bluuebunny/crossref_metadata_2025 huggingface dataset:
Low Recruitment of Trees Dispersed by Animals in African Forest Fragments
Authors: Cordeiro N. J. , Howe H. F.
Published: March 2003

Abstract: We investigated the effects of forest fragmentation on the disappearance of fruit‐eating animals and the recruitment of animal‐, wind‐, and gravity‐dispersed trees in 80‐year‐old forest patches in the East Usambara Mountains of Tanzania. We compared adult and juvenile trees in forest transects in a 3500–ha submontane forest with those in four forest fragments of 521, 30, 9, and 0.5 ha. Preliminary results show that recruitment of seedlings and juveniles of 31 animal‐dispersed tree species was more than three times greater in continuous forest and large forest fragments (≥30 ha) than in small forest fragments (≤9 ha), whereas recruitment of eight wind‐ and gravity‐dispersed trees of the forest interior was unaffected. Recruitment of 10 endemic, animal‐dispersed tree species was 40 times lower in small fragments than in continuous forest or large fragments. Counts of diurnal primates and birds in all five sites indicated that frugivorous species have declined with decreasing fragment size. These results are consistent with the idea that loss of dispersal agents depresses tree recruitment in the course of forest fragmentation.
Integration of Science and Community‐Based Conservation in the Mexico/ U.S. Borderlands
Authors: Curtin Charles G.
Published: March 2003

Abstract: Ranchers, conservationists, and researchers in the Mexico–United States borderlands have implemented a community‐based conservation program that relies on monitoring and peer‐reviewed science. Their collaboration with the Malpai Borderlands Group supports large‐scale, long‐term studies, but—perhaps more importantly—it helps assure that science effectively addresses local concerns. Conservation programs are organized around understanding and maintaining the processes that sustain arid landscapes, including fire and herbivory (by both cattle and native species), and understanding how they interact with climate. Sustaining ecosystem processes in the face of climatic variability requires a sound foundation of monitoring and research and a good working relationship between people and organizations with diverse goals and interests. This collaboration between ranching, research, and conservation communities demonstrates that these groups, working together for mutual benefit, can reach scientific and conservation goals unobtainable by any one group on its own.
Spatial Factors and Stochasticity in the Evaluation of Sustainable Hunting of Tapirs
Authors: Salas Leonardo A. , Kim John B.
Published: March 2003

Abstract: Sustainable hunting, the extraction of game without reducing its density, is a desirable approach to the use of wildlife. Assessment of sustainable extraction in many parts of the world is difficult; it has recently been done by a method proposed by Robinson and Redford (1991): a maximum number of animals that can be extracted per unit area is calculated based on life‐history parameters and density estimates. If extraction is higher than that maximum number, it is deemed unsustainable. We extended the method by adding spatial and stochastic components through an individual‐based model of a population of female tapirs (  Tapirus sp.) and conducted a sensitivity analysis to evaluate the importance of spatial and life‐history parameters. Our analysis suggests that spatial factors, such as the shape of the hunted area and the size of the surrounding population, may be important in determining the sustainability of extraction. For long‐lived, slow‐reproducing mammals such as tapirs, survival to age of last reproduction is the most critical parameter, but the shape of the hunting zone and population density can be critical, especially in unsustainable hunting scenarios. We advocate long‐term studies of tapirs to collect information on spatial movements and survival rates that could then be used for development of proper management plans.
Experimental Evidence of Disrupted Dispersal Causing Decline of an Australian Passerine in Fragmented Habitat
Authors: Cooper Caren B. , Walters Jeffrey R.
Published: March 2003

Abstract: We evaluated two hypothetical explanations for the decline of the cooperatively breeding Brown Treecreeper ( Climacteris picumnus ) in fragmented habitat: habitat degradation and isolation. We monitored the reproductive performance of approximately 50 breeding groups in Eucalyptus woodlands in the New England tablelands of northeastern New South Wales during 1996–1998. In addition, we translocated females to contiguous woodland and woodland fragments with unpaired males. We predicted that experimentally relocated females would reject territories with unpaired males in fragments if the habitat was degraded but not if males were unpaired due to isolation. We moved 11 females to fragments with unpaired males and 5 females to contiguous habitat with unpaired males. Nine females remained with males in fragments. Five of these females attempted nesting and 3 produced fledglings. No female relocated to contiguous habitat with an unpaired male remained or paired. We rejected habitat degradation as an explanation for the current decline of Brown Treecreepers within remnants, although degradation likely played a role in the past at a regional scale. Exceedingly low female recruitment within fragments and a lack of female dispersal between fragments provide additional evidence that female dispersal into territories in fragments rarely occurs naturally. We conclude that patch isolation is responsible for the high proportion of unpaired males in fragmented habitat.
Timescale of Perennial Grass Recovery in Desertified Arid Grasslands Following Livestock Removal
Authors: Valone Thomas J. , Meyer Marc , Brown James H. , Chew Robert M.
Published: March 2003

