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Sample records for high postpartum relapse

  1. High risk of postpartum relapses in neuromyelitis optica spectrum disorder.

    Science.gov (United States)

    Klawiter, Eric C; Bove, Riley; Elsone, Liene; Alvarez, Enrique; Borisow, Nadja; Cortez, Melissa; Mateen, Farrah; Mealy, Maureen A; Sorum, Jaime; Mutch, Kerry; Tobyne, Sean M; Ruprecht, Klemens; Buckle, Guy; Levy, Michael; Wingerchuk, Dean; Paul, Friedemann; Cross, Anne H; Jacobs, Anu; Chitnis, Tanuja; Weinshenker, Brian

    2017-11-28

    To study the effect of pregnancy on the frequency of neuromyelitis optica spectrum disorder (NMOSD) relapse and evaluate rates of pregnancy-related complications in an international multicenter setting. We administered a standardized survey to 217 women with NMOSD from 7 medical centers and reviewed their medical records. We compared the annualized relapse rate (ARR) during a baseline period 2 years prior to a participant's first pregnancy to that during pregnancy and to the 9 months postpartum. We also assessed pregnancy-related complications. There were 46 informative pregnancies following symptom onset in 31 women with NMOSD. Compared to baseline (0.17), ARR was increased both during pregnancy (0.44; p = 0.035) and during the postpartum period (0.69; p = 0.009). The highest ARR occurred during the first 3 months postpartum (ARR 1.33). A total of 8 of 76 (10.5%) with onset of NMOSD prior to age 40 experienced their initial symptom during the 3 months postpartum, 2.9 times higher than expected. The postpartum period is a particularly high-risk time for initial presentation of NMOSD. In contrast to published observations in multiple sclerosis, in neuromyelitis optica, relapse rate during pregnancy was also increased, although to a lesser extent than after delivery. © 2017 American Academy of Neurology.

  2. Risk of postpartum relapse in bipolar disorder and postpartum psychosis : A systematic review and meta-analysis

    NARCIS (Netherlands)

    Wesseloo, R.; Kamperman, A.M.; Munk-Olsen, T.; Pop, V.J.M.; Kushner, S.A.; Bergink, V.

    2016-01-01

    Objective: Women with a history of bipolar disorder, postpartum psychosis, or both are at high risk for postpartum relapse. The aim of this meta-analysis was to estimate the risk of postpartum relapse in these three patient groups. Method: A systematic literature search was conducted in all public

  3. Preventing Postpartum Smoking Relapse: A Randomized Clinical Trial.

    Science.gov (United States)

    Levine, Michele D; Cheng, Yu; Marcus, Marsha D; Kalarchian, Melissa A; Emery, Rebecca L

    2016-04-01

    Most women who quit smoking during pregnancy will relapse postpartum. Previous efforts to prevent postpartum relapse have been unsuccessful at increasing rates of sustained abstinence. To evaluate the relative efficacy of 2 different approaches to prevent postpartum smoking relapse. Pregnant women who recently had quit smoking were recruited before the end of pregnancy. Intervention sessions were conducted through a combination of telephone calls and in-person visits beginning at delivery and continuing through 24 weeks postpartum. Participants completed assessments at the prenatal baseline and at 12, 24, and 52 weeks postpartum. Participants were recruited between March 2008 and December 2012. The dates of the analysis were April 2014 to February 2015. Women received postpartum-adapted, behavioral smoking relapse prevention intervention and were randomly assigned to an enhanced cognitive behavioral intervention that included additional specialized strategies and content focused on women's postpartum concerns about mood, stress, and weight (Strategies to Avoid Returning to Smoking [STARTS]) or a supportive, time and attention-controlled comparison (SUPPORT). Intervention began before delivery and continued through 24 weeks postpartum. The primary outcome was biochemically confirmed sustained tobacco abstinence at 52 weeks postpartum. Secondary outcomes were self-reported mood, levels of perceived stress, and degree of concern about smoking-related weight gain. The study cohort comprised 300 participants (150 randomly assigned to each group). Their mean (SD) age was 24.99 (5.65) years. Overall, 38.0% (114 of 300), 33.7% (101 of 300), and 24.0% (72 of 300) of the sample maintained abstinence at 12, 24, and 52 weeks' postpartum, respectively. There were no differences between the intervention groups in abstinence or time to relapse. Self-reported depressive symptoms and perceived stress significantly improved over time, and improvements were similar for both

  4. Postpartum smoking relapse--a thematic synthesis of qualitative studies.

    Science.gov (United States)

    Notley, Caitlin; Blyth, Annie; Craig, Jean; Edwards, Alice; Holland, Richard

    2015-11-01

    Many women quit smoking during pregnancy, but relapse after the baby is born. To understand why and identify ways of preventing this, this study reviewed the qualitative literature on women's experience of postpartum smoking relapse. A systematic review of qualitative studies and process evaluations of trials. We undertook a thematic synthesis of published qualitative data. We screened 1336 papers. Twenty-two papers reporting on 16 studies were included, reporting on the views of 1031 postpartum women. Factors affecting relapse and barriers and facilitators to relapse prevention were identified around the key themes of beliefs, social influences, motivation, physiological factors and identity. Women's beliefs about smoking as a means of coping with stress and the need for social support, especially from a partner, emerged as important. Extrinsic motivation to quit during the pregnancy (for the health of the fetus) appeared to be a factor in prompting relapse after the baby was born. During the immediate postpartum period women believed that physiological changes influence cigarette cravings. The stress of caring for a newborn, sleeplessness and adjusting to a new mothering identity were also reported to be important. Among women who quit smoking during pregnancy, those who relapse postpartum talk commonly about no longer needing to protect the baby and the effects of stress. Partner support and a sense of changed identity are cited as factors preventing relapse. © 2015 Society for the Study of Addiction.

  5. Preventing postpartum smoking relapse: an opportunity for neonatal nurses.

    Science.gov (United States)

    Forest, Sharron

    2009-08-01

    Smoking during pregnancy and exposure to environmental tobacco smoke have harmful and sometimes devastating effects on the health of the newborn. Although interventions for smoking cessation during pregnancy demonstrate effectiveness for increasing smoking abstinence, the majority of women relapse in the postpartum period. However, modifying contributing factors for relapse may improve the success of sustained abstinence. Many parents are eager to quit smoking and willing to participate in smoking cessation interventions. Through a population-based approach to healthcare, neonatal nurses are in an ideal position to prevent relapse and to promote smoking abstinence; they can coordinate and lead efforts for establishing smoking cessation strategies that integrate obstetric, newborn, and pediatric services.

  6. Prevention of postpartum psychosis and mania in women at high risk

    NARCIS (Netherlands)

    V. Bergink (Veerle); P.F. Bouvy (Paul); J. Vervoort (Jeroen); K.M. Koorengevel (Kathelijne); E.A.P. Steegers (Eric); S.A. Kushner (Steven)

    2012-01-01

    textabstractObjective: Women with a history of bipolar disorder or postpartum psychosis are at extremely high risk of relapse postpartum. Although lithium prophylaxis has demonstrated efficacy in reducing postpartum relapse, the timing of prophylaxis remains controversial given the balance of risks

  7. Mediators of the association of major depressive syndrome and anxiety syndrome with postpartum smoking relapse.

    Science.gov (United States)

    Correa-Fernández, Virmarie; Ji, Lingyun; Castro, Yessenia; Heppner, Whitney L; Vidrine, Jennifer Irvin; Costello, Tracy J; Mullen, Patricia Dolan; Cofta-Woerpel, Ludmila; Velasquez, Mary M; Greisinger, Anthony; Cinciripini, Paul M; Wetter, David W

    2012-08-01

    Based on conceptual models of addiction and affect regulation, this study examined the mechanisms linking current major depressive syndrome (MDS) and anxiety syndrome (AS) to postpartum smoking relapse. Data were collected in a randomized clinical trial from 251 women who quit smoking during pregnancy. Simple and multiple mediation models of the relations of MDS and AS with postpartum relapse were examined using linear regression, continuation ratio logit models, and a bootstrapping procedure to test the indirect effects. Both MDS and AS significantly predicted postpartum smoking relapse. After adjusting for MDS, AS significantly predicted relapse. However, after adjusting for AS, MDS no longer predicted relapse. Situationally based self-efficacy, expectancies of controlling negative affect by means other than smoking, and various dimensions of primary and secondary tobacco dependence individually mediated the effect of both MDS and AS on relapse. In multiple mediation models, self-efficacy in negative/affective situations significantly mediated the effect of MDS and AS on relapse. The findings underscore the negative impact of depression and anxiety on postpartum smoking relapse and suggest that the effects of MDS on postpartum relapse may be largely explained by comorbid AS. The current investigation provided mixed support for affect regulation models of addiction. Cognitive and tobacco dependence-related aspects of negative and positive reinforcement significantly mediated the relationship of depression and anxiety with relapse, whereas affect and stress did not. The findings emphasize the unique role of low agency with respect to abstaining from smoking in negative affective situations as a key predictor of postpartum smoking relapse. © 2012 American Psychological Association

  8. Factors associated with smoking relapse in the postpartum period: an analysis of the child health surveillance system data in Southeast England.

