bluuebunny/crossref_metadata_2025_split huggingface dataset:
Instrumental vaginal deliveries; are midwives safer practitioners? A retrospective cohort study
Authors: Black Mairead , Mitchell Elaine , Danielian Peter 
Published: October 2013

AbstractObjectiveTo compare obstetric morbidity of midwife‐performed instrumental vaginal deliveries with those performed by doctors.DesignRetrospective cohort study.SettingUniversity Hospital, UK.PopulationWomen undergoing an instrumental vaginal delivery of a singleton infant outside of the operating theater in Aberdeen Maternity Hospital, between June 2005 and June 2010.MethodsProspectively entered data were obtained from the hospital data management system. Obstetric outcomes of deliveries by midwives were compared with those performed by any doctor and, in a secondary analysis, with those by junior doctors (fewer than two years at ‘registrar’ level). Sociodemographic characteristics and clinical outcomes were compared using the chi‐squared test, Mann–Whitney U‐test and independent sample t‐test.Main outcome measuresThird‐ or fourth‐degree tears.ResultsAmong 2540 women identified, 330 (13%) were delivered by midwives. Maternal and clinical characteristics were comparable in each group. Midwives were more likely to use ventouse as their instrument of choice. Women delivered by midwives were less likely to suffer a third‐ or fourth‐degree tears than those delivered by doctors and junior doctors. This difference did not reach statistical significance once adjusted for instrument used: odds ratio 0.6 (95% confidence interval: 0.3–1.2) and odds ratio 0.6 (95% confidence interval: 0.3–1.1), respectively.ConclusionsInstrumental vaginal deliveries performed by trained midwives are associated with equivalent maternal morbidity to those performed by doctors once adjusted for midwives' preference for the ventouse. This study highlights the potential contribution of an advanced role for midwives in the labor ward.
Causes of stillbirth at different gestational ages in singleton pregnancies
Authors: Stormdal Bring Hanna , Hulthén Varli Ingela A. , Kublickas Marius , Papadogiannakis Nikos , Pettersson Karin 
Published: October 2013

AbstractObjectiveTo compare causes of stillbirth in preterm and term pregnancies.DesignCohort study.SettingAll delivery wards in Stockholm, 1998–2009.PopulationStillbirths from singleton pregnancies of gestational age ≥22+0 (n = 1089) extracted from a web‐based database including all stillbirths in the major Stockholm area since 1998.MethodsThe parents of the stillborns were all offered an extensive standardized investigation. The causes of death were assigned in a perinatal audit using the Stockholm classification of stillbirth. Singleton stillbirths were divided into preterm (gestational week 22+0–36+6) and term/post‐term (gestational week ≥37+0). The term/post‐term group was subdivided into term (gestational week 37+0–40+6) and post‐term stillbirths (gestational week ≥41+0).Main outcome measureCauses of stillbirth at different gestational ages.ResultsA higher proportion of placental abruption and preeclampsia/hypertension was seen in preterm stillbirths compared with term/post‐term stillbirths, which instead had a higher proportion of umbilical cord complications and infection. Infection was more common in post‐term than term stillbirths (46.5 vs. 19.8%, p < 0.001).ConclusionIncreased knowledge of causes of stillbirth in different gestational ages may be valuable in developing strategies for prevention of fetal death. The high proportion of infection in post‐term stillbirths could be clinically important and warrants further studies.
Prevalence of intimate partner violence among women seeking termination of pregnancy compared to women seeking contraceptive counseling
Authors: Öberg Mariella , Stenson Kristina , Skalkidou Alkistis , Heimer Gun 
Published: October 2013

