bluuebunny/crossref_metadata_2025_split huggingface dataset:
Standards for the management of cervical and vulval carcinoma
Authors: D'Arcy Thomas J. , Roy Amy , Thomas Anna , McIndoe Angus , Soutter W. P. 
Published: August 2005

Objective
To examine the feasibility of achieving designated target standards for the management of women with cervical and vulval cancer.Design
Retrospective casenote review.Setting
The Gynaecological Oncology Centre at Hammersmith Hospital, London.Population
Sixty‐one women with cervical and vulval cancer presenting to the gynaecological oncology clinic at the Hammersmith Hospital during 1996 and 1997. Various aspects of the management of those women were compared with standards suggested by a multidisciplinary panel of local experts. Targets included the referral and treatment process, the accuracy of staging, and measures of surgical performance.Results
The target interval of seven days between receipt of the referral and the first visit at the cancer centre was achieved in 93% of women. Surgical treatment was administered to 92% of the women within the target of 20 working days from the first clinic appointment. Tumour close to or involving the margins of the specimen was noted in 13% of cervical and 9% of vulval cancers. The node count fell below the target standards in 13% of pelvic and 10% of groin dissections. Appropriate imaging investigations for staging were not undertaken in 15 of 39 cases (38%) of cervical cancer and in 5 out of 22 (23%) of vulval cancers.Conclusion
The suggested targets of process and surgical performance are reasonable and achievable. These standards would be appropriate for national use. The area most clearly identified where these targets were not achieved was the requesting of complementary staging investigations. This could be addressed by the use of a simple investigation protocol to be included in each patient's notes and available at specialist clinics and gynaecology wards.
Anal sphincter tears: prospective study of obstetric risk factors
Authors: Samuelsson E. , Ladfors L. , Wennerholm U. B. , Gåreberg B. , Nyberg K. , Hagberg H. 
Published: August 2005

Objective
To evaluate intrapartum risk factors for anal sphincter tear.Design
A prospective observational study.Setting
Delivery unit at the University Hospital in Göteborg, Sweden.Participants
2883 consecutive women delivered vaginally during the period between 1995 and 1997. Information was obtained from patient records and from especially designed protocols which were completed during and after childbirth.Main outcome measures
Anal sphincter (third and fourth degree) tear.Results
Anal sphincter tear occurred in 95 of 2883 women (3.3%). Univariate analysis demonstrated that the risk of anal sphincter tear was increased by nulliparity, high infant weight, lack of manual perineal protection, deficient visualisation of perineum, severe perineal oedema, long duration of delivery and especially protracted second phase and bear down, use of oxytocin, episiotomy, vacuum extraction and epidural anaesthesia. After analysis with stepwise logistic regression, reported as odds ratio, 95% confidence interval, the following factors remained independently associated with anal sphincter tear: slight perineal oedema (0.40, 0.26–0.64); manual perineal protection (0.49, 0.28–0.86); short duration of bear down (0.47, 0.24–0.91); no visualisation of perineum (2.77, 1.36–5.63); parity (0.59, 0.40–0.89); and high infant weight (2.02, 1.30–3.16). Analysis of variance showed that manual perineal protection had a stronger influence on lowering the frequency, and lack of visualisation of perineum and infant weight had a stronger influence on raising the frequency, of anal sphincter tears in nulliparous compared with parous women.Conclusions
Perineal oedema, poor ocular surveillance of perineum, deficient perineal protection during delivery, protracted final phase of the second stage, parity and high infant weight all constitute independent risk factors for anal sphincter tear. Such information is essential in order to reduce perineal trauma during childbirth.
Patterns in the incidence of age‐related ovarian cancer in South East England 1967–1996
Authors: Olaitan Adeola , Mocroft Amanda , Jacobs Ian 
Published: August 2005