    Science.gov (United States)

    Harmer, Clare; Memon, Anjum

    2013-05-01

    There is increasing evidence that a high proportion (47%-63%) of women who quit smoking during pregnancy relapse during the postpartum period. The purpose of this population-based study was to examine the association between selected sociodemographic factors and smoking relapse in the early postpartum period (within the first 6 weeks) in women who had successfully quit smoking during the pregnancy. The study included 512 women resident in East Sussex, United Kingdom, who had quit smoking during the pregnancy. Information on the prevalence of smoking and selected sociodemographic factors and breast feeding at the 6-weeks postpartum review by health visitor was obtained from the Child Health Surveillance System, which records and monitors the health and development of children from birth until school entry. Of the 512 women who had quit smoking during the pregnancy, 238 (46.5%) relapsed in the early postpartum period. In the bivariate analysis, there was an association between deprivation and smoking relapse in the early postpartum period (OR = 5.3, 95% CI: 2.5-11.4), with a significant trend in increasing risk of relapse with increasing level of deprivation (p postpartum period. On the other hand, women who were breast feeding were significantly less likely to relapse (OR = 0.6, 95% CI: 0.4-0.9). Factors associated with early postpartum smoking relapse identified in this study, particularly breast feeding, high parity, and concurrent smoking by partner/other household member(s), may contribute to the development of effective and targeted interventions to maintain smoking cessation in women and their household.

  9. Mediators of the Association of Major Depressive Syndrome and Anxiety Syndrome with Postpartum Smoking Relapse

    Science.gov (United States)

    Correa-Fernandez, Virmarie; Ji, Lingyun; Castro, Yessenia; Heppner, Whitney L.; Vidrine, Jennifer Irvin; Costello, Tracy J.; Mullen, Patricia Dolan; Cofta-Woerpel, Ludmila; Velasquez, Mary M.; Greisinger, Anthony; Cinciripini, Paul M.; Wetter, David W.

    2012-01-01

    Objective: Based on conceptual models of addiction and affect regulation, this study examined the mechanisms linking current major depressive syndrome (MDS) and anxiety syndrome (AS) to postpartum smoking relapse. Method: Data were collected in a randomized clinical trial from 251 women who quit smoking during pregnancy. Simple and multiple…

  10. Translation and adaptation of smoking relapse-prevention materials for pregnant and postpartum Hispanic women.

    Science.gov (United States)

    Simmons, Vani Nath; Cruz, Ligia M; Brandon, Thomas H; Quinn, Gwendolyn P

    2011-01-01

    Quitting smoking is one of the most important behavior changes a pregnant woman can make, with health benefits extending beyond pregnancy for the woman and her child. Increasing numbers of pregnant women are quitting smoking; however, the majority resume smoking later in their pregnancy or shortly after giving birth. Previous research has demonstrated the efficacy of self-help smoking relapse-prevention booklets; however, there is a dearth of materials available in Spanish for Hispanic smokers. The goal of the present study was to translate and adapt existing, theoretically based, smoking relapse-prevention materials for pregnant and postpartum Hispanic women. This article describes the transcreation approach used to ensure the Forever Free for Baby and Me booklets were linguistically and culturally relevant for the heterogeneous populations of Hispanic women. The authors conducted multistage formative research to adapt the booklets and modify vignettes and graphics. Compared with previous research conducted with pregnant non-Hispanic women, results revealed the following: (a) a lack of association or concern about smoking and weight gain, (b) the importance of family approval of behavior, and (c) stress related to difficulties surrounding the immigration experience. The authors' qualitative findings confirm and extend past research that has suggested ways to enhance the cultural relevance and acceptability of a health intervention.

  11. ?I Was a Full Time Proper Smoker?: A Qualitative Exploration of Smoking in the Home after Childbirth among Women Who Relapse Postpartum

    OpenAIRE

    Orton, Sophie; Coleman, Tim; Lewis, Sarah; Cooper, Sue; Jones, Laura L.

    2016-01-01

    Background: \\ud Many women stop smoking during pregnancy but relapse shortly afterwards, potentially putting their infants at risk of secondhand smoke (SHS) exposure. Women who were able to stop during pregnancy may be a motivated group, receptive to making behaviour changes postpartum to protect their infant from SHS exposure. Understanding more about their experiences of relapse, and if this influences home smoking behaviours and children’s exposure to SHS in the home may help to inform int...

  12. Therapeutics of postpartum depression.

    Science.gov (United States)

    Thomson, Michael; Sharma, Verinder

    2017-05-01

    Postpartum depression is a prevalent disorder affecting many women of reproductive age. Despite increasing public awareness, it is frequently underdiagnosed and undertreated leading to significant maternal morbidity and adverse child outcomes. When identified, postpartum depression is usually treated as major depressive disorder. Many studies have identified the postpartum as a period of high risk for first presentations and relapses of bipolar disorder. Areas covered: This article reviews the acute and prophylactic treatment of postpartum major depressive disorder, bipolar depression and major depressive disorder with mixed features. The safety of antidepressant and mood stabilizing medications in pregnancy and breastfeeding will also be reviewed. Expert commentary: Differentiating postpartum major depressive disorder and postpartum bipolar depression can be difficult given their clinical similarities but accurate identification is vital for initiating proper treatment. Antidepressants are the mainstay of drug treatment for postpartum major depressive disorder, yet randomized controlled trials have shown conflicting results. A paucity of evidence exists for the effectiveness of antidepressant prophylaxis in the prevention of recurrences of major depressive disorder. Mood stabilizing medications reduce the risk of postpartum bipolar depression relapse but no randomized controlled trials have examined their use in the acute or prophylactic treatment of postpartum bipolar depression.

  13. "I Was a Full Time Proper Smoker": A Qualitative Exploration of Smoking in the Home after Childbirth among Women Who Relapse Postpartum.

    Directory of Open Access Journals (Sweden)

    Sophie Orton

    Full Text Available Many women stop smoking during pregnancy but relapse shortly afterwards, potentially putting their infants at risk of secondhand smoke (SHS exposure. Women who were able to stop during pregnancy may be a motivated group, receptive to making behaviour changes postpartum to protect their infant from SHS exposure. Understanding more about their experiences of relapse, and if this influences home smoking behaviours and children's exposure to SHS in the home may help to inform intervention development to prevent infant SHS exposure.Guided by interpretative phenomenological methodology we conducted and analysed nine semi-structured interviews with women who quit smoking during pregnancy, but relapsed ≤3 months postpartum.Central to mothers' accounts of their smoking behaviours during pregnancy and postpartum was their desire to be a 'responsible mother'. Mothers described using strategies to protect their infant from SHS exposure, and held strong negative attitudes towards other smoking parents. After relapsing, mothers appeared to reposition themselves as 'social' or 'occasional' smokers rather than 'regular' smokers.Findings suggest that interventions to prevent/reduce infants' home SHS exposure should build on mothers' intentions to be responsible parents. As mothers who relapse principally view themselves as 'social' or 'occasional' smokers, interventions that are highlighted as relevant for women with these types of smoking patterns may be more likely to be responded to, and, ultimately, be effective.

  14. “I Was a Full Time Proper Smoker”: A Qualitative Exploration of Smoking in the Home after Childbirth among Women Who Relapse Postpartum

    Science.gov (United States)

    Coleman, Tim; Lewis, Sarah; Cooper, Sue

    2016-01-01

    Background Many women stop smoking during pregnancy but relapse shortly afterwards, potentially putting their infants at risk of secondhand smoke (SHS) exposure. Women who were able to stop during pregnancy may be a motivated group, receptive to making behaviour changes postpartum to protect their infant from SHS exposure. Understanding more about their experiences of relapse, and if this influences home smoking behaviours and children’s exposure to SHS in the home may help to inform intervention development to prevent infant SHS exposure. Methods Guided by interpretative phenomenological methodology we conducted and analysed nine semi-structured interviews with women who quit smoking during pregnancy, but relapsed ≤3 months postpartum. Findings Central to mothers’ accounts of their smoking behaviours during pregnancy and postpartum was their desire to be a ‘responsible mother’. Mothers described using strategies to protect their infant from SHS exposure, and held strong negative attitudes towards other smoking parents. After relapsing, mothers appeared to reposition themselves as ‘social’ or ‘occasional’ smokers rather than ‘regular’ smokers. Conclusions Findings suggest that interventions to prevent/reduce infants' home SHS exposure should build on mothers' intentions to be responsible parents. As mothers who relapse principally view themselves as ‘social’ or ‘occasional’ smokers, interventions that are highlighted as relevant for women with these types of smoking patterns may be more likely to be responded to, and, ultimately, be effective. PMID:27308829

  15. "I Was a Full Time Proper Smoker": A Qualitative Exploration of Smoking in the Home after Childbirth among Women Who Relapse Postpartum.

