bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of the Hypertonia Assessment Tool (HAT): a discriminative tool for hypertonia in children
Authors: JETHWA ANITA , MINK JONATHAN , MACARTHUR COLIN , KNIGHTS SHANNON , FEHLINGS TARA , FEHLINGS DARCY 
Published: October 2009

Aim  The aim of this study was to develop a tool to identify paediatric hypertonia subtypes.Method  Items generated by experts were subscaled (spasticity, dystonia, rigidity). The tool was administered to 34 children (19 males, 15 females, mean age 8y 2mo, range 2y 5mo–18y 7mo) with hypertonia and cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels: I, n=7; II, n=5; III, n=7 level IV, n=7; and level V, n=8 level. Kuder–Richardson Formula 20 determined internal consistency. To assess reliability, two physicians administered the tool to 25 additional children with CP (15 males, 10 females; mean age 10y 8mo; GMFCS levels I, n=4; II, n=3; III, n=7; IV, n=4; and V, n=7) on two occasions, 2 weeks apart. To evaluate validity, a third physician diagnosed the hypertonia by neurological examination.Results  The internal consistency of the spasticity items was moderate (α=0.58), and dystonia was high (α=0.79). Item reduction eliminated seven of the 14 original items. The agreement of the spasticity and rigidity subscales was adequate (prevalence‐adjusted bias‐adjusted kappa [PABAK] ranging from moderate [0.57] to excellent [1.0]) for validity, test–retest reliability, and interrater reliability. For dystonia agreement was lower, with PABAK ranging from fair (0.30) to good (0.65). Eighty‐seven per cent had spasticity and 78% had dystonia.Interpretation  The Hypertonia Assessment Tool has good reliability and validity for identifying spasticity and the absence of rigidity, and moderate findings for dystonia.
Relationship between neuromuscular body functions and upper extremity activity in children with cerebral palsy
Authors: BRÆNDVIK SIRI M , ELVRUM ANN‐KRISTIN G , VEREIJKEN BEATRIX , ROELEVELD KARIN 
Published: October 2009

Aim  Our aim was to investigate the relationship between the dimensions of neuromuscular body function and elbow, forearm, and hand activity in the upper extremities in children/adolescents with spastic cerebral palsy (CP), within the framework of the World Health Organization International Classification of Functioning, Disability and Health.Method  Twenty‐three participants (10 males, 13 females, mean age 13y, SD 3y, range 8–18y) with spastic CP (21 with hemiplegia, two with diplegia) at Manual Ability Classification System levels I to III participated in the study. Neuromuscular body function measures were (1) muscle strength in the elbow, forearm, and grip, (2) muscle tone in elbow flexors and forearm supinators, (3) active supination range and elbow extension range, and (4) force control at submaximal level in elbow flexion. Activity measures were actual use of the affected hand in bimanual activities (Assisting Hand Assessment) and instructed use of the affected hand (Melbourne Assessment of Unilateral Upper Limb Function).Results  Nearly all the neuromuscular body function variables were significantly correlated with activity. The combination of active supination range and strength explained 74% of the variance in actual use, and the combination of active supination range and force control explained 74% of the variance in instructed use.Interpretation  In high‐functioning children and adolescents with CP, limited active supination range and difficulties in generating and modulating force are strongly related to limitations in hand activity. Further studies are needed to establish cause and effect in this relationship.
Mode of delivery and the risk of delivery‐related perinatal death among twins at term: a retrospective cohort study of 8073 births
Authors: Smith Gordon C.S. , Shah Imran , White Ian R. , Pell Jill P. , Dobbie Richard 
Published: October 2009

