bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of postpartum hemorrhage by uterine balloon tamponade: Prospective evaluation of effectiveness
Authors: DOUMOUCHTSIS STERGIOS K. , PAPAGEORGHIOU ARIS T. , VERNIER CHIARA , ARULKUMARAN SABARATNAM 
Published: August 2008

AbstractObjective. To evaluate uterine balloon tamponade in the management of postpartum hemorrhage (PPH). Method and study design. Prospective audit. Setting. St George's Hospital, London. Population. Twenty‐seven women with intractable PPH managed by uterine balloon tamponade using a Sengstaken‐Blakemore Oesophageal Catheter (SBOC) when medical management was not effective, and prior to surgical intervention. Main outcome measures. Success rate of the SBOC in arresting hemorrhage. The need for additional measures, use of anesthesia and complication rates is reported. Results. During the study period there were 27 women who had placement of the catheter. In 22 cases (81%) hemostasis was achieved, while in five cases (19%) the SBOC failed in arresting hemorrhage. Of the five failures, hysterectomy was required in four cases and in the remaining case the failure was associated with expulsion of the balloon, but hemostasis was achieved with further conservative measures. Among the failed cases there was one maternal death due to amniotic fluid embolism with cardiac arrest and PPH secondary to coagulopathy. In cases where the balloon was successful it was removed around 24 hours later. In these cases no further bleeding was observed, and no complications occurred from the procedure. Conclusions. Placement of a SBOC successfully treats atonic PPH refractory to medical management in around 80% of cases. It is simple, inexpensive and in those with successful placement no surgical morbidity was observed. The potential for it to be used by inexperienced operators in areas with limited resources makes it a useful adjunct in management of PPH.
Sagittal suture overlap in cephalopelvic disproportion: Blinded and non‐participant assessment
Authors: BUCHMANN ECKHART J. , LIBHABER ELENA 
Published: August 2008

AbstractObjective. To determine the role of assessment of overlap of fetal skull bones (molding) in intrapartum prediction of cephalopelvic disproportion (CPD). Design. Prospective cross‐sectional study. Setting. South African high‐risk obstetric unit that receives referrals from other facilities. Population. Women of at least 37 weeks’ gestation in the active phase of labor, with singleton vertex presentations and live fetuses, and without previous cesarean sections. Method. The researcher was blinded to parity and previous clinical information on the women, and not involved in their obstetric care. The researcher performed clinical assessments, including estimation of level of head, cervical dilatation, head flexion, position, overlap of fetal skull bones, caput succedaneum and asynclitism. A single assessment was done on each woman. Main outcome measure. CPD, defined as cesarean section for poor progress in labor. Results. The author examined 504 women, and CPD occurred in 113 (22.4%). In multivariate logistic regression analysis, sagittal suture overlap was independently associated with CPD. Other factors associated were maternal height, duration of labor, birth weight, and the interaction between caput succedaneum and cervical dilatation at the time of examination. Lambdoid suture overlap was not significantly associated with CPD, and could be determined in only 66.5% of examinations because of frequent head deflexion. Conclusion. Assessment of sagittal suture overlap, but not lambdoid suture overlap, is useful for prediction of CPD. Knowledge of sagittal suture overlap may assist in decisions on clinical management where there is poor progress in a trial of labor.
Diagnosis and prediction of parental origin of triploidies by fetal nuchal translucency and maternal serum free β‐hCG and PAPP‐A at 11–14 weeks of gestation
Authors: BARKEN SIDSEL S. , SKIBSTED LILLIAN , JENSEN LISA N. , SPERLING LENE , ZINGENBERG HELLE , BRØNDUM‐NIELSEN KAREN 
Published: August 2008

AbstractThe study objective was to determine the parental origin of triploidy in relation to findings from early risk assessment in a combined screening program between 2004 and the end of 2006. Triploidy was diagnosed in six chorion villus samples and two samples from missed abortions. After informed consent, quantitative fluorescence polymerase chain reaction analysis was performed on the five cases where we received blood from both parents and tissue from fetuses. In four cases the origin of the triploidy was paternal and in one maternal, in accordance with previous findings in type I and type II triploidies. Finding triploidy is possible by risk assessment (ultrasound and double test), and thereby women may have the opportunity for early termination of pregnancy.
Maternal fatalities, fetal and neonatal deaths related to motor vehicle crashes during pregnancy: A national population‐based study
Authors: KVARNSTRAND LAURA , MILSOM IAN , LEKANDER THOMAS , DRUID HENRIK , JACOBSSON BO 
Published: August 2008