    Science.gov (United States)

    Orton, Sophie; Coleman, Tim; Lewis, Sarah; Cooper, Sue; Jones, Laura L

    2016-01-01

    Many women stop smoking during pregnancy but relapse shortly afterwards, potentially putting their infants at risk of secondhand smoke (SHS) exposure. Women who were able to stop during pregnancy may be a motivated group, receptive to making behaviour changes postpartum to protect their infant from SHS exposure. Understanding more about their experiences of relapse, and if this influences home smoking behaviours and children's exposure to SHS in the home may help to inform intervention development to prevent infant SHS exposure. Guided by interpretative phenomenological methodology we conducted and analysed nine semi-structured interviews with women who quit smoking during pregnancy, but relapsed ≤3 months postpartum. Central to mothers' accounts of their smoking behaviours during pregnancy and postpartum was their desire to be a 'responsible mother'. Mothers described using strategies to protect their infant from SHS exposure, and held strong negative attitudes towards other smoking parents. After relapsing, mothers appeared to reposition themselves as 'social' or 'occasional' smokers rather than 'regular' smokers. Findings suggest that interventions to prevent/reduce infants' home SHS exposure should build on mothers' intentions to be responsible parents. As mothers who relapse principally view themselves as 'social' or 'occasional' smokers, interventions that are highlighted as relevant for women with these types of smoking patterns may be more likely to be responded to, and, ultimately, be effective.

  16. Bortezomib or high-dose dexamethasone for relapsed multiple myeloma

    NARCIS (Netherlands)

    P.G. Richardson (Paul Gerard); P. Sonneveld (Pieter); M.W. Schuster (Michael); D. Irwin (David); E.A. Stadtmauer (Edward); T. Facon (Thierry); J-L. Harousseau (Jean-Luc); D. Ben-Yehuda (Dina); S. Lonial (Sagar); H. Goldschmidt (Hartmut); D. Reece (Donna); J.F. San Miguel (Jesús Fernando); J. Bladé (Joan); M. Boccadoro (Mario); J. Cavenagh (Jamie); W. Dalton (William); A.L. Boral (Anthony); D.-L. Esseltine (Dixie-Lee); J.B. Porter (Jane); D. Schenkein (David); K.C. Anderson (Kenneth)

    2005-01-01

    textabstractBACKGROUND: This study compared bortezomib with high-dose dexamethasone in patients with relapsed multiple myeloma who had received one to three previous therapies. METHODS: We randomly assigned 669 patients with relapsed myeloma to receive either an intravenous bolus of bortezomib (1.3

  17. High serum testosterone levels during postpartum period are associated with postpartum depression.

    Science.gov (United States)

    Aswathi, A; Rajendiren, Soundravally; Nimesh, Archana; Philip, R Ravi; Kattimani, Shivanand; Jayalakshmi, D; Ananthanarayanan, P H; Dhiman, Pooja

    2015-10-01

    In view of the reported cases of mood disorders that occur in mothers following childbirth and believing that sex steroid hormones contribute to mood and behavioral changes, this study has been aimed to explore the role of sex steroid hormones as an etiological factor for postpartum depression (PPD). This study was conducted at JIPMER, Puducherry, India between January 2010 and 2011. 103 women were recruited in the study after childbirth, out of which 62 women who were believed to be suffering from PPD were categorized as cases and the remaining 41 with no mood changes as controls, using Edinburgh Postpartum Depression Scale (EPDS) (cases had EPDS score ≥10 at 24-28h, controls had score postpartum). The hormones estimated in these two groups included estradiol, progesterone and testosterone, and their levels were compared between these two groups. A significantly high testosterone levels were observed in cases with PPD at 24-28h when compared to controls. Estradiol and progesterone levels did not show significant difference between cases and controls. ROC analysis done at 24-28h showed that testosterone levels beyond 42.71ng/mL predict the development of PPD with 79% sensitivity, 63% specificity, 68% positive predictive value, 74% negative predictive value with AUC being 0.708. This study shows that there is an association between persistent high serum testosterone level in women following childbirth and PPD. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Patterns of Relapse in High-Risk Neuroblastoma Patients Treated With and Without Total Body Irradiation

    International Nuclear Information System (INIS)

    Li, Richard; Polishchuk, Alexei; DuBois, Steven; Hawkins, Randall; Lee, Stephanie W.; Bagatell, Rochelle; Shusterman, Suzanne; Hill-Kayser, Christine; Al-Sayegh, Hasan; Diller, Lisa; Haas-Kogan, Daphne A.; Matthay, Katherine K.; London, Wendy B.

    2017-01-01

    Purpose: External beam radiation therapy to initial sites of disease may influence relapse patterns in high-risk neuroblastoma. However, the effect of systemic irradiation by use of total body irradiation (TBI) on anatomic patterns of relapse has not previously been investigated. Methods and Materials: We retrospectively analyzed patients receiving definitive treatment of high-risk neuroblastoma with subsequent relapse in bony metastatic sites, with a date of relapse between January 1, 1997, and December 31, 2012. Anatomic sites of disease, defined by metaiodobenzylguanidine (MIBG) avidity, were compared at diagnosis and at first relapse. The Fisher exact test was performed to compare relapse in initially involved sites between patients treated with and without TBI. Results: Seventy-four patients with a median age at diagnosis of 3.5 years (range, 0.3-15.3 years) had relapse in 227 sites of MIBG-avid metastatic disease, with a median time to relapse of 1.8 years. Of the 227 sites of first relapse, 154 sites (68%) were involved at diagnosis. When we compared relapse patterns in patients treated with and without TBI, 12 of 23 patients (52%) treated with TBI had relapse in ≥1 previously MIBG-avid site of disease whereas 40 of 51 patients (78%) treated without TBI had relapse in ≥1 previously MIBG-avid site of disease (P=.03). Conclusions: Patients treated with systemic irradiation in the form of TBI were significantly less likely to have relapse in prior sites of disease. These findings support further investigation into the role of radiopharmaceutical therapies in curative multimodality therapy.

  19. Patterns of Relapse in High-Risk Neuroblastoma Patients Treated With and Without Total Body Irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Li, Richard [Harvard Medical School, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States); Polishchuk, Alexei [School of Medicine, University of California San Francisco, San Francisco, California (United States); DuBois, Steven [Harvard Medical School, Boston, Massachusetts (United States); Dana-Farber/Boston Children' s Cancer and Blood Disorders Center, Boston, Massachusetts (United States); Hawkins, Randall [School of Medicine, University of California San Francisco, San Francisco, California (United States); Lee, Stephanie W. [Brigham and Women' s Hospital, Boston, Massachusetts (United States); Bagatell, Rochelle [Children' s Hospital of Philadelphia, Philadelphia, Pennsylvania (United States); Shusterman, Suzanne [Harvard Medical School, Boston, Massachusetts (United States); Dana-Farber/Boston Children' s Cancer and Blood Disorders Center, Boston, Massachusetts (United States); Hill-Kayser, Christine [Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Al-Sayegh, Hasan [Brigham and Women' s Hospital, Boston, Massachusetts (United States); Dana-Farber/Boston Children' s Cancer and Blood Disorders Center, Boston, Massachusetts (United States); Diller, Lisa [Harvard Medical School, Boston, Massachusetts (United States); Dana-Farber/Boston Children' s Cancer and Blood Disorders Center, Boston, Massachusetts (United States); Haas-Kogan, Daphne A. [Harvard Medical School, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States); Dana-Farber/Boston Children' s Cancer and Blood Disorders Center, Boston, Massachusetts (United States); Matthay, Katherine K. [School of Medicine, University of California San Francisco, San Francisco, California (United States); London, Wendy B. [Harvard Medical School, Boston, Massachusetts (United States); Dana-Farber/Boston Children' s Cancer and Blood Disorders Center, Boston, Massachusetts (United States); and others

    2017-02-01

    Purpose: External beam radiation therapy to initial sites of disease may influence relapse patterns in high-risk neuroblastoma. However, the effect of systemic irradiation by use of total body irradiation (TBI) on anatomic patterns of relapse has not previously been investigated. Methods and Materials: We retrospectively analyzed patients receiving definitive treatment of high-risk neuroblastoma with subsequent relapse in bony metastatic sites, with a date of relapse between January 1, 1997, and December 31, 2012. Anatomic sites of disease, defined by metaiodobenzylguanidine (MIBG) avidity, were compared at diagnosis and at first relapse. The Fisher exact test was performed to compare relapse in initially involved sites between patients treated with and without TBI. Results: Seventy-four patients with a median age at diagnosis of 3.5 years (range, 0.3-15.3 years) had relapse in 227 sites of MIBG-avid metastatic disease, with a median time to relapse of 1.8 years. Of the 227 sites of first relapse, 154 sites (68%) were involved at diagnosis. When we compared relapse patterns in patients treated with and without TBI, 12 of 23 patients (52%) treated with TBI had relapse in ≥1 previously MIBG-avid site of disease whereas 40 of 51 patients (78%) treated without TBI had relapse in ≥1 previously MIBG-avid site of disease (P=.03). Conclusions: Patients treated with systemic irradiation in the form of TBI were significantly less likely to have relapse in prior sites of disease. These findings support further investigation into the role of radiopharmaceutical therapies in curative multimodality therapy.