Objective  To determine the risk of perinatal death among twins born at term in relation to mode of delivery.Design  Retrospective cohort study.Setting  Scotland 1985–2001.Population  All twin births at or after 36 weeks of gestation, excluding antepartum stillbirths and perinatal deaths due to congenital abnormality (n= 8073).Methods  The outcome of first and second twins was compared using McNemar's test and the outcome of twin pairs in relation to mode of delivery was compared using exact logistic regression.Main outcome measures  Intrapartum stillbirth or neonatal death of either twin.Results  Overall, there were six deaths of first twins and 30 deaths of second twins (OR for second twin 5.00, 95% CI 2.00–14.70). The odds ratio for death of the second twin due to intrapartum anoxia was 21 (95% CI 3.4–868.5). The associations were similar for twins delivered following induction of labour and for sex discordant twins. However, there was no association between birth order and the risk of death among 1472 deliveries by planned caesarean section. There was death of either twin among 2 of 1472 (0.14%) deliveries by planned caesarean section and 34 of 6601 (0.52%) deliveries by other means (P= 0.05, odds ratio for planned caesarean section 0.26 [95% CI 0.03–1.03]). The association was similar when adjusted for potential confounders. Assuming causality, we estimate that 264 caesarean deliveries (95% CI 158–808) would be required to prevent each death.Conclusion  Planned caesarean section may reduce the risk of perinatal death of twins at term by approximately 75% compared with attempting vaginal birth. This is principally due to reducing the risk of death of the second twin due to intrapartum anoxia.
A randomised double blind trial comparing misoprostol or placebo in the management of early miscarriage
Authors: Blohm F. , Fridén B.E. , Milsom I. , Platz‐Christensen J.J. , Nielsen S. 
Published: October 2009

Objectives  To study if misoprostol 400 μg, administered vaginally, increased the successful resolution of early miscarriage compared with placebo.Design  Randomised, double blind placebo controlled study.Setting  Sahlgrenska University Hospital, Göteborg, Sweden.Sample  One hundred and twenty‐six women seeking medical attention for early miscarriage.Method  Women with a non‐viable, first trimester miscarriage were randomised to vaginal administration of misoprostol 400 μg or placebo.Main outcome measures  Main outcome measure was the proportion of successful complete resolution of miscarriage. Secondary outcomes were incidence of infection, bleeding, gastrointestinal side effects, pain, use of analgesics and length of sick leave between groups.Results  Sixty‐four patients were randomised to misoprostol and 62 to placebo. Eighty‐one percent in the misoprostol and 52% in the placebo group had a complete miscarriage within one week of the primary visit (RR 1.57; 95% CI 1.20–2.06). Patients in the misoprostol group reported more pain as assessed on a visual analogue scale (60.4 [31.0] vs 43.8 [37.1] mm; P < 0.007) and required analgesics more often (83%vs 61%, RR 1.35; 95% CI 1.08–1.70). There were no significant differences in the occurrence of gastrointestinal side effects, infection, reduction in haemoglobin or sick leave between the groups.Conclusions  Treatment with 400 μg misoprostol administered vaginally increased the success rate of resolvement of uncomplicated early miscarriages compared with placebo. However, women who received misoprostol experienced more pain and required more analgesics than those who did not.
Modulation of cytokine production by dydrogesterone in lymphocytes from women with recurrent miscarriage
Authors: Raghupathy Raj , Al Mutawa Esraa , Makhseed Ma'asoumah , Azizieh Fawaz , Szekeres‐Bartho Julia 
Published: October 2009

Objective  To examine the effects of dydrogesterone on the production of Th1 and Th2 cytokines by lymphocytes from women undergoing unexplained recurrent spontaneous miscarriage (RSM).Design  Controlled prospective, clinical study conducted in a maternity hospital and a university‐based immunology laboratory.Setting  Faculty of Medicine, Kuwait University and Kuwait Maternity Hospital.Sample  Thirty women with unexplained RSM.Methods  Peripheral blood mononuclear cells (PBMC) from women with unexplained RSM were isolated from venous blood by density gradient sedimentation and stimulated with phytohaemagglutinin (PHA). Culture supernatants assayed for interferon (IFN)‐γ, tumour necrosis factor (TNF)‐α, interleukin (IL)‐4, IL‐6 and IL‐10 by ELISA. Levels of the progesterone‐induced blocking factor (PIBF) were also measured.Main outcome measures  Cytokine production in the presence and absence of progesterone and dydrogesterone.Results  Dydrogesterone significantly inhibited the production of the Th1 cytokines IFN‐γ (P= 0.0001) and TNF‐α (P= 0.005) and induced an increase in the levels of the Th2 cytokines IL‐4 (P= 0.03) and IL‐6 (P= 0.017) resulting in a substantial shift in the ratio of Th1/Th2 cytokines. The effect of dydrogesterone was blocked by the addition of the progesterone‐receptor antagonist mifepristone, indicating that dydrogesterone was acting via the progesterone receptor. Dydrogesterone induced the production of PIBF.Conclusion  Dydrogesterone inhibits the production of the Th1 cytokines IFN‐γ and TNF‐α from lymphocytes and up‐regulates the production of the Th2 cytokines IL‐4 and IL‐6, inducing a Th1 to Th2 cytokine shift.
Obstetric management of a woman's first delivery and the implications for pelvic floor surgery in later life
Authors: Uma Ramalingam , Libby Gillian , Murphy Deirdre J. 
Published: October 2009