AbstractObjectiveTo estimate the prevalence of intimate partner violence (IPV) among women seeking termination of pregnancy (TOP) in comparison to women seeking contraceptive counseling.DesignCase–control study.SettingFamily planning unit, Uppsala University Hospital.PopulationWomen seeking TOP (n = 635) and women seeking contraceptive counseling (n = 591) answered a self‐administered questionnaire regarding experience of IPV. In addition, the women were interviewed by specially trained staff.MethodComparisons were made between the two groups and between those who had previously undergone TOP and those who had never done so with experience of IPV as the main outcome measure. Multivariate logistic regression was used to adjust for age, education and occupation.ResultsIn total, 29% of women seeking TOP and 22% of women seeking contraceptive counseling reported experience of violence. Women seeking TOP were more likely to report physical violence [adjusted odds ratio (aOR) = 1.6, 95% confidence interval (CI) 1.2–2.1] and experience of violence during the past year (aOR = 2.3, 95% Cl 1.1–4.8). Women who had ever undergone TOP were also more likely to report IPV compared with women with no history of TOP (aOR = 1.7, 95% CI 1.3–2.3). Among women with repeated TOP, 51% reported experience of IPV.ConclusionWomen seeking TOP reported to a greater extent experience of IPV. However, women seeking contraceptive counseling also had a high prevalence of violent experiences. These results stress the importance of caregivers approaching both groups of women with questions about IPV to identify exposed women and offer them help.
Optic nerve hypoplasia in children and adolescents; prevalence, ocular characteristics and behavioural problems
Authors: Teär Fahnehjelm Kristina , Dahl Sara , Martin Lene , Ek Ulla 
Published: October 2013

AbstractPurposeTo report prevalence, ocular characteristics and coexisting behavioural problems in children and adolescents with optic nerve hypoplasia (ONH), which is a common cause of visual impairment in children in western countries, often associated with neurological or endocrinological problems and where autism has been reported in severe cases with blindness.MethodsThis is a population‐based cross‐sectional study of patients <20 years of age who had been diagnosed with ONH and lived in the county of Stockholm in December 2009. Ophthalmological assessments including fundus photographs with optic disc analyses were made. A questionnaire was used to screen for behaviour and development.ResultsThe prevalence of ONH in all living children <18 years of age in Stockholm was 17.3/100 000 with a prevalence of visual impairment (<0.3) of 3.9/100 000. In total, 66 patients, median age 9.3 years (0.6–19.4), 36 with bilateral and 30 with unilateral ONH, were included in the current study; 53 were re‐examined clinically, group A, and 13 agreed to retrospective analyses of existing medical records, group B. Analyses of the optic discs were made in fundus photographs from 53 patients comparing a semi‐automated (Retinal Size Tool) and a manual method (Zeki). There was a strong curvilinear correlation (rS = −0.91 p < 0.0001 for both eyes). Behavioural problems were more common (p < 0.05) in bilateral ONH.ConclusionOptic nerve hypoplasia is a common ocular malformation with a prevalence of 17.3/100 000 children and adolescents <18 years of age in Stockholm. Unilateral ONH seems as common as bilateral.
Premature infants with birth weights of 1500–1999 g exhibit considerable delays in several developmental areas
Authors: Guerra Camila C , de Moraes Barros Marina C , Goulart Ana Lucia , Fernandes Luciana V , Kopelman Benjamin I , dos Santos Amélia MN 
Published: October 2013

AbstractAimTo establish the prevalence and factors associated with developmental scores and delays in premature infants.MethodsA cross‐sectional study was conducted on 100 premature infants with corrected ages of 18–24 months (actual ages 19.9 ± 2.0 months) and birth weights of 1500–1999 g. Bayley III scales were used to assess developmental scores, percentage of children with developmental scores <85, factors associated with developmental scores and delays in at least one developmental domain.ResultsThe percentages and 95% confidence intervals of those children with developmental delays were as follows: cognitive (2.0%; 0.6–7.0%), language (5.0%; 2.2–11.2%), motor (3.0%; 1.0–8.5%), socio‐emotional (13.0%; 7.8–20.1%), general adaptive (26.0%; 18.4–35.4%), conceptual (17.0%; 10.9–25.6%), social (46.0%; 36.6–55.7%) and practical (21.0%; 14.2–30.0%). Factors associated with delay in at least one developmental domain were as follows: caesarean delivery, low per capita income and peri‐intraventricular haemorrhage. Factors associated with a reduction in developmental scores were as follows: non‐white ethnicity, lower social class, caesarean delivery, male gender, peri‐intraventricular haemorrhage, mechanical ventilation and length of hospitalisation.ConclusionPremature infants with birth weights of 1500–1999 g exhibited considerable delays in several developmental areas. In addition to biological factors, environmental factors contributed to the reduced scores and/or developmental delays.
Motivational interviewing improves exclusive breastfeeding in an Australian randomised controlled trial
Authors: Elliott‐Rudder M , Pilotto L , McIntyre E , Ramanathan S 
Published: October 2013