  20. [Post-partum thyroiditis].

    Science.gov (United States)

    Neves, Celestino; Alves, Marta; Delgado, Luís; Medina, J Luís

    2009-01-01

    In the post-partum period the immune alterations are associated with the multiple autoimmune diseases relapse. After birth, immune-tolerance variation slowly disappear, and is observed a return to a normal state - after an exacerbation period - of autoimmune reactivity, during which a great increase in T cells and autoantibodies is observed. In this period - 3 to 9 months after birth - the thyroid autoimmune disease relapses or reappears. The reactivation of the immune system in the post-partum period unchains an acute phase of celular destruction which characterizes the post-partum thyroiditis.

  1. Relapses in Multiple Sclerosis: Definition, Pathophysiology, Features, Imitators, and Treatment

    Directory of Open Access Journals (Sweden)

    Serhan Sevim

    2016-09-01

    Full Text Available Relapse in multiple sclerosis (MS is defined as a neurologic deficit associated with an acute inflammatory demyelinating event that lasts at least 24 hours in the absence of fever and infection. Myelinoclasis and axonal transection occur in relapses. Diagnosis, prognosis, treatment, and many other features of the disease are directly related to the relapses. MS starts as the relapsing-remitting (RRMS form in 85% of patients. A large number of relapses in the first years, polysymptomatic relapses, and pyramidal system, brain stem, and spinal cord involvement are signs of a poor outcome. The average frequency of relapses is approximately one per year during the first years of RRMS. The frequency of relapses increases during systemic infections, psychological stress, and in the postpartum first 3 months. Seventy-five percent of relapses are monosymptomatic. Pseudo-relapses and paroxysmal symptoms are distinguished from relapses by their sudden onset, sudden termination, and shorter duration. Contrast enhancement is valuable in imaging, but undetectable in most relapses. The regression in the first few weeks of relapses is explained by reduction of the edema, and by remyelination in the following months. Relapses and their features are also among the main determinants of treatment. High-dose methylprednisolone and early treatment with adrenocorticotropic hormone reduce post-relapse disability and shorten the duration of relapses. Plasmapheresis is a good option for patients who do not respond to steroid treatment. Identification of relapses by patients and physicians, distinguishing them from imitators, proper evaluation, treatment when necessary, and monitoring the results are of great importance for patients with MS. The educational levels of patients and physicians regarding these parameters should be increased. Well-designed studies that evaluate the long-term effect of relapse treatment on disability are needed.

  2. The relationship between serum adiponectin and postpartum luteal activity in high-producing dairy cows.

    Science.gov (United States)

    Kafi, Mojtaba; Tamadon, Amin; Saeb, Mehdi

    2015-05-01

    The aims of the present study were to initially determine the pattern of serum adiponectin concentrations during a normal estrous cycle in high-producing postpartum dairy cows and then evaluate the relationship between the serum concentrations of adiponectin and insulin with the commencement of postpartum luteal activity and ovarian activities in clinically healthy high-producing Holstein dairy cows. During a normal estrous cycle of cows (n = 6), serum adiponectin concentrations gradually decreased (P Cows with higher peak of milk yield had lower serum adiponectin concentrations by week 7 postpartum (P = 0.01). Serum adiponectin and insulin concentrations in cows with different postpartum luteal activity (based on the progesterone profile) were evaluated using the following class of cows: normal (≤45 days, n = 11) and delayed (>45 days, n = 11) commencement of luteal activity (C-LA) and four different profiles of normal luteal activity (NLA, n = 5), prolonged luteal phase (n = 6), delayed first ovulation (n = 6), and anovulation (AOV, n = 5). Serum adiponectin concentrations decreased gradually by week 3 postpartum in NLA and then increased; whereas in AOV and delayed first ovulation, they were decreased after week 3 postpartum (P cows was more than that of NLA cows. Insulin concentrations were almost maintained at a stable level in NLA cows (P > 0.05), whereas they increased in the other groups (P cows with C-LA greater than 45 days decreased more than those with C-LA 45 days or less after week 3 postpartum (P = 0.002). Serum adiponectin concentrations at week 7 postpartum were lower in delayed C-LA (P = 0.01). Milk yield in cows with C-LA greater than 45 days increased more than cows with C-LA 45 days or less postpartum (P = 0.002). Insulin concentrations increased relatively in parallel from weeks 1 to 7 postpartum in cows either with C-LA greater than 45 or with C-LA 45 days or less. We showed for the first time the profile of serum adiponectin concentrations

  3. A simple model for prediction postpartum PTSD in high-risk pregnancies.

    Science.gov (United States)

    Shlomi Polachek, Inbal; Dulitzky, Mordechai; Margolis-Dorfman, Lilia; Simchen, Michal J

    2016-06-01

    This study aimed to examine the prevalence and possible antepartum risk factors of complete and partial post-traumatic stress disorder (PTSD) among women with complicated pregnancies and to define a predictive model for postpartum PTSD in this population. Women attending the high-risk pregnancy outpatient clinics at Sheba Medical Center completed the Edinburgh Postnatal Depression Scale (EPDS) and a questionnaire regarding demographic variables, history of psychological and psychiatric treatment, previous trauma, previous childbirth, current pregnancy medical and emotional complications, fears from childbirth, and expected pain. One month after delivery, women were requested to repeat the EPDS and complete the Post-traumatic Stress Diagnostic Scale (PDS) via telephone interview. The prevalence rates of postpartum PTSD (9.9 %) and partial PTSD (11.9 %) were relatively high. PTSD and partial PTSD were associated with sadness or anxiety during past pregnancy or childbirth, previous very difficult birth experiences, preference for cesarean section in future childbirth, emotional crises during pregnancy, increased fear of childbirth, higher expected intensity of pain, and depression during pregnancy. We created a prediction model for postpartum PTSD which shows a linear growth in the probability for developing postpartum PTSD when summing these seven antenatal risk factors. Postpartum PTSD is extremely prevalent after complicated pregnancies. A simple questionnaire may aid in identifying at-risk women before childbirth. This presents a potential for preventing or minimizing postpartum PTSD in this population.

  4. Limbic encephalitis presenting as a post-partum psychiatric condition.

    Science.gov (United States)

    Gotkine, Marc; Ben-Hur, Tamir; Vincent, Angela; Vaknin-Dembinsky, Adi

    2011-09-15

    We describe a woman who presented with a psychiatric disorder post-partum and subsequently developed seizures and cognitive dysfunction prompting further investigation. A diagnosis of limbic encephalitis (LE) was made and antibodies to voltage-gated potassium channel complex (VGKC) detected. These antibodies are found in many non-paraneoplastic patients with LE. Although antibody-mediated conditions tend to present or relapse post-partum, VGKC-LE in the post-partum period has not been described. Case report. Clinical and imaging data were consistent with limbic encephalitis. High titres of anti-VGKC-complex antibodies confirmed the diagnosis of VGKC-LE. The similarities between the psychiatric symptomatology of VGKC-LE and post-partum psychiatric disorders raise the possibility that some instances of post-partum psychiatric conditions are manifestations of immune-mediated, non-paraneoplastic LE. Copyright © 2011 Elsevier B.V. All rights reserved.

  5. High rates of relapse in adolescents crack users after inpatient clinic discharge

    Directory of Open Access Journals (Sweden)

    Rosemeri Siqueira Pedroso

    Full Text Available ABSTRACT Objective The objective of the present study was to evaluate 88 adolescent crack users referred to hospitalization and to follow them up after discharge to investigate relapse and factors associated with treatment. Methods Cohort (30 and 90 days after discharge from a psychiatric hospital and a rehab clinic for treatment for chemical dependency in Porto Alegre between 2011 and 2012. Instruments: Semi-structured interview, conducted to evaluate the sociodemographic profile of the sample and describe the pattern of psychoactive substance use; Crack Use Relapse Scale/CURS; Questionnaire Tracking Users to Crack/QTUC; K-SADS-PL. Results In the first follow-up period (30 days after discharge, 65.9% of participants had relapsed. In the second follow-up period (90 days after discharge, 86.4% of participants had relapsed. Conclusion This is one of the first studies that show the extremely high prevalence of early relapse in adolescent crack users after discharge, questioning the cost/benefit of inpatient treatment for this population. Moreover, these results corroborate studies which suggested, young psychostimulants users might need tailored intensive outpatient treatment with contingency management and other behavioral strategies, in order to increase compliance and reduce drug or crime relapse, but this specific therapeutic modality is still scarce and must be developed in Brazil.

  6. Postpartum Sterilization

    Science.gov (United States)

    f AQ FREQUENTLY ASKED QUESTIONS FAQ052 CONTRACEPTION Postpartum Sterilization • What is sterilization? • What is postpartum sterilization? • How is postpartum sterilization performed? • What kind of anesthesia is used for postpartum sterilization? • How ...