Abstract: Over the past two centuries, perennial grass cover has declined and shrub density has increased in many arid grasslands. These changes in vegetation, characteristic of desertification, are thought to have occurred often following prolonged periods of intense grazing by domestic livestock. At many such sites, however, the subsequent removal of livestock grazing for up to 20 years has not resulted in increased grass cover. The apparent stability of vegetation following the cessation of livestock grazing has led to the hypothesis that desertified arid grasslands exist in alternate stable states of either grassland or shrubland over timescales relevant to management. To better understand the timescale of grass recovery in historic arid grasslands dominated by shrubs, we examined the vegetation at two nearby desertified sites that differed in the length of time since livestock removal. There was little difference between the site ungrazed for 20 years and the shrub‐dominated vegetation on the other side of the exclusion fence. At a site ungrazed for 39 years there was significantly higher perennial grass cover inside the exclusion fence than outside, and nearly all the increase had occurred over the past 20 years. These data suggest that there may be time lags of 20 years or more in the response of perennial grasses to removal of livestock in historic grassland ecosystems dominated by shrubs.
The Use of Focal Species in Designing a Habitat Network for a Lowland Area of Lombardy, Italy
Authors: Bani Luciano , Baietto Marco , Bottoni Luciana , Massa Renato
Published: March 2003

Abstract: Ecological networks consist of core areas connected by corridors and shielded by buffer zones. It is now largely accepted that extensive networks need to be established at different scales to conserve biodiversity. We propose using focal species to plan woodland ecological networks because such species encompass the structural and functional needs of entire ecological communities. To this end, we chose (1) the type of landscape to be conserved and (2) the suitable focal species for that task. The study area (2500 km 2) was north of Milan where human activity is heavy but wooded patches are mostly protected as regional parks. We used an interpreted satellite image to compare land‐use patterns with the presence or abundance of focal species. This method produced “suitability maps” for focal species—woodland birds and mammalian carnivores—on which ecological corridors can be drawn as lines connecting core areas through the best available habitat in the matrix. These potential corridors are a useful guideline for implementation of a regional ecological network.
Estimating the Effects of Road Mortality on Turtle Populations
Authors: Gibbs James P. , Shriver W. Gregory
Published: March 2003

Abstract:Road mortality is suspected to have contributed to widespread population declines in turtles in the United States, a country with exceptionally high turtle diversity. We examined the issue through a modeling study that integrated road maps and traffic‐volume data with simulated movements of (1) small‐bodied pond turtles, (2) large‐bodied pond turtles, and (3) terrestrial and semiterrestrial (“land”) turtles. Our model predicted that road networks typical of the northeastern, southeastern, and central regions have the potential to limit land‐turtle populations and, to a lesser extent, populations of large‐bodied pond turtles. Nowhere are populations of small‐bodied pond turtles likely threatened regionally by road mortality. We conclude that the demographic traits of some turtles, in combination with their mobility, may jeopardize population persistence within road networks typical of the eastern and central United States.
Interspecific Effects of Artifically Propagated Fish: an Additional Conservation Risk for Salmon
Authors: Levin Phillip S. , Williams John G.
Published: March 2003

Abstract: For more than 120 years, hatcheries have released enormous numbers of Pacific salmon to compensate for numerous human insults to their populations, yet the ecological effects of this massive effort are poorly understood. We tested the hypothesis that hatchery‐reared steelhead salmon ( Oncorhynchus mykiss) released into the Snake River Basin negatively affect the survival of wild Snake River steelhead and chinook ( O. tshawytscha) salmon. Because climatic conditions can influence salmon survival, we included an index of the El Niño–Southern Oscillation ( ENSO) as a covariate in our analyses. Based on time series of hatchery releases and rates of smolt‐to‐adult survival, we demonstrate that the survival of wild chinook salmon is negatively associated with hatchery releases of steelhead. The state of the ( ENSO) did not affect the strength of this relationship. We observed no relationship between survival of wild steelhead and steelhead hatchery releases. Our results suggest that industrial‐scale production of hatchery fish may hinder the recovery of some threatened salmonids and that the potential interspecific impact of hatcheries must be considered as agencies begin the process of hatchery reform.
Land Use in Watersheds of the Venezuelan Andes: a Comparative Analysis
Authors: Allan J. D. , Brenner A. J. , Erazo J. , Fernandez L. , Flecker A. S. , Karwan D. L. , Segnini Samuel , Taphorn D. C.
Published: March 2003

Abstract: The influence of deforestation on tropical watersheds has received limited study. We compared seven catchments in the Venezuelan Andes to examine variation in the relative extent of forested versus disturbed land and the potential consequences of changing land use on river ecosystems. These watersheds formed a northeast ( Río Acarigua) to southwest ( Río Bumbun) transect and exhibited a gradient in readily observable human settlement and disturbance. Overall, forest cover increased and agriculture and pasture land decreased from the Acarigua to the Bumbun. Human building density and road density showed a parallel trend. Catchments varied in intrinsic characteristics as well. Catchments to the northeast originated at lower elevations and had wider, flatter valleys in the lowest piedmont zone, compared with rivers to the southwest. All seven catchments had broadly similar forest cover at approximately 50–60% within the lowest ( 200–800 m) elevation zone, but they exhibited a strong gradient in the amount of forested versus disturbed land in zones at 800–1400 m and 1400–2600 m. Although the number of buildings was greatest in the 200‐ to 800‐m zone, building density was greater in the 800‐ to 1400‐m zone for the more disturbed catchments, possibly reflecting the areas suitable for coffee production. Land‐use change within these catchments is likely to alter hydrology, sediment transport, and habitat conditions within river systems, with adverse consequences for aquatic biodiversity.
Freshwater Protected Areas: Strategies for Conservation
Authors: Saunders D. L. , Meeuwig J. J. , Vincent A. C. J.
Published: March 2003

