bluuebunny/crossref_metadata_2025_split huggingface dataset:
A prospective randomised controlled trial of the Kiwi Omnicup versus conventional ventouse cups for vacuum‐assisted vaginal delivery
Authors: Groom KM , Jones BA , Miller N , Paterson‐Brown S 
Published: January 2006

Objective  To evaluate the performance and safety of the Kiwi Omnicup and compare it to conventional vacuum cups in routine clinical practice.Design  A randomised controlled trial of the Kiwi Omnicup versus conventional vacuum cups.Setting  Queen Charlotte's and Chelsea Hospital, a tertiary referral hospital in London from April 2001 to March 2004.Population  Women requiring assisted vaginal delivery by ventouse.Methods  Women were randomised to the Kiwi Omnicup (n = 206) or conventional vacuum cups (n = 198). Data regarding maternal demographics, labour, mode of delivery and maternal and neonatal outcome were collected.Main outcome measures  Failure of delivery with instrument of first choice.Results  The Kiwi Omnicup was less successful at delivery with instrument of first choice than the conventional ventouse, failure rate 30.1 versus 19.2% (RR 1.58; 95% CI 1.10–2.24). It was associated with a greater number of cup detachments (mean 0.68 compared with 0.28, with 44% compared with 18% having at least one detachment [P < 0.0001]). There was no difference in the incidence of severe maternal trauma, and there were no cases of serious neonatal injury.Conclusions  The Kiwi Omnicup is less successful than conventional ventouse in achieving vaginal delivery, but its safety profile is comparable.
Does the angle of episiotomy affect the incidence of anal sphincter injury?*
Authors: Eogan M , Daly L , O'Connell PR , O'Herlihy C 
Published: January 2006

Objective  Mediolateral episiotomy is associated with lower rates of significant perineal tears than midline episiotomy. However, the relationship between precise angle of episiotomy from the perineal midline and risk of third‐degree tear has not been established. This study quantifies this relationship.Design  Case–control study.Setting  National Maternity Hospital, Dublin, Ireland.Sample  One hundred primiparous women who had undergone right mediolateral episiotomy 3 months previously.Methods  Two groups of primiparous women were compared. Cases had sustained clinically apparent anal sphincter injury during delivery, while controls had not. The angle of episiotomy measured from the midline was marked on a superimposed sheet of transparent plastic film and measured using a protractor. Data were analysed using Student's t test, chi‐square test and logistic regression analysis.Main outcome measures  Angle of mediolateral episiotomy from the perineal midline.Results  Fifty‐four cases and 46 controls were assessed. Cases were more likely to have undergone assisted delivery and consequently to have been delivered by an obstetrician than by a midwife. The mean angle of episiotomy measured significantly smaller in cases (30°, 95% CI 28–32°) than in controls (38°, 95% CI 35–41°; P < 0.001). Analysis showed a 50% relative reduction in risk of sustaining third‐degree tear for every 6° away from the perineal midline that an episiotomy was cut.Conclusions  These results show that a larger angle of episiotomy is associated with a lower risk of third‐degree tear and mediolateral episiotomy incisions should be made at as large an angle as possible to minimise the risk of sphincter disruption.
New postnatal urinary incontinence: obstetric and other risk factors in primiparae
Authors: Glazener CMA , Herbison GP , MacArthur C , Lancashire R , McGee MA , Grant AM , Wilson PD 
Published: January 2006

