bluuebunny/crossref_metadata_2025_split huggingface dataset:
The clinical utility of maternal self‐reported personal and familial psychiatric history in identifying women at risk for postpartum depression
Authors: DENNIS CINDY‐LEE , ROSS LORI E. 
Published: December 2009

AbstractBackground. To determine whether maternal self‐reported data on personal and family psychiatric history would significantly predict postpartum depressive symptomatology at 8 weeks postpartum and to examine which of these variables were the most predictive for inclusion in an obstetrical clinical assessment aimed at early identification of postpartum depression. Methods. As part of a longitudinal study, a population‐based sample of 622 women completed mailed questionnaires at 1 and 8 weeks postpartum. Results. At 8 weeks postpartum, mothers who indicated that they had any personal psychiatric history were almost four times more likely to exhibit depressive symptomatology (Edinburgh Postnatal Depression Scale score > 9) than those with no previous mental health difficulties (odds ratio [OR] 3.65, 95% CI 2.30–5.82). Any family psychiatric history was not a significant risk factor. Variables most predictive of depressive symptomatology at 8 weeks, explaining 42% of the variance, included: maternal antenatal depression (OR 3.77, p = 0.03), maternal history of postpartum depression (OR 2.21, p = 0.02), and Edinburgh Postnatal Depression Scale score >9 at 1 week postpartum (OR 18.23, p<0.001). Conclusions. The results suggest that maternal variables, particularly those related to the index and past pregnancies, not family psychiatric history, are the best predictors of postpartum depressive symptoms. These findings highlight the importance of assessing symptoms of depression and anxiety during pregnancy and the early postpartum period, in order to facilitate timely identification of women at risk for developing postpartum depression.
Feasibility of myomectomy performed by minilaparotomy
Authors: Fambrini Massimiliano , Penna Carlo , Pieralli Annalisa , Andersson Karin L. , Zambelli Valentina , Scarselli Gianfranco , Marchionni Mauro 
Published: December 2009

AbstractBackground. To evaluate feasibility and clinical outcomes of myomectomy performed through minilaparotomic access in a large series of consecutive patients. Methods. All patients submitted to laparotomic conservative surgery for uterine myomas through an initial minilaparotomic approach (4–8‐cm transverse skin incision) were retrospectively evaluated. Preoperative findings, surgical technique, rate of laparotomic enlargement, operative time, surgical complications and length of recovery were the main analyzed outcomes. Results. One hundred and seventy out of 212 patients experienced minilaparotomic approach for uterine myomatosis. In 97 (57.1%) multiple myomas were present (maximum, 23). The size of the largest myoma ranged from 2 to 19 cm (median 5.6). In 161 (94.7%) patients myomectomy was ended through minilaparotomic access with a mean length of skin incision of 6.2 cm (4–7.8). The correlation between severe obesity and laparotomic enlargement was statistically significant (p<0.05). The mean operative time was 57 min (32–118). One bladder intraoperative injury was successfully managed through minilaparotomic incision. Bowel or vascular complications never occurred. Estimated blood loss was not significant except in three cases (1.9%) requiring transfusion. Febrile complications were observed in nine patients (5.6%). The median postoperative stay in uncomplicated patients was 2.5 days (2–4). Conclusions. Our report supports the wide application of minilaparotomic myomectomy and suggests that more than 85% of women with fit uterine myomatosis could be successfully managed in this way with a failure rate of 5.3% in eligible patients. The main criteria of minimal invasive surgery seem to be by minilaparotomic myomectomy, which should be considered a valid option for uterine myohas conservative treatment.
Prevention of postpartum hemorrhage by uterotonic agents: comparison of oxytocin and methylergometrine in the management of the third stage of labor
Authors: FUJIMOTO MIKI , TAKEUCHI KYOUSUKE , SUGIMOTO MAKOTO , MARUO TAKESHI 
Published: December 2009