  7. Multiparity is associated with high motivation to change diet among overweight and obese postpartum women.

    Science.gov (United States)

    Bastian, Lori A; Pathiraja, Viranga C; Krause, Katrina; Namenek Brouwer, Rebecca J; Swamy, Geeta K; Lovelady, Cheryl A; Østbye, Truls

    2010-01-01

    Pregnancy is associated with weight gain and obesity. The aim of this study was to identify the effect of parity and other factors on motivation to change diet to lose weight in a cohort of overweight and obese postpartum women. Active Mothers Postpartum is a randomized, controlled trial aimed at postpartum weight reduction. At baseline, we measured motivation to change diet to lose weight among 491 overweight/obese postpartum women. Logistic regression was used to model the effect of parity on motivation to change diet at baseline while adjusting for potential confounders including age, race, education, body mass index category, and breastfeeding status. Approximately two thirds (68%) of participants were highly motivated to change their diet to lose weight. In the multivariable model, women with three or more children had 2.5 times the odds of high motivation compared with primigravid women, and women not breastfeeding had 1.6 times the odds of high motivation compared with any breastfeeding. Although risk for obesity is incurred starting with a woman's first pregnancy, women in this study were more motivated to change their diet to lose weight after their third pregnancy. Further research is needed to understand how to best capitalize on the high motivation in women with several children as well as how to improve motivation for primigravid women and women who are breastfeeding. Copyright 2010 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  8. High interleukin-6 mRNA expression is a predictor of relapse in colon cancer

    DEFF Research Database (Denmark)

    Olsen, Jesper; Kirkeby, Lene T; Olsen, Jørgen

    2015-01-01

    AIM: To investigate the expression of interleukin-6 (IL6) in colon cancer tissue, and to examine if the risk of relapse is influenced by IL6 expression. MATERIALS AND METHODS: Fresh-frozen biopsies from tumor and normal adjacent tissues were taken from patients with colon cancer during surgery...... for clinicopathological characteristics (Hazard Ratio=2.16, 95% CI=1.07-4.40; pcolon cancer tissue at the transcriptional level and is significantly associated with increased risk of relapse....... to normal adjacent tissue (pcancer stage. We found a significant association between high IL6 expression and risk of relapse (Hazard Ratio=2.23, 95% CI=1.10-4.53; p

  9. ADAR2 editing activity in newly diagnosed versus relapsed pediatric high-grade astrocytomas

    International Nuclear Information System (INIS)

    Tomaselli, Sara; Galeano, Federica; Massimi, Luca; Di Rocco, Concezio; Lauriola, Libero; Mastronuzzi, Angela; Locatelli, Franco; Gallo, Angela

    2013-01-01

    High-grade (WHO grade III and IV) astrocytomas are aggressive malignant brain tumors affecting humans with a high risk of recurrence in both children and adults. To date, limited information is available on the genetic and molecular alterations important in the onset and progression of pediatric high-grade astrocytomas and, even less, on the prognostic factors that influence long-term outcome in children with recurrence. A-to-I RNA editing is an essential post-transcriptional mechanism that can alter the nucleotide sequence of several RNAs and is mediated by the ADAR enzymes. ADAR2 editing activity is particularly important in mammalian brain and is impaired in both adult and pediatric high-grade astrocytomas. Moreover, we have recently shown that the recovered ADAR2 activity in high-grade astrocytomas inhibits in vivo tumor growth. The aim of the present study is to investigate whether changes may occur in ADAR2-mediated RNA editing profiles of relapsed high-grade astrocytomas compared to their respective specimens collected at diagnosis, in four pediatric patients. Total RNAs extracted from all tumor samples and controls were tested for RNA editing levels (by direct sequencing on cDNA pools) and for ADAR2 mRNA expression (by qRT-PCR). A significant loss of ADAR2-editing activity was observed in the newly diagnosed and recurrent astrocytomas in comparison to normal brain. Surprisingly, we found a substantial rescue of ADAR2 editing activity in the relapsed tumor of the only patient showing prolonged survival. High-grade astrocytomas display a generalized loss of ADAR2-mediated RNA editing at both diagnosis and relapse. However, a peculiar Case, in complete remission of disease, displayed a total rescue of RNA editing at relapse, intriguingly suggesting ADAR2 activity/expression as a possible marker for long-term survival of patients with high-grade astrocytomas

  10. The comparison of postpartum with non-postpartum depression: a rose by any other name.

    OpenAIRE

    Whiffen, V E

    1991-01-01

    A strong tradition exists in the psychiatric literature to consider postpartum depression a distinct diagnosis. However, the empirical evidence indicates that, in terms of etiology and relapse rates, postpartum depression is indistinguishable from non-postpartum depression. Symptomatically, postpartum depression seems to involve a milder disturbance, suggesting that it is best seen as an adjustment disorder. This paper summarizes the empirical evidence relevant to the distinct diagnosis quest...

  11. Reirradiation and lomustine in patients with relapsed high-grade gliomas

    International Nuclear Information System (INIS)

    Arcicasa, Mauro; Roncadin, Mario; Bidoli, Ettore; Dedkov, Anatolyi; Gigante, Marco; Trovo, Mauro G.

    1999-01-01

    Purpose: The aim of this study was to evaluate the toxicity, response, and survival of patients with relapsed high-grade gliomas after radiation therapy (RT) combined with lomustine (CCNU). Methods and Materials: Thirty-one patients with relapsed gliomas at least 6 months after completion of RT were reirradiated. Twenty-four patients had a pathological diagnosis of high-grade gliomas, whereas 7 had a radiological diagnosis of relapsed malignant gliomas. The study focused on patients with high-grade relapsed gliomas. A total dose of 34.5 Gy was delivered in 23 fractions over 4.5 weeks. Oral administration of CCNU (130 mg/m 2 ) was begun at the same time as RT, and was repeated every 6 weeks until disease progression, or up to 12 courses. Results: Twelve of 24 patients had surgery before RT plus CCNU treatment. Median interval between RT courses was 14 months (range 6-73). All patients received a complete course of RT, and 22 of 24 patients received at least one course of CCNU. Objective responses were seen in 14 evaluable patients: 3 with partial response, 5 with stable disease, and 6 with progressive disease. Duration of partial response was 20, 9, and 8 months. Median time to progression and overall survival from the onset of retreatment were 8.4 months (range 1-22) and 13.7 months (range 1-63+), respectively. One case of G4 thrombocytopenia was observed. Five patients had G1 or G2 leucopenia and 3 patients had G3 leucopenia. Moderate nausea and vomiting were reported in 4 patients. One patient, after one course of CCNU, refused further chemotherapy. No significant difference in survival from relapse was found between patients who underwent surgery before RT plus CCNU and those who received only RT plus CCNU (p = 0.74). Conclusion: Overall, the acute toxicity was moderate, and patient compliance was good. Reirradiation of high-grade glioma was associated with modest subjective and objective response rates. It is remarkable that median overall survival from relapse

  12. High parity predicts use of long-acting reversible contraceptives in the extended postpartum period among women in rural Uganda.

    Science.gov (United States)

    Anguzu, Ronald; Sempeera, Hassard; Sekandi, Juliet N

    2018-01-01

    The use of implants and Intra-uterine devices (IUD) during the post-partum period is very low in Uganda especially in rural settings. Long-acting reversible contraceptives (LARC) are known to be the most cost-effective for prevention of unintended pregnancy and unsafe abortions. This study aimed at determining the factors associated with long-acting reversible contraceptive use among women in the extended postpartum period in rural Uganda. We conducted a household-based, cross-sectional study among 400 women in two rural communities in Mityana district, central Uganda. Eligible women were aged 15 to 45 years who had childbirth within 12 months of study enrollment in September 2014. The outcome variable was self-reported use of a LARC method, either IUD or implants in the extended postpartum period. The main independent variables were previous childbirths (parity), fertility desire, willingness to use modern contraception, duration of postpartum period and previous pregnancies (gravidity). A logistic regression model was run in STATA v12.0 to compute adjusted odds ratios (AOR) for factors that predicted LARC use statistically significant at p  postpartum period (AOR = 4.07, 95%CI 1.08-15.4). Willingness to use modern contraception, desire for more children and postpartum duration had no significant association with LARC use in the extended postpartum period. This study revealed low use of LARC within twelve months of child birth despite women's willingness to use them. High parity (≥5 childbirths) predicted LARC use. The next logical step is to identify barriers to using LARC in the extended postpartum period and design appropriate interventions to increase access and use especially in multi-parous women.

  13. An open trial of mindfulness-based cognitive therapy for the prevention of perinatal depressive relapse/recurrence.

    Science.gov (United States)

    Dimidjian, Sona; Goodman, Sherryl H; Felder, Jennifer N; Gallop, Robert; Brown, Amanda P; Beck, Arne

    2015-02-01

    Pregnant women with histories of depression are at high risk of depressive relapse/recurrence during the perinatal period, and options for relapse/recurrence prevention are limited. Mindfulness-based cognitive therapy (MBCT) has strong evidence among general populations but has not been studied among at-risk pregnant women to prevent depression. We examined the feasibility, acceptability, and clinical outcomes of depression symptom severity and relapse/recurrence associated with MBCT adapted for perinatal women (MBCT-PD). Pregnant women with depression histories were recruited from obstetrics clinics in a large health maintenance organization at two sites and enrolled in MBCT-PD (N = 49). Self-reported depressive symptoms and interview-based assessments of depression relapse/recurrence status were measured at baseline, during MBCT-PD, and through 6-months postpartum. Pregnant women reported interest, engagement, and satisfaction with the program. Retention rates were high, as were rates of completion of daily homework practices. Intent to treat analyses indicated a significant improvement in depression symptom levels and an 18 % rate of relapse/recurrence through 6 months postpartum. MBCT-PD shows promise as an acceptable, feasible, and clinically beneficial brief psychosocial prevention option for pregnant women with histories of depression. Randomized controlled trials are needed to examine the efficacy of MBCT-PD for the prevention of depressive relapse/recurrence during pregnancy and postpartum.

