bluuebunny/crossref_metadata_2025_split huggingface dataset:
An Early Labor Assessment Program: A Randomized, Controlled Trial
Authors: McNiven Patricia S. , Williams Jack I. , Hodnett Ellen , Kaufman Karyn , Hannah Mary E. 
Published: March 2003

Background:Approximately 31 percent of cesarean deliveries in the United States and Canada are performed for dystocia. The aim of this study was to determine the effectiveness of early labor assessment to reduce cesarean birth rates for low‐risk nulliparous women.Methods:Two hundred and nine low‐risk nulliparous women were randomly allocated to either the early labor assessment group or the direct admission to hospital group. Women in the early labor assessment group were evaluated and, if found to be in false or latent labor, were encouraged to go home or walk before admission to the labor unit. Those in the direct admission group were admitted to the labor unit without an assessment. Data were collected and analyzed about method of delivery, duration of labor, intrapartum interventions, and neonatal well‐being. Women completed an evaluation of their experience in the early postpartum period.Results:Significant decreases occurred in duration of labor, use of epidural analgesia for pain, and use of oxytocin to augment labor in the early labor assessment group. These women evaluated their labor and birth experience more positively than women in the direct admission group. No significant differences were found in the frequency of cesarean section or instrumental vaginal delivery for the two groups.Conclusions:Early labor assessment has the potential to reduce the number of women receiving oxytocin for augmentation, the rate of epidural analgesia for pain relief, and the duration of the active and second stages of labor, and to improve women's evaluations of their labor and birth experiences. (BIRTH 25:1, March 1998)
Maternal Perceptions of Labor with Fetal Monitoring by Pulse Oximetry in a Research Setting
Authors: Arikan Gürkan M. , Haeusler Martin C. H. , Deutsch Maria T. , Greimel Elfriede R. , Dorfer Martha 
Published: March 2003

Objective:
Little research has evaluated maternal experience with fetal pulse oximety for fetal surveillance. The purpose of this study was to compare maternal perceptions of labor with intrapartal cardiotocography with or without fetal pulse oximetry in a research setting.
Methods:
One hundred women with vaginal, vertex deliveries and uncomplicated fetal outcomes were enrolled. The study group was a subset of 50 mothers who had participated in a pulse oximetry trial. The control group of 50 mothers was monitored by cardiotocography only. Both groups were matched for age, parity, weeks of gestation, epidural anesthesia use, and duration of labor. A global measure of maternal perception of labor was established by experience with labor, general attitude toward monitoring devices, satisfaction with monitoring, nursing and medical care, and anxiety, each of which was evaluated separately. The mothers in the study group were also interviewed about aspects related to the fetal pulse oximetry research setting, such as information, movement restriction, discomfort, care, privacy, and safety. The questionnaires were based on a standardized rating scale model, and the interviews were conducted two to four days after delivery. The results were analyzed by chi‐squared, paired t test, and ANOVA.Results: No significant differences were observed between the study and control participants in any parameter concerning the maternal perception of labor. Mothers' experiences with pulse oximetry as assessed by interview was overwhelmingly positive. Conclusions: Fetal monitoring by pulse oximetry in a research setting did not affect maternal perceptions of labor. Mothers' experiences with pulse oximetry were highly positive, suggesting that research in fetal pulse oximetry need not compromise maternal perceptions of labor. (BIRTH 25:3 September 1998)This study received financial support from the Austrian Science Foundation (Grant 9344‐Med), Graz, Austria. 9344‐Med
Breastfeeding Peer Support: Maternal and Volunteer Perceptions from a Randomized Controlled Trial
Authors: Dennis Cindy‐Lee 
Published: March 2003