Abstract: Freshwater species and habitats are among the most threatened in the world. One way in which this growing conservation concern can be addressed is the creation of freshwater protected areas. Here, we present three strategies for freshwater protected‐area design and management: whole‐catchment management, natural‐flow maintenance, and exclusion of non‐native species. These strategies are based on the three primary threats to fresh waters: land‐use disturbances, altered hydrologies, and introduction of non‐native species. Each strategy draws from research in limnology and river and wetland ecology. Ideally, freshwater protected areas should be located in intact catchments, should have natural hydrological regimes, and should contain no non‐native species. Because optimal conservation conditions are often difficult to attain, we also suggest alternative management strategies, including multiple‐use modules, use of the river continuum concept, vegetated buffer strips, partial water discharges, and eradication of exotic species. Under some circumstances it may be possible to focus freshwater conservation efforts on two key zones: adjacent terrestrial areas and headwaters.
Experimental Effects of Hiking on Breeding Mexican Spotted Owls
Authors: Swarthout Elliott C. H. , Steidl Robert J.
Published: March 2003

Abstract: On the Colorado Plateau, some environments occupied by Mexican Spotted Owls (  Strix occidentalis lucida ) receive a great deal of recreational use. To assess the effects of hikers on breeding owls, we quantified changes in the activity budgets of owls at nests in response to a controlled amount of hiking in canyons of southern Utah in 1997 and 1998. We examined differences in the duration and frequency of eight behaviors as well as in the type and frequency of owl vocalizations between hiking and control treatments. In general, activity budgets of owls did not change markedly when hikers were near nests, although during hiking treatments, females decreased the amount of time they handled prey by 57% and decreased the amount of time they performed daytime maintenance behaviors by 30%. Further, hikers caused both females and males to increase the frequency of contact vocalizations by 58% and 534%, respectively. The order in which we applied treatments at nests ( control‐hiking or hiking‐control ) also influenced owl responses to hiking treatments, suggesting that observers near nests may have affected owl behavior. We concluded that the cumulative effects of high levels of short‐duration recreational hiking near nests may be detrimental to Mexican Spotted Owls. Given current levels of visitation rates to most remote canyons occupied by owls, however, owl populations on the Colorado Plateau are not likely threatened by hiking. Notable exceptions are those canyons that receive use by ≥50 hikers per day. We recommend monitoring of owl occupancy, nest success, and hiking intensity in these high‐use canyons.
Smoking and Smoking Relapse During Pregnancy and Postpartum: Results of a Qualitative Study
Authors: Edwards Nancy , Sims‐Jones Nicki
Published: March 2003

Background:

The purpose of this study was to describe women's smoking experience during pregnancy and postpartum. Primiparous women recruited during a randomized controlled trial to assess the effectiveness of postpartum visiting were invited to participate in a qualitative study.

Methods:

A semistructured protocol guided the face‐to‐face interview. Interviews were audiotaped and transcribed. Data were coded independently by the authors, and the final coding system for emergent themes was developed through a consensus process.

Results:

Of the 47 women invited to participate, 22 agreed to be interviewed. Three major themes emerged from the analysis: pregnancy as a context for stopping smoking, returning to smoking, and social pressures on smoking behavior. Concerns about the baby's health were cited as central reasons for stopping. Breastfeeding provided a reason for continued smoking cessation, whereas social events often demarcated a resumption of women's smoking choices.

Conclusions:

Results provide guidance for the timing and content of interventions to prevent smoking relapse. (BIRTH 25:2 June 1998)
Volunteer Peer Counselors Increase Breastfeeding Duration Among Rural Low‐Income Women
Authors: Schafer Elisabeth , Vogel Mary Kay , Viegas Swarna , Hausafus Cheryl
Published: March 2003

Background:

The purpose of this demonstration project was to test the effectiveness of a volunteer peer counseling program for promoting breastfeeding in a community.

Methods:

The two‐year project was conducted in Iowa from September 1994 to September 1996. Both intervention and control groups were rural low‐income pregnant and postpartum women who qualified for the Women, Infants and Children's (WIC) nutritional program. The intervention was initiated in two counties with 143 clients, of whom 72 completed the project. The control group was drawn from six counties that had received no significant breastfeeding promotion programs during the previous three years. The intervention was the assignment of trained volunteers with previous successful personal experience with breastfeeding as peer counselors to low‐income pregnant women. Both before and after the baby was born, the volunteers taught a series of in‐home, one‐to‐one lessons about healthy diet and breastfeeding, and maintained informal contact to answer questions or help with concerns.