Objective  To determine the influence of intrapartum care during a first delivery on the risk of pelvic floor surgery in later life.Design  Nested case–control study with record linkage of a historical cohort and a current morbidity database.Setting  Hospital births in Dundee 1952–1966.Population  The 7556 primiparous women from the Walker cohort.Methods  The cases (n= 352) were women who delivered a first singleton baby at term (≥37 weeks) and subsequently had pelvic floor surgery. Controls (n= 1403) were women who delivered their first baby during the same time period and did not undergo surgery. Univariate and multivariate logistic regression analyses were performed taking account of demographic, anthropometric and obstetric factors.Main outcome measure  Pelvic floor surgery.Results  Caesarean section was associated with a reduced risk of pelvic floor surgery compared with spontaneous vaginal delivery (odds ratio 0.16, 95% CI 0.05–0.55). Forceps delivery and infant birthweight >4.0 kg were not identified as significant risk factors (OR 0.94, 95% CI 0.71, 1.25, and OR 0.94, 95% CI 0.50, 1.75, respectively). Episiotomy and prolonged labour (>12 hours) may be associated risk factors but were of borderline significance (OR 1.46, 95% CI 0.99, 2.10, and OR 1.51, 95% CI 1.00, 2.27).Conclusion  Caesarean section in a first pregnancy appears to protect against pelvic floor surgery in later life.
Breastfeeding expectations versus reality: a clusterrandomised controlled trial
Authors: Lavender Tina , Baker Lisa , Smyth Rebecca , Collins Stuart , Spofforth Anne , Dey Paola 
Published: October 2009

Objective  To evaluate the affect of an antenatal educational breastfeeding intervention on women's breastfeeding duration.Design  Cluster randomised controlled trial. Unit of randomisation: electoral ward. The primary outcome was the proportion that fulfilled their antenatal breastfeeding expectation. Secondary outcomes were the number of women breastfeeding on discharge and at four months. Data were collected using a series of questionnaires and diaries.Setting  Teaching hospital in North West of England.Participants  Women who expressed a desire to breastfeed at the start of their pregnancy.Methods  Women were allocated to either routine antenatal education or an additional single educational group session supervised by a lactation specialist and attended by midwives from their locality.Main outcome measure  The proportion of women who fulfilled their expectation of breastfeeding.Result  One thousand three hundred and twelve women were randomised, with 1249 (95%) women available for analysis. There was no difference between the groups in the proportion of women who attained their expected duration of breastfeeding (OR 1.2; 95% CI 0.89–1.6; χ2= 1.4, df= 1, P= 0.2; mean cluster size 156, design effect 1.6). There were no differences between the groups in the uptake of breastfeeding on discharge (OR = 1.2; 95% CI 0.8–1.7; χ2= 1.1, df= 1, P= 0.3; mean cluster size 163, design effect = 2.0) or exclusively at four months (OR = 1.1; 95% CI 0.6–1.8; χ2= 0.07, df= 1, P= 0.8; mean cluster size 156, design effect 1.6).Conclusion  The provision of a single educational group session supervised by a lactation specialist, and attended by midwives and women, failed to promote the uptake of breastfeeding. Public health interventions, which encourage positive attitudes to breastfeeding within the family and wider community, should be developed and evaluated.
Primary mode of delivery and subsequent pregnancy
Authors: Mollison J. , Porter M. , Campbell D. , Bhattacharya S. 
Published: October 2009

Objective  To investigate the relationship between primary mode of delivery and subsequent pregnancy and to compare the findings with a previous study conducted on an earlier cohort from the same population.Design  Population cohort.Setting  Aberdeen City, Scotland.Population  Women who delivered their first singleton child in Aberdeen Maternity Hospital between 1980 and 1997.Methods  Population‐based data relating to the index and next pregnancy event, if any, were obtained from the Aberdeen Maternity Neonatal Databank. Subsequent pregnancy was compared across the three modes of delivery groups using log rank tests and Cox proportional hazards regression models.Main outcome measure  First subsequent pregnancy following index delivery.Results  Women who delivered by caesarean section (CS) were less likely to have a subsequent pregnancy compared with those who had a spontaneous vaginal delivery (SVD), hazard ratio = 0.91 (95% CI 0.87, 0.95). This confirmed the findings of a previous study conducted on an earlier cohort of the same population. The median time to next pregnancy following CS was 36.3 months, 31.8 months following instrumental vaginal delivery (IVD) and 30.4 months following SVD. In contrast to the earlier study where women who had an instrumental delivery were found to be an intermediate group, we found no difference in subsequent pregnancy following IVD compared with SVD, HR = 1.0 (95% CI 0.96, 1.03).Conclusions  Following an initial delivery by CS, fewer women went on to have another pregnancy compared with SVD. The incidence of subsequent pregnancy is similar following instrumental and SVD.
Domestic violence risk during and after pregnancy: findings from a British longitudinal study
Authors: Bowen Erica , Heron Jon , Waylen Andrea , Wolke Dieter ,   and the ALSPAC study team
Published: October 2009

