bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mother and child health care in Kabul, Afghanistan with focus on the mother: women's own perspective
Authors: Kaartinen Leena , Diwan Vinod 
Published: March 2003

Background. The study examined the pattern of utilization of Maternal and Child Health (MCH)‐services of women with child‐bearing experience in a suburb of city Kabul.Methods. A semi‐structured questionnaire administered to 100 women in the community and 40 in the maternal hospital. Interviews and observations in the local MCH‐clinic were used to collect the relevant information.Results. Sixty one of the 100 women in the community delivered at home exclusively, 35 having experienced both home and institutional deliveries, four women had hospital childbirths only. Approximately half of the women decided about utilizing the modern MCH services themselves. Women valued in the MCH‐clinic mainly medical care and vaccinations. Delivery was seen primarily as a technical event, but when probed more deeply it was obvious, that fear of death was the driving power for decisions made. With at‐home deliveries female relatives were preferred as birth assistants. If outside assistance was required, trained midwives were preferred rather than traditional birth attendants. Institutional delivery was seen as the last resource for complicated deliveries, but was also esteemed by many because of the security and cleaness. Professional skill, but also empathy and justice were appreciated in professionals.Conclusions. Promoting rooming‐in and early breast feeding in the maternity wards, ongoing education of the MCH‐staff about communication skills, ethics and teaching methods, dialogue with decision makers on all levels in the society about MCH including family planning, ongoing training and support of community midwives (dayas) in the community by local MCH‐staff, adequate supplies, inexpensive services, incentive money for the competent staff members are recommended.
The term breech presentation. A retrospective study with regard to the planned mode of delivery
Authors: Belfrage Patrick , Gjessing Leif 
Published: March 2003

Background. To analyze retrospectively a large group of term breech and vertex deliveries, with regard to the influence of the mode of delivery on the frequency of fetal and maternal complications.Methods. All singleton breech deliveries after completed 36 weeks of pregnancy, with a live fetus, delivered at Rogaland Central Hospital, from September 1 1996 to the May 10 2001 were included (n = 575). Correspondingly as a control group, 582 cases in vertex presentation were analyzed.Results. Planned vaginal delivery (VD) for the fetus in breech presentation (n = 448) in comparison with elective caesarean section (CS) (n = 127) increased early neonatal morbidity (3.6% vs. 0%). The frequency of Apgar scores < 7 at 5 min also increased (4.2% vs. 0.8%), as well as umbilical artery pH < 7.0 (4.4% vs. 0%), and referrals to the neonatal intensive care unit (NICU) (15.8% vs. 6.3%). Corresponding figures for planned VD of the fetus in vertex presentation were: 0.5% neonatal morbidity, 0.2% Apgar scores < 7 at 5 min, 8.1% admissions to NICU and 1.5% pH < 7.0 in umbilical arteries. Results comparing maternal morbidity in the different breech groups were inconclusive, but there were more maternal complications in the breech group planned for VD than in the corresponding vertex group (5.1% vs. 1.9%).Conclusions. Elective CS for breech presentation will significantly decrease the risks for the fetus in comparison with planned VD.
Development and clinical experience with the new evidence‐based tocolytic atosiban
Authors: Husslein Peter 
Published: March 2003

The incidence of preterm birth has remained unchanged for the last few decades. This is due, in part, to the complex etiology of preterm labor, and the limited ability of tocolytic agents to prolong pregnancy as a result of limited efficacy and poor safety profiles. The recent introduction of the oxytocin antagonist, atosiban, represents a new generation of uterine‐specific tocolytics, which are associated with more favorable safety profiles. This paper discusses the rationale behind the development of the oxytocin antagonists and provides a review of the phase II and III trials that have investigated atosiban. Also included is a retrospective analysis of 83 women assessed in the Vienna Medical School, providing an insight into the benefits associated with atosiban in the everyday clinical setting.The introduction of a safer tocolytic agent offers the potential to change the current approach to the management of preterm labor. This includes a prolonged period of treatment at earlier or later gestational ages and possibly an extended use to women with contraindications who would normally have been excluded from treatment, e.g. preterm premature rupture of the membranes.
Soluble tumor necrosis factor receptor II and soluble cell adhesion molecule 1 as markers of tumor necrosis factor‐α release in preeclampsia
Authors: Visser Wil , Beckmann Ilse , Knook Marco A. H. , Wallenburg Henk C. S. 
Published: March 2003