AbstractObjectives. Firstly, determine the mortality rate for: pregnant women; fetuses and neonates, due to motor vehicle crashes (MVCs) during pregnancy; and secondly, the rate of major injuries among pregnant women and the rate of involvement of pregnant women in crashes. Design. A national population‐based, retrospective descriptive study. Setting. Sweden, 1991–2001. Population. All pregnant and non‐pregnant women age 15–44. Methods. Linkage of national traffic, medical and autopsy registers. Main outcome measures. Maternal death or injury and corresponding fetal death. Results. MVCs during pregnancy caused 1.4 maternal fatalities per 100,000 pregnancies and a fetus/neonate mortality rate of least 3.7 per 100,000 pregnancies. The incidence of maternal major injury was 23/100,000 pregnancies and crash involvement was 207/100,000 pregnancies. Conclusions. MVCs during pregnancy were a significant cause of maternal fatalities, fetal and neonatal deaths, responsible for almost 1/3 of all maternal deaths and fatalities, and caused nearly three times more fetal plus neonatal deaths than maternal fatalities.
Prepregnancy weight status and the risk of adverse pregnancy outcome
Authors: HAUGER MARIT S. , GIBBONS LUZ , VIK TORSTEIN , BELIZÁN JOSÉ M. 
Published: August 2008

AbstractObjective. To examine the association between maternal pre‐pregnancy weight status and the risk of stillbirth, pre‐eclampsia and preterm delivery. Design. Hospital‐based cohort study using prospectively recorded data. Setting. Ten public hospitals in Buenos Aires, Argentina. Population. 46,964 pregnant women who had a delivery during 2003–2006. Methods. Prepregnancy body mass index (BMI) was used to categorize women in four weight categories from underweight to obese. The reference group were women with BMI between 18.5 and 24.9. Crude and adjusted odds ratios were calculated using multiple logistic regression analysis. Main Outcome. Preterm birth, pre‐eclampsia and stillbirth. Results. The risk of preterm delivery decreased with increasing BMI, with the highest risk among underweight women (OR: 1.45; 95% CI: 1.26–1.67), and the lowest risk among the overweight. The risk of pre‐eclampsia was highest among overweight (OR: 1.55; 95%CI: 1.30–1.86) and obese women (OR: 3.10; 95%CI: 2.54–3.78). Obese or overweight women did not have an increased risk of stillbirth in this study. Conclusions. Overweight and obese women have an increased risk for pre‐eclampsia, while underweight women have an increased risk for preterm delivery. There is a high prevalence of overweight women in the obstetric population in Buenos Aires.
Rapid prenatal diagnosis of spinal muscular atrophy by denaturing high‐performance liquid chromatography system
Authors: SHAW SHENG‐WEN , SHAW SHENG‐WEN , CHENG PO‐JEN , SHAW SHENG‐WEN , CHENG PO‐JEN , CHANG SHUENN‐DHY , LIN YU‐TING , HUNG CHIA‐CHENG , CHEN CHIH‐PING , SU YI‐NING 
Published: August 2008

AbstractObjective. Use of Denaturing High‐Performance Liquid Chromatography (DHPLC) in prenatal diagnosis of spinal muscular atrophy (SMA). Methods. Thirty‐three members of 7 families participated in carrier test and disease detection of SMA. Prenatal genetic diagnosis was performed if both parents were carriers or any family members had SMA. DNA extracted from blood, chorionic villi and amniotic fluid was amplified and used for DHPLC. Results. Twenty SMA carriers, seven SMA affected cases, and six normal individuals were identified. SMA status was demonstrated by genotyping and total copy number determinations of SMN1 and SMN2. Families 1–3 were classified as group one (SMA affecting previously born child). Group two, comprising families 4 and 5, had lost a child due to an unknown muscular disease. Group three (SMA‐affected parent) comprised families 6 and 7; carrier testing was done. DHPLC prenatal genetic diagnosis was made in seven pregnancies, one in each family (affected, n = 2; carrier, n = 3; normal, n = 2). Pregnancy was terminated for the two affected fetuses. The others were delivered uneventfully and SMA free. Conclusion. DHPLC prenatal diagnosis of SMA and determination of SMA status in adults is possible, and SMN1 and SMN2 copy numbers can be determined.
Factors associated with symptoms of pelvic floor dysfunction six years after primary operation of genital prolapse
Authors: CRAFOORD KRISTINA , SYDSJÖ ADAM , JOHANSSON THOMAS , BRYNHILDSEN JAN , KJØLHEDE PREBEN 
Published: August 2008

