bluuebunny/crossref_metadata_2025_split huggingface dataset:
Advances in sebaceous gland research: potential new approaches to acne management
Authors: Downie M. M. T. , Guy R. , Kealey T. 
Published: November 2004

SynopsisSebaceous gland development and function is regulated by an expanding array of molecules including transcription factors, hormones, retinoids, growth factors, cytokines and nuclear hormone receptors. We have reviewed the literature to present the current understanding of sebaceous gland development and physiology, with particular emphasis on the control of the sebaceous gland and its implications for acne management. Interestingly, retinoids, cytokines and nuclear hormone receptors appear to be promising inhibitors of sebum synthesis, thus offering new approaches to acne management.
Rupture of the sphincter ani: the recurrence rate in second delivery
Authors: Elfaghi Ibtesam , Johansson‐Ernste Birgit , Rydhstroem Hakan 
Published: November 2004

Background  Injury to the genital tract sustained during childbirth can lead to transient or protracted morbidity. Attention should be paid to avoidable risk factors that can cause this complication.Aim  To analyse the recurrence, at a later delivery, of trauma to the genital tract, subsequent to perineal laceration of the sphincter ani (third or fourth degree), sustained at an earlier delivery.Design  A population‐based study.Setting  In Sweden, 1973–1997 inclusive.Population  All women with a vaginal, singleton delivery in Sweden.Methods  The Medical Birth Registry, the National Board of Health and Welfare was used to identify cases of ruptured sphincter ani.Main outcome measures  OR was calculated with 95% confidence interval. A stratified analysis was performed using the Mantel‐Haenszel technique.Major end point  Rupture of the sphincter ani (third or fourth degree) at second delivery.Results  The incidence of anal sphincter rupture increased sixfold during the study period, from 0.5% in 1973 to 3.0% in 1997. Women who had sustained a laceration of this type ran a significantly increased risk of a recurrence at a later delivery. This effect persisted even after stratification for birthweight, year of birth, parity and maternal age (OR 4.74, 95% confidence interval 4.34–5.17). When only fourth degree rupture was considered (rupture of both anal sphincter and rectum), the corresponding figures were 6.52 (95% CI 5.29–8.04). This effect also persisted after stratification for birthweight, year of birth, parity and maternal age. The OR for giving birth a second time, subsequent to a third or fourth degree perineal laceration at first delivery, was 0.68 (95% CI 0.67–0.70).Conclusion  Our findings suggest that the risk of an anal sphincter rupture at delivery increases five to sevenfold when there has been a similar rupture at a previous delivery. Further study is needed before safe recommendations can be made concerning the subsequent mode of delivery to be adopted, following rupture in the sphincter ani at a previous birth.
Management of genital chlamydial infections at termination of pregnancy services in England and Wales: where are we now?
Authors: LaMontagne D. Scott , Pimenta Jeanne M. , Fenton Kevin A. , Mallinson Harry , Hopwood Jenny 
Published: November 2004

Objective  To determine the range of policies and practices related to the management of genital chlamydial infection employed at termination of pregnancy services in England and Wales.Design  Cross‐sectional descriptive study.Setting  England and Wales.Population  Termination of pregnancy providers.Methods  Survey questionnaire administered to termination of pregnancy providersMain outcome measures  Policies and practices for the management of genital chlamydial infection in women seeking termination of pregnancy with comparison to the national guidelines of the chief medical officer (CMO) and the Royal College of Obstetricians and Gynaecologists (RCOG).Results  One hundred and thirty‐eight (48%) practices responded to the survey, with representation across England and Wales. Policies for screening and/or treatment of chlamydial infection existed for 70% of providers. We found three practice patterns for the management of genital chlamydial infection among termination of pregnancy attenders: 70% of providers tested their own attenders prior to termination and treated if necessary; about 25% of providers administered prophylaxis without testing; and a small number of providers (<5%) neither tested nor treated attenders.Conclusion  These patterns may be the result of differences in the CMO and RCOG guidelines. Given the impact of untreated genital chlamydial infection in women attending for termination, consistent recommendations from the CMO and RCOG may encourage uniform practice for the management of chlamydial infection in this vulnerable population.
Hypoxia induced activin secretion by the fetoplacental unit: differential responses related to gestation
Authors: Loose Jan M. , Miller Suzanne L. , Supramaniam Veena G. , Ward Janelle W. , O'Connor Anne E. , De Krester David M. , Wallace Euan M. , Jenkin Graham 
Published: November 2004