Background.  The purpose of this case‐controlled study was to investigate whether plasma concentrations of TNF‐receptors I and II and tumor necrosis factor‐α‐induced cell adhesion molecule 1 VCAM‐1 could serve as more sensitive markers of tumor necrosis factor‐α release in preeclamptic women than a direct measurement of circulating tumor necrosis factor‐α.Methods.  Plasma concentrations of soluble tumor necrosis factor receptor I and II, immunoreactive tumor necrosis factor‐a and soluble cell adhesion molecule VCAM‐1 were determined in 21 patients with severe proteinuric preeclampsia (23–35 weeks' gestation) and 21 gestational age‐matched normotensive controls by enzyme‐linked immunoassays. Concentrations of bioactive tumor necrosis factor‐α were assessed by the WEHI 164 bioassay. Data were statistically evaluated by Wilcoxon's rank sum and sign tests, and Spearman's test was used to evaluate clinical and biochemical correlations.Results.  Bioactive tumor necrosis factor‐α was detected in 19 of 21 preeclamptic and 18 of 21 normotensive women, with no difference in plasma concentrations between both groups. Immunoreactive tumor necrosis factor‐α, soluble TNF‐receptors and soluble cell adhesion molecule VCAM‐1 were significantly increased in plasma of preeclamptic patients, and a statistically significant positive correlation was observed between immunoreactive tumor necrosis factor‐α and TNFRII. In preeclamptic patients a statistically significant negative correlation was observed between TNFRII and platelet count, and between soluble cell adhesion molecule VCAM‐1 and birthweight ratio.Conclusion.  These results show that plasma concentrations of soluble tumor necrosis factor receptor II and soluble cell adhesion molecule VCAM‐1 reflect the release of tumor necrosis factor‐α and provide sensitive markers of excessive release of this cytokine in preeclampsia.
Experience of in vitro fertilization surrogacy in Finland
Authors: Söderström‐Anttila Viveca , Blomqvist Tom , Foudila Tuija , Hippelainen Maritta , Kurunmaki Henri , Siegberg Rita , Tulppala Maija , Tuomi‐Nikula Merja , Vilska Sirpa , Hovatta Outi 
Published: March 2003

Background.  In vitro fertilization (IVF) surrogacy makes it possible for women who do not have a functional uterus to have their own genetic offspring. We describe here our experience of IVF surrogacy in Finland over a 10‐year period.Methods.  This retrospective study included 17 women who underwent ovarian stimulation in connection with surrogacy in 1991–2001 at four clinics. The surrogate mothers were unpaid volunteers: six sisters, three mothers, one husband's sister, one cousin, four friends and three other volunteers. Thorough counseling was given to the commissioning couples and to the surrogate mothers and their partners. The commissioning couples were prepared to adopt their biological children.Results.  Twenty‐eight surrogate IVF cycles were started in 17 women. One couple received donated oocytes. Trans‐vaginal oocyte retrieval was feasible in every case, including those five women with congenital absence of the vagina and uterus. An average of 1.8 embryos was transferred at a time, and 11 pregnancies were achieved [50% per fresh embryo transfer (ET) and 16% per frozen‐thawed ET]. Nine healthy singletons and one set of twins were born. One pregnancy ended in miscarriage. The mean birth weight of singleton infants was 3498 g (2270–4650 g). The birth weights of the twins were 2900 and 2400 g. In all cases the genetic parents took care of the infant immediately after birth. Two surrogate mothers had postpartum depression.Conclusions.  Altruistic IVF surrogacy works well, but careful counseling of all parties involved is essential.
Effect of magnesium sulfate, isradipine, and ritodrine on contractions of myometrium: pregnant human and rat
Authors: Kantas Emine , Cetin Ali , Kaya Tijen , Cetin Meral 
Published: March 2003