AbstractObjective. To determine prevalence of pelvic floor dysfunction (PFD) symptoms in women six years after primary pelvic organ prolapse (POP) surgery and analyze predictive factors for these symptoms. Design. Cross‐sectional observational study. Setting. Three Swedish hospitals. Sample. Women who underwent primary POP surgery in 1993 and had no subsequent POP surgery during the following six years. Methods. Clinical data from patient records and a postal questionnaire concerning symptoms of PFD completed in 1999. Main outcome measures. Prevalence of PFD symptoms, predictive factors. Results. Urinary incontinence episodes ≥weekly were reported by 41%, feeling of vaginal bulging by 18% and solid stool incontinence by 15%. Thirty nine percent were sexually active; 15% refrained completely from sexual activity because of own discomfort or pain and 46% had no sexual activity due to lack of or sick partner. Discomfort or pain during sexual activity was experienced by 42%. Previous incontinence surgery and urinary incontinence prior to POP surgery were predictive factors for urinary incontinence. Anterior repair was protective for the postoperative symptoms of incomplete bladder and bowel emptying and vaginal bulging. Posterior repair was a risk factor for incomplete bowel emptying and solid stool incontinence. The association between posterior repair and discomfort or pain during sexual activity was not significant. Conclusion. The prevalence of PFD symptoms six years after primary POP surgery seemed high. The extent of POP surgery was predictive for postoperative symptoms of urinary and bowel dysfunction but not for discomfort or pain during sexual activity.
Improved accuracy of postpartum blood loss estimation as assessed by simulation
Authors: MASLOVITZ SHARON , BARKAI GAD , LESSING JOSEPH B. , ZIV AMITAI , MANY ARIEL 
Published: August 2008

AbstractObjective. Caregivers underestimate the amount of blood loss, but this almost five decades‐old assumption has not been validated. We aimed at assessing the accuracy of estimated blood loss by obstetrical teams during a simulated Postpartum hemorrhage (PPH) scenario. Study design. a prospective study conducted as part of the simulation‐based training course, using sophisticated mannequin simulators adapted for obstetrical training by specially designed devices. Setting. Part of the simulation‐based training course. Population. Obstetrical teams consisted of physicians and obstetrical nurses. Methods. Each of the participating obstetrical teams assessed blood loss during PPH scenarios. Their estimates were compared to the actual predefined 3.5‐liter blood loss. An intervention group underwent a similar course in which they recorded their estimations after 1, 2 and 3.5 liters were lost. Outcome measures. Blood loss estimates after completion of the scenario in both groups. Results. Fifty obstetrical teams took part in the study. Eight comprised the interventional group. The average estimated blood loss was 1,780 ml (49% underestimation) for non‐interventional teams. The interventional groups estimated blood loss to be 2,400 ml (32% underestimation). The main method of estimating blood loss was ‘gut feeling’, followed by verbalized guesses of team members and assessments of the ‘patient's’ hemodynamic status. Conclusions. Accuracy of blood loss estimations by a simulation‐based PPH scenario was 50–60%. Measurements at predetermined intervals significantly improved accuracy of these estimations. Our study suggests that implementation of periodic estimations of blood loss in the management of PPH might improve clinical judgment.
Two ways of estimating the euro value of the illicit market for cannabis in France
Authors: LEGLEYE STEPHANE , LAKHDAR CHRISTIAN BEN , SPILKA STANISLAS 
Published: August 2008

AbstractIntroduction. The most recent health surveys in general population are used in order to estimate the annual market size for cannabis in France in 2005. Methods. Two methods for arriving at an estimate are proposed: the first based on reported consumption, the other on reported expenditure on cannabis. Results. The annual sales figure for cannabis in France is between746 and 832 million euros. Men's expenditure accounts for between 80 and 85% of total expenditure and those aged between 15 and 24 years account for the greatest part of the size of the cannabis market, between 57 and 60%, depending upon the method. Conclusions. According to these estimates, consumers' average annual expenditure on cannabis is around €202 in France, compared to estimates obtained for New Zealand and Holland (€124) and the United States (€362).
Are we becoming more alike? Comparison of substance use in Australia and the United States as seen in the 1995, 1998, 2001 and 2004 national household surveys
Authors: MAXWELL JANE CARLISLE 
Published: August 2008