AbstractAimTo increase maintenance of breastfeeding through improved primary care support.MethodA cluster randomised controlled trial recruited 15 rural family doctor's offices and 330 women who were currently breastfeeding took part. Eight practices formed the intervention group (154 women) and seven formed the control group (176 women). The practice nurses who provided the intervention used a specially designed motivational flowchart to speak to the mothers when they brought their child for immunisation at 2, 4 and 6 months. The nurses also attended preparatory workshops on breastfeeding management, counselling skills, motivational interviewing and reflective practice and were given resources and support. Breastfeeding rates were measured at 4 and 6 months.ResultsRandomisation equally distributed all measured variables except prenatal intentions to rejoin employment within 12 months (70% intervention, 56% control, p < 0.05). After adjustment, the 4‐month figures showed significantly higher rates of exclusive breastfeeding (OR 1.88; 95%CI 1.01–3.50; p = 0.047) and full breastfeeding (water/juice allowed) (OR 1.95; 95%CI 1.03–3.69; p = 0.04) in the intervention group. There were no differences at 6 months.ConclusionA motivational interviewing intervention by primary care health professionals who have undertaken a replicable training programme is feasible and effective in increasing exclusive breastfeeding and full/predominant breastfeeding at 4 months.
Children with multiple viral respiratory infections are older than those with single viruses
Authors: Rotzén‐Östlund Maria , Eriksson Margareta , Tiveljung Lindell Annika , Allander Tobias , Zweygberg Wirgart Benita , Grillner Lena 
Published: October 2013

AbstractAimTo study the clinical impact of multiple viral respiratory infections compared to single infections.MethodsDemographic data from 37 multiple infection periods in children <5 years of age were compared to data from 193 episodes with single infections. Clinical data derived from patient records of the multiple infection episodes were further compared to data from 93 matched control episodes with single infections.ResultsThe mean age of patients with multiple viral findings was 12.7 months, compared to 5.7 months for those with single findings (p < 0.01). Wheezing was the most common diagnosis in both groups, except among children who were only infected with the coronavirus. No differences were found regarding duration of hospitalisation, oxygen treatment or admittance to the intensive care unit.ConclusionChildren with multiple viral findings in their respiratory secretions were older than those with a single detected virus. Otherwise, no major differences in comorbidity, presentation or clinical outcome were observed between the two groups.
Lack of sleep could increase obesity in children and too much television could be partly to blame
Authors: Magee Christopher , Caputi Peter , Iverson Don 
Published: October 2013

AbstractAimTo examine the bidirectional relationship between short sleep duration and body mass index (BMI). A secondary aim was to investigate whether reduced physical activity and increased screen time (television and computer use) mediated these associations.MethodsThis study utilised data from the Longitudinal Study of Australian Children, which is an observational cohort study of Australian children. The sample included 2984 (52.4% boys) children followed from 4 to 5 years of age until 8 to 9 years of age. Sleep duration, screen time and covariates were reported by parents, with BMI measured objectively. Cross‐lagged modelling investigated the bidirectional association between sleep duration and BMI; lagged panel mediation modelling examined physical activity and screen time as potential mediators.ResultsShort sleep duration at 4 to 5 years of age was significantly associated with higher BMI at 8 to 9 years of age (β= −.07, p = .044). The relationship between short sleep duration at 4 to 5 years of age and higher BMI at 8 to 9 years of age was partially mediated by increased television viewing at 6 to 7 years of age (β = −.01, 95% confidence interval [−.02, −.002]).ConclusionShort sleep duration could be a risk factor for obesity in children. Increased television viewing may be one mechanism underlying this longitudinal relationship.
The triply troubled teenager – chronic conditions associated with fewer protective factors and clustered risk behaviours
Authors: Nylander Charlotte , Seidel Carina , Tindberg Ylva 
Published: October 2013