Background.  Magnesium sulfate, isradipine, and ritodrine are smooth muscle relaxants used for treating preterm labor. The aim of this study is to investigate the action profile of these drugs on the amplitude and frequency of spontaneous contractions of isolated myometrial strips of pregnant human and rat.Material and methods.  Isolated myometrial strips were obtained from humans undergoing elective cesarean section at term pregnancy and Wistar albino rats on gestational days 19–21. These strips were mounted in organ baths for recording of isometric tensions. The effect of magnesium sulfate, isradipine, and ritodrine on the amplitude and frequency of spontaneous contractions was compared with the anova test.Results.  Ritodrine (10−8−10−5 M) concentration‐dependently inhibited the frequency and amplitude of spontaneous contractions of myometrial strips. At 10−4 M, tachyphylaxis of ritodrine occurred and contractions started again. Magnesium sulfate (10−7−10−4 M) inhibited the frequency but did not change the amplitude of the spontaneous contractions. Isradipine (10−7−10−4 M) had a concentration‐related inhibitor effect on both the frequency and amplitude of the spontaneous contractions. The effects of magnesium sulfate, isradipine, and ritodrine were considerably similar in myometrium strips obtained from pregnant rats and humans.Conclusions.  Because of tachyphylaxis, the effectiveness of ritodrine is limited for inhibition of myometrial contractions. Magnesium sulfate reduced the frequency of spontaneous contractions without affecting the amplitude. Isradipine may be an interesting therapeutic alternative in situations where inhibition of uterine activity is desirable.
Insulin dose during glucocorticoid treatment for fetal lung maturation in diabetic pregnancy: test of analgoritm
Authors: Mathiesen Elisabeth R. , Christensen Ann‐Birgitte L. , Hellmuth Ellinor , Hornnes Peter , Stage Edna , Damm Peter 
Published: March 2003

Objective.  Poor glycemic control is often a serious clinical problem during glucocorticoid treatment for fetal lung maturation in pregnant women with diabetes. An algorithm for improved subcutaneous insulin treatment during glucocorticoid treatment in insulin‐dependent diabetic women was developed and tested.Study design.
The sample, divided into two cohorts, consisted of all insulin‐dependent diabetic women (
n
=16) receiving glucocorticoid treatment (betamethasone 12 mg i.m., repeated after 24 h) from 1996 to 1999. In the first cohort the increments of insulin dose were based on the level of blood glucose obtained. Based on the first cohort an algorithm to determine increments of insulin dose was developed. In the second cohort (
n  = 8) the insulin dose was increased by up to 40%, according to the algorithm, starting immediately after glucocorticoid treatment; prior to a detectable increase in blood glucose.Results.
After betamethasone, the daily insulin dose for the following 5 days was increased by 6, 38, 36, 27 and 17% in the first cohort vs. 27, 45, 40, 31 and 11% in the second cohort. The algorithm was used in the second cohort. The median blood glucose was 6.7, 14.3, 12.3, 7.7 and 7.7 vs. 7.7, 8.2, 9.6, 7.0 and 7.4 mmol/l (
p <0.05 for day 2 and 3) in the two cohorts, respectively. None developed ketoacidosis or severe hypoglycemia.Conclusion.

An algorithm with an increasing insulin dose of up to 40% shortly after glucocorticoid treatment for fetal lung maturation in diabetic women prevents severe dysregulation of metabolic control.
Characterization of women with a history of recurrent vulvovaginal candidosis
Authors: Novikova Natalia , Mårdh Per‐Anders 
Published: March 2003