Objective  To determine whether activin A levels reflect oxygen availability in basal and hypoxic conditions in the late pregnant fetus and newborn lamb.Design  In vivo animal experimental study.Setting  Department of Physiology, Monash University.Population  Chronically catheterised fetal sheep in late gestation.Methods  Fetal hypoxia was induced at 125 (n= 4), 135 (n= 4) or 145 days (‘term’; n= 3) gestational age by maternal nitrogen exposure, for 4 hours, during which maternal and fetal arterial, and amniotic fluid samples were collected. Lambs (age one, five and eight days; n= 3) were exposed to 1 hour of hypoxia via nitrogen exposure.Main outcome measures  Activin A, prostaglandin E2 (PGE2) and cortisol were analysed in plasma and amniotic fluid, and whole blood was used to determine Pao2, Paco2, %O2, lactate and pH.Results  Basal activin A concentrations in the fetal arterial circulation remained unchanged between 125 days (0.230 [0.10] ng/mL) and term (0.28 [0.10] ng/mL), as did fetal oxygen saturation (59.11% [4.74%] to 52.25% [4.84%]) and pH (7.35 [0.02] to 7.37 [0.02]). Moderate fetal hypoxia (50% fall in fetal arterial %O2) produced a significant increase in circulating activin A (2.05 [0.67] ng/mL) and a significant decrease in pH (7.27 [0.03]) at 125 days of gestation, however, at 135 and 145 days, activin A and pH remained unchanged. Fetal activin A concentration was significantly correlated with pH (P= 0.036) but not %O2 (P= 0.072). Hypoxia in the lambs did not alter circulating activin A.Conclusions  In response to hypoxia, activin A is increased in the circulation of 125‐day‐old fetuses, but not in older fetuses. Fetal arterial activin A levels sensitively reflect pH but not oxygen saturation, with increasing activin A in conditions of metabolic acidosis.
Incidence of breast abscess in lactating women: report from an Australian cohort
Authors: Amir Lisa H. , Forster Della , McLachlan Helen , Lumley Judith 
Published: November 2004

Objectives  To report the incidence of breast abscess in lactating women.Design  Data were combined from two studies (a randomised controlled trial and a survey) to provide a cohort of women for this report.Setting  Women were recruited from two hospitals on one site in Melbourne, Victoria, the Royal Women's Hospital (public) (1999–2001) and Frances Perry House (private) (2000–2001).Participants  A total of 1193 of 1311 (91%) primiparous, English‐speaking women from a diverse range of backgrounds, including those receiving public clinic care, private care and birth centre care.Methods  A structured telephone interview was conducted on breastfeeding at six months postpartum.Main outcome measures  Lactational mastitis and breast abscess.Results  Two hundred and seven women experienced mastitis. Five women developed a breast abscess: 0.4% of women who commenced breastfeeding (95% CI 0.14–0.98); 2.9% of women who took antibiotics for mastitis (95% CI 1.0–6.7).Conclusion  Although many authors estimate that 11% of women with mastitis develop a breast abscess, the incidence of lactating breast abscesses in Australia appears to be lower than reported in the past. Our estimate is that 3% of women with mastitis will develop a breast abscess.
Testing positive for human papillomavirus in routine cervical screening: examination of psychosocial impact
Authors: McCaffery Kirsten , Waller Jo , Forrest Sue , Cadman Louise , Szarewski Anne , Wardle Jane 
Published: November 2004