Objective  The objectives of this study were to examine the rates of domestic violence reported during and after pregnancy and to assess the importance of family adversity.Design  Prospective longitudinal cohort study.Setting  Bristol Avon, Southwest England.Population  Seven thousand five hundred and ninety‐one pregnant women with due dates between 1.4.91 and 31.12.92.Methods  Questionnaires administered at 18 weeks of gestation and 8 weeks, 8 months, 21 months and 33 months postpartum.Main outcome measures  The experience of emotional or physical cruelty by an intimate partner at each time point.Results  Fewer women reported domestic violence victimisation during pregnancy than they did postpartum (18 weeks of gestation: 1% physical cruelty, 4.8% emotional cruelty, 5.1% any victimisation; 33 months postpartum: 2.9% physical, 10.8% emotional, 11% any victimisation). Women who reported being victimised during pregnancy also reported significantly higher levels of social adversity during pregnancy. The number of social adversities reported during pregnancy also predicted postpartum victimisation. Women who reported only one adversity during pregnancy were 2.73 (95% CI, 2.16–3.45) times more likely to report physical victimisation at 33 months postpartum. Women who reported 5 adversities during pregnancy were 14.69 (95% CI, 7.35–29.37) times more likely to report such victimisation at 33 months postpartum. For emotional cruelty, women who reported only one adversity during pregnancy were 2.10 (95% CI 1.80–2.46) times more likely to report emotional victimisation at 33 months postpartum and 6.10 (95% CI 3.51–10.59) times more likely to report such victimisation when five or more adversities were present during pregnancy.Conclusions  Levels of social adversity reported in pregnancy are important predictors of concurrent and future victimisation. Screening for social adversity factors could help identify women at high risk for future domestic violence.
Specific PGF2α receptor (FP) antagonism and human uterine contractility in vitro
Authors: Friel Anne M. , O'Reilly Michael W. , Sexton Donal J. , Morrison John J. 
Published: October 2009

Objective  PGF2α acts through its receptor, FP, as an important smooth muscle contractile agent. The aim of this study was to investigate the effects of specific FP antagonism, using the novel‐specific FP non‐competitive antagonist THG113.31, on spontaneous and agonist‐elicited contractions in pregnant and non‐pregnant human myometrium in vitro.Design  Scientific study.Setting  University hospital and laboratories.Population  Women undergoing caesarean section or hysterectomy.Methods  Biopsies of human myometrium were obtained at elective caesarean section (n= 22) and from hysterectomy specimens from premenopausal women (n= 8). Dissected strips were mounted in tissue baths under physiological conditions. The effects of THG113.31 on spontaneous and oxytocin‐induced contractions, in pregnant myometrium, and on phenylephrine‐induced contractions, in non‐pregnant myometrium, were measured. The effects of PGF2α on spontaneous contractions, in pregnant tissue, in the presence and absence of THG113.31, were investigated. The integrals of contractile activity measured were compared with those from simultaneously run control experiments. The pD2 and mean maximal effect observed for THG113.31, and for PGF2α in the presence and absence of THG113.31, were calculated.Main outcome measures  Changes in contractility.Results  THG113.31 exerted a potent relaxant effect in both spontaneous and oxytocin‐induced contractility in pregnant tissue (P < 0.001), and phenylephrine‐induced contractility in non‐pregnant tissue (P < 0.001), compared with control experiments. PGF2α exerted a significant contractile effect on spontaneous contractions in pregnant tissue and this effect was not significantly attenuated by THG113.31 (P > 0.05).Conclusion  THG113.31 exerted a significant relaxant effect on human spontaneous and oxytocin‐induced contractility but did not alter PGF2α‐elicited contractility. These data raise questions about the exact mechanism of effect of THG113.31 and its interaction with FP. The uterorelaxant potency of THG113.31 in human myometrium in vitro indicates that it may be of limited use as a tocolytic compound.
Factors related to breast abscess after delivery: a population‐based study
Authors: Kvist Linda J. , Rydhstroem Hakan 
Published: October 2009

