bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk factors for stress, urge or mixed urinary incontinence in Italy
Authors: Parazzini Fabio , Chiaffarino Francesca , Lavezzari Maurizio , Giambanco Vincenzo ,   on behalf of VIVA Study Group,   A list of VIVA members is provided on page 932
Published: December 2003

Objective
To assess risk factors for different type of urinary incontinence—stress, urge or mixed—and overactive bladder without urinary incontinence.Design
Case–control study.Setting
Gynaecology clinics.Population
Women attending first level gynaecological centres.Methods
Cases were 1062 women with urinary incontinence or overactive bladder aged 40 years or more (mean age 62.3 years, range 40–88) consecutively observed in first level gynaecological centres. Controls were 1143 women (mean age 58 years, range 40–86) observed in the same centre after the identification of the cases, without any symptoms related to urinary incontinence or overactive bladder.Main outcome measures
Determinants of different types of urinary incontinence and overactive bladder.Results
The risk of urinary incontinence was lower in more educated patients and increased with body mass index (BMI). The number of vaginal births was associated with the risk of stress and mixed urinary incontinence, but not urge urinary incontinence and overactive bladder. In comparison with nulliparae, the odds ratios (OR) for stress and mixed urinary incontinence were 5.4 (95% confidence interval [CI] 1.9–15.0) and 1.6 (95% CI 1.0–2.6), respectively, for women reporting one or two vaginal birth and 5.1 (95% CI 1.8–14.5) and 2.2 (95% CI 1.3–3.7), respectively, for three or more. A history of operative vaginal delivery was directly associated with the risk of stress and mixed urinary incontinence and increased the risk of urge urinary incontinence and of overactive bladder, but the latter ORs were not statistically significant. When compared with women with no birth, a history of caesarean section increased the risk of stress urinary incontinence. A history of hysterectomy, recurrent urinary infection and perineal trauma increased the risk of all types of urinary incontinence.Conclusions
Vaginal births increased the risk of stress and mixed urinary incontinence, but not of urge urinary incontinence and overactive bladder. The risk of all types of urinary incontinence was increased in women with higher BMI, with a history of hysterectomy, urinary infection and perineal traumas. These factors were not related to the risk of overactive bladder.
Myometrial and placental artery reactivity alone cannot explain reduced placental perfusion in pre‐eclampsia and intrauterine growth restriction
Authors: Ong Stephen S. , Moore Rachel J. , Warren Averil Y. , Crocker Ian P. , Fulford Jon , Tyler Damian J. , Gowland Penny A. , Baker Philip N. 
Published: December 2003

Objectives
(1) To investigate a possible association between myometrial and placental artery vasoreactivity and perfusion at the basal and chorionic plates, respectively. (2) To confirm that myometrial arteries from women with pre‐eclampsia and intrauterine growth restriction exhibit an attenuated endothelium‐dependent vasodilatory response.Methods
Women with normal pregnancy, pre‐eclampsia and intrauterine growth restriction had a magnetic resonance scan to assess placental perfusion using a technique called intravoxel incoherent motion. At delivery, myometrial and chorionic plate placental arteries were assessed on a wire myograph. Vessels were pre‐constricted with the thromboxane mimetic U46619 and dilated with incremental doses of bradykinin.Results
Pre‐constricted myometrial arteries from women with pre‐eclampsia or intrauterine growth restriction exhibited an attenuated vasodilatory response to bradykinin, compared with normal pregnancy (P < 0.0001). Pre‐constricted placental arteries exhibited a minimal vasodilatory response in all three groups of women (P = 0.10). Maximal constrictor and vasodilatory responses of myometrial arteries were not associated with the perfusing fraction at the basal plate. Maximal constrictor and vasodilatory responses of chorionic plate placental arteries were not associated with the perfusing fraction at the chorionic plate.Conclusion
We confirm that myometrial arteries from women with pre‐eclampsia or intrauterine growth restriction exhibit an attenuated endothelium‐dependent vasodilatory response. Apart from vasoreactivity of small arteries, other factors may be involved in the control of placental perfusion.
The usefulness of ultrasound assessment of amniotic fluid in predicting adverse outcome in prolonged pregnancy: a prospective blinded observational study
Authors: Morris J.M. , Thompson K. , Smithey J. , Gaffney G. , Cooke I. , Chamberlain P. , Hope P. , Altman D. , MacKenzie I.Z. 
Published: December 2003

