Acid Inhibitory Potency of Twice a Day Omeprazole is not Affected by Eradication of Helicobacter pylori in Healthy Volunteers
Authors: Thomson Alan B. R. , Keelan Monika , Lastiwka Rosann , Appelman‐Eszcuck Sharon , Zuk Lori , Drozdowski Laurie , Prentice Anne , Sinclair Paul
Published: March 2003

Background & Aims. The acid inhibitory effect of proton pump inhibitors is reported to be greater in the presence than in the absence of an H. pylori infection. This study was undertaken to test the hypothesis that the acid inhibitory effect of omeprazole given twice a day is greater in H. pylori infected healthy volunteers than in the same individuals following eradication because of differences in the pharmacodynamics of omeprazole, greater duodenogastric reflux, the effects of ammonia produced by the H. pylori, or lower gastric juice concentrations of selected cytokines, which may inhibit gastric acid secretion.

Materials and Methods. We undertook 24‐hour pH‐metry in 12 H. pylori‐positive healthy volunteers: (1) when on no omeprazole; (2) when on omeprazole 20 mg bid for 8 days; (3) 2 months after eradication of H. pylori and when on no omeprazole; and (4) after eradication of H. pylori and when on omeprazole 20 mg twice a day.

Results. In subjects given omeprazole, eradication of H. pylori reduced pH and percentage pH ≥ 3, as well as increasing the area under the H+ concentration‐time curve. These differences were not due to alterations in (1) gastric juice concentrations of IL‐1α, IL‐8, IL‐13, epidermal growth factor, or bile acids; (2) serum gastrin concentrations; or (3) the pharmacokinetics of omeprazole. There was no change in the difference in the H+ concentration‐time curve ‘without omeprazole’ minus ‘with omeprazole’, when comparing ‘after’ versus ‘before’ eradication of H. pylori.

Conclusions. Eradication of H. pylori was not associated with an alteration in the acid inhibitory potency when comparing the difference in gastric acidity ‘with’ versus ‘without’ omeprazole. When the results were expressed by simply taking into account the acid measurements while on omeprazole before versus after eradication of H. pylori, the acid inhibition with omeprazole was greater in the presence than in the absence of a H. pylori infection. The clinical significance of the small difference is not clear.
Working Toward Better Cancer Pain Management for Children
Authors: Anghelescu Doralina , Oakes Linda
Published: March 2003

purpose: Management of the pain experienced by children with cancer is critical to minimize the psychological distress and physiologic responses to their illness and its treatment.

overview: A team approach to providing care, using guidelines for pharmacologic management intertwined with nonpharmacologic strategies, while individualizing the care of a specific child, is required. Pain management must start with assessment using tools that are age appropriate and well suited to the clinical situation. Dosages of the recommended opioid and nonopioid medications that are suitable for children as well as the role of locally, systemically, and epidurally administered anesthetic agents are described by the authors.

clinical implications: By following this practical approach, children can be prepared and supported during the various intensive oncology therapies often associated with pain that are now offered in the hope of improving the survival of children with cancer.