  14. Postpartum Depression

    Science.gov (United States)

    ... do not need treatment. The symptoms of postpartum depression last longer and are more severe. You may ... treatment right away, often in the hospital. Postpartum depression can begin anytime within the first year after ...

  15. Treatment of relapsed or refractory acute leukemia in childhood with bisantrene combined with high dose aracytine.

    Science.gov (United States)

    Leblanc, T; Deméocq, F; Leverger, G; Baruchel, A; Lemerle, S; Vannier, J P; Nelken, B; Guillot, T; Schaison, G

    1994-01-01

    Bisantrene is an anthracene derivative which has demonstrated activity in acute myeloblastic leukemia (AML) and in lymphoma. The present study was designed to assess the reinduction rate and toxicity of bisantrene (250 mg/m2/d x 5) associated with aracytine (100 mg/m2 twice a day x 5) in refractory and relapsed acute childhood leukemia. Patients who relapsed after bone marrow transplantation were eligible. Twenty-six children were included. Diagnoses were as follows: 13 AML, 9 acute lymphoblastic leukemia (ALL), and 4 undifferentiated leukemia (AUL). All patients had been very highly pretreated, especially with anthracyclines, and most of them were of poor prognosis. The overall response rate was 46% with a 95% confidence interval ranging from 27-65%. According to diagnosis, complete remission (CR) rates are: AML: 5/13, ALL: 5/9, and AUL: 2/4. Four children died, three from infection and one from acute lysis syndrome. The major toxicity was infection with grade 3 and 4 episodes occurring in 42% of patients. No significant cardiac toxicity was noted. Hepatic and renal toxicity was noted. Hepatic and renal toxicity were limited and transient. Bisantrene in association with aracytine is effective in both AML and ALL of childhood. Bisantrene should be evaluated with a five-day schedule in other pediatric malignancies. In children with acute leukemia previously treated with high dose aracytine, new combination regimen is warranted.

  16. Treatment strategies in patients with AML or high-risk myelodysplastic syndrome relapsed after Allo-SCT.

    Science.gov (United States)

    Sauer, T; Silling, G; Groth, C; Rosenow, F; Krug, U; Görlich, D; Evers, G; Albring, J; Besoke, R; Mesters, R M; Müller-Tidow, C; Kessler, T; Büchner, T; Berdel, W E; Stelljes, M

    2015-04-01

    Non-relapse mortality after Allo-SCT has significantly decreased over the last years. Nevertheless, relapse remains a major cause for post SCT mortality in patients with AML and high-risk myelodysplastic syndrome (MDS). In this retrospective single-center analysis, we have analyzed the treatment outcomes of 108 patients with AML or MDS, who relapsed after Allo-SCT. Seventy of these patients (65%) were treated with salvage therapies containing chemotherapy alone, allogeneic cell-based treatment or the combination of both. Thirty-eight patients (35%) received palliative treatment. Median OS after diagnosis of relapse was 130 days. Compared with patients who received chemotherapy alone, response to salvage therapy was significantly improved in patients treated with a combination of chemo- and allogeneic cell-based therapy (CR rate 57% vs 13%, P=0.002). Among risk factors concerning pretreatment characteristics, disease status before first Allo-SCT, and details of transplantation, only the time interval from Allo-SCT to relapse was an independent predictor of response to salvage therapy and OS. These data confirmed that time to relapse after transplantation is an important prognostic factor. Up to now, only patients eligible for treatment regimens containing allogeneic cell-based interventions achieved relevant response rates.

  17. Conventional-Dose versus High-Dose Chemotherapy for Relapsed Germ Cell Tumors

    Directory of Open Access Journals (Sweden)

    Deaglan J. McHugh

    2018-01-01

    Full Text Available The majority of metastatic germ cell tumors (GCTs are cured with cisplatin-based chemotherapy, but 20–30% of patients will relapse after first-line chemotherapy and require additional salvage strategies. The two major salvage approaches in this scenario are high-dose chemotherapy (HDCT with autologous stem cell transplant (ASCT or conventional-dose chemotherapy (CDCT. Both CDCT and HDCT have curative potential in the management of relapsed/refractory GCT. However, due to a lack of conclusive randomized trials, it remains unknown whether sequential HDCT or CDCT represents the optimal initial salvage approach, with practice varying between tertiary institutions. This represents the most pressing question remaining for defining GCT treatment standards and optimizing outcomes. The authors review prognostic factors in the initial salvage setting as well as the major studies assessing the efficacy of CDCT, HDCT, or both, describing the strengths and weaknesses that formed the rationale behind the ongoing international phase III “TIGER” trial.

  18. IIVP salvage regimen induces high response rates in patients with relapsed lymphoma before autologous stem cell transplantation.

    Science.gov (United States)

    Abali, Huseyin; Oyan, Basak; Koc, Yener; Kars, Ayse; Barista, Ibrahim; Uner, Aysegul; Turker, Alev; Demirkazik, Figen; Tekin, Fatma; Tekuzman, Gulten; Kansu, Emin

    2005-06-01

    Patients with relapsed lymphoma can be cured with high-dose chemotherapy and autologous hematopoietic stem cell transplantation (HSCT). New therapeutic approaches with better cytoreductive capacity are needed for relapsed patients to keep their chance for cure with transplantation. We report 30 patients with relapsed lymphoma, median age 43 years, treated with IIVP salvage regimen consisting of ifosfamide, mesna, idarubicin, and etoposide for 2 or 3 cycles. Seventeen patients had non-Hodgkin lymphoma (NHL) and 13 patients had Hodgkin disease (HD). Fourteen (47%) patients were at their first relapse. Overall response rate was 86.6% (n = 26) with 19 patients (63.3%) achieving complete response. Overall response rate was 92% in patients with HD and 82% in NHL. The most frequent side effects observed were grade III-IV neutropenia (87%) and thrombocytopenia (73%). IIVP regimen is a highly effective salvage therapy for patients with relapsed HD or NHL who are candidates for autologous HSCT. Close follow up is necessary because of the high incidence of grade III-IV hematologic toxicity.

  19. Gemcitabine and docetaxel in relapsed and unresectable high-grade osteosarcoma and spindle cell sarcoma of bone

    OpenAIRE

    Palmerini, E.; Jones, R. L.; Marchesi, E.; Paioli, A.; Cesari, M.; Longhi, A.; Meazza, C.; Coccoli, L.; Fagioli, F.; Asaftei, S.; Grignani, G.; Tamburini, A.; Pollack, S. M.; Picci, P.; Ferrari, S.

    2016-01-01

    Background Few new compounds are available for relapsed osteosarcoma. We retrospectively evaluated the activity of gemcitabine (G) plus docetaxel (D) in patients with relapsed high-grade osteosarcoma and high-grade spindle cell sarcoma of bone (HGS). Methods Patients receiving G 900?mg/m2 d 1, 8; D 75?mg/m2 d 8, every 21?days were eligible. Primary end-point: progression-free survival (PFS) at 4?months; secondary end-point: overall survival (OS) and response rate. Results Fifty-one patients w...

  20. Change in Pattern of Relapse After Antiangiogenic Therapy in High-Grade Glioma

    International Nuclear Information System (INIS)

    Narayana, Ashwatha; Kunnakkat, Saroj D.; Medabalmi, Praveen; Golfinos, John; Parker, Erik; Knopp, Edmond; Zagzag, David; Eagan, Patricia; Gruber, Deborah; Gruber, Michael L.

    2012-01-01

    Purpose: Local recurrence is the dominant pattern of relapse in high-grade glioma (HGG) after conventional therapy. The recent use of antiangiogenic therapy has shown impressive radiologic and clinical responses in adult HGG. The preclinical data suggesting increased invasiveness after angiogenic blockade have necessitated a detailed analysis of the pattern of recurrence after therapy. Methods and Materials: A total of 162 consecutive patients with HGG, either newly diagnosed (n = 58) or with recurrent disease (n = 104) underwent therapy with bevacizumab at 10 mg/kg every 2 weeks and conventional chemotherapy with or without involved field radiotherapy until disease progression. The pattern of recurrence and interval to progression were the primary aims of the present study. Diffuse invasive recurrence (DIR) was defined as the involvement of multiple lobes with or without crossing the midline. Results: At a median follow-up of 7 months (range, 1–37), 105 patients had recurrence, and 79 patients ultimately developed DIR. The interval to progression was similar in the DIR and local recurrence groups (6.5 and 6.3 months, p = .296). The hazard risk of DIR increased exponentially with time and was similar in those with newly diagnosed and recurrent HGG (R 2 = 0.957). The duration of bevacizumab therapy increased the interval to recurrence (p < .0001) and improved overall survival (p < .0001). However, the pattern of relapse did not affect overall survival (p = .253). Conclusion: Along with an increase in median progression-free survival, bevacizumab therapy increased the risk of DIR in HGG patients. The risk of increased invasion with prolonged angiogenic blockade should be addressed in future clinical trials.