Objective  To examine the psychosocial impact of testing positive for high risk human papillomavirus (HPV) among women attending primary cervical screening.Design  Cross sectional survey. Measures were taken at baseline and one week after the receipt of HPV and cytology screening results.Setting  Well women's clinic in London, UK.Population or Sample  Four hundred and twenty‐eight women aged 20–64 years.Methods  Postal questionnaire survey.Main outcome measures  Psychosocial and psychosexual outcomes were anxiety, distress and feelings about current, past and future sexual relationships.Results  Women with normal cytology who tested positive for HPV (HPV+) were significantly more anxious and distressed than women who were negative (HPV−) using both a state anxiety measure [F(1,267) = 29, P < 0.0001] and a screening specific measure of psychological distress [F(1,267) = 69, P < 0.0001]. Women with an abnormal or unsatisfactory smear result, who tested HPV+, were significantly more distressed than HPV− women with the same smear result [F(1,267) = 8.8, P= 0.002], but there was no significant difference in state anxiety. Irrespective of cytology result, HPV+ women reported feeling significantly worse about their sexual relationships. Approximately one‐third of women who tested positive reported feeling worse about past and future sexual relationships compared with less than 2% of HPV− women.Conclusion  The findings suggest that testing positive for HPV may have an adverse psychosocial impact, with increased anxiety, distress and concern about sexual relationships. Psychosocial outcomes of HPV testing need further investigation and must be considered alongside clinical and economic decisions to include HPV testing in routine cervical screening.
Risks of induction of labour in women with a uterine scar from previous low transverse caesarean section
Authors: Locatelli Anna , Regalia Anna Laura , Ghidini Alessandro , Ciriello Elena , Biffi Anna , Pezzullo John C. 
Published: November 2004

Objective  Recent studies have shown that among women with uterine scars from previous caesarean section of any type, induction of labour is associated with increased risk of uterine rupture compared with spontaneous labour. We have assessed the risk of uterine rupture in a cohort of women with a previous low transverse caesarean section in whom induction and management of labour were performed according to a strict protocol.Design  Cohort study.Setting  University Hospital.Population  All women with a singleton pregnancy and a previous low transverse caesarean section requiring induction of labour from 1/1/1992 to 12/30/2001 (n= 310) were compared with a control cohort during the same study period constituted of women with a previous low transverse caesarean section in spontaneous labour (n= 1011).Methods  Clinical characteristics and rate of uterine rupture of women with previous caesarean section undergoing induction of labour were compared with those of women with previous caesarean section in spontaneous labour.Main outcome measure  Incidence of uterine rupture.Results  Uterine rupture occurred in 0.3% in the previous caesarean section—induction group versus 0.3% in the previous caesarean section—spontaneous labour group (P= 0.9). Logistic regression analysis showed no significant difference in the rate of uterine rupture between the induction and spontaneous labour group (P= 0.67) after controlling for maternal age, parity, duration of labour, gestational age at delivery and birthweight.Conclusion  Among women with a previous low transverse caesarean section, induction of labour is not associated with significantly higher rates of uterine rupture compared with spontaneous labour, provided a consistent protocol with strict criteria for intervention is adopted.
Women's perceived experiences of abuse in the health care system: their relationship to childhood abuse
Authors: Swahnberg Katarina , Wijma Barbro , Wingren Gun , Hilden Malene , Schei Berit 
Published: November 2004

Objectives  The aim of this study was to determine whether there was an association between any lifetime experiences of emotional, physical and/or sexual abuse and perceived abuse in the health care system. Furthermore, we wanted to ascertain if adult victims of perceived abuse in the health care system reported exposure to childhood emotional, physical and/or sexual abuse more often than non‐victims did.Design  A cross sectional questionnaire study. The first hypothesis was tested in the total sample, and the second hypothesis in a case–control analysis. The cases were those women who reported perceived experiences of abuse in the health care system as adults. Exposure was defined as experience of emotional, physical and/or sexual abuse in childhood.Settings  Three Swedish gynaecological clinics.Sample  A total of 2439 gynaecology patients (response rate 81%).Methods  Postal questionnaire.Main outcome measure  Associations between experiences of emotional, physical and/or sexual abuse, and perceived abuse in the health care system; all operationalised in The NorVold Abuse Questionnaire (NorAQ).Results  A general association was found between lifetime experiences of emotional, physical and/or sexual abuse and perceived abuse in the health care system. Adult victims of abuse in the health care system reported experiences of emotional, physical and/or sexual abuse in childhood more often than non‐victims did. These findings also held after adjustment for age and educational level.Conclusions  We found associations between experiences of any lifetime abuse and perceived abuse in the health care system. Adult victimisation in the health care system was associated with childhood exposure to emotional, physical and/or sexual abuse. These associations call for attention and need to be further investigated.
What do they know?: a content analysis of women's perceptions of trial information
Authors: Kenyon Sara , Dixon‐Woods Mary 
Published: November 2004