ABSTRACT: Background: Several studies have demonstrated the positive effects of peer support on various breastfeeding outcomes, but no study has assessed women's and peer volunteers’ views on, or the nature and intensity of, the supportive intervention. The objective of this study was to describe maternal and peer volunteer perceptions of their experience while participating in a breastfeeding peer support trial.Methods: A randomized controlled trial was conducted to evaluate the effect of telephone‐based peer (mother‐to‐mother) support on breastfeeding duration. Two hundred and fifty‐six primiparous breastfeeding women were randomly allocated to receive either conventional care or conventional care plus peer support. Three primary outcome measures were peer volunteer activity logs, maternal perceptions of peer support, and evaluations of the peer volunteer experience.Results: Questionnaires were completed by 98.5 percent (n=130) of the mothers in the peer support group. Mothers reported their peer volunteers were available when difficulties were experienced, increased their confidence, decreased their concerns, and assisted them in reaching their breastfeeding goals. These supportive interactions resulted in 81.5 percent of mothers (n=106) being satisfied with their peer support experience and suggesting that every new mother should be offered this intervention. Similarly, all the peer volunteers interviewed (n=30) viewed their experience positively. They suggested some intervention modifications as follows: ensure that mothers enrolled in the program want peer support; provide peer volunteers with ongoing educational sessions and opportunities to ‘‘socialize'’ with other volunteers; and disseminate the results of peer support efforts.Conclusions: Both mothers and peer volunteers perceived their intervention experiences positively. Whereas maternal satisfaction was related to the number and duration of peer volunteer contacts, peer volunteers enjoyed their training session and the opportunity to assist mothers for a variety of reasons. Specific intervention modifications should be implemented to enhance peer volunteer satisfaction and retention. (BIRTH 29:3 September 2002)
Decreased Prevalence of Helicobacter pylori Infection in Gastroesophageal Reflux Disease
Authors: Varanasi Ravikant V. , Fantry George T. , Wilson Keith T. 
Published: March 2003

Background. An increased incidence of reflux esophagitis has been reported after eradication of H. pylori in patients with duodenal ulcer. To determine if H. pylori is associated with lower rates of esophagitis, we studied the prevalence of H. pylori infection in patients with and without reflux esophagitis and a subgroup of patients with concomitant peptic ulcer disease. Methods. Patients who underwent esophagogastroduodenoscopy and had diagnostic testing for H. pylori over a 30‐month period were studied. H. pylori infection was determined by rapid urease testing, gastric histopathology, or serology. Reflux esophagitis was determined by endoscopic and/or histologic criteria. Results. Of 514 patients, 39.5% had H. pylori infection and 22.2% had reflux esophagitis. The prevalence of H. pylori infection in patients with reflux esophagitis was 30.7%, compared with 42.0% in patients without esophagitis (p = 0.039). The odds ratio for esophagitis risk with H. pylori infection was 0.61 (95% CI, 0.39–0.95). Neither patient age nor gender affected H. pylori prevalence. In patients with duodenal ulcer, H. pylori was present in 36.4% of patients with esophagitis and in 69.2% of patients without esophagitis (p = 0.018). The odds ratio for esophagitis with H. pylori infection in these patients was 0.25 (95% CI, 0.09–0.73). Conclusions. Our study demonstrates that H. pylori infection is significantly less prevalent in patients with reflux esophagitis and may protect against its development. In duodenal ulcer patients, this effect was more dramatic. Further study is required to confirm these findings and elucidate mechanisms underlying possible beneficial effects of H. pylori.
Miconazole Gel Increases the Cure Rate of Helicobacter pylori Infection When Added to Lansoprazole and Amoxicillin in a Randomized Trial
Authors: Ikezawa Kazuto , Kashimura Hiromasa , Mahmudul Hassan , Nakahara Akira , Yanaka Akinori , Matsuzaki Yasushi , Mutoh Hiroshi , Tanaka Naomi 
Published: March 2003

Background. Miconazole is an antimycotic agent with bacteriocidal activity against Helicobacter pylori in vitro. Its role in the clinical eradication of H. pylori has not been studied. The objective of this study was to investigate the efficacy and side effect profile of miconazole for the treatment of H. pylori. Materials and Methods. We studied 65 patients with gastritis or peptic ulcer disease in whom H. pylori infection was confirmed by a rapid urease test and microbiologic assessment. In vitro miconazole sensitivity was assessed for the H. pylori strains isolated from the enrolled patients. All patients were randomized to receive either dual therapy consisting of lansoprazole 30 mg daily and amoxicillin 500 mg three times a day for 14 days (LA, n = 33) or triple therapy using the LA regimen plus miconazole gel 100 mg three times a day for 14 days (LAM, n = 32). At least 8 weeks after the treatment, successful therapy was validated by the histological and microbiologic assessment. Adverse effects and drug adherence were monitored by direct questioning. Results. The minimum inhibitory concentrations of miconazole ranged from 3.13 to 6.25 mg/L. H. pylori was eradicated in 16 of 33 patients (48%, 95% CI = 31% to 67%) after LA therapy, and 24 of 32 patients (75%, 95% CI = 59% to 91%) after LAM therapy (p < .03). There was no significant difference in the occurrence of adverse events between the two groups. Conclusion. The addition of miconazole gel to the LA regimen significantly improved the cure rate of H. pylori without an increase in adverse effects.
Experimental Infection in Cats with a cagA+ Human Isolate of Helicobacter pylori
Authors: Perkins S.E. , Fox J.G. , Marini R.P. , Shen Z. , Dangler C.A. , Ge Z. 
Published: March 2003