  1. Change in Pattern of Relapse After Antiangiogenic Therapy in High-Grade Glioma

    Energy Technology Data Exchange (ETDEWEB)

    Narayana, Ashwatha, E-mail: ashwatha.narayana@nyumc.org [Department of Radiation Oncology, New York University Langone Medical Center, New York, NY (United States); Department of Neurosurgery, New York University Langone Medical Center, New York, NY (United States); Kunnakkat, Saroj D. [Department of Radiation Oncology, New York University Langone Medical Center, New York, NY (United States); Medabalmi, Praveen [Department of Biostatistics, New York University Langone Medical Center, New York, NY (United States); Golfinos, John; Parker, Erik [Department of Neurosurgery, New York University Langone Medical Center, New York, NY (United States); Knopp, Edmond [Department of Radiology, New York University Langone Medical Center, New York, NY (United States); Zagzag, David [Department of Pathology, New York University Langone Medical Center, New York, NY (United States); Eagan, Patricia [Department of Neuro-Oncology, New York University Langone Medical Center, New York, NY (United States); Atlantic Health System, Overlook Hospital, Summit, NJ (United States); Gruber, Deborah [Department of Neuro-Oncology, New York University Langone Medical Center, New York, NY (United States); Gruber, Michael L. [Department of Neurosurgery, New York University Langone Medical Center, New York, NY (United States); Department of Neuro-Oncology, New York University Langone Medical Center, New York, NY (United States); Atlantic Health System, Overlook Hospital, Summit, NJ (United States)

    2012-01-01

    Purpose: Local recurrence is the dominant pattern of relapse in high-grade glioma (HGG) after conventional therapy. The recent use of antiangiogenic therapy has shown impressive radiologic and clinical responses in adult HGG. The preclinical data suggesting increased invasiveness after angiogenic blockade have necessitated a detailed analysis of the pattern of recurrence after therapy. Methods and Materials: A total of 162 consecutive patients with HGG, either newly diagnosed (n = 58) or with recurrent disease (n = 104) underwent therapy with bevacizumab at 10 mg/kg every 2 weeks and conventional chemotherapy with or without involved field radiotherapy until disease progression. The pattern of recurrence and interval to progression were the primary aims of the present study. Diffuse invasive recurrence (DIR) was defined as the involvement of multiple lobes with or without crossing the midline. Results: At a median follow-up of 7 months (range, 1-37), 105 patients had recurrence, and 79 patients ultimately developed DIR. The interval to progression was similar in the DIR and local recurrence groups (6.5 and 6.3 months, p = .296). The hazard risk of DIR increased exponentially with time and was similar in those with newly diagnosed and recurrent HGG (R{sup 2} = 0.957). The duration of bevacizumab therapy increased the interval to recurrence (p < .0001) and improved overall survival (p < .0001). However, the pattern of relapse did not affect overall survival (p = .253). Conclusion: Along with an increase in median progression-free survival, bevacizumab therapy increased the risk of DIR in HGG patients. The risk of increased invasion with prolonged angiogenic blockade should be addressed in future clinical trials.

  2. Effects of a progesterone-based oestrous synchronization protocol in 51- to 57-day postpartum high-producing dairy cows.

    Science.gov (United States)

    Garcia-Ispierto, I; López-Gatius, F; Bech-Sàbat, G; Yániz, J L; Angulo, E; Maris, C; Floc'h, S; Martino, A

    2010-10-01

    The aim of this study was to investigate the effect of applying a progesterone-based oestrous synchronization protocol at 51-57 days postpartum in high-producing dairy cows. The data analysed were derived from 1345 lactating cows. Cows between 51 and 57 days postpartum were assigned to the groups: control, PRID (receiving a progesterone-releasing intravaginal device for 9 days, and prostaglandin F(2α) 24 h before PRID removal) or GnRH-PRID (the same as the PRID group plus GnRH at PRID insertion). Oestrus was detected by using pedometers and confirmed by examination of the genital tract at AI. Oestrous and conception rates before days 71-77 postpartum, pregnancy loss in early pregnant cows or the cumulative conception rate registered on day 120 postpartum were considered as the dependent variables in four consecutive logistic regression analyses. Based on the odds ratios, the oestrous rate increased by a factor of 1.73 in cows showing oestrus before treatment for each unit increase in the number of previous oestruses; decreased by a factor of 0.44 in the control group with respect to the treatment groups; and by a factor of 0.61 in cows without luteal structures at treatment with respect to cows with corpora lutea. The conception rates of cows inseminated before days 71-77 postpartum remained similar across the groups, whereas the likelihood of pregnancy loss for cows becoming pregnant during this period was 0.11 times lower in the PRID group than in the control. Based on the odds ratio, the likelihood of a higher cumulative conception rate on day 120 postpartum: increased in cows showing oestrus before treatment by a factor of 1.41 for each unit increase in the number of previous oestruses, was reduced 0.56-fold in control cows compared with treated cows, and was also reduced by a factor of 0.98 for each kilogram of milk production increase recorded at treatment. In conclusion, although oestrous synchronization programmes performed in this study did not improve

  3. High-risk human papilloma virus management in pregnancy with cervical intraepithelial neoplasia during pregnancy and postpartum in China.

    Science.gov (United States)

    He, Yue; Wu, Yu-Mei; Zhao, Qun; Wang, Tong; Song, Fang; Zhu, Li

    2014-02-01

    To investigate the relationship between cervical intraepithelial neoplasia (CIN) and high-risk human papilloma virus (HR-HPV) during pregnancy and postpartum in China. In this prospective case-control study, 168 pregnant women with CIN and cervicitis were diagnosed by colposcopic cervical biopsy. All the cases underwent hybrid capture assay version II (HCII) to detect HR-HPV DNA load amounts and the tests were completed in 3-6 months after childbirth. During pregnancy: as the CIN grade increased, the HR-HPV infection rates increased (P = 0.002), but HR-HPV DNA load amounts (in logarithms) did not change obviously (P = 0.719). 3-6 months postpartum: as the CIN grade increased, the natural negative rate of HR-HPV decreased (P = 0.000), while the amount of HR-HPV DNA (in logarithms) increased (P = 0.036); especially the amount of HR-HPV DNA in pregnant women with CINIII was significantly higher than that of other grades. During pregnancy and 3-6 months postpartum : the amount of HR-HPV DNA (in logarithms) during pregnancy was higher than that of 3-6 months postpartum with the same grade of CIN. The findings emphasize the importance of undergoing the HCII test 3-6 months postpartum. It should be noted that HR-HPV may turn negative in pregnancy with CINIII 3-6 months after childbirth. Further treatments of pregnancy with CIN should be considered according to the CIN grade diagnosed by cervical biopsy via colposcopy 3-6 months after birth, but not according to the persistence of HR-HPV during pregnancy. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

  4. Effects of Prepartum Monensin Feeding on Energy Metabolism and Reproductive Performance of Postpartum High-Producing Holstein Dairy Cows

    Directory of Open Access Journals (Sweden)

    Mahmood Changizi Mohammadi, Abbas Rowshan Ghasrodashti1, Amin Tamadon2,3 and Mohammad Amin Behzadi4*

    2012-01-01

    Full Text Available This study was designed to determine the effects of monensin in preparturient diet on postpartum milk production, energy metabolism, and reproductive performance of Holstein dairy cows. Forty Holstein dairy cows on close-up period were randomly divided into monensin treated (300 mg/day in close-up ration, top dress and control groups. Body condition score (BCS was estimated three weeks before and three weeks after calving. Milk production and milk fat percentage were recorded in both groups within 3 weeks postpartum. Blood samples were collected from five randomly selected cows of each group three weeks after calving. Serum concentrations of insulin like growth factor-I (IGF-I, insulin, glucose, and beta-hydroxybutyrate (BHBA were measured. Calving to the first observed estrus interval and calving to conception interval were compared between two groups. The results of the experiment showed that loss of BCS (P=0.3, increase of milk production (P=0.9, and milk fat percentage (P>0.05 were not significantly different between two groups during the period of study. In addition, mean serum glucose concentration (P=0.001 and serum insulin concentration (P=0.01 in monensin group were significantly higher than control cows in the first week postpartum. Moreover, serum BHBA concentration did not significantly change in monensin group. Serum IGF-I concentration in monensin group was significantly higher than control group in three weeks postpartum (P<0.01. The present study indicated that monensin treatment decreased calving to the first observed estrus interval (P=0.05 and calving to conception interval (P=0.002. In conclusion, supplementing the close-up ration can increase postpartum serum IGF-I concentration and prevent the increase of serum BHBA concentration. These may result in enhancement reproductive performance of high-producing dairy cows.