Results:

Women in the intervention group improved dietary intake when compared with the control group. Knowledge of breastfeeding and good nutrition improved slightly. Eighty‐two percent of intervention compared with 31 percent of control group women initiated breastfeeding. Mean duration of breastfeeding for intervention and control group women was 5.7 and 2.5 weeks, respectively. At 4 weeks, 56 percent of intervention and 10 percent of control group women were still breastfeeding.

Conclusion:

A volunteer peer counseling program that provides low‐income women with role models, accurate information, support, and encouragement can increase the duration of breastfeeding, and thus contribute to healthier infants. (BIRTH 25:2 June 1998)
Distribution of Genital Tract Trauma in Childbirth and Related Postnatal Pain
Authors: Albers Leah , Garcia Jo , Renfrew Mary , McCandlish Rona , Elbourne Diana
Published: March 2003

Background: The full extent of genital tract trauma in spontaneous births is not well documented. The purpose of this study was to describe the range and extent of childbirth trauma and related postnatal pain using data from a large randomized clinical trial of perineal management techniques (n = 5471). Methods: Descriptive analysis was conducted on trial participants who delivered spontaneously at term and were examined by their midwife after birth (n = 5404). Data are reported for sites of trauma, and the relation to episiotomy, suturing, and maternal reports of pain at 2 days, 10 days, and 3 months after birth. Results: Eighty‐five percent of all women experienced some form of trauma, with first‐ or second‐degree perineal lacerations occurring in two‐thirds of women and outer vaginal tears occurring in one‐half. Tears to the rectum and vaginal vault were more common with episiotomy. Nearly all unsutured trauma was restricted to perineal first‐ or second‐degree, outer vaginal, and labial sites. Pain declined over time, and a gradient in pain was observed according to the site and complexity of trauma. Conclusions: Genital tract trauma is extremely common with spontaneous vaginal birth. Effective measures to prevent or reduce its occurrence would benefit many new mothers.
What Is Recommended for Healthy Women During Pregnancy? A Comparison of Seven Prenatal Clinical Practice Guideline Documents
Authors: Haertsch Maggie , Campbell Elizabeth , Sanson‐Fisher Rob
Published: March 2003

Background: Several countries have developed clinical practice guidelines for the content of prenatal care. This study examines the consistency of recommendations in clinical practice guidelines describing routine prenatal care. Methods: The recommendations for low‐risk women in seven guideline documents were examined: two from Australia, two from the United States, two from Canada, and one from Germany. The recommendations were listed into the four areas of “general health screening and health promotion during pregnancy,”“organization of care,”“clinical tests and screening,” and “education specific for pregnancy.”Results: A total of 69 recommendations were identified within the seven documents, most of which fell within the “clinical tests and screening” domain. Notable differences were identified in the number of recommendations made within the same country. Of the 69 recommendations, only four were included in all seven documents. Conclusion: Little consistency was demonstrated within or among countries in terms of the content of their prenatal care guidelines, suggesting a need to reexamine their content and the evidence on which such recommendations are based.
Breastfeeding Twins: Guidelines for Success
Authors: Hattori Ritsuko , Hattori Haruo
Published: March 2003

Background: Although the frequency of twin births has increased in Japan, little information is available about breastfeeding twins. An intervention of breastfeeding support was implemented to promote breastfeeding for mothers of twins and to compare the factors related to breastfed and formula‐fed twins. Methods: Eleven Japanese twins‐mother pairs received breastfeeding support according to a breastfeeding protocol for twins, and a control group of seven pairs received routine care. Perinatal data were obtained from clinical records for analysis. Results: No significant differences were evident between the two groups in terms of maternal age, gestational age, birthweight, the age at which breastfeeding was initiated, amount of supplementary feeding in hospital, infants' age at discharge, or duration of mothers' hospital stay. At age 3 months, 13 infants in the intervention group were being exclusively breastfed and 9 were almost exclusively breastfed. In the control group 4 infants were almost exclusively and 10 were exclusively formula‐fed. The mothers in the intervention group breastfed and expressed milk significantly more frequently than the mothers in the control group during their hospital stay. Conclusions: Mothers of twins face many obstacles in breastfeeding, and health care professionals should offer individualized care and support.
Decision Making in Analyses of Women's Birth Stories
Authors: VandeVusse Leona
Published: March 2003

Background: Complex interactions occur among women and caregivers throughout labor. Analyzing women's birth stories provides a rich data source on these interactions. The purpose of this qualitative study was to clarify how decisions were made in labor by analyzing women's birth stories. Methods: A convenience sample of 15 primiparous and multiparous Midwestern women contributed a total of 33 birth stories. Qualitative methods were used, including analyses of the content and themes of stories. Results: The primary types of decision making that were identified ranged on a continuum from unilateral to joint (shared), and were associated with various emotions expressed by the women. Conclusions: A model of decision making was derived from the data that may help caregivers change practices in ways that will benefit women. Caregivers can also benefit by understanding women's critiques of the birth care they received, and can use this knowledge to improve women's experiences of birth and therefore their satisfaction with the process.
Is It Necessary to Suture All Lacerations After a Vaginal Delivery?
Authors: Lundquist Martina , Olsson Ann , Nissen Eva , Norman Margareta
Published: March 2003