AbstractAimThis study aimed to measure protective factors and risk behaviour among adolescents with chronic conditions (CCs) and to evaluate the impact of protective factors on risk‐taking.MethodsA population‐based study of 7262 students aged 15 and 17 years old was performed in Sörmland, Sweden 2008 (response rate 82%). The questionnaire explored background factors, CCs, risk behaviours and protective factors. CCs were reported by 8%, while 58% had no health problems.ResultsGirls with CCs encompassed less individual protective factors, while boys with CCs tended to over‐report all individual risk behaviours compared with healthy peers. Both boys and girls with CCs were more likely to report few protective factors and co‐occurrence of risk behaviours. The adjOR for clustered health risk behaviours was 1.6 (1.0–2.5) in youths with CCs and ≥4 protective factors and 6.3 (3.6–10.9) in youths with CCs and 0–3 protective factors, as compared to healthy peers with ≥4 protective factors.ConclusionAdolescents with CCs reported fewer protective factors and more risk behaviours than their healthy peers. The vulnerability of adolescents with CCs and few protective factors is important to acknowledge. Professionals should provide stronger protection for these adolescents, to prevent risky behaviour.
Acute molecular responses in untrained and trained muscle subjected to aerobic and resistance exercise training versus resistance training alone
Authors: Fernandez‐Gonzalo R. , Lundberg T. R. , Tesch P. A. 
Published: October 2013

AbstractAimThis study assessed and compared acute muscle molecular responses before and after 5‐week training, employing either aerobic (AE) and resistance exercise (RE) or RE only.MethodsTen men performed one‐legged RE, while the contralateral limb performed AE followed by RE 6 h later (AE+RE). Before (untrained) and after (trained) the intervention, acute bouts of RE were performed with or without preceding AE. Biopsies were obtained from m. vastus lateralis of each leg pre‐ and 3 h post‐RE to determine mRNA levels of VEGF, PGC‐1α, MuRF‐1, atrogin‐1, myostatin and phosphorylation of mTOR, p70S6K, rpS6 and eEF2.ResultsPGC‐1α and VEGF expression increased (P < 0.05) after acute RE in the untrained, but not the trained state. These markers showed greater response after AE+RE than RE in either condition. Myostatin was lower after AE+RE than RE, both before and after training. AE+RE showed higher MuRF‐1 and atrogin‐1 expression than RE in the untrained, not the trained state. Exercise increased (P < 0.05) p70S6K phosphorylation both before and after training, yet this increase tended to be more prominent for AE+RE than RE before training. Phosphorylation of p70S6K was greater in trained muscle. Changes in these markers did not correlate with exercise‐induced alterations in strength or muscle size.ConclusionConcurrent exercise in untrained skeletal muscle prompts global molecular responses consistent with resulting whole muscle adaptations. Yet, training blunts the more robust anabolic response shown after AE+RE compared with RE. This study challenges the concept that single molecular markers could predict training‐induced changes in muscle size or strength.
Review article: immunogenicity of anti‐TNF biologics in IBD – the role of patient, product and prescriber factors
Authors: Moss A. C. , Brinks V. , Carpenter J. F. 
Published: October 2013