AbstractObjectives. To determine the efficacy of intravenous oxytocin administration compared with intravenous methylergometrine administration for the prevention of postpartum hemorrhage (PPH), and the significance of administration at the end of the second stage of labor compared with that after the third stage. Methods. A prospective study was undertaken: two major groups (oxytocin group and methylergometrine group) of 438 women with singleton pregnancy and vaginal delivery were studied during a 15‐month period. These two groups were subdivided into three subgroups: 1. intravenous injection (two minutes) group immediately after the delivery of the fetal anterior shoulder, 2. intravenous injection (two minutes) group immediately after the delivery of the placenta, and 3. drip infusion (20 min) group immediately after the delivery of the fetal head. In each group, quantitative postpartum blood loss, frequencies of blood loss >500 ml, and need of additional uterotonic treatment were evaluated. Results. As compared with methylergometrine, oxytocin administration was associated with a significant reduction in postpartum blood loss and in frequency of blood loss >500 ml. The risk of PPH was significantly reduced with intravenous injection of oxytocin after delivery of the fetal anterior shoulder, compared with intravenous injection of oxytocin after expulsion of the placenta (OR 0.33, 95%CI 0.11–0.98) and intravenous injection of methylergometrine after delivery of the fetal anterior shoulder (OR 0.31, 95%CI 0.11–0.85). Conclusions. Intravenous injection of 5 IU oxytocin immediately after delivery of fetal anterior shoulder is the treatment of choice for prevention of PPH in patients with natural course of labor.
Group intervention for women with pelvic girdle pain in pregnancy. A randomized controlled trial
Authors: HAUGLAND KARI STRAUME , RASMUSSEN SVEIN , DALTVEIT ANNE KJERSTI 
Published: December 2009

AbstractBackground. Low back and pelvic pain is common in pregnancy and postpartum, but there is no well documented effect of treatment in pregnancy. The aim of the study was to assess whether a group intervention program for pregnant women with pelvic girdle pain has any effect on pain and daily function postpartum. Methods. Pregnant women with pelvic pain between the 18th and 32nd week of gestation were invited to participate in a randomized clinical study. Among 958 examined women, 569 (59%) fulfilled the inclusion criteria. Women randomized to the intervention group (n = 275) participated in an education program that consisted of information, ergonomics, exercises, pain management, advice for daily life movement, pelvic belt/crutches, and information about delivery. Women randomized to the control group (n = 285) were not offered any treatment, but were free to seek advice or other treatment. Clinical measures and self‐evaluated utility of the intervention were measured by a visual analogue scale 0–10. Results. Mean debut of pelvic girdle pain in pregnancy was at week 15. Altogether 42% of the women reported problems with low back pain earlier, and 34% reported a family history of pelvic girdle pain in pregnancy. Median visual analogue scale score for all activities at inclusion was 6 both in the control group and the intervention group. At 6 and 12 months postpartum the score was reduced to 1.7/1.6 and 1.1/0.9. In the intervention group, 75% marked a self‐evaluated utility visual analogue scale score >7. In the control group, 60% had searched for alternative treatment. Conclusions. Postpartum pelvic girdle pain improved with time both in the intervention group and the control group, but there were no statistically significant differences between the groups. Self‐evaluated utility of the intervention was, however, high in the intervention group.
Outcome in obstetric care related to oxytocin use. A population‐based study
Authors: Oscarsson Maria E. , Amer‐Wåhlin Isis , Rydhstroem† Hakan , Källén Karin 
Published: December 2009

AbstractBackground. The purpose of this study was to investigate the delivery outcome in relation to oxytocin use in labor. Methods. We studied 106,755 deliveries from 1995 to 2002 in the Perinatal Revision South, a population‐based register comprising information from 10 hospitals in southern Sweden. Results. Oxytocin use in labor increased from 27.6% in 1995/96 to 33.2% in 2001/02 (p<0.000006). Oxytocin was administered to 47.7% of the nulliparas and 18.5% of the multiparas. There were large differences between hospitals (range among nulliparas: 32.6–60.4%; among multiparas: 13.9–27.0%). After exclusion of deliveries with induction of labor and deliveries lasting >12 h, there was a significant association between oxytocin use and Apgar score < 7 at 5 min (OR 2.3; 95% CI 1.8–2.9), need for neonatal intensive care (OR 1.6; 95% CI 1.5–1.7), and operative delivery (OR 4.0; 95% CI 3.7–4.2). Conclusions. In deliveries with relatively short duration (≤12 h), a significant association was seen between oxytocin use and adverse outcome. Even though the results are difficult to interpret, the significant difference between the use of oxytocin in different hospitals, as well as the increase of oxytocin use over time, calls for a randomized controlled study to elucidate the advantages and disadvantages of oxytocin use during labor and delivery.
Smoking and the risk of developing hypertensive diseases in pregnancy: what is the effect on HELLP syndrome?
Authors: LEENERS BRIGITTE , NEUMAIER‐WAGNER PERUKA , KUSE SABINE , RATH WERNER 
Published: December 2009