Background:
Midwives tend to leave minor perineal lacerations to heal spontaneously, and clinical experience and studies show that women can suffer from their stitched lacerations. The study purpose was to determine any differences in the healing process and experience of minor perineal lacerations when they were sutured or not sutured.
Methods:
Eighty term pregnant primiparas with minor perineal lacerations of grades I–II were randomized after childbirth. The experimental group was nonsutured and the control group was sutured. A follow‐up examination was performed at 2 to 3 days, 8 weeks, and 6 months after the delivery. Participants were asked about the type of discomfort, and the effect of the laceration on breastfeeding and sexual intercourse.
Results:
No significant differences were found in the healing process. The type of pain differed between the groups, but the amount of discomfort was the same. The sutured group had to visit the midwife more often because of discomfort from the stitches. Sixteen percent of the women in the sutured group, but none in the nonsutured group (p= 0.0385), considered that the laceration had had a negative influence on breastfeeding.Conclusions:Minor perineal lacerations can be left to heal spontaneously. The benefits for the woman include the possibility of having a choice, avoiding the discomfort of anesthesia and suturing, providing positive affects on breastfeeding.
Measuring Social Support in Pregnancy: Can It Be Simple and Meaningful?
Authors: Webster Joan , Linnane John W.J. , Dibley Linda M , Hinson Janis K , Starrenburg Suzanne E , Roberts Janice A
Published: March 2003

Background:
It is important to determine the level of a woman's social support at the booking‐in interview for prenatal care, but measurement tends to be ad hoc and nonquantifiable. The purpose of this study was to describe the Maternity Social Support Scale and the relationship between support scale ratings and the Edinburgh Postnatal Depression Scale and other health and service use outcomes.
Methods:
Women (n= 901) who attended the antenatal clinic at the Royal Women's Hospital in Brisbane, Australia, were asked to complete a support scale as part of their booking‐in interview. Participants were contacted at 16 weeks postpartum and invited to complete a follow‐up questionnaire. Relationships between the scale and study outcomes were explored using analysis of variance and chi‐square tests.Results:Women with low social support in pregnancy were more likely than well‐supported women to report poorer health during pregnancy (p= 0.006) and postnatally (p < 0.001), to book later for prenatal care (p= 0.000), to seek medical help more frequently (p= 0.004), and to be more depressed postnatally(p= 0.0001).Conclusion:Social support during pregnancy can be measured in a meaningful and simple way through the use of a short questionnaire administered at the prenatal booking‐in visit.
Childbirth and the Development of Acute Trauma Symptoms: Incidence and Contributing Factors
Authors: Creedy Debra K , Shochet Ian M , Horsfall Jan
Published: March 2003

Background:
Little is known about the relationship between women's birthing experiences and the development of trauma symptoms. This study aimed to determine the incidence of acute trauma symptoms and posttraumatic stress disorder in women as a result of their labor and birth experiences, and to identify factors that contributed to the women's psychological distress.
Method:
Using a prospective, longitudinal design, women in their last trimester of pregnancy were recruited from four public hospital antenatal clinics. Telephone interviews with 499 participants were conducted at 4 to 6 weeks postpartum to explore the medical and midwifery management of the birth, perceptions of intrapartum care, and the presence of trauma symptoms.
Results:
One in three women (33%) identified a traumatic birthing event and reported the presence of at least three trauma symptoms. Twenty‐eight women (5.6%) met DSM‐IV criteria for acute posttraumatic stress disorder. Antenatal variables did not contribute to the development of acute or chronic trauma symptoms. The level of obstetric intervention experienced during childbirth (β= 0.351, p < 0.0001)and the perception of inadequate intrapartum care (β= 0.319, p < 0.0001) during labor were consistently associated with the development of acute trauma symptoms.Conclusions:Posttraumatic stress disorder after childbirth is a poorly recognized phenomenon. Women who experienced both a high level of obstetric intervention and dissatisfaction with their intrapartum care were more likely to develop trauma symptoms than women who received a high level of obstetric intervention or women who perceived their care to be inadequate. These findings should prompt a serious review of intrusive obstetric intervention during labor and delivery, and the care provided to birthing women.
Continuity of Caregivers for Care During Pregnancy and Childbirth
Authors: Hodnett E.D.
Published: March 2003

A substantive amendment to this systematic review was last made on 04 March 1998. Cochrane reviews are regularly checked and updated if necessary.

Background: Care is often provided by multiple caregivers, many of whom work only in the antenatal clinic, labour ward, or postnatal unit. However, continuity of care is provided by the same caregiver or a small group from pregnancy through the postnatal period.

Objectives: The objective of this review was to assess continuity of care during pregnancy and childbirth and the puerperium with usual care by multiple caregivers.

Search strategy: The Cochrane Pregnancy and Childbirth Group trials register was searched.

Selection criteria: Controlled trials comparing continuity of care with usual care during pregnancy, childbirth and the postnatal period.

Data collection and analysis: Trial quality was assessed. Study authors were contacted for additional information.