Objective  To identify obstetric and other risk factors for urinary incontinence that occurs during pregnancy or after childbirth.Design  Questionnaire survey of women.Setting  Maternity units in Aberdeen (Scotland), Birmingham (England) and Dunedin (New Zealand).Population  A total of 3405 primiparous women with singleton births delivered during 1 year.Methods  Questionnaire responses and obstetric case note data were analysed using multivariate analysis to identify associations with urinary incontinence.Main outcome measures  Urinary incontinence at 3 months after delivery first starting in pregnancy or after birth.Results  The prevalence of urinary incontinence was 29%. New incontinence first beginning after delivery was associated with older maternal age (oldest versus youngest group, OR 2.02, 95% CI 1.35–3.02) and method of delivery (caesarean section versus spontaneous vaginal delivery, OR 0.28, 95% CI 0.19–0.41). There were no significant associations with forceps delivery (OR 1.18, 95% CI 0.92–1.51) or vacuum delivery (OR 1.16, 95% CI 0.83–1.63).Incontinence first occurring during pregnancy and still present at 3 months was associated with higher maternal body mass index (BMI > 25, OR 1.68, 95% CI 1.16–2.43) and heavier babies (birthweight in top quartile, OR 1.56, 95% CI 1.12–2.19). In these women, caesarean section was associated with less incontinence (OR 0.39, 95% CI 0.27–0.58) but incontinence was not associated with age.Conclusions  Women have less urinary incontinence after a first delivery by caesarean section whether or not that first starts during pregnancy. Older maternal age was associated with new postnatal incontinence, and higher BMI and heavier babies with incontinence first starting during pregnancy. The effect of further deliveries may modify these findings.
Altered placental syncytin and its receptor ASCT2 expression in placental development and pre‐eclampsia
Authors: Chen C‐P , Wang K‐G , Chen C‐Y , Yu C , Chuang H‐C , Chen H 
Published: January 2006

Objective  To investigate the alterations of syncytin, a fusogenic membrane protein involved in syncytiotrophoblastic layer formation, and its receptor ASCT2 expression in placental development and pre‐eclampsia.Design  Analyses of syncytin and ASCT2 expression in placentas from different stages of pregnancy and women with pre‐eclampsia and in cytotrophoblasts cultured in normoxic and hypoxic conditions.Setting  Placental samples were collected from a tertiary medical centre.Population  Sixteen women with pre‐eclampsia and 58 pregnant women presented as pregnancy (5–19 weeks of gestation) for elective termination, preterm birth, or normal term delivery.Methods  The quantitative real‐time polymerase chain reaction was used to study the syncytin and ASCT2 expression during placental development in 35 placentas from women without pre‐eclampsia (ranged from 5 to 40 weeks of gestation) and the alterations of pre‐eclamptic placentas (n= 16) compared with gestational‐age‐matched controls (n= 16). Western blot analysis was performed to study the protein level of syncytin in pre‐eclamptic placentas and gestational‐age‐matched controls. The hypoxic effect on trophoblastic syncytin and ASCT2 expression was further studied in cytotrophoblasts cultured in 2% oxygen (n= 7).Main outcome measures  Syncytin and ASCT2 messenger RNA (mRNA) in placental tissue and cytotrophoblasts.Results  The level of syncytin mRNA expression increased significantly since the first trimester of pregnancy until 37 weeks of gestation, when the level of syncytin expression was reduced. The ASCT2 mRNA expression was decreased significantly since the second trimester and was relatively stable since then to 40 weeks of gestation. Furthermore, a significant reduction in syncytin mRNA expression was observed in pre‐eclamptic placentas and cytotrophoblasts cultured in hypoxia, but not a reduction in ASCT2 mRNA expression. Correlatively, the protein level of syncytin was decreased in pre‐eclamptic placentas.Conclusions  A reduced placental expression of syncytin but not ASCT2 may contribute to altered cytotrophoblastic cell fusion processes and disturbed placental function in pre‐eclampsia. Correspondingly, hypoxia decreases syncytin but not ASCT2 gene expression in cultured cytotrophoblasts.
Occult anal sphincter injuries—myth or reality?
Authors: Andrews Vasanth , Sultan Abdul H , Thakar Ranee , Jones Peter W 
Published: January 2006