AbstractIntroduction. This paper reports the results of the 1995, 1998, 2001 and 2004 Australian and US household surveys, with emphasis on changes since 2001. Design and Methods. The US survey data were recalculated to match age groups in the Australian data. Statistically significant changes are reported. Differences in prevalence of use by gender within age group were tested for significance. Results. The past‐year use of ‘any illicit drug’, cannabis, cocaine, tranquillisers and injecting drugs decreased between 2001 and 2004 in Australia, but remained stable for all these drugs except ecstasy between 2002 and 2004 in the United States. The use of hallucinogens decreased in both countries. Alcohol and use of many illicit drugs by teenage girls in both countries increased to rates similar to or higher than boys, and teens in both countries reported binge and heavy drinking in the past month. Australians in their 20s had the highest rates of use, but in the United States, past‐year use of many drugs was highest among teenagers. Discussion. More treatment services are needed, particularly for people dependent upon non‐opiate drugs. The changes in acceptability of use of different drugs and their perceived availability are related to changes in prevalence rates. Even with the similarities in levels of use, there are differences in patterns of use and preferences for certain drugs in each country, and geographic proximity to drug sources is a factor.
Estimating the prevalence of individuals likely to use publicly funded alcohol treatment services: an indirect estimation technique
Authors: CLEMENS SUSAN L. , RITTER ALISON 
Published: August 2008

AbstractIntroduction and Aims. Determining prevalence estimates of illicit or stigmatised behaviours is problematic, due to under‐reporting and difficulties in sampling adequately populations most at risk of engaging in such behaviours. This has led to the development of indirect prevalence estimation techniques such as multiplier methods, capture–recapture, multivariate indicator methods and back‐calculation. This study reports on the development of a treatment multiplier to estimate the number of clients estimated to seek treatment through publicly funded services annually. Design and Methods. This study uses a multiplier method of indirect prevalence estimation, using the number of clients receiving publicly funded treatment as the benchmark population. Data for the multiplier were collected through a drug and alcohol telephone information and referral helpline. Participants are callers seeking assistance for their own alcohol use. Results. Results indicate that up to 40 200 individuals (95% confidence interval: 34 900, 47 000) may seek treatment at these agencies annually. This estimate represents a 300% increase in current publicly funded treatment provision. Discussion and Conclusion. This method was cost‐effective and resulted in estimates similar to those obtained through a population‐based survey. This method can be adapted easily to areas with a complete registry of clients receiving publicly funded alcohol or drug treatment services and a helpline service with adequate geographic coverage.
Three exploratory studies of college theme parties
Authors: CLAPP JOHN D. , KETCHIE JULIE M. , REED MARK B. , SHILLINGTON AUDREY M. , LANGE JAMES E. , HOLMES MEGAN R. 
Published: August 2008

AbstractIntroduction and Aims. The objectives of this exploratory research were to (1) explore the characteristics and risks associated with college theme parties, (2) assess differences in risk associated with college theme parties compared to non‐theme parties and (3) to assess differences in risk associated with risqué theme parties as compared to non‐risqué theme parties. Design and methods. We used a mixed methods design. Results are presented from three exploratory studies of alcohol consumption in college theme parties: (1) four qualitative focus groups of students who have attended such events, (2) a web‐based survey and (3) a multi‐level (observational, survey, breath blood alcohol samples) study of 226 college parties, 29 of which were themed events. Focus group participants included a convenience sample of 17 college students aged 18–24 years; participants for the web survey included a convenience sample of 407 college students; participants for the multi‐level study of college parties included 1725 randomly selected individuals at college parties. Results. Themes tended to be highly sexualised. Compared to non‐themed parties, theme parties have been observed to be more rowdy, louder, involve drinking games, feature kegs and feature hard liquor. Discussion and Conclusions. Themed parties are associated with heavy drinking and are consistent with environments sought by heavy drinkers. As a result, themed parties are marked by a greater number of alcohol‐related problems. Further research is needed to understand more clearly the risks involved in themed and risqué themed events.
Alcohol advertising in the New Zealand university student press
Authors: COUSINS KIM , KYPRI KYPROS 
Published: August 2008