AbstractBackground. The aim of our study was to investigate the role of smoking in the development of HELLP syndrome, pre‐eclampsia and gestational hypertension. Methods. A self‐administered questionnaire was sent to 2,600 women who had contacted the German Pre‐eclampsia Self‐help Group previously for information on hypertensive disorders in pregnancy and to 1,233 controls. Diagnoses were verified by reviewing medical records and classified according to ISSHP criteria. Student's t‐test, Wilcoxon test, Chi‐square test, and multiple logistic regressions were used for statistical analysis. Results. After matching age, parity, nationality, and education a total of 905 women with a hypertensive disease in pregnancy and 945 controls were evaluated for the present study. In comparison to the patients, controls smoked significantly more often during their pregnancies (8.5%/18%, p<0.0001). Smoking during pregnancy was associated with a decreased risk of developing hypertensive disorders in pregnancy by 56%. The most prominent effect of smoking was on the risk of developing HELLP syndrome (OR 0.19, 95% CI 0.08–0.43) followed by HELLP syndrome + pre‐eclampsia (OR 0.33, 95% CI 0.17–0.63), pre‐eclampsia only (OR 0.46, 95% CI 0.26–0.8), and gestational hypertension (OR 0.66, 95% CI 0.41–1.08). Conclusions. Smoking is associated with an 80% reduction of the risk developing HELLP syndrome. However, pregnant women should be advised to quit smoking. Understanding the different effects of smoking in the etiology of each subtype of hypertensive diseases in pregnancy will improve the knowledge of underlying pathophysiological mechanisms and may help in designing more effective prevention and treatment strategies.
Recombinant factor VIIa in the management of postpartum bleeds: an audit of clinical use
Authors: SOBIESZCZYK SLAWOMIR , BRĘBOROWICZ GRZEGORZ H. , PLATICANOV VILIYAN , TANCHEV STOYAN , KESSLER CRAIG M. 
Published: December 2009

AbstractBackground. This paper presents an analysis of 25 patient cases in which recombinant factor VIIa was used in the management of postpartum hemorrhage, including severe and/or life‐threatening bleeds. Anecdotal experiences in the empirical use of this agent are described and dosing regimens, effects on bleeding, and safety data are presented.Methods. Data were extracted from the international, internet‐based, voluntary registry, haemostasis.com. Search results were manually cross‐checked against monthly summary reports and cases of confirmed postpartum hemorrhage were analyzed by the authors. Case providers were contacted individually to approve the use of their cases, supply any missing data, and validate the data already held.Results. Of 43 reported gynecological admissions for hemorrhage, 13 were excluded as they did not relate to childbirth, and 5 due to insufficient data. The remaining 25 records, all associated with postpartum hemorrhage, were submitted by 14 doctors from 5 countries. Following administration of recombinant factor VIIa, bleeding stopped in 18 cases (72%), markedly decreased in 2 (8%), and decreased in 4 (16%). Bleeding increased following recombinant factor VIIa administration in only 1 patient (4%). Requirements for replacement blood products and crystalloids/colloids were also greatly curtailed. A full recovery was achieved by most patients (22/25, 88%) with few complications, even when recombinant factor VIIa was administered as salvage therapy. There were no thrombotic complications associated with recombinant factor VIIa administration.Conclusions. This review provides the largest aggregate of cases in which recombinant factor VIIa has been used to control obstetrical bleeding. A review of these cases suggests that this agent may be a useful and safe adjunctive therapy in the management of postpartum hemorrhage.
Comparison of ultrasound and autopsy findings in pregnancies terminated due to fetal anomalies
Authors: AMINI HASHEM , ANTONSSON PER , PAPADOGIANNAKIS NIKOS , ERICSON KATHARINA , PILO CHRISTINA , ERIKSSON LARS , WESTGREN MAGNUS , AXELSSON OVE 
Published: December 2009