Objective  To examine interpretations of study information by women participating in ORACLE, a trial of antibiotics in preterm labour.Design  Questionnaire survey sent to women recruited to the ORACLE trial.Setting  United Kingdom.Population  A questionnaire was sent to 3074 ORACLE participants in a purposively selected sample of 55 collaborating maternity units, chosen to reflect a range of regions and of district general and teaching hospitals.Methods  Content analysis was applied to verbatim text provided in response to an open question. Responses were also compared with a framework based on key points about the purpose of ORACLE. Closed questions were analysed using descriptive statistics.Main outcome measures  Participants' interpretations of the purpose of the study.Results  A response rate of 61% was achieved, and 1462 participants provided written answers to a specific question on why the study was being carried out. Content analysis suggested that the information leaflet was highly valued as a source of information about the trial. There was evidence that women's interpretations of the purpose of the trial were not identical to those that the investigators intended. Of the five key points about the trial described in the information leaflet, 400 (27%) participants reported one key point, 550 (38%) two key points, 229 (16%) three key points and 23 (1.5%) four key points. None reported five key points and it was not possible to classify 46 responses (3%). Vague, confused understanding or poor recall were evident in 204 (14%) of responses.Conclusion  Although the ORACLE trial was run as a model of good practice at the time, this study suggests that it may not be possible to demonstrate full understanding of trial purpose and design by all participants. Emphasis should be on the provision of full information that involves consumers in its design and evaluation.
Trends in the cause of late fetal death, 1982–2000
Authors: Bell Ruth , Parker Louise , MacPhail Sheila , Wright Chris 
Published: November 2004

Background  Progress in reducing late fetal deaths has slowed in recent years, despite changes in intrapartum and antepartum care.Objectives  To describe recent trends in cause‐specific fetal death rates.Design  Retrospective cohort study.Setting  North of England.Population/Sample  3,386 late fetal deaths (≥28 weeks of gestation and at least 500 g), occuring between 1982 and 2000.Methods  Data on deaths were obtained from the Northern Perinatal Mortality Survey. Data on live births were obtained from national birth registration statistics. Rate ratios (RR) and 95% confidence intervals (CI) for fetal deaths in 1991–2000 compared with 1982–1990 were calculated.Main outcome measures  Cause‐specific late fetal death rates per 10,000 total births.Results  Mortality in singletons declined from 51.5 per 10,000 births in 1982–1990 to 42.0 in 1991–2000 (RR 0.82, 95% CI 0.76–0.87). There was a greater decline in multiples, from 197.9 to 128.0 per 10,000 (RR 0.65, 95% CI 0.51–0.83). In singletons, the largest reductions occurred in intrapartum‐related deaths, and deaths due to congenital anomalies, antepartum haemorrhage and pre‐eclampsia. There was little change in the rate of unexplained antepartum death occurring at term (RR 0.97, 95% CI 0.84–1.11) or preterm (RR 0.94, 95% CI 0.82–1.07), these accounting for about half of all late fetal deaths. Unexplained antepartum deaths declined in multiple births and in singletons of birthweight <1500 g.Conclusions  While late fetal mortality due to many specific causes has declined, unexplained antepartum death rates have remained largely unchanged. Improved identification of deaths due to growth restriction and infection, which may otherwise be classified as unexplained, is important. Further investigation of the underlying aetiologies of genuinely unexplained deaths is needed.
The use of levonorgestrel‐releasing intrauterine system for treatment of menorrhagia in women with inherited bleeding disorders
Authors: Kingman C.E.C. , Kadir R.A. , Lee C.A. , Economides D.L. 
Published: November 2004