Main results: Two studies involving 1815 women were included. Both trials compared continuity of care by midwives with non‐continuity of care by a combination of physicians and midwives. The trials were of good quality. Compared to usual care, women who had continuity of care from a team of midwives were less likely to be admitted to hospital antenatally (odds ratio 0.79, 95% confidence interval 0.64–0.97) and more likely to attend antenatal education programs (odds ratio 0.58, 95% confidence interval 0.41–0.81). They were also less likely to have drugs for pain relief during labour (odds ratio 0.53, 95% confidence interval 0.44–0.64), and their newborns were less likely to require resuscitation (odds ratio 0.66, 95% confidence interval 0.52–0.83). No differences were detected in Apgar scores, low birthweight, and stillbirths or neonatal deaths. While they were less likely to have an episiotomy (odds ratio 0.75, 95% confidence interval 0.60–0.94), women receiving continuity of care were more likely to have either a vaginal or perineal tear (odds ratio 1.28, 95% confidence interval 1.05, 1.56). They were more likely to be pleased with their antenatal, intrapartum, and postnatal care.

Reviewers' conclusions: Studies of continuity of care show beneficial effects. It is not clear whether these are due to greater continuity of care, or to midwifery care.

Citation: Hodnett ED. Continuity of caregivers for care during pregnancy and childbirth (Cochrane Review). In: The Cochrane Library, Issue 2, 2000. Oxford: Update Software.

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

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Prevalence and Persistence of Health Problems After Childbirth: Associations with Parity and Method of Birth
Authors: Thompson Jane F. , Roberts Christine L. , Currie Marian , Ellwood David A.
Published: March 2003

ABSTRACT: Background: Awareness about the extent of maternal physical and emotional health problems after childbirth is increasing, but few longitudinal studies examining their duration have been published. The aim of this study was to describe changes in the prevalence of maternal health problems in the 6 months after birth and their association with parity and method of birth.

Methods: A population‐based, cohort study was conducted in the Australian Capital Territory (ACT), Australia. The study population, comprising women who gave birth to a live baby from March to October 1997, completed 4 questionnaires on the fourth postpartum day, and at 8, 16, and 24 weeks postpartum. Outcome measures were self‐reported health problems during each of the three 8‐week postpartum periods up to 24 weeks.

Results: A total of 1295 women participated, and 1193 (92%) completed the study. Health problems showing resolution between 8 and 24 weeks postpartum were exhaustion/extreme tiredness (60–49%), backache (53–45%), bowel problems (37–17%), lack of sleep/baby crying (30–15%), hemorrhoids (30–13%), perineal pain (22–4%), excessive/prolonged bleeding (20–2%), urinary incontinence (19–11%), mastitis (15–3%), and other urinary problems (5–3%). No significant changes occurred in the prevalence of frequent headaches or migraines, sexual problems, or depression over the 6 months. Adjusting for method of birth, primiparas were more likely than multiparas to report perineal pain and sexual problems. Compared with unassisted vaginal births, women who had cesarean sections reported more exhaustion, lack of sleep, and bowel problems; reported less perineal pain and urinary incontinence in the first 8 weeks; and were more likely to be readmitted to hospital within 8 weeks of the birth. Women with forceps or vacuum extraction reported more perineal pain and sexual problems than those with unassisted vaginal births after adjusting for parity, perineal trauma, and length of labor.

Conclusions: Health problems commonly occurred after childbirth with some resolution over the 6 months postpartum. Some important differences in prevalence of health problems were evident when parity and method of birth were considered. (BIRTH 29:2 June 2002)
Effect of cagA Status on the Sensitivity of Enzyme Immunoassay in Diagnosing Helicobacter pylori–Infected Children
Authors: Plebani Mario , Guariso Graziella , Fogar Paola , Basso Daniela , Gallo Nicoletta , Zambon Carlo Federico , Mozrzymas Renata , Celadin Marilena , Zacchello Franco
Published: March 2003

Background. The aims of our study were twofold. First, we sought to evaluate in symptomatic children the influence of the Helicobacter pylori genotype on gastritis, abdominal pain, and circulating anti–H. pylori IgG antibodies (anti–H. pylori IgG) or pepsinogen A (PGA) and C (PGC). Additionally, we sought to assess anti–H. pylori IgG, PGA, and PGC patterns in a large cohort (N = 921) of asymptomatic children.

Materials and Methods. In 183 symptomatic children, H. pylori infection and the presence of gastritis were evaluated by histology. In a subgroup of 20 H. pylori–positive children, the H. pylori genotype was evaluated also by polymerase chain reaction. Nine hundred and twenty‐one asymptomatic children, aged 11 to 14 years, were studied by anti–H. pylori IgG, PGA, and PGC serum determination.

Results. The infection was found in 33 of 183 symptomatic children; among the 20 H. pylori–positive children for which the H. pylori genotype was available, cagA was present or absent in equal percentages. H. pylori infection was associated with more severe gastritis and higher serum levels of anti–H. pylori IgG and PGC but not with abdominal pain. In infected children, higher levels of anti–H. pylori IgG and the presence of abdominal pain were associated with infections caused by cagA‐positive strains. In the cohort of 921 asymptomatic children, raised levels of anti–H. pylori IgG, PGA, and PGC were found in approximately 5% of the cases.