Objective
To study the age‐related trends in the incidence rates of ovarian cancer in South East England between 1967 and 1996.Design
A retrospective review of systematically collected data on ovarian cancer in South East England.Methods
Data were obtained from the Thames Cancer Registry on the numbers and rates per 100,000 population of ovarian cancer per five‐year age group (0–85+) in the 30‐year period from 1967 to 1996 from the 26 health authorities in the Thames region. Linear regression was performed to determine the changes in incidence rates of ovarian cancer per age group over time.Main outcome measures
The change in overall incidence of ovarian cancer in South East England, as well as the change in incidence of ovarian cancer in each five‐year age groups (20–85+) in the 30‐year study period.Results
There was a strong positive correlation between ovarian cancer rates and year of diagnosis in women aged ≥ 70 years, and this was particularly marked in women > 85 years of age. There was a negative correlation between rates and year of diagnosis in women aged 45–59 years. The analysis did not demonstrate a significant correlation between ovarian cancer rates and year of diagnosis in women < 44 years of age or women aged 60–69 years.Conclusions
There have been significant changes in the pattern of ovarian cancer incidence in South East England during the 30‐year period studied. The observed changes in ovarian cancer incidence in younger women may, in part, be explained by known reproductive factors. The rise in ovarian cancer rates among the older age group is difficult to explain, but has important implications for the future planning and provision of cancer services.
Flatus and faecal incontinence: prevalence and risk factors at 16 weeks of gestation
Authors: Højberg Karen‐Elise , Salvig Jannie Dalby , Winsløw Nitnoi Albertsen , Bek Karl Møller , Laurberg Søren , Secher Niels Jørgen 
Published: August 2005

Objective
To evaluate the prevalence of anal incontinence at 16 weeks of gestation and to identify possible maternal and obstetrical risk factors.Design
Cross sectional study and cohort study.Setting
Department of Obstetrics and Gynaecology, Aarhus University Hospital, Denmark.Participants
Cross sectional study: 7557 women attending antenatal care. Cohort study: a subgroup of 1726 pregnant women with one previous delivery at our department.Results
The prevalence of anal incontinence within the preceding year was 8.6%. Incontinence of liquid and solid stools was reported in 2.3% and 0.6%, respectively. Isolated flatus incontinence at least once a week was reported in 4.2%. The risk of flatus incontinence at least once a week was increased with age > 35 years (OR 1.6; 95% CI 1.1–2.4) and with previous lower abdominal or urological surgery (OR 1.5, 95% CI 1.1–2.1) in a logistic regression model controlling for maternal factors. Increasing parity did not increase the risk. The risk of flatus incontinence was increased after anal sphincter tear and birthweight > 4000 g in a logistic regression model controlling for maternal and obstetric variables. Episiotomy was insignificantly associated, while spontaneous perineal tear > 3 cm and a number of other intrapartum factors were not associated.Conclusion
True faecal incontinence is rare among younger women. However, an age > 35 years and previous lower abdominal or urological surgery increased the risk of flatus incontinence in contrast to increasing parity. This suggests that childbirth plays a minor role compared with age. However, when analysing obstetric variables separately, a birthweight > 4000 g, and anal sphincter tears were significant risk factors for flatus incontinence.
The development and evaluation of a computer‐assisted teaching programme for intrapartum fetal monitoring
Authors: Beckley Sarah , Stenhouse Elizabeth , Greene Keith 
Published: August 2005

Objective
The development and evaluation of a computer‐assisted teaching programme of cardiotocog‐raphy and acid‐base balance.Design
Randomised controlled trial.Participants
One hundred and seventeen midwifery and obstetric staff at Derriford Hospital, Plymouth.Methods
The obstetricians and midwives were randomly allocated to use the teaching programme, either early or late. The late group (control) used the teaching programme three months after the early group. To assess the effect of the teaching programme, participants were tested on four occasions over eight months by a multiple choice questionnaire. Two questionnaires on ease of use were also completed.Main outcome measures
Multiple choice questionnaire scores and opinion questionnaire results.Results
The mean score in the early group improved from 50.8% (test 1, pre‐teaching programme) to 70.2% (test 2, post‐teaching programme). The mean score in the control group was 50.3% (test 1) and 54.8% (test 2). Knowledge was retained up to seven months.Conclusions
The teaching programme was effective in improving knowledge of acid‐base balance and cardiotocography and can be used by all staff whilst on duty on the labour ward.
24 hour rhythm to the onset of preterm labour
Authors: Lindow S. W. , Jha R. R. , Thompson J. W. 
Published: August 2005