Background  The levonorgestrel‐releasing intrauterine system (LNG‐IUS) is used commonly by gynaecologists as a contraceptive and to treat menorrhagia. However, its efficacy has not been examined in women with inherited bleeding disorders.Design  A prospective pilot study.Setting  A teaching hospital in north London with a designated haemophilia centre.Population  Female patients with a known inherited bleeding disorder.Methods  Sixteen women with subjective and objective menorrhagia caused by inherited bleeding disorders (13 von Willebrand's Disease, two factor XI deficiency and one Hermansky–Pudlak syndrome), who had previously undergone unsuccessful medical treatment were followed up for nine months after LNG‐IUS insertion. Bleeding was measured by pictorial chart and haemoglobin concentration.Main outcome measure  Results  All women reported that their periods were improved, pictorial chart scores were lower and 56% became amenorrhoeic. None reported side effects.Conclusion  The LNG‐IUS is well tolerated and effective and improves quality of life.
Ignorance of electrosurgery among obstetricians and gynaecologists
Authors: Mayooran Zorana , Pearce Scott , Tsaltas Jim , Rombauts Luk , Brown T. Ian H. , Lawrence Anthony S. , Fraser Kym , Healy David L. 
Published: November 2004

Objective  The purpose of this study was to assess the level of skill of laparoscopic surgeons in electrosurgery.Design  Subjects were asked to complete a practical diathermy station and a written test of electrosurgical knowledge.Setting  Tests were held in teaching and non‐teaching hospitals.Sample  Twenty specialists in obstetrics and gynaecology were randomly selected and tested on the Monash University gynaecological laparoscopic pelvi‐trainer. Twelve candidates were consultants with 9–28 years of practice in operative laparoscopy, and 8 were registrars with up to six years of practice in operative laparoscopy. Seven consultants and one registrar were from rural Australia, and three consultants were from New Zealand.Methods  Candidates were marked with checklist criteria resulting in a pass/fail score, as well as a weighted scoring system. We retested 11 candidates one year later with the same stations.Main outcome measures  No improvement in electrosurgery skill in one year of obstetric and gynaecological practice.Results  No candidate successfully completed the written electrosurgery station in the initial test. A slight improvement in the pass rate to 18% was observed in the second test. The pass rate of the diathermy station dropped from 50% to 36% in the second test.Conclusion  The study found ignorance of electrosurgery/diathermy among gynaecological surgeons. One year later, skills were no better.
Gene expression profile of long‐lived Ames dwarf mice and Little mice
Authors: Amador‐Noguez Daniel , Yagi Kazuo , Venable Susan , Darlington Gretchen 
Published: November 2004

SummaryAmes dwarf mice (Prop1df/df) and Little mice (Ghrhrlit/lit) are used as models of delayed aging and show significant increases in lifespan (50% and 25%, respectively) when compared with their wild‐type siblings. To gain further insight into the molecular basis for the extended longevity of these mice, we used oligonucleotide microarrays to measure levels of expression of over 14 000 RNA transcripts in liver during normal aging at 3, 6, 12 and 24 months. We found that the Prop1df/df and Ghrhrlit/lit genotypes produce dramatic alterations in gene expression, which are predominantly maintained at all ages. We found 1125 genes to be significantly affected by the Prop1df/df genotype and 1152 genes were significantly affected by the Ghrhrlit/lit genotype; 547 genes were present in both gene lists and showed parallel changes in gene expression, suggesting common mechanisms for the extended longevity in these mutants. Some of the functional gene classes most affected in these mutants included: amino acid metabolism, TCA cycle, mitochondrial electron transport, fatty acid, cholesterol and steroid metabolism, xenobiotic metabolism and oxidant metabolism. We found that the Prop1df/df genotype, and to a minor extent the Ghrhrlit/lit genotype, also produced complex alterations in age‐dependent changes in gene expression as compared with wild‐type mice. In some cases these alterations reflected a partial delay or deceleration of age‐related changes in gene expression as seen in wild‐type mice but they also introduced age‐related changes that are unique for each of these mutants and not present in wild‐type mice.