Conclusions. Infection with cagA‐positive H. pylori strains can be associated with increased frequency of reported abdominal pain and higher circulating levels of anti–H. pylori IgG. The serological assessment of H. pylori IgG using H. pylori antigens containing significant amounts of cagA protein may, therefore, underestimate the true prevalence of infection.
Host Determinants of Helicobacter pylori Infection and Its Clinical Outcome
Authors: Nguyen Thanh N. , Barkun Alan N. , Fallone Carlo A.
Published: March 2003

Greater than one‐half of the world's population harbors Helicobacter pylori. The majority of infected individuals, however, remain asymptomatic, with only 10% to 20% developing diseases, including peptic ulcer disease, gastric cancer, and gastric mucosa–associated lymphoid tissue lymphoma. This article reviews host factors that may predispose an individual to both the acquisition of H. pylori infection and subsequent clinical outcome. Individuals with specific blood group antigens and human leukocyte antigen genotypes may be more susceptible to H. pylori infection. Additional factors, such as the age of acquisition, the host immune response, the site of infection, acid secretion, and interactions with nonhost factors (including bacterial virulence factors and environmental influences) may play a role in determining clinical outcome. Further investigation is required to clarify the mechanisms by which these interactions occur and, more critically, to determine their relative importance. This knowledge will enable the identification of individuals at risk of developing clinical disease with H. pylori infection.
Helicobacter pyloriVaccine Development and Use: A Cost‐Effectiveness Analysis Using the Institute of Medicine Methodology
Authors: Rupnow Marcia F.T. , Owens Douglas K. , Shachter Ross , Parsonnet Julie
Published: March 2003

Background.Prophylactic vaccination has been suggested as a better strategy than antibiotics to controlHelicobacter pyloriinfection. We evaluated the cost‐effectiveness (CE) ofH. pylorivaccine development and use in the United States and developing countries, using a method developed by the Institute of Medicine (IOM).

Methods.The IOM model includes costs of vaccine development, vaccination program, and averted medical treatments; morbidity and mortality prevented; expected efficacy and use; and proportion of disease that is vaccine‐preventable. The model employs infant mortality equivalence (IME) to estimate disease burden; with IME, the societal cost of infection‐related morbidity is expressed as equivalent to a specific rate of infant deaths. We tested model assumptions by univariate sensitivity analyses.

Results.In the United States,H. pylorivaccine would save 1,176 IME and would cost $58.71 million (1997 dollars) annually, yielding a CE ratio of $49,932 per IME; the health benefits would exceed all IOM‐studied vaccines, even when efficacy dropped to 55%.H. pylorivaccine could be cost‐saving if priced at less than $60 per course. In developing countries,H. pylorivaccine would rank unfavorably both in terms of health benefits (33,518 IME) and costs ($5,254 million). None of the changes in assumptions improved significantly theH. pylorivaccine's ranking relative to other IOM‐studied vaccines.

Conclusions.Compared to other vaccines evaluated in the IOM study,H. pylorivaccine warrants public resource allocation for accelerated development and use in the United States but not for use in developing countries.
Mucosal Production of Antigastric Autoantibodies in Helicobacter pylori Gastritis
Authors: Faller Gerhard , Ruff Silke , Reiche Nicole , Hochberger Jürgen , Hahn Eckhart G. , Kirchner Thomas
Published: March 2003

Background. Apart form bacterial virulence factors of Helicobacter pylori, certain host factors influence the pathogenesis of H. pylori gastritis. In particular, antigastric autoantibodies that are detectable in the sera of a substantial proportion of H. pylori were shown to correlate with the development of gastric atrophy. The aim of this study was to analyze the possible antigastric autoimmune response in H. pylori gastritis at the site where the action is, i.e., in the gastric mucosa.

Material and Methods. Gastric biopsy specimens from antrum and corpus mucosa of 24 H. pylori–infected and of 33 noninfected patients were cultured for 3 days, and tissue culture supernatants were analyzed for the amount of locally produced IgA and IgG. Antigastric autoantibodies were screened in the sera and in the supernatants by means of immunohistochemistry.

Results. The infected patients had significantly higher concentrations of locally produced IgA, whereas the IgG concentrations were virtually the same in infected and noninfected patients. IgG or IgA antigastric autoantibodies, or both, were detectable only in the sera (38%) and supernatants (17%) of infected patients. Interestingly, the patient with the strongest local autoimmune response showed body‐predominant H. pylori gastritis, with destruction of gastric glands and atrophy of the body mucosa.

Conclusions. These results demonstrate that antigastric autoimmune reactions are detectable at the site of the disease and might be relevant for the pathogenesis of gastric mucosa atrophy in H. pylori gastritis.
Helicobacter pylori Infection in Asymptomatic Children: Comparison of Diagnostic Tests
Authors: Malaty Hoda M. , Logan Nancy D. , Graham David Y. , Ramchatesingh Jacqueline E. , Reddy Siddharta G.
Published: March 2003

Background. Childhood is known to be a major risk period for acquiring Helicobacter pylori infection. Studies of the epidemiology of H. pylori infection depend on the validity of the diagnostic tools used to detect the infection in the pediatric setting. This study aims to conduct a combination of diagnostic tests on the same children, evaluate the sensitivity and the specificity of IgG antibody testing compared with the 13C‐urea breath test, and examine the variability in the prevalence of H. pylori infection in asymptomatic children based on the use of different diagnostic tests.