Objectives  To establish the true prevalence of clinically recognisable and occult obstetric anal sphincter injuries (OASIS).Design  Prospective interventional study.Setting  Busy district general hospital.Sample  Two hundred and fifty‐four women having their first vaginal delivery over a 12‐month period were invited. Two hundred and forty‐one (95%) participated and 208 (86%) attended follow up.Methods  Women had a clinical examination at delivery by the accoucheur and repeated by an experienced research fellow immediately after delivery. All identified OASIS were verified and repaired by the duty specialist registrar or consultant. Endoanal ultrasound was performed immediately postpartum prior to suturing and repeated seven weeks later.Main outcome measures  Prevalence of recognised and occult anal sphincter injuries.Results  Fifty‐nine (24.5%) women sustained OASIS. The prevalence of OASIS increased significantly from 11% to 24.5% when women were re‐examined. Of these, 30 occurred in deliveries by midwives who missed 26 (87%) and 29 following deliveries by doctors who missed 8 (28%) injuries. All clinically apparent OASIS were also identified on endoanal ultrasound. In addition, three (1.2%) women had an occult anal sphincter injury. Two of these occult sphincter injuries were isolated to the internal anal sphincter (IAS) and would not usually be clinically detectable.Conclusions  OASIS occur more frequently than previously reported. Many remain undiagnosed and are subsequently classified as occult when identified on anal endosonography. Genuine occult injuries are rare. Training in perineal anatomy and recognition of OASIS needs to be enhanced in order to increase detection of OASIS and minimise the risk of consequent anal incontinence.
Does training in obstetric emergencies improve neonatal outcome?
Authors: Draycott Tim , Sibanda Thabani , Owen Louise , Akande Valentine , Winter Cathy , Reading Sandra , Whitelaw Andrew 
Published: January 2006

Objectives  To determine whether the introduction of Obstetrics Emergency Training in line with the recommendations of the Clinical Negligence Scheme for Trusts (CNST) was associated with a reduction in perinatal asphyxia and neonatal hypoxic–ischaemic encephalopathy (HIE).Design  A retrospective cohort observational study.Setting  A tertiary referral maternity unit in a teaching hospital.Population  Term, cephalic presenting, singleton infants born at Southmead Hospital between 1998 and 2003 were identified; those born by elective Caesarean sections were excluded.Method  Five‐minute Apgar scores were reviewed. Infants that developed HIE were prospectively identified throughout this period. The study compared the period ‘pre‐training’ (1998–1999), with the period ‘post‐training’ (2001–2003).Main outcome measures  Five‐minute Apgar scores and HIE.Results  Infants (19,460) were included. Infants born with 5‐minute Apgar scores of ≤6 decreased from 86.6 to 44.6 per 10,000 births (P < 0.001) and those with HIE decreased from 27.3 to 13.6 per 10,000 births (P= 0.032) following the introduction of the training courses in 2000. Antepartum and intrapartum stillbirth at term rates remained unchanged, at about 15 and 4 per 10,000 births, respectively.Conclusion  The introduction of obstetric emergencies training courses was associated with a significant reduction in low 5‐minute Apgar scores and HIE. This improvement has been sustained as the training has continued. This is the first time an educational intervention has been shown to be associated with a clinically important, and sustained, improvement in perinatal outcome.
The prevalence of major abnormalities of the levator ani in urogynaecological patients
Authors: Dietz HP , Steensma AB 
Published: January 2006

Objectives  While morphological abnormalities of the pubovisceral muscle have been described on magnetic resonance imaging (MRI), their relevance remains unclear. This study was designed to define prevalence and clinical significance of such abnormalities in urogynaecological patients.Design  Prospective observational study.Setting  Tertiary urogynaecological clinic.Population  Three hundred and thirty‐eight consecutive women referred for urodynamic assessment.Methods  Participants underwent a clinical assessment, multichannel urodynamics and imaging with 3D translabial ultrasound. Blinded offline analysis was performed with the software 4D View (GE Kretztechnik, Zipf, Austria).Main outcome measures  Major morphological abnormalities of the pubovisceral muscle.Results  Defects of the pubovisceral muscle were found in 15.4% of parous women. They were exclusively anteromedial (uni‐ or bilateral), only occurred among women who had delivered vaginally and were associated with anterior and central compartment prolapse (all P < 0.001). There was no association with symptoms of bladder dysfunction or urodynamic findings.Conclusions  Major morphological abnormalities of the pubovisceral muscle are common in parous urogynaecological patients. They are associated with prolapse of the anterior and central compartment, but not with symptoms of bladder dysfunction or urodynamic findings.
How Did Welfare Reform Affect the Health Insurance Coverage of Women and Children?
Authors: Cawley John , Schroeder Mathis , Simon Kosali I. 
Published: January 2006