AbstractObjective. To compare antenatal diagnoses with autopsy findings in pregnancies terminated after ultrasound detection of fetal anomalies. A second aim was to study the quality of antenatal fetal diagnosis over time. Design. Retrospective, multicenter study over two consecutive six‐year periods in Uppsala and Stockholm. Setting. Cases were identified through fetal autopsy reports. Subjects. Three hundred and twenty‐eight fetuses from pregnancies terminated between 1992 and 2003 because of ultrasonographically diagnosed anomalies. Main outcome measures. The findings at the last ultrasound examination were compared with the autopsy reports. Results. In 299 cases (91.2%) ultrasound findings either exactly matched or were essentially similar to the autopsy findings. In 23 cases (7%) ultrasound findings were not confirmed at autopsy, but the postnatal findings were at least as severe as the antenatal ones. In six cases (1.8%) termination was performed for an anomaly which proved to be less severe than was predicted by ultrasound. The number of such cases was the same in both six‐year periods, while the total number of cases increased from 113 in the first to 215 in the second period. Fetal examination provided further diagnostic information in 47% of the cases. In 10% a syndrome was disclosed. Conclusion. Termination of pregnancy was not always based on a correct antenatal diagnosis. All fetuses but one from terminated pregnancies had evident anomalies. In six cases (1.8%) the decision to terminate was based on suboptimal prognostic and diagnostic information. Fetal autopsy by an experienced perinatal pathologist is essential to provide a definitive diagnosis.
Acupuncture administered after spontaneous rupture of membranes at term significantly reduces the length of birth and use of oxytocin. A randomized controlled trial
Authors: GAUDERNACK LISE CHRISTINE , FORBORD SOLFRID , HOLE ELI 
Published: December 2009

AbstractBackground. The objective was to investigate whether acupuncture could be a reasonable option for augmentation in labor after spontaneous rupture of membranes at term and to look for possible effects on the progress of labor. Methods. In a randomized controlled trial 100 healthy parturients, with spontaneous rupture of membranes at term, were assigned to receive either acupuncture or no acupuncture. The main response variables were the duration of active labor, the amount of oxytocin given, and number of inductions. Results. Duration of labor was significantly reduced (mean difference 1.7 h, p = 0.03) and there was significant reduction in the need for oxytocin infusion to augment labor in the study group compared to the control group (odds ratio 2.0, p = 0.018). We also discovered that the participants in the acupuncture group who needed labor induction had a significantly shorter duration of active phase than the ones induced in the control group (mean difference 3.6 h, p = 0.002). These findings remained significant also when multiple regression was performed, controlling for potentially confounding factors like parity, epidural analgesia, and birth weight. Conclusion. Acupuncture may be a good alternative or complement to pharmacological methods in the effort to facilitate birth and provide normal delivery for women with prelabor rupture of membranes.
Maternal mortality in the Greater Accra region in Ghana: assessing completeness of registration and data quality
Authors: YAKUBU ZAKARIAH AFISAH , ALEXANDER SOPHIE , VAN ROOSMALEN JOS , YAO KWAWUKUME ENYONAM 
Published: December 2009

AbstractObjective. To assess the completeness of registration of maternal mortality by comparing various data sources and to review the quality of information pertaining to individual cases. Data source and methods. Female deaths aged 10–50 years in the Greater Accra region in Ghana from January 1, 2000 to December 31, 2000 were recorded. Identified maternal deaths (International Classification of Diseases, 9th revision) in four major hospitals in the region were compared with those registered in the civil registers. Results. During the study period, 148 maternal deaths were identified and a total of 21,183 live births were recorded in the study hospitals, yielding a maternal mortality ratio of 699/105 live births. This ratio is more than six times the officially reported maternal mortality ratio for the whole region in the same period. Ninety‐two percent of the deaths were due to direct obstetric causes and 8% to indirect causes. One hundred and twenty‐one of the cases were correctly classified and registered. By using the multiple source approach, 27 new cases were identified, an under‐registration of 18%. The sources of error were misclassification (n = 25) and error in registration (n = 2). Conclusion. The process of registration of deaths in this region is incomplete. Enhanced registration systems (including routine linkage of death and birth certificates) on a regular basis could be used in Ghana.
Psychiatry in the Land of the Sphinx: Is an Overseas Elective Justified?
Authors: Rege Sanil 
Published: December 2009