SummaryBackgroundAnti‐drug antibodies (ADAs) to biologic therapies contribute to the loss of response and infusion reactions to anti‐TNF drugs in patients with inflammatory bowel disease (IBD). The reasons behind this immunogenicity are complex, and have not been the focus of a dedicated review for prescribers.AimTo provide an overview of the patient, product and prescriber factors, which have been associated with the immunogenicity of anti‐TNF therapy, and draw conclusions for clinical practice.MethodsReview of representative observational studies and clinical trials from the IBD and other literature, which report associations with ADA development, with a focus on infliximab and adalimumab.ResultsADAs develop in 10–20% of patients receiving anti‐TNF maintenance therapy, and these patients are three times more likely to lose response as ADA‐negative patients. Patient genotype plays a role in ADA risk in a minority of patients, but age or disease type is not a major factor. Drug mishandling, such as agitation or freeze–thaw cycles, can induce protein aggregates, which are known to be immunogenic. Prescription of maintenance therapy with concomitant immunomodulators, and achieving suitable trough drug levels, reduces the risk of ADAs in patients with IBD.ConclusionsPatients and prescribers can take several steps to reduce the risk of development of anti‐drug antibodies to anti‐TNF antibodies. Further research is required to determine if immunogenic factors identified in other situations apply to use of anti‐TNFs in IBD.
Optimising delivery of care in coeliac disease – comparison of the benefits of repeat biopsy and serological follow‐up
Authors: Sharkey L. M. , Corbett G. , Currie E. , Lee J. , Sweeney N. , Woodward J. M. 
Published: October 2013

SummaryBackgroundThe majority of deleterious health consequences of coeliac disease (CD) are most likely to be secondary to intestinal inflammation; hence, mucosal recovery is a desirable goal of therapy. Follow‐up in CD is controversial and serological response is often used as a surrogate for histological recovery.AimsTo inform the clinical management of CD using comparative serological and histological data from a biopsy‐driven pathway of care.MethodsA retrospective analysis of the Cambridge Coeliac Clinic database of 595 patients routinely followed up by biopsy and serology.ResultsPaired biopsy results were available for 391 patients (15% seronegative). Persisting villous atrophy (VA) occurred in 182 patients (47%). The sensitivity of anti‐tissue transglutaminase (TTG) antibody for ongoing VA was only 43.6%. Information on dietetic management and further biopsy to assess response was available for 94 initially unresponsive patients, in whom targeted dietetic intervention by removal of identified gluten sources or avoidance of trace amounts of gluten led to resolution of persistent VA in 50%. The effects of institution of a formal care pathway are analysed in 298 patients. Discharge to primary care and clinical management was facilitated by the information derived from repeat biopsy.ConclusionsSerology appears to be a poor surrogate marker for mucosal recovery on a gluten‐free diet; dietary assessment fails to identify a potential gluten source in many patients with ongoing villous atrophy. The benefits of re‐biopsy on diet include stratification of patients with coeliac disease suitable for early discharge from secondary care or those requiring more intensive clinical management.
Randomised controlled trial: sequential vs. standard triple therapy for Helicobacter pylori infection in Chinese children–a multicentre, open‐labelled study
Authors: Huang J. , Zhou L. , Geng L. , Yang M. , Xu X.‐W. , Ding Z.‐L. , Mao M. , Wang Z.‐L. , Li Z.‐L. , Li D.‐Y. , Gong S.‐T. 
Published: October 2013

SummaryBackgroundStudies have showed that 10‐day sequential treatment regimen achieved higher Helicobacter pylori eradication rate than standard triple therapies.AimTo compare a 10‐day sequential therapy and standard triple therapy in Chinese children with H. pylori infection.MethodsA prospective, multicentre, open‐label, randomised controlled trial was conducted in four tertiary medical centres in China. Children with H. pylori gastritis were randomly assigned to a 10‐day sequential therapy consisting of omeprazole and amoxicillin for 5 days followed by omeprazole, clarithromycin and metronidazole for the remaining 5 days, or 7‐day or 10‐day standard triple therapy comprising of omeprazole, amoxicillin and clarithromycin. H. pylori eradication was assessed by H. pylori stool antigen test.ResultsA total of 360 patients were included. The eradication rate achieved with the 10‐day sequential therapy was significantly higher than either the 7‐day or 10‐day standard triple treatment, either by the intention‐to‐treat analysis (81.4% vs. 61.9% or 67.7%, P < 0.05) or per‐protocol analysis (89.7% vs. 70.8% or 77.8%, P < 0.05).ConclusionsThe 10‐day sequential regimen was significantly more effective than standard 7‐day or 10‐day triple regimens in eradicating H. pylori infection in Chinese children.