Objective
To determine whether a single ultrasound scan at or beyond 40 weeks of gestation to detect a single deepest pool of amniotic fluid <2 cm and amniotic fluid index (AFI) <5 cm is clinically useful in the prediction of subsequent adverse pregnancy outcome.Design
A prospective double blind cohort study.Setting
A university teaching hospital delivering approximately 6000 women annually.Population
One thousand and five hundred and eighty‐four pregnant women at or beyond 40 weeks of gestation.Methods
Ultrasound assessment of liquor to detect the single deepest pool of amniotic fluid and derive the AFI at or after 40 weeks of gestation.Main outcome measures
Perinatal death, meconium aspiration, birth asphyxia, intervention in labour for fetal distress, a cord arterial pH <7 and admission to the neonatal unit.Results
An AFI <5 cm but not a single deepest pool <2 cm was significantly associated with birth asphyxia or meconium aspiration. An AFI <5 cm was also significantly associated with caesarean section for fetal distress in labour, a cord arterial pH <7 at delivery and low Apgar scores. Despite there being a statistically significant association with adverse outcomes the sensitivity of AFI was low at 28.6%, 12% and 11.5% for major adverse outcome, fetal distress in labour or admission to the neonatal unit, respectively.Conclusions
The AFI is superior to a measure of the single deepest pool as an assessment of the fetus at or after 40 weeks but has a poor sensitivity for adverse pregnancy outcome. Routine use is likely to lead to increased obstetric intervention without improvement in perinatal outcomes.
WHO multinational study of three misoprostol regimens after mifepristone for early medical abortion. I: Efficacy
Authors: von Hertzen Helena , Honkanen Helena , Piaggio Gilda , Bartfai György , Erdenetungalag Radnaabazar , Gemzell‐Danielsson Kristina , Gopalan Sarala , Horga Mihai , Jerve Fridtjof , Mittal Suneeta , Ngoc Nguyen Thi Nhu , Peregoudov Alexandre , Prasad R.N.V. , Pretnar‐Darovec Alenka , Shah Rashmi S. , Song Si , Tang Oi Shan , Wu Shang Chun ,   For WHO Research Group on Post‐Ovulatory Methods for Fertility Regulation,   The collaborators are listed on page 817
Published: December 2003

Objectives
To compare the efficacy of oral and vaginal administration of misoprostol after a single oral dose of 200 mg of mifepristone and to investigate whether the efficacy can be improved and the duration of bleeding shortened by continuing oral misoprostol for one week.Design
Double blind, randomised controlled trial.Setting
Fifteen gynaecological clinics in 11 countries.Population
A total of 2219 healthy pregnant women requesting medical abortion with ≤63 days of amenorrhoea.Methods
Mifepristone 200 mg administered orally on day one, followed by 0.8 mg misoprostol either orally or vaginally on day three. The oral group and one of the vaginal groups continued with 0.4 mg of oral misoprostol twice daily for seven days.Main outcome measures
Complete abortion was the main outcome. Secondary outcomes were side effects, timing of expulsion and duration of bleeding.Results
The crude complete abortion rate was 92.3% in the oral plus continued oral misoprostol group, in the vaginal‐only group it was 93.5%, and it was 94.7% in the vaginal group that continued with oral misoprostol, when considering undetermined cases as failures. Among women with amenorrhoea length ≥57 days, the risk of failure of complete abortion was almost three times higher in the oral plus continued oral misoprostol group (RR = 2.8, 95% CI 1.3 to 5.8), and over two times higher in the vaginal‐only group (RR = 2.2, 95% CI 1.0 to 4.7), when compared with the vaginal plus continued oral misoprostol group. Among women with amenorrhoea length <57 days, the differences were not significant. Timing of expulsions and duration of bleeding were similar in the three groups.Conclusions
For amenorrhoea length ≥57 days, vaginal misoprostol is more effective than oral when continued with 0.4 mg oral misoprostol twice daily for seven days. Misoprostol continuation improved the efficacy in this amenorrhoea group compared with a single dose of vaginal misoprostol on day three, but it did not shorten the duration of bleeding. No differences in efficacy were observed when amenorrhoea length was <57 days.
Sexual psychophysiology and effects of sildenafil citrate in oestrogenised women with acquired genital arousal disorder and impaired orgasm: a randomised controlled trial
Authors: Basson Rosemary , Brotto Lori A. 
Published: December 2003