Objective: The aim of this paper is to provide a descriptive account of a 6-month sabbatical in Egypt to highlight the diversity of benefits in incorporating such activities within psychiatric training programs. Conclusions: An overseas elective offers an exciting practical opportunity to broaden one's experience of transcultural psychiatry and obtain a perspective on mental illness and its cultural variations. It also promotes an understanding of health service management in low and middle income countries and offers the opportunity to contribute to their healthcare at minimal cost. However, the elective needs to be undertaken at an optimal period of a psychiatrist's career and with minimal disruption to local services. Training schemes and employers could provide more opportunities for interested trainees, with specified projects and aims in mind, to undertake such electives so that they can begin to develop expertise in treating a particular cultural group. In turn, this would go a long way to producing culturally capable psychiatrists for the wide range of ethnic minorities in Australia.
Shared Mental Health Care for a Marginalized Community in Inner-City Canada
Authors: Kisely Stephen , Chisholm Pamela 
Published: December 2009

Objectives: This paper describes the experience and evaluation of a shared care project targeted at marginalized individuals living in the North End of Halifax, Nova Scotia. This population has high rates of psychiatric disorder, often comorbid with chronic medical conditions, and people have difficulty in obtaining the help they need. This primary care liaison service covers all ages and includes outreach to emergency shelters, transitional housing and drop-in centres. Collaborative care improved access, satisfaction and outcomes for marginalized individuals in urban settings. Primary care providers with access to the service reported greater comfort in dealing with mental health problems, and satisfaction with collaborative care, as well as mental health services in general. Results were significantly better than those of control practices when such data were available. The median wait time was 6 days in comparison with 39.5 days for the comparison site. Conclusions: This model can complement other initiatives to improve the health of marginalized populations, and may be relevant to Australia.
China–Australia Training on Psychosocial Crisis Intervention: Response to the Earthquake Disaster in Sichuan
Authors: Ng Chee , Ma Hong , Raphael Beverley , Yu Xin , Fraser Julia , Tang Denghua 
Published: December 2009

Objective: This paper describes the AusAID-funded psychosocial training program conducted jointly by Chinese and Australian mental health facilitators in the wake of the devastating earthquake disaster in Sichuan. Conclusions: A total of 280 professional and volunteer leaders in disaster mental health response from across China took part in the national disaster mental health training program. A comprehensive, evidence-based and practical program was collaboratively developed and delivered to meet the needs of the medical professionals and volunteer mental health workers working in the field. Results of the training evaluation indicated high levels of uptake and usefulness for the participants. Further outcome assessments will be utilized at the service delivery and community levels. The training program has contributed significantly to the building of national and local capacity to deliver psychological first-aid and psychosocial response management to assist the populations who have been affected by disaster.
Psychiatrically Impaired Medical Practitioners: An Overview with Special Reference to Impaired Psychiatrists
Authors: Wilson Andrew , Rosen Alan , Randal Patte , Pethebridge Andrew , Codyre David , Barton David , Norrie Peter , McGeorge Peter , Rose Lynette 
Published: December 2009

Objective: This paper will define and describe impairment in medical practitioners due to mental illness, with special reference to the specialty of psychiatry, and then review the prevalence and identification of impaired practitioners.Methods: The quantitative and qualitative evidence regarding the incidence and impact of medical practitioner impairment due to mental illness (and, to some extent, substance use), with special reference to impaired psychiatrists, is reviewed.Results: Medical practitioner impairment due to mental illness has a severe impact on their lives and their families due to both the effects of the disorder and the experience of communal, professional and self stigma.Conclusions: The consequences of impairment among medical practitioners and specialist psychiatrists as well as the under-reporting of impaired practitioners is a significant problem.