Background. Helicobacter pylori has been cultured from the inflamed gastric mucosa of naturally and experimentally‐infected cats. The lesions in the H. pylori‐infected cat stomach mimic many of the features seen in human stomachs infected with H. pylori. This study sought to determine whether H. pylori‐negative, specific pathogen‐free cats with normal gastric mucosa were susceptible to colonization with a human cagA+ strain of H. pylori, and whether gastritis developed after infections.Methods.Four H. pylori‐negative cats treated with cimetidine were orally dosed 3 times at 2‐day intervals with 3 ml (1.5 × 108 CFU/ml) of H. pylori .Results.All experimentally‐infected cats became persistently colonized as determined by H. pylori isolation from gastric tissue by culture at 12 weeks, and all 4 cats were found positive by PCR during serial gastric biopsies and necropsy at 15 weeks postinoculation. The 2 control cats did not have H. pylori isolated, nor was gastric tissue positive by PCR. The H. pylori isolated from the 4 experimentally‐infected cats had RFLP patterns specific for the flaA gene identical to those of the inoculating strain. All 4 H. pylori‐infected cats had multifocal gastritis, consisting of lymphoid aggregates plus multiple large lymphoid nodules. In the control cats, one cat had a few focal lymphocytic aggregates in the body submucosa, whereas the second cat had normal gastric mucosa.Conclusion.Human cagA+H. pylori readily colonized the cat stomach and produced a persistent gastritis. The findings demonstrate the utility of the cat to study H. pylori induced pathogenesis.
Accuracy of Four Commercially Available Serologic Tests, Including Two Office‐based Tests and a Commercially Available 13C Urea Breath Test, for Diagnosis of Helicobacter pylori
Authors: Cohen Hartley , Rose Steven , Lewin David N. , Retama Betty , Naritoku Wesley , Johnson Cindy , Bautista Lorraine , Crowe Helen , Pronovost Allan 
Published: March 2003

Background.Diagnosis of H. pylori infection may be made by endoscopic (invasive) tests, or by nonendoscopic (noninvasive) tests. Our aim was to evaluate recently available nonendoscopic tests, including two office‐based serologic tests and a commercially available 13C urea breath test.Methods.Gastric biopsy specimens (for culture and stain) from 178 patients (mean age 46 ± 13.3 years, 79 men and 99 women), none of whom had received anti‐H. pylori therapy, were tested for H. pylori infection. These tests were compared against two commercial serum IgG antibody immunoassays (Biowhittaker’s Pyloristat, and Quidel), 2 office‐based serum qualitative IgG antibody tests (FlexSure HP, and QuickVue One‐Step), the Meretek 13C urea breath test, and the CLOtest (a biopsy urease test).Results.The breath test (n = 147) had the best accuracy (96%) of the noninvasive tests studied. The serologic tests had similar accuracy to one another (84%–90%). The major drawback of the serologic tests was suboptimal specificity (75%–87%). Diagnosis of H. pylori based on the two office‐based tests were not significantly different compared to the quantitative IgG antibody tests. The CLOtest had an accuracy of 97%.Conclusions.The Meretek 13C urea breath test is an excellent test, but is considerably more expensive than serologic tests. The FlexSure HP and the QuickVue One‐Step office‐based qualitative IgG serologic antibody tests gave similar results to laboratory based quantitative antibody tests, and are acceptable for initial diagnosis of H. pylori infection. The advantages of the office‐based tests are low cost, simplicity, and immediacy of results.
CagA and VacA: Virulence Factors of Helicobacter pylori in Thai patients with Gastroduodenal Diseases
Authors: Mahachai Varocha , Tangkijvanich Pisit , Wannachai Natnipa , Sumpathanukul Piched , Kullavanijaya Pinit 
Published: March 2003