Objective. To measure the change in U.S. women and children's health insurance coverage as a result of welfare reform (i.e. the creation of Temporary Assistance for Needy Families or TANF) in 1996.Data Source. 1992–1999 longitudinal data from the Survey of Income and Program Participation (SIPP) merged with data on the timing of state implementation of welfare reform after 1996. Two key advantages of the SIPP data are that they permit matching type of insurance coverage to the welfare policy environment in each state in each month, and permit controlling for individual‐level fixed effects.Study Design. We measure how much insurance coverage changed after welfare reform using a difference in differences method that eliminates the influence of time‐invariant unobserved individual heterogeneity and of statewide trends in insurance coverage. Models also control for individual, state, and year fixed effects, individual‐level characteristics such as education, age, and number of children, plus state‐level variables such as real per capita income, real minimum wage, and Medicaid eligibility.Data Collection/Extraction Methods. We limit our analysis to the SIPP data specific to the month just completed prior to the interview; as a result, we have up to twelve observations for each individual in the SIPP. This paper uses pooled data from the 1992–1996 panels of the SIPP covering the period 1992–1999. Publicly available state identifiers permit the merger of state policies and macroeconomic variables with the SIPP.Principal Findings. TANF implementation is associated with an 8.1 percent increase in the probability that a welfare‐eligible woman was uninsured. Welfare reform had less of an impact on the health insurance coverage of children. For example, TANF implementation was associated with a 3.0 percent increase in the probability that a welfare‐eligible child lacked health insurance.Conclusions. An unintended consequence of welfare reform was to adversely impact the health insurance coverage of economically vulnerable women and children, and that this impact was several times larger than the previous literature implies.
Religious Involvement and the Use of Mental Health Care
Authors: Harris Katherine M. , Edlund Mark J. , Larson Sharon L. 
Published: January 2006

Objectives. To examine the association between religious involvement and mental health care use by adults age 18 or older with mental health problems.Methods. We used data from the 2001–2003 National Surveys on Drug Use and Health. We defined two subgroups with moderate (n=49,902) and serious mental or emotional distress (n=14,548). For each subgroup, we estimated a series of bivariate probit models of past year use of outpatient care and prescription medications using indicators of the frequency of religious service attendance and two measures of the strength and influence of religious beliefs as independent variables. Covariates included common Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, disorders symptoms, substance use and related disorders, self‐rated health status, and sociodemographic characteristics.Results. Among those with moderate distress, we found some evidence of a positive relationship between religious service attendance and outpatient mental health care use and of a negative relationship between the importance of religious beliefs and outpatient use. Among those with serious distress, use of outpatient care and medication was more strongly associated with service attendance and with the importance of religious beliefs. By contrast, we found a negative association between outpatient use and the influence of religious beliefs on decisions.Conclusion. The positive relationship between religious service participation and service use for those with serious distress suggests that policy initiatives aimed at increasing the timely and appropriate use of mental health care may be able to build upon structures and referral processes that currently exist in many religious organizations.
Operational Failures and Interruptions in Hospital Nursing
Authors: Tucker Anita L. , Spear Steven J. 
Published: January 2006

Objective. To describe the work environment of hospital nurses with particular focus on the performance of work systems supplying information, materials, and equipment for patient care.Data Sources. Primary observation, semistructured interviews, and surveys of hospital nurses.Study Design. We sampled a cross‐sectional group of six U.S. hospitals to examine the frequency of work system failures and their impact on nurse productivity.Data Collection. We collected minute‐by‐minute data on the activities of 11 nurses. In addition, we conducted interviews with six of these nurses using questions related to obstacles to care. Finally, we created and administered two surveys in 48 nursing units, one for nurses and one for managers, asking about the frequency of specific work system failures.Principal Findings. Nurses we observed experienced an average of 8.4 work system failures per 8‐hour shift. The five most frequent types of failures, accounting for 6.4 of these obstacles, involved medications, orders, supplies, staffing, and equipment. Survey questions asking nurses how frequently they experienced these five categories of obstacles yielded similar frequencies. For an average 8‐hour shift, the average task time was only 3.1 minutes, and in spite of this, nurses were interrupted mid‐task an average of eight times per shift.Conclusions. Our findings suggest that nurse effectiveness can be increased by creating improvement processes triggered by the occurrence of work system failures, with the goal of reducing future occurrences. Second, given that nursing work is fragmented and unpredictable, designing processes that are robust to interruption can help prevent errors.
‘Healthy Types of Young Danes’: Australia's Unwilling Post‐War Migrants
Authors: Kristensen Jeppe 
Published: January 2006