ObjectiveSome postmenopausal women lose genital sexual responsivity despite preserved subjective sexual arousal from non‐genital stimuli. When oestrogen replacement is without benefit, both the underlying pathophysiology and management of this acquired genital female sexual arousal disorder are unclear. We aimed to study the effect of sildenafil on sexual arousal and orgasmic functioning of such women. Secondly, we aimed to explore the concordance between a detailed historical assessment of genital response in real life, with laboratory vaginal photoplethysmographic assessment of genital vasocongestion.DesignSession one consisted of a semi‐structured clinical interview to assess real life sexual arousal. Session two employed vaginal pulse amplitude and self‐report questionnaire assessment of erotica‐induced sexual arousal. Sessions three and four were a randomised, double‐blind, placebo‐controlled crossover administration of sildenafil on orgasm latency, intensity, perception of genital congestion and subjective arousal to eroticaplusclitoral vibrostimulation.SettingUniversity associated Sexual Medicine Clinic and Psychophysiology Laboratory.SampleVolunteer sample of 34 oestrogenised postmenopausal women with acquired genital female sexual arousal disorder and impaired orgasm.MethodsSildenafil (50 mg) or placebo administered over two laboratory sessions.Main outcome measuresOrgasm latency and intensity during drug sessions; subjective and psychophysiological sexual arousal during photoplethysmography session.ResultsThe erotic video significantly increased subjective sexual arousal in all women. Vaginal pulse amplitude responses varied from robust to absent. Although across all women, sildenafil improved neither arousal nor orgasm, subsequent analyses comparing highversuslow vaginal pulse amplitude responders revealed significantly reduced latency to orgasm, and increased subjective sexual arousal and perception of genital arousal in the latter group of women.ConclusionThe data suggest that oestrogenised postmenopausal women with genital female sexual arousal disorder and orgasmic impairment based only on clinical assessment do not benefit from sildenafil. However, the photoplethysmograph had predictive value—those women showing low vaginal pulse amplitude response benefited from sildenafil compared with women with a higher response. Thus, oestrogenised women diagnosed with acquired genital female sexual arousal disorder may be a heterogeneous group and the photoplethysmograph might be useful in their further characterisation.
The burden of disease from neonatal mortality: a review of South Asia and Sub‐Saharan Africa
Authors: Hyder Adnan A. , Wali Salman A. , McGuckin Jeffery 
Published: December 2003

Objective
To assess the burden of neonatal mortality in two developing regions.Design
Review of secondary data collated through literature review.Setting
Community and facility based studies and national health surveys.Population
Neonatal (<28 days) population of South Asia and Sub‐Saharan Africa.Methods
Data on neonatal mortality were gathered from peer‐reviewed literature, reports of the Demographic and Health Surveys and websites of country‐based organisations. The base year for this study is 1995. For each country, a weighted mean neonatal mortality rate was calculated and the total number of neonatal deaths estimated. Country data were summarised over each region to estimate annual regional neonatal deaths and rates. The burden of disease from neonatal mortality was determined using a summary measure of health—healthy life years.Main outcome measures
Numbers of deaths and healthy life years (HeaLYs).Results
Neonatal mortality rate for South Asia ranged from 41.9 to 56.9 per 1000 live births for 1995. Sri Lanka was an exception with a neonatal mortality rate between 16.3 and 18.6 per 1000 live births. The estimated regional neonatal mortality rate for South Asia was 46.27 per 1000 live births for 1995. There was a significant lack of data from Sub‐Saharan Africa, resulting in highly variable neonatal mortality rates, ranging from 13 per 1000 live births in Kenya to 108 per 1000 live births in Senegal. The mean regional neonatal mortality for Sub‐Saharan Africa for 1995 was estimated at 38.8 per 1000 live births.Conclusion
The burden of neonatal mortality in only these two regions of the developing world represents more than 2 million annual deaths. A call for greater investments in neonatal research and health programs is a logical extension to this review of evidence.
The incidence of sterilisation in the UK
Authors: Rowlands Sam , Hannaford Philip 
Published: December 2003