Background. The aim of this study was to assess the seroprevalence of cytotoxin‐associated gene A (cagA) and vacuolating cytotoxin gene A (vacA) of Helicobacter pylori in selected Thai populations with specific gastroduodenal diseases.Materials and Methods. The immunoblot assay was used to detect serum antibodies against CagA and VacA obtained from the following patients: 87 cases of nonulcer dyspepsia (NUD), 61 cases of duodenal ulcer (DU), 49 cases of gastric ulcer (GU), and 10 cases of gastric cancer (GC).Results. Serum antibodies to CagA were detected in 75.4% of all patients (70.1% of NUD, 78.7% of DU, 77.6% of GU, and 90% of GC). Although the prevalence of CagA seropositivity in GC patients was higher than in the other three groups, the difference was not statistically significant (p > .05).Conclusions. The high seroprevalence of the CagA‐positive H. pylori strain in patients with peptic ulcer, GC, and NUD indicates that this strain is common in Thai patients with gastroduodenal diseases. Furthermore, phenotypic classification of H. pylori into type 1 (CagA‐positive, VacA‐positive) and type 2 (CagA‐negative, VacA‐negative) is not a useful marker for screening patients with severe forms of gastroduodenal diseases.
Influence of Oral Helicobacter pylori on the Success of Eradication Therapy Against Gastric Helicobacter pylori
Authors: Miyabayashi Hideharu , Furihata Kenichi , Shimizu Toshiki , Ueno Ichirou , Akamatsu Taiji 
Published: March 2003

Background. The goal of this study was to see whether Helicobacter pylori (H. pylori) in the oral cavity might adversely affect the outcome of eradication therapy for gastric H. pylori.Materials and Methods. Forty‐seven patients (36 males, 11 females) with gastric H. pylori infection were enrolled in this study. Gastric H. pylori infection was confirmed by both immunohistological staining with anti‐H. pylori antibody and bacterial culture of biopsy specimens. The therapeutic regimen consisted of 30 mg/day lansoprazole, 750 mg/day metronidazole, and 400 mg/day clarithromycin administered for 2 weeks. A fragment of the H. pylori urease gene was amplified by nested PCR for DNA extracted from saliva and dental plaque from the same patients. We examined the correlation between the gastric eradication success rate and the prevalence of H. pylori in the oral cavity as determined by PCR before and after the eradication therapy.Results. The eradication success rate was significantly lower in the oral H. pylori‐positive cases (12/23, 52.1%) than in the negative cases (22/24, 91.6%) at 4 weeks after the therapy (p = .0028). Two years later, only 16 of the 23 (69.5%) oral H. pylori‐positive cases were disease‐free, as compared to 23 of the 24 (95.8%) oral H. pylori‐negative cases (p = .018).Conclusions. H. pylori in the oral cavity affected the outcome of eradication therapy and was associated with a recurrence of gastric infection. We recommend that oral H. pylori should be examined by nested PCR and, if positive, should be considered a causal factor in refractory or recurrent cases.
Curing Helicobacter pylori Infection in Patients with Duodenal Ulcer Does Not Provoke Gastroesophageal Reflux Disease
Authors: Befrits Ragnar , Sjöstedt Svante , Ödman Bengt , Sörngård Heléne , Lindberg Greger 
Published: March 2003

Background. It has been suggested that the incidence of gastroesophageal reflux disease (GERD) increases after successful eradication of Helicobacter pylori infection. We present data on development of GERD from a controlled study of H. pylori eradication in 165 duodenal ulcer patients.Methods. Patients (mean age, 55 years; 102 men; current smokers; n = 74) were randomly assigned 2 : 1 to receive omeprazole, 40 mg twice daily, in combination with either amoxicillin, 750 mg twice daily, or placebo. Endoscopy and dyspeptic symptoms, including heartburn, were assessed at inclusion and at 6, 12, and 24 months after treatment. In addition, symptoms were assessed at 18 months. Patients with erosive esophagitis or reflux symptoms requiring treatment at inclusion were not included in the study.Results. Fifty‐one of 145 (35%) evaluable patients developed heartburn, and 13 of 145 (9%) developed esophagitis during follow‐up. The life‐table analysis of the cumulated risk of developing heartburn showed that patients whose H. pylori infection was eradicated had a significantly lower risk for developing heartburn than those with persistent H. pylori infection. The groups did not show any difference in cumulative risk of developing esophagitis.Conclusion. Our data show that successful eradication of H. pylori infection does not increase the incidence of GERD in duodenal ulcer patients.
Challenges to Therapy in the Future
Authors: O’Morain Colm , Montague Sean 
Published: March 2003