Background.  To characterize history, signs, and symptoms in women with a history of recurrent vulvovaginal candidosis (RVVC) and who had consulted with symptoms generally associated with the condition.Methods.  Eighty‐three women with a history consistent with RVVC were interviewed regarding 32 parameters and 10 signs found at the clinical examination were noted. Candida cultures were made from the introitus and the posterior vaginal fornix.Results.  Only in a few of the 43 women with and the 40 without a positive yeast culture could any of the many etiological factors that have been associated with RVVC be traced. Only two factors differed between the groups, namely yogurt intake, which was reported by 28 (68%) and 38 (95%) women in these groups, respectively. Vaginal douching was performed by 10 (23%) women in the Candida‐positive group and by 17 (42%) women in the Candida‐negative group. Pruritis and burning occurred in 31 (72%) and 22 (51%) of culture‐positive patients, which was less frequent than in the culture‐negative group, i.e. reported by 19 (47%) and 9 (22%) patients, respectively (p= 0.022 and p= 0.007). Edema (p= 0.026) of the vulva as well as erythema (p= 0.019) and edema (p= 0.008) of the vaginal mucosa, caseous discharge (p= 0.016), were found more often in the Candida culture‐positive cases.Conclusions.  History and results of clinical examination of patients with RVVC are not enough to distinguish those who are culture‐positive from those who are culture‐negative for Candida from the genital tract.
Twin pregnancy outcome and chorionicity
Authors: Baghdadi Sabah , Gee Harold , Whittle Martin J. , Khan Khalid S. 
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 18–21. © Acta Obstet Gynecol Scand 2003Background.  Based on research of relatively poor quality, it is generally believed that dichorionic twins have lower perinatal mortality than monochorionic twins. We assessed the relationship between the pattern of perinatal loss in twin pregnancy and chorionicity.Methods.  A cohort study of 238 consecutive sets of twin pregnancies registered in our antenatal service over a 2‐year period (1996–98) had chorionicity determined by ultrasound at 12–16 weeks' gestation. Follow up included scanning at 20 weeks' gestation for anomaly, and at 2–3‐weekly intervals from 24 weeks' gestation onwards for growth and well being. Hazard ratios were computed for comparing the risk of death according to chorionicity. The perinatal loss patterns were analyzed according to gestational age at demize and that at delivery using survival analysis.Results.  Overall, 17/238 (7.1%) twin pregnancies suffered mortality: 14/190 (7.3%) amongst the dichorionic and 3/48 (6.2%) amongst the monochorionic twins. The hazard ratio for mortality was 0.89 (95% confidence interval 0.27–2.97, p = 0.85), considering gestational age at demize as the outcome. For gestational age at delivery as the outcome, the hazard ratio for mortality was 0.93 (95% confidence interval 0.27–3.15, p = 0.91). Survival analysis showed that amongst the dichorionic twins the hazard of death continued to rise throughout gestation. In contrast, the hazard of death for the monochorionic twins rose gradually to a maximum at 28 weeks' gestation and was then constant.Conclusion.  Chorionicity did not affect the overall fetal loss rate amongst the twin pregnancies in our setting. There were differences in patterns of loss according to chorionicity, which require further investigation.
Relationship between polycystic ovaries, body mass index and insulin resistance
Authors: Cresswell Janet , Fraser Robert B. , Bruce Christine , Egger Peter , Phillips David , Barker David J. P. 
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 61–64. © Acta Obstet Gynecol Scand 2003Background. To investigate insulin levels in lean and overweight women with and without polycystic ovaries. An observational, cross‐sectional study at The Northem General Hospital, Sheffield, UK.Methods. Sixty‐eight women born at Jessop Hospital, Sheffield, between 1952 and 1953 were divided into four groups according to the status of their polycystic ovaries and body mass index: either > or ∼ 25. Therefore, this was an unselected sample, unlike previous studies that have recruited from endocrine clinics or similar. Subjects underwent pelvic ultrasonography to visualize their ovaries in order to diagnose or exclude polycystic ovaries. They all underwent a short insulin tolerance test.Results. Women with a body mass index > 25 and with polycystic ovaries were the most insulin resistant. Women with a body mass index of ≤?25 and with normal ovaries were the most insulin sensitive. Women with a body mass index ≤?25 and polycystic ovaries were the more resistant than those with a body mass index > 25 and with normal ovaries.Conclusion. Obesity increases insulin resistance, and the presence of polycystic ovaries increases insulin resistance. The presence of polycystic ovaries appears to have a stronger influence than obesity on insulin resistance. This is the first study to demonstrate these relationships using unselected volunteers.
Laser acupuncture and low‐calorie diet during visceral obesity therapy after menopause
Authors: Wozniak Piotr , Stachowiak Grzegorz , PiÊta‐DoliÑska Agnieszka , Oszukowski Przemyslaw 
Published: March 2003

Acta Obstet Gynecol Scand 2003; 82: 69–73. © Acta Obstet Gynecol Scand 2003Background.  To compare the efficiency of low‐calorie diet and low‐calorie diet applied together with laser acupuncture in the therapy of visceral obesity in postmenopausal women.Methods.  The study population consisted of 74 postmenopausal females with visceral obesity who were divided into two groups according to an employed 6‐month slimming procedure. In the first group (n = 36) a low‐calorie diet was applied, while women in the second group (n = 38) were on the same kind of diet, having additionally one cycle of laser acupuncture procedure at the same time. At baseline and at the end of the study, body weight, body mass index and waist‐to‐hip ratio were determined in all women.Results.  After 6 trial months both groups exhibited a statistically significant drop in body weight, body mass index and waist‐to‐hip ratio. The mean reduction of body weight, body mass index and waist‐to‐hip ratio was significantly higher in the second group of women (laser acupuncture plus low‐calorie diet).Conclusions.  (1) Our results testify that the combination of a low‐calorie diet and laser acupuncture is characterized by a higher efficacy than a low‐calorie diet alone in lowering body weight, body mass index and waist‐to‐hip‐ratio. (2) Laser acupuncture is an additional useful healing method in the therapy of visceral postmenopausal obesity.
A comparison between one‐ and two‐field 60° fundus photography when screening for diabetic retinopathy
Authors: Von Wendt Gunvor , Rönnholm Petri , Heikkilä Kauko , Summanen Paula 
Published: March 2003