Objective
To describe the time of onset of contractions which result in preterm delivery to investigate if there is a diurnal influence.Design
The admission register for the neonatal unit was used to identify admissions for prematurity over a three‐year period. Obstetric case records were then reviewed to obtain the recorded time of onset of contractions when delivery was preceded by spontaneous labour.Setting
A maternity hospital in the United Kingdom.Main outcome measures
The time of onset of spontaneous contractions which result in preterm labour and delivery.Results
Four hundred and twenty‐five women in preterm labour were studied. A significant diurnal rhythm in the timing of onset of contractions was noted with 42% of deliveries occurring in labour which commenced between midnight and 0600 hours. Subgroup analysis indicated that there was a significant rhythm in second trimester preterm labours, male and female babies and that this rhythm was present during both the winter and summer months.Conclusion
The periodicity of preterm labour onset demonstrates a rhythm which is similar to the rhythm in the onset of labour at term. Preterm labour most commonly begins between midnight and 0600 hours.
Contraction kinetics of isolated human myometrium during menstrual cycle and pregnancy
Authors: Tchirikov Mikhail , Peiper Ulrich , Schröder Hobe J. 
Published: August 2005

Objective
To investigate the interaction between actin and myosin in the myometrium by studying the contraction kinetics of isolated samples of human myometrium.Design
Experimental and observational cross‐sectional study.Setting
Eppendorf University Hospital, Hamburg.Samples
Myometrium samples were taken from women in the follicular phase (n= 6) or luteal phase (n= 6) of the menstrual cycle and during pregnancy at term (n= 25).Methods
The frequency, extent and rate of force development were determined in spontaneously active myometrial preparations. From a resting force of 2 mN, sustained tonic contractions were induced by K+‐depolarisation (124 mM), or by protein kinase C activation (19.9 μM indolactam). The steady force was reversibly interrupted by rapid length changes (100 Hz sinus vibrations lasting 1 s, 5% of muscle length). Extent (steady plateau), as well as rate of force increase after cessation of vibrations, were derived from bi‐exponential functions fitted to the time course of force recovery.Results
Frequency of spontaneous contractions was higher in the follicular phase [mean (SD) 18.3 contractions/hour (1.0)] than in the luteal phase [13.4 contractions/hour (8.1)] or in pregnancy at term [8.8 contractions/hour (7.6)]. During indolactam treatment, steady force in pregnancy at term was significantly increased [8.8 mN (4.0)], compared with the follicular phase [3.7 mN (0.9)]. Force recovery was distinctly slower in pregnancy at term during indolactam treatment [time constant 99.2 s (57.9); P < 0.005] than during K+‐depolarisation [time constant 29.1 s (5.9)], whereas in the follicular phase the rate of force recovery was faster with indolactam [16.8 s (7.1)] than with K+ depolarisation [24.4 s (5.9); P < 0.005].Conclusions
The responses of human myometrium to contraction stimuli differ according to the reproductive state. Membrane depolarisation causes similar responses in all myometrial strips. In contrast, near term stimulation of protein kinase C generates a large tonic force and slow contraction kinetics, whereas early in the menstrual cycle contraction kinetics are fast.
Plasma from women with pre‐eclampsia induces an in vitro alteration in the endothelium‐dependent behaviour of myometrial resistance arteries
Authors: Hayman Richard , Warren Averil , Brockelsby Jerry , Johnson Ian , Baker Philip 
Published: August 2005

Objective
To compare the in vitro effect of plasma from normal pregnant women and women with pre‐eclampsia on the endothelium‐dependent behaviour of myometrial resistance arteries from normal pregnant women.Design
An in vitro comparative study.Setting
Nottingham City Hospital.Sample
Uterine biopsy specimens were obtained from normal pregnant women delivered by elective caesarean section at term. Plasma was collected from nulliparous women with pre‐eclampsia (n= 18), and from multiparous normal pregnant women (n= 18), all samples being matched for maternal age and gestation at venepuncture. Pools of plasma from women with pre‐eclampsia and normal pregnant women were formed from these samples and were used in all the experiments.Methods
Myometrial resistance vessels obtained from the uterine biopsies were incubated with normal pregnant plasma, plasma from women with pre‐eclampsia, or without plasma. Wire myography was employed to study the effect of plasma on the endothelium‐dependent behaviour of these vessels.Results
Incubation of vessels from normal pregnant women with plasma from women with pre‐eclampsia resulted in a significant reduction in endothelium‐dependent relaxation, compared with vessels incubated either with plasma from normal pregnant women or without plasma. This alteration in endothelial function occurred after an incubation period of one hour and required a threshold concentration for its effect to become established. Removal of the vascular endothelium abolished these changes in vessel behaviour. There were no plasma‐induced alterations in the endothelium‐independent behaviour of the vascular smooth muscle.Conclusions
This study supports the hypothesis that plasma from women with pre‐eclampsia is capable of altering endothelium‐dependent myometrial relaxation in vessels from pregnant women.
Physical health problems after childbirth and maternal depression at six to seven months postpartum
Authors: Brown Stephanie , Lumley Judith 
Published: August 2005