Quadruple therapy (with a proton pump inhibitor (PPI), metronidazole, tetracycline and bismuth) is generally reserved for second‐line treatment; however, studies using this regimen for 7 days have found it to be effective even in metronidazole‐resistant strains. Resistance is an ongoing problem with antimicrobial therapy but considerable progress has now been made into understanding the underlying genetic mechanisms of this process. Metronidazole resistance in Europe is usually in the range of 20–30% of strains but may be as high as 70% in some countries. One genetic mechanism involved is thought to be a mutation of the rdxA gene. Macrolide resistance appears to be on the increase in Europe, varying from 1% in some countries to 13% in others. The genetic mechanism involved has been shown to be a point mutation of a ribosomal RNA. Amoxicillin resistance is an emerging problem that has an adverse effect on eradication rates in clinical practice. Resistance has been shown to be caused by the absence of one of the four binding proteins in the cell wall. Few novel antibiotics have been developed for use in eradication therapy, although rifabutin, secnidazole and furazolidone have shown some success as part of combination therapy. Alternative therapies that have been tested include mucosal protective agents which have been used in place of a PPI in some eradication regimens with some success, and the somatostatin analog, octreotide, that has been used as part of quadruple therapy in place of a PPI and produced eradication rates of approximately 88%. The ultimate challenge is still to develop a safe and effective vaccine against Helicobacter pylori. Current and future research will also focus on identifying genetic targets for therapy, adhesion molecule analogs to prevent binding of the bacterium, and urease inhibitors.The current triple therapy treatment options available for the eradication of Helicobacter pylori infection are over 90% effective in susceptible organisms and there are very few medical conditions to which we can offer such efficacious treatment. Unfortunately, the recommendations made at consensus conferences are not always put into practice and physicians in primary care may be unaware of the true efficacy of eradication therapy. Treatment is very simple: three drugs, twice a day for 1 week. The main focus for both primary care physicians and gastroenterologists should be to reinforce the need for patient compliance, otherwise we will see an increase in antibiotic resistance. Patients should be prewarned that they may experience some mild side effects and should be encouraged to complete the course of treatment. The real challenge for the future will be the management of patients who do not respond to first‐line treatment. This paper will focus on potential problems with therapy, such as antibiotic resistance, and possible future solutions, such as novel antibiotics and vaccines.
Beneficial Effect of Helicobacter pylori Eradication in Dermatologic Diseases
Authors: Shiotani Akiko , Okada Kazuhisa , Yanaoka Kimihiko , Itoh Hidekazu , Nishioka Shingo , Sakurane Mikihisa , Matsunaka Masahiro 
Published: March 2003

AbstractBackground.A relationship between skin diseases, particularly rosacea and chronic urticaria, and H. pylori infection has been suggested.Methods.We preformed a prospective evaluation of the effect of H. pylori eradication in patients with a variety of chronic skin diseases. Patients were followed monthly for at least one year after cure of the infection. The effect of therapy was scored using a three point scale: complete remission (> 90% improvement), partial remission (50–90% improvement) or no improvement (< 50 improvement). The relationship between response and anti‐H. pylori Ig G and E to specific H. pylori antigens was analyzed by Western blot analysis.Results.Eighty‐eight H. pylori‐infected patients with skin disease were enrolled. Treatment was successful in 73% of patients with chronic urticaria as 23% (6 of 26) had complete and 50% had partial remission. Sixty‐two percent (18 of 29) with pruritus cutaneus had partial remission as well as 30% with prurigo chronica multiformis had complete remission. Western blotting was done on 24 patients with skin disease and a 44K H. pylori antigen was detected by Ig E analysis in 100% (5 of 5) patients with complete remission compared to 23% (3 of 13) in those without skin disease.Conclusions.These results suggest it may be prudent to test patients with chronic urticaria, prurigo chronica multiformis, pruritus cutaneus, and eczema nummulare for H. pylori infection and to eradicate the infection in those whose test is positive.