AbstractFollowing the Second World War the Chifley government initiated an ambitious new immigration programme, which would dramatically alter the make‐up of Australian society. This article focuses on the initial Australian preference for white‐skinned migrants from Scandinavia, and the response of one of those countries – Denmark – to the Australian recruiting drive. It examines the official Danish resistance to Australian migration initiatives, and the way in which Australia was portrayed in Denmark. It is argued that the migrant issue went further than economic opportunity, and can be understood in terms of a discursive clash between dominant national myths in the respective countries – with Australia as a natural haven for energetic, opportunity‐seeking Europeans, and Denmark as a humane, sophisticated welfare state that took care of its citizens from cradle to grave. Understanding how alternative, non‐British sources of white immigration dried up in the post‐war era is a hitherto neglected context for understanding Australia's gradual retreat from the ‘white Australia’ immigration policy.
The Question of Economic Decline in Seventeenth‐Century Italy: Myth or Reality?
Authors: D’Amico Stefano 
Published: January 2006

AbstractWas the Italian economic crisis of the seventeenth century an irreversible decline or a readjustment of the socio‐economic structures? Did the prosperous Italian cities lose forever their economic role or were they able to adapt to the changing demands of the international markets? This article examines the main phases of the historiographical debate on these issues from its beginning in the 1950s to the most recent developments.
Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review
Authors: Brezo J. , Paris J. , Turecki G. 
Published: January 2006

Objective:  Involvement of personality traits in susceptibility to suicidality has been the subject of research since the 1950s. Because of the diversity of conceptual and methodological approaches, the extent of their independent contribution has been difficult to establish. Here, we review conceptual background and empirical evidence investigating roles of traits in suicidal behaviors.Method:  We selected original studies published in English in MEDLINE and PsycINFO databases, focusing on suicidal ideation, suicide attempts, or suicide completions, and using standardized personality measures.Results:  Most studies focused on investigating risk for suicide attempts. Hopelessness, neuroticism, and extroversion hold the most promise in relation to risk screening across all three suicidal behaviors. More research is needed regarding aggression, impulsivity, anger, irritability, hostility, and anxiety.Conclusion:  Selected personality traits may be useful markers of suicide risk. Future research needs to establish their contributions in relation to environmental and genetic variation in different gender, age, and ethnocultural groups.
The ductus venosus and intrahepatic venous system in Callithrix jacchus jacchus and Macaca fascicularis fetuses
Authors: Tchirikov Michael , Schlabritz‐Loutsevitch Natalia E. , Hubbard Gene B. , Tardif Suzette , Schröder Hobe J. , Nathanielsz Peter W. 
Published: January 2006

AbstractBackground The ductus venosus (DV) and the intrahepatic branches of the portal vein are arranged as parallel vessels. Blood shunting through the DV ensures fetal survival during periods of stress. The availability of a suitable animal model with similar structure and function to the human fetus would greatly improve the understanding of DV function. The anatomical and histological structure of the DV has not been thoroughly investigated in non‐human primate species.Methods Morphological investigations were performed on eight marmoset (Callithrix jacchus jacchus) at 112.5 ± 5.5 days gestational age (mean ± SEM) and four near‐term (165 days) cynomolgus (Macaca fascicularis) fetuses.Results The DV drains into the collectus venosus. An asymmetrical muscular lip forms a contractile element of the isthmic portion of the DV. A spherical ‘dividing’ eminence was found on the dorsal wall of the venous collector just above the outlet of the DV in marmoset fetuses.Conclusions Our findings regarding the structure of the DV in cynomolgus and marmoset fetuses were generally in agreement with previous descriptions of the morpho‐histological structure of the DV in human fetuses.