Objective
To estimate incidence rates for tubal occlusion and vasectomy, and to examine how these vary with age, geographical area and time.Design
Search of patient files for operation codes in the years 1992–1999 and calculation of person time.Population and setting
General Practice Research Database.Methods
Patient files of women aged 20–54 years and men aged 20–64 years were searched for sterilisation operation codes. Annual incidence rates in five year aged bands were calculated for sterilisation operations for both sexes. Figures were examined according to National Health Service Region and population density category of the general practices. The relationship between year of operation and mean age at operation was also examined.Main outcome measures
Incidence rates by year, age group and geographical area.Results
The average annual incidence of sterilisation in the eight year period was 4.75 per 1000 person years at risk for women aged 20–54 and 4.48 per 1000 person years at risk for men aged 20–64. For women, there was a statistically significant 30% decrease in incidence of tubal occlusion over the study period. There was no change in vasectomy rates over time. About one‐third of all vasectomies in the UK are estimated to be performed outside hospital and community clinic settings. The rates of sterilisation in both sexes were much lower in Greater London than elsewhere in the UK.Conclusions
The popularity of tubal occlusion appears to be on the decline. Since 1996, the UK has been one of very few countries in which sterilisation incidence in men is greater than that in women.
Low plasma volume following pregnancy complicated by pre‐eclampsia predisposes for hypertensive disease in a next pregnancy
Authors: Aardenburg Robert , Spaanderman Marc E.A. , Ekhart Timo H. , van Eijndhoven Hugo W. , van der Heijden Olivier W.H. , Peeters Louis L.H. 
Published: December 2003

Objective
A large number of women with a history of pre‐eclampsia/HELLP have a low plasma volume at least six months postpartum. The objective of this study was to determine whether a low plasma volume in formerly pre‐eclamptic women and HELLP patients is associated with an increased risk for recurrent hypertensive complications in a next pregnancy.Design
Prospective observational study.Setting
Tertiary obstetric centre.Sample
Formerly pre‐eclamptic women and controls.Methods
In 316 women with a history of pre‐eclampsia and/or HELLP, we measured, plasma volume along with haemodynamic, metabolic and haemostatic variables at least six months postpartum. A group of 22 healthy parous controls was used as a reference. After standardising plasma volume for body mass index, women were subdivided into normotensive and normal plasma volume (n = 199), normotensive and low plasma volume (n = 76) and hypertensive (n = 41) subgroups, which were compared for demography, clinical parameters and course of a next pregnancy.Main outcome measures
Recurrent hypertensive disease of pregnancy.Results
Relative to the normal plasma volume subgroup, normotensive women in the low plasma volume subgroup have a higher body mass index, a lower total vascular compliance and a shorter estimated systemic circulation time. They have a higher HOMA index and higher fasting triglyceride levels. In normotensive and hypertensive former patients alike, low plasma volume is associated with a higher recurrence of hypertensive complications in a next pregnancy compared with normotensive women with normal plasma volume.Conclusion
Low plasma volume in normotensive women with a history of pre‐eclampsia and/or HELLP is associated with overweight, reduced vascular compliance and insulin resistance and a predisposition for recurrent pre‐eclampsia and HELLP syndrome in a next pregnancy.
Can enquiries into severe acute maternal morbidity act as a surrogate for maternal death enquiries?
Authors: Pattinson R.C. , Buchmann E. , Mantel G. , Schoon M. , Rees H. 
Published: December 2003