  5. Postpartum Thyroiditis

    Science.gov (United States)

    American Thyroid Association ® Postpartum Thyroiditis www.thyroid.org What is the thyroid gland? The thyroid gland is a butterfly-shaped endocrine gland that ... as they should. What are the symptoms of postpartum thyroiditis? Thyroiditis is a general term that refers ...

  6. Postpartum complications

    International Nuclear Information System (INIS)

    Kronthal, A.J.; Kuhlman, J.E.; Fishman, E.K.

    1990-01-01

    This paper reports the CT findings of major postpartum complications and determine what role CT plays in their evaluation. The CT scans of nine patients with major postpartum complications were retrospectively reviewed. Patients had been referred to CT for evaluation of postpartum fever, abdominal pain, and elevated results of liver function tests. Complications identified at CT included hepatic infarctions (n = 2), endometritis (n = 2), postoperative wound abscess (n = 1), massive abdominal hemorrhage (n = 1), septic thrombophlebitis (n = 1), and renal vein thrombosis (n = 1). CT findings of hepatic infarction included wedge-shaped areas of decreased enhancement conforming to a vascular distribution

  7. ANALYSIS OF RELAPSE RATE AND METASTASES OF HIGH DIFFERENTIATED THYROID CANCER

    Directory of Open Access Journals (Sweden)

    E. V. Savenok

    2015-01-01

    Full Text Available  Analysis of rate of relapses and metastases with well-differentiated thyroid cancer was performed for patients in 2009 to 2013. The study involved 189 patients with thyroid cancer including 98 (51.9 % patients suffering from papillary thyroid cancer, 77 (40.7 % patients suffering from follicular thyroid cancer, and 14 (7.4 % patients suffering from medullary thyroid cancer. 2.04 % of the 98 patients suffering from papillary thyroid cancer manifested a relapse, and lymphogenic metastases of cancer were revealed with 1.0 % of patients. With follicular thyroid cancer (n = 77, lymphogenic metastases were registered in 7.8 % of cases, relapses were revealed in 1.3 % of cases. This analysis demonstrated that observation of patients for 5 years revealed a higher percentage of metastases with patients that suffered from follicular thyroid cancer.

  8. Relapsed childhood high hyperdiploid acute lymphoblastic leukemia: presence of preleukemic ancestral clones and the secondary nature of microdeletions and RTK-RAS mutations

    DEFF Research Database (Denmark)

    Davidsson, J; Paulsson, K; Lindgren, D

    2010-01-01

    Although childhood high hyperdiploid acute lymphoblastic leukemia is associated with a favorable outcome, 20% of patients still relapse. It is important to identify these patients already at diagnosis to ensure proper risk stratification. We have investigated 11 paired diagnostic and relapse samp...

  9. Relapsed childhood high hyperdiploid acute lymphoblastic leukemia: presence of preleukemic ancestral clones and the secondary nature of microdeletions and RTK-RAS mutations

    DEFF Research Database (Denmark)

    Davidsson, J; Paulsson, K; Lindgren, D

    2010-01-01

    Although childhood high hyperdiploid acute lymphoblastic leukemia is associated with a favorable outcome, 20% of patients still relapse. It is important to identify these patients already at diagnosis to ensure proper risk stratification. We have investigated 11 paired diagnostic and relapse...

  10. Postpartum Psychosis

    Science.gov (United States)

    ... survivors of postpartum psychosis never had delusions containing violent commands. Delusions take many forms, and not all ... and families PP Psychosis Books Resources and Creative Media Help in an Emergency Emergency Hotlines are available ...

  11. Limbic encephalitis presenting as a post-partum psychiatric condition.

    OpenAIRE

    Gotkine, Marc; Ben-Hur, Tamir; Vincent, Angela; Vaknin-Dembinsky, Adi

    2011-01-01

    OBJECTIVE: We describe a woman who presented with a psychiatric disorder post-partum and subsequently developed seizures and cognitive dysfunction prompting further investigation. A diagnosis of limbic encephalitis (LE) was made and antibodies to voltage-gated potassium channel complex (VGKC) detected. These antibodies are found in many non-paraneoplastic patients with LE. Although antibody-mediated conditions tend to present or relapse post-partum, VGKC-LE in the post-partum period has not b...

  12. Postpartum choriocarcinoma

    International Nuclear Information System (INIS)

    Sirichand, P.; Das, C.M.; Hassan, N.

    2006-01-01

    Choriocarcinoma, following term pregnancy, is a rare form of gestational trophoblastic disease. The usual presentation is with persistent primary or secondary postpartum hemorrhage, the diagnosis is often delayed because of failure to recognize this mode of presentation of the disease. Early diagnosis is important because this rare condition is potentially curable with appropriate chemotherapy. A case of postpartum choriocarcinoma, following a term pregnancy is reported that was successfully treated with methotrexate therapy and surgery. (author)

  13. Intravenous iron isomaltoside 1000 administered by high single-dose infusions or standard medical care for the treatment of fatigue in women after postpartum haemorrhage

    DEFF Research Database (Denmark)

    Holm, Charlotte; Thomsen, Lars Lykke; Norgaard, Astrid

    2015-01-01

    1000 with standard medical care on physical fatigue in women with postpartum haemorrhage. METHODS/DESIGN: In a single centre, open-labelled, randomised trial, women with postpartum haemorrhage exceeding 700 mL will be allocated to either a single dose of 1,200 mg of iron isomaltoside 1000 or standard...... Inventory. The primary objective will be considered to have been met if an intravenous high single dose of iron isomaltoside 1000 is shown to be superior to standard medical care in women after postpartum haemorrhage regarding physical fatigue.For claiming superiority, we set the minimal clinically relevant...... randomised controlled studies have compared the clinical efficacy and safety of standard medical care with intravenous administration of iron supplementation after postpartum haemorrhage.The primary objective of this study is to compare the efficacy of an intravenous high single-dose of iron isomaltoside...

  14. Early detection of tumor relapse/regrowth by consecutive minimal residual disease monitoring in high-risk neuroblastoma patients

    Science.gov (United States)

    Hirase, Satoshi; Saitoh, Atsuro; Hartomo, Tri Budi; Kozaki, Aiko; Yanai, Tomoko; Hasegawa, Daiichiro; Kawasaki, Keiichiro; Kosaka, Yoshiyuki; Matsuo, Masafumi; Yamamoto, Nobuyuki; Mori, Takeshi; Hayakawa, Akira; Iijima, Kazumoto; Nishio, Hisahide; Nishimura, Noriyuki

    2016-01-01

    Neuroblastoma is an aggressive pediatric tumor accounting for ~15% of cancer-associated mortalities in children. Despite the current intensive therapy, >50% of high-risk patients experience tumor relapse or regrowth caused by the activation of minimal residual disease (MRD). Although several MRD detection protocols using various reverse transcription-quantitative polymerase chain reaction (RT-qPCR) markers have been reported to evaluate the therapeutic response and disease status of neuroblastoma patients, their clinical significance remains elusive. The present study reports two high-risk neuroblastoma patients, whose MRD was consecutively monitored using 11 RT-qPCR markers (CHRNA3, CRMP1, DBH, DCX, DDC, GABRB3, GAP43, ISL1, KIF1A, PHOX2B and TH) during their course of treatment. The two patients initially responded to the induction therapy and reached MRD-negative status. The patients' MRD subsequently became positive with no elevation of their urinary homovanillic acid, urinary vanillylmandelic acid and serum neuron-specific enolase levels at 13 or 19 weeks prior to the clinical diagnosis of tumor relapse or regrowth. The present cases highlight the possibility of consecutive MRD monitoring using 11 markers to enable an early detection of tumor relapse or regrowth in high-risk neuroblastoma patients. PMID:27446404

  15. Postpartum Blood Clots

    Science.gov (United States)

    ... Video) Fetal Ultrasound Scanning Additional Content Medical News Postpartum Blood Clots By Julie S. Moldenhauer, MD, Associate Professor ... Professional Version Postdelivery Period Overview of the Postdelivery (Postpartum) Period Postpartum Infections Postpartum Infections of the Uterus ...

  16. High post-partum levels of corticosterone given to dams influence postnatal hippocampal cell proliferation and behavior of offspring: A model of post-partum stress and possible depression.

    Science.gov (United States)

    Brummelte, Susanne; Pawluski, Jodi L; Galea, Liisa A M

    2006-09-01

    Post-partum stress and depression (PPD) have a significant effect on child development and behavior. Depression is associated with hypercortisolism in humans, and the fluctuating levels of hormones, including corticosterone, during pregnancy and the post-partum, may contribute to PPD. The present study was developed to investigate the effects of high-level corticosterone (CORT) post-partum in the mother on postnatal neurogenesis and behavior in the offspring. Sprague-Dawley dams were treated with either CORT (40 mg/kg) or sesame oil injections daily for 26 days beginning the day after giving birth. Dams were tested in the forced swim test (FST) and in the open field test (OFT) on days 24-26 post-partum. Results showed that the dams exposed to