Objective  To investigate whether there are underlying factors, other than breastfeeding behaviours, which may contribute to the development of breast abscess during the year following delivery.Design  A population‐based study.Setting  In Sweden.Population  The 1,454,068 singleton deliveries during 1987–2000.Methods  Data retrieval from two national patient registers: the Medical Birth Registry and the National Discharge Register. Stratified Mantel–Haenszel analysis.Main outcome measures  Odds ratios with 95% confidence intervals for possible risk factors for breast abscess in the year following delivery.Results  During the year following delivery 1401 women had surgery because of a breast abscess. This gives a rate of 0.1%. Sixty‐five percent of cases occurred between three and eight weeks postpartum. An annual increase in the odds ratio (OR) was found between 1993 and 1999. Lowest risk was found among mothers who were ≤24 years and a significantly increased risk among mothers ≥30 years. There was a 3.6‐fold increased risk for breast abscess associated with primiparity and OR for post‐maturity (>41 weeks) was 5.Conclusion  Primiparous women appear to be at a greater risk for the development of breast abscess during lactation than multiparous women. Mothers over the age of 30 years and those who give birth post‐maturely are also at a significantly increased risk. Primiparous women and women over 30 years could be targeted for extra information in preparation for parenthood classes about how to avoid over distension of the breasts during breastfeeding. Further research is needed to understand the role of post‐maturity and to investigate why some women recover spontaneously from inflammatory processes of the breast.
PALLIATIVE CARE, PUBLIC HEALTH AND JUSTICE: SETTING PRIORITIES IN RESOURCE POOR COUNTRIES
Authors: BLINDERMAN CRAIG 
Published: October 2009

ABSTRACTMany countries have not considered palliative care a public health problem. With limited resources, disease‐oriented therapies and prevention measures take priority. In this paper, I intend to describe the moral framework for considering palliative care as a public health priority in resource‐poor countries. A distributive theory of justice for health care should consider integrative palliative care as morally required as it contributes to improving normal functioning and preserving opportunities for the individual. For patients requiring terminal care, we are guided less by principles of justice and more by the duty to relieve suffering and society's commitment to protecting the professional's obligation to uphold principles of beneficence, compassion and non‐abandonment. A fair deliberation process is necessary to allow these strong moral commitments to serve as reasons when setting priorities in resource poor countries.
2‐Methylhopanoids are maximally produced in akinetes of Nostoc punctiforme: geobiological implications
Authors: DOUGHTY D. M. , HUNTER R. C. , SUMMONS R. E. , NEWMAN D. K. 
Published: October 2009

Abstract2‐Methylhopanes, molecular fossils of 2‐methylbacteriohopanepolyol (2‐MeBHP) lipids, have been proposed as biomarkers for cyanobacteria, and by extension, oxygenic photosynthesis. However, the robustness of this interpretation is unclear, as 2‐methylhopanoids occur in organisms besides cyanobacteria and their physiological functions are unknown. As a first step toward understanding the role of 2‐MeBHP in cyanobacteria, we examined the expression and intercellular localization of hopanoids in the three cell types of Nostoc punctiforme: vegetative cells, akinetes, and heterocysts. Cultures in which N. punctiforme had differentiated into akinetes contained approximately 10‐fold higher concentrations of 2‐methylhopanoids than did cultures that contained only vegetative cells. In contrast, 2‐methylhopanoids were only present at very low concentrations in heterocysts. Hopanoid production initially increased threefold in cells starved of nitrogen but returned to levels consistent with vegetative cells within 2 weeks. Vegetative and akinete cell types were separated into cytoplasmic, thylakoid, and outer membrane fractions; the increase in hopanoid expression observed in akinetes was due to a 34‐fold enrichment of hopanoid content in their outer membrane relative to vegetative cells. Akinetes formed in response either to low light or phosphorus limitation, exhibited the same 2‐methylhopanoid localization and concentration, demonstrating that 2‐methylhopanoids are associated with the akinete cell type per se. Because akinetes are resting cells that are not photosynthetically active, 2‐methylhopanoids cannot be functionally linked to oxygenic photosynthesis in N. punctiforme.