Objective
To assess whether severe acute maternal morbidity (SAMM, ‘near misses’) can be used as a surrogate of an analysis of maternal deaths to describe the pattern of severe maternal disease and avoidable factors related to it.Design
Prospective, descriptive study.Setting
A SAMM and maternal mortality audit was conducted in three clearly defined geographical areas, consisting of rural and urban settings in South Africa.Population
Indigent black African pregnant women.Method
Cases of SAMM and maternal deaths were collected in the areas and a comparison was made of the disease profiles and avoidable factors, missed opportunities and substandard care.Main outcome measures
The proportion of primary obstetric causes and avoidable factors in women with SAMM and maternal deaths, and the mortality indices of the primary obstetric causes of death and organ system dysfunction.Results
A total of 423 women with SAMM and 128 maternal deaths were collected over two years. Demographic factors were similar between the groups except that significantly more maternal deaths had not attended any antenatal care. The primary obstetric causes of SAMM and maternal death did not correlate. The four most common causes of SAMM were complications of hypertension (27.2%), postpartum haemorrhage (18.0%), antepartum haemorrhage (12.8%) and abortion (11.3%), whereas the four most common causes of maternal death were non‐pregnancy related sepsis (26.6%), complications of hypertension (23.4%), pre‐existing medical disease (14.1%) and abortion (10.9%). The types of avoidable factors were similar between both groups although administrative factors occurred significantly more frequently in the maternal death group as did poor problem identification and monitoring.Conclusion
Review of SAMM gives a different disease pattern to that obtained from maternal death audits. However, in diagnosing inadequacies in the health system, similar information was obtained.
Noise-induced stress response and hearing loss in goldfish (Carassius auratus)
Authors: Smith Michael E. , Kane Andrew S. , Popper Arthur N. 
Published: December 2003

SUMMARYFishes are often exposed to environmental sounds such as those associated with shipping, seismic experiments, sonar and/or aquaculture pump systems. While efforts have been made to document the effects of such anthropogenic(human-generated) sounds on marine mammals, the effects of excess noise on fishes are poorly understood. We examined the short- and long-term effects of increased ambient sound on the stress and hearing of goldfish (Carassius auratus; a hearing specialist). We reared fish under either quiet(110-125 dB re 1 μPa) or noisy (white noise, 160-170 dB re 1 μPa)conditions and examined animals after specific durations of noise exposure. We assessed noise-induced alterations in physiological stress by measuring plasma cortisol and glucose levels and in hearing capabilities by using auditory brainstem responses. Noise exposure did not produce long-term physiological stress responses in goldfish, but a transient spike in plasma cortisol did occur within 10 min of the noise onset. Goldfish had significant threshold shifts in hearing after only 10 min of noise exposure, and these shifts increased linearly up to approximately 28 dB after 24 h of noise exposure. Further noise exposure did not increase threshold shifts, suggesting an asymptote of maximal hearing loss within 24 h. After 21 days of noise exposure, it took goldfish 14 days to fully recover to control hearing levels. This study shows that hearing-specialist fishes may be susceptible to noise-induced stress and hearing loss.
Development of respiratory function in the American locustSchistocerca americanaI. Across-instar effects
Authors: Greenlee Kendra J. , Harrison Jon F. 
Published: December 2003

SUMMARYWe tested the hypothesis that oxygen delivery from the atmosphere to the tissues becomes more difficult as grasshoppers increase in body size throughout development due to increases in tracheal length. If this is true,then older, larger grasshoppers should have smaller safety margins [higher critical oxygen partial pressures (PO2s)] for oxygen delivery than younger, smaller grasshoppers. We exposed grasshoppers of first, third and fifth instars and adults to decreasing levels of atmospheric O2 and measured their ventilatory responses. Contrary to our prediction, we found that larger grasshoppers had critical PO2s eight times lower than juveniles due in part to their threefold lower mass-specific metabolic rates and their ability to quadruple convective gas exchange. Adults more than doubled abdominal pumping frequency and increased tidal volume by 25% as PO2 decreased fourfold, whereas the youngest juveniles showed no such responses. This study indicates that juveniles may be more susceptible to hypoxia in natural situations, such as exposure to high altitude or restricted burrows. Also, larger size is not necessarily correlated with a smaller safety margin for oxygen delivery in insects.