AbstractUniversity students drink more heavily than their non‐student peers in New Zealand. The promotion of alcohol via advertising is a known contributor to heavy drinking. The aim of this paper was to determine the nature and extent of alcohol‐related advertising and related policies at New Zealand universities. We sought to obtain all issues for 2005, of student newspapers at five New Zealand universities that had participated in an ongoing research project examining alcohol‐related harm. The number of alcohol‐related advertisements was determined and counts were weighted by the proportion of the page they took up. We surveyed senior university administrators to determine whether policies existed to regulate alcohol advertising on campus. The number of alcohol‐related advertisements in student publications ranged from 1 to 129 across the academic year (median: 74 advertisements, 34 full‐page equivalents). At three universities, most advertisements promoted bars, pubs and restaurants, while at the other two universities, most alcohol‐related advertising was for events sponsored by a brewery, alcohol company or local pub. At one university with almost no advertising, a brewery sponsorship agreement with the student association forbade other parties from advertising alcohol and related events. Alcohol‐related advertising is pervasive in the New Zealand university student press. Student associations should consider the ethics of alcohol industry sponsorship in light of the high prevalence of heavy drinking in this population group.
Drugs and pregnancy—outcomes of women engaged with a specialist perinatal outreach addictions service
Authors: MAYET SORAYA , GROSHKOVA TEODORA , MORGAN LOUISE , MacCORMACK TRACEY , STRANG JOHN 
Published: August 2008

AbstractSubstance misuse during pregnancy may result in harm to both mother and child. The aims of this study were to assess changes in outcomes of women seen by a specialist perinatal addictions outreach service (1989–1991 versus 2002–2005) and compare outcomes to the local hospital maternity population (2004–2005). A cross‐sectional audit of health‐care records was conducted comparing the outcomes of women in 2002–2005 with earlier data from 1989–1991 and the local maternity population (2004–2005). The service was attended by 126 women, of whom 83% of opioid‐dependent women started/continued opioid maintenance treatment. Of 118 babies delivered, there were two stillbirths and one early neonatal death, 20% were premature, 28% were low birth weight, 21% required the Special Care Baby Unit and 21% of babies born to opioid‐dependent mothers were treated for neonatal abstinence syndrome (NAS). Fewer babies required treatment for NAS in 2002–2005 compared to 1989–1991 (21% versus 44%). There were higher rates of miscarriage (3% versus <1%), low birth weight (28% versus 9%) and premature babies (20% versus 9%) compared to the local maternity population (2004–2005). Integrated perinatal addictions treatment may deliver benefits; however, engaging women into treatment earlier and reducing substance use before conception remains the objective.
Management of acute pain in methadone maintenance therapy in‐patients
Authors: HINES SUSAN , THEODOROU STAN , WILLIAMSON ANNA , FONG DAMIAN , CURRY KENNETH 
Published: August 2008

AbstractMethadone maintained treatment (MMT) patients may be given less opioid analgesia for acute pain than the general patient, due to requests for analgesia being misinterpreted as craving for drugs. Pain studies have showed that MMT patients have hyperalgesic responses and that cross‐tolerance to opioids may be present, suggesting that they may need more analgesia than the non‐MMT patient. This study compares the pain management of MMT patients and controls during an acute hospital stay. It is a retrospective study of MMT in‐patients and controls matched for medical condition, age and gender, comparing the analgesia given and pain stated in hospital notes. Patients with a chronic pain condition were excluded. MMT patients and controls did not differ in relation to median morphine dose received or average number of pain reports per day, and only a small proportion of both groups engaged in drug‐seeking behaviour. Behavioural problems were significantly more common among MMT patients (39% versus 5%, p < 0.001). The fact that the opioid doses were not significantly different between subjects and controls seems to contradict the experimental evidence that patients on methadone tend to be hyperalgesic. Alternatively, MMT patients may be hyperalgesic, and statistically equal levels of opioid analgesia given to both groups may indicate an effective under‐treatment of pain in the hyperalgesic MMT group. Inadequate analgesia may contribute to both behavioural problems and premature discharge. Resolving these uncertainties will require prospective studies.