Objective
To investigate the relationship between maternal physical and emotional health problems six to nine months after childbirth.Design
Statewide postal survey, incorporating the Edinburgh Postnatal Depression Scale, distributed to women six to seven months after childbirth, with telephone interview follow up of a sub‐sample of participants at seven to nine months postpartum.Participants
The postal survey was distributed to all women who gave birth in a two‐week period in Victoria, Australia in September 1993, except those who had a stillbirth or known neonatal death. Follow up interviews were conducted with respondents to the postal survey who provided contact details and expressed interest in participating in further research selected to recruit three groups of equivalent size according to scores on the Edinburgh Postnatal Depression Scale: a low scoring group (< 9); a borderline group (9–12); and a group with scores indicating probable depression (> 13).Results
The response rate to the postal survey was 62.5% (n= 1336). Respondents were representative of the total sample in terms of mode of delivery, parity and infant birthweight; young women, single women and women of non‐English speaking background were under‐represented. The participation rate in telephone follow up interviews was: 89.1% (n= 204), comprising 66 women with an Edinburgh Postnatal Depression Scale score of < 9; 72 women scoring 9–12; and 66 scoring ≥ 13. The point prevalence of depression at six to seven months postpartum was 16.9% (225/1331, 95% CI 14.9–18.9%). Physical and related health problems associated with significantly increased odds of (OR 3.42 [2.2–5.3]); urinary incontinence (OR 2.23 [1.5–3.4]); back pain (OR 2.20 [1.6–3.0]); sexual problems (OR 2.16 [1.6–3.0]); more coughs, colds and minor illnesses than usual (OR 2.78 [1.9–4.1]); bowel problems (OR 1.93 [1.3–2.9]) and relationship difficulties (OR 3.88 [2.8–5.4]). At follow up, three physical health factors were associated with statistically significant linear trends with poorer levels of emotional wellbeing. These were: tiredness (χ2 for linear trend = 12.38, P < 0.001); urinary incontinence (χ2 for linear trend = 5.63, P= 0.02); and more minor illnesses than usual (χ2 for linear trend = 7.94, P= 0.005).Conclusion
The study confirms a link between maternal emotional wellbeing and physical health and recovery in the postnatal period and has important implications for clinical practice. Strategies for encouraging greater disclosure of physical and emotional health problems, assessment of the physical health of recent mothers presenting with depression, and emotional health of recent mothers presenting with other morbidity should be high priorities for all health professionals in contact with mothers in the year following childbirth.
Levonorgestrel‐releasing (20 μg/day) intrauterine systems (Mirena) compared with other methods of reversible contraceptives
Authors: French R. S. , Cowan F. M. , Mansour D. , Higgins J. P. T. , Robinson A. , Procter T. , Morris S. , Guillebaud J. 
Published: August 2005