ABSTRACT.Purpose: To compare the severity level of diabetic retinopathy obtained when assessed from two versus only one 60° photographic field using colour transparencies and red‐free, black‐and‐white photographs. To compare the areal coverage of these two photographic strategies to that of seven‐field 30° photography.Methods: Two ophthalmologists graded photographs of 74 eyes of 74 type I and II diabetes patients. Inter‐method agreement was expressed in percentages and using kappa statistics and scatter‐diagrams. The comparison of the approximate photographic areal coverage was done from diagrams using planimetry.Results: The severity level of retinopathy when judged from two photographic fields was more severe in 13.5% (Grader 1) and in 16.2% (Grader 2) from colour transparencies and in 13.5% (Grader 1) and in 14.9% (Grader 2) from red‐free black‐and‐white prints, as compared to assessments from only one field. Kappa values (0.84–0.86) for inter‐method agreement for five pooled retinopathy levels revealed good agreement. Neither grader missed retinopathy requiring clinical assessment or treatment (levels ≥47) when minimal retinopathy (levels 14–20) was detected using only one 60° colour slide or red‐free photograph. A second optic disc‐centred field provided valuable additional information when more severe retinopathy lesions (levels ≥30) were detected in the macula‐centred field. One macula‐centred 60° photograph covered 60% and two 60° photographs 80% of the area covered by seven‐field 30° photography. Two‐field 60° photography covers areas left outside seven‐field 30° photography.Conclusion: We propose the use of one macula‐centred 60° photograph when screening for the first lesions of diabetic retinopathy. After they have been found two‐field 60° photography is recommended.
Spotting of disc haemorrhages on fundus pictures; on Kodachrome slides and on digitally enhanced images
Authors: Holm O. , Krakau C. E. T. 
Published: March 2003

ABSTRACT.Purpose: To find out whether digital processing can facilitate interpretation of fundus photographs.Methods: Digitised fundus pictures were manipulated and enhanced by a process called histogram equalisation. Essentially, the gamma values for red (R), green (G), and blue (B) were separately modified. The principle is explained and exemplified.Material and Results: Small disc haemorrhages, which may normally be hard to detect, became more visible after histogram equalisation, which is demonstrated in test series.Conclusion: Digital histogram equalisation offers a new way of looking at fundus pictures, which, alone or combined with other capabilities of digital processing, has great potential for diagnosis, as well as for follow up studies. The possibility to decide the true nature of suspect spots after applying the enhancement procedure is likewise of great value.
Prolonged persistence on the ocular surface of fortified gentamicin ointment as compared to fortified gentamicin eye drops
Authors: Lomholt Jeanet Andersen , Møller Jens Kjølseth , Ehlers Niels 
Published: March 2003

ABSTRACT.Purpose: A comparative study on the elimination of gentamicin from the ocular surface and the concentration of gentamicin in the anterior chamber following application of either an ointment or eye drops containing equal concentrations (1.5%) of gentamicin.Methods: A disc‐diffusion test was used to determine the concentration of gentamicin in fornix inferior of 10 persons. The anterior chamber concentration of gentamicin was determined in 5 cataract patients by the TDX analyzer, Abbot Laboratories, Il., USA.Results: Ten minutes following application, the concentration of gentamicin was significantly higher in the eyes receiving ointment (310.6 mg/L) compared to drops (45 mg/L) (p<0.01).Furthermore, gentamicin could be detected 40 minutes after application in the eyes receiving ointment compared to 10 minutes in the eyes receiving drops. The anterior chamber concentration of gentamicin after application of either drops or ointment was lower than 0.6 mg/L and thus below detection limit.Conclusions: The persistance of gentamicin ointment was significantly longer on the ocular surface as compared to gentamicin eye drops. Gentamycin ointment may thus provide a means to reduce the high application frequency presently in use with eye drops to treat bacterial keratitis and thereby reduce patient inconvenience, especially during nighttime.