Methods. 13C‐urea breath test (13C‐UBT), whole blood FlexSure (systemic antibodies), and OraSure (salivary antibodies) tests were conducted on 287 asymptomatic children (151 boys, 136 girls; ages 2–18 years). The three tests were conducted on each child during the same day. The prevalence was calculated using each test independently.

Results. H. pylori infection was detected in 32%, 22%, or 18% of the studied children, based on UBT, OraSure, or FlexSure, respectively. A total of 103 children tested positive for any one test (92 on UBT, 8 on FlexSure, 3 on OraSure), giving a prevalence of 35% based on the “parallel” method. Only 39 children tested positive in all three tests, giving a prevalence of 14% based on the “serial” method. Using the UBT as the gold standard, the sensitivity of FlexSure and OraSure were 48% and 65%, respectively, and the specificity of both tests was greater than 95%. When we applied the parallel method, the sensitivity and specificity of the combined antibody tests (FlexSure+OraSure) compared to the UBT were 71% and 95%, respectively.

Conclusions. Among asymptomatic children, there is a wide variation in the prevalence of H. pylori infection based on the diagnostic test used. The study shows that antibody assays are less suitable than the UBT. However, under certain conditions, the IgG assays (combined systemic, salivary, or both) are less expensive alternative tools to the UBT for epidemiological studies in children.
p53 Expression in the Gastric Mucosa Before and After Eradication of Helicobacter pylori
Authors: Satoh Kiichi , Kihira Ken , Kawata Hiroshi , Tokumaru Kenkichi , Kumakura Yasuhisa , Ishino Yumiko , Kawakami Satoshi , Inoue Keiko , Kojima Toshichika , Satoh Yukihiro , Mutoh Hiroyuki , Sugano Kentaro
Published: March 2003

Background.

Accumulation of p53 has been recognized in the gastric mucosa infected with Helicobacter pylori. We investigated the prevalence of p53‐positive cells in the gastric mucosa before and one month after eradication of H. pylori and the relationship between p53 positivity and inflammation and cell proliferation.

Methods.

The subjects included 24 H. pylori‐positive patients. They achieved eradication one month after anti‐H. pylori therapy. Biopsies were taken from the greater curvatures of the antrum and middle body. H. pylori status was assessed using culture and tissue section (Giemsa stain). Serial sections were used for examination of gastritis (hematoxylin and eosin stain) and for immunostaining of p53, Ki‐67 and myeloperoxidase (MPO). p53 index and Ki‐67 labeling index (LI) were calculated by counting p53‐positive and Ki‐67‐positive cells in the entire gastric pits longitudinally sectioned and expressing them as a percentage of the total cells in a gastric pit. In the neck regions with and without p53‐positive cells, polymorphonuclear leukocytes (PMNs) were counted in the corresponding area (/50 × 50 µm2) of the sections stained both with p53 and MPO.

Results.

p53‐positive cells decreased significantly after eradication of H. pylori. Before eradication, the number of PMNs was significantly higher in the neck regions with p53‐positive cells than in those without.

Conclusions.

In the gastric mucosa infected with H. pylori, p53‐positive cells were found in the neck region infiltrated with PMNs. p53 expression decreased significantly one month after eradication of H. pylori.
Probing 23S Ribosomal RNA Cleavage Sites in Coccoid Helicobacter pylori
Authors: Monstein Hans‐Jürg , De La Cour Charlotta D. , Jonasson Jon
Published: March 2003

Background.

Previous studies have revealed that extensive nonrandom fragmentation of ribosomal RNA occurs during conversion of Helicobacter pylori to the coccoid form. The 16S rRNA fragmentation has been characterised in some detail. The aim of the present study was to define corresponding cleavage‐sites in the 3′‐half of the 23S rRNA molecule.

Materials and Methods.

Northern blot analysis using 23S rRNA specific antisense riboprobes and a 5′‐end‐labelled oligonucleotide probe was used to analyse the 23S rRNA fragmentation pattern in coccoid H. pylori type strain CCUG 17874T and H. pylori 26695, for which the genome has been sequenced. A double‐stranded cDNA‐dependent (ds‐cDNA) primer‐extension analysis technique using 23S rRNA ds‐cDNA and a primer targeting the vicinity of the peptidyl‐transferase centre was used to determine cleavage sites at the nucleotide level.

Results.

We report here the mapping of putative cleavage sites within domains IV and V, enclosing the peptidyl transferase centre, in the 3′‐half of the 23S rRNA molecule. Three cleavage sites were located in domain IV. Two other cleavage sites were located in the peptidyl transferase centre, and one presumptive multiple‐break site between helices 77 and 78 in domain V. The DNA motifs were different from the postulated A + U rich single‐strand cleavage sites recognised by RNase E, which has been implicated in rRNA degradation in Escherichia coli.

Conclusions.

The present analysis suggests that a hitherto unknown mechanism is responsible for the nonrandom fragmentation of rRNA in coccoid H. pylori, which may have important consequences for the growth, and survival of the bacterium.