Objective
To assess the relative contraceptive effectiveness, tolerability and acceptability of the levonorgestrel‐releasing (20 μg per day) intrauterine system (LNG‐20) compared with reversible contraceptive methods in women of reproductive age.Design
A systematic review and meta‐analysis of randomised controlled trials.Identification
Studies were identified through seven databases, and by contacting investigators and organisations working in the contraceptive field.Main outcome measures
Unplanned pregnancy and continuation of contraceptive method.Results
Five of the seven randomised controlled trials which met the inclusion criteria were included in the meta‐analyses; four were comparisons of the LNG‐20 intrauterine system with nonhormonal intrauterine devices. LNG‐20 intrauterine systems were compared with intrauterine devices divided into two categories, those > 250 mm3 (Copper T 380 Ag and Copper T 380 A intrauterine devices) and those ≤ 250 mm3 (Nova‐T, Copper T 220C and Copper 200 intrauterine devices). Pregnancy rates for the LNG‐20 intrauterine system users were significantly less likely to become pregnant compared with users of intrauterine devices ≤ 250 mm3, and significantly less likely to have an ectopic pregnancy. LNG‐20 intrauterine system users were more likely to experience amenorrhoea and device expulsion than women using intrauterine devices > 250 mm3. LNG‐20 intrauterine system users were significantly more likely than all the intrauterine device users to discontinue because of hormonal side effects and amenorrhoea. When the LNG‐20 intrauterine system was compared with Norplant‐2, the LNG‐20 users were significantly more likely to experience oligo‐amenorrhoea, but significantly less likely to experience prolonged bleeding and spotting.Conclusions
The effectiveness of the LNG‐20 intrauterine system was similar to or better than other contraceptive methods with which it was compared. Amenorrhoea was the main reason for the discontinuation of the LNG‐20 intrauterine system, usually unnecessarily, since this end‐organ suppression of bleeding is benign, associated with normal oestrogen levels. Women choosing this method should be informed of potential amenorrhoea when having pre‐contraceptive counselling and that absent bleeding may be viewed as a positive outcome.
The effects of family planning education provided to different gender groups
Authors: Özgür Servet , Bozkurt Ali Ihsan , Özçirpici Birgül 
Published: August 2005

Objective
To determine whether women or men should be preferred as the target group of the family planning education.Design
Community trial (educational intervention study).Setting
Three villages having similar characteristics in Gaziantep, Turkey.Population
Currently married women aged between 15–49 and their husbands in these villages.Methods
Family planning education was given only to women in the first village, only to men in the second village and to both women and their husbands in the third village.Main outcome measures
Changes in knowledge, attitudes, the behaviour of married women and their husbands between surveys performed before and after family planning education.Results
Important changes in knowledge, attitudes, and behaviour were determined in all intervention groups after family planning education. The rate of effective contraceptive usage among women using any one of the contraceptive methods described significantly increased in all groups, especially where family planning education was given to both sexes.Conclusions
Family planning education given to one of the couples may easily affect the other. Consistent and regular education is more important than selecting target gender groups for family planning education.
Cervicovaginal fibronectin and cervical length at 23 weeks of gestation: relative risk of early preterm delivery
Authors: Heath V. C. F. , Daskalakis G. , Zagaliki A. , Carvalho M. , Nicolaides K. H. 
Published: August 2005

Objectives
To establish the prevalence of cervicovaginal fetal fibronectin positivity at 23 weeks of gestation in a routine population of singleton pregnancies and determine the relative risk of spontaneous delivery before 33 weeks in women with a fibronectin positive result.Design
Prospective clinical study.Setting
Inner city antenatal clinic.Population
Singleton pregnancies attending for routine antenatal care.Methods
Cervicovaginal fetal fibronectin and cervical length were measured at 23 weeks of gestation. The distribution of fibronectin positivity within subgroups according to maternal characteristics was calculated and the relative risk of spontaneous delivery before 33 weeks was estimated.Main outcome measures
Prevalence of a fibronectin positive result and its relation to cervical length measurement and spontaneous preterm delivery before 33 weeks.Results
Of 5146 women participating in the study, 182 (3.5%) had a fibronectin positive result and 76 (1.5%) had a cervical length of ≤ 15 mm. Fibronectin positive women were more likely to be Afro‐Caribbean in origin, to have had a previous second trimester miscarriage and to have a short cervix. In the 5068 women who were managed expectantly, the significantly independent relative risk of spontaneous delivery at < 33 weeks was 46.2 (95% CI 18.8–113.6), for cervical length of ≤ 15 mm, 8.1 (95% CI 3.8–17.5) for a fibronectin positive result, and 4.4 (95% CI 2.2–9.1) for cigarette smoking.Conclusion
Fibronectin positivity at 23 weeks of gestation provides useful prediction of pregnancies at risk of spontaneous preterm delivery before 33 weeks, with a relative risk that is twice as high as cigarette smoking, but is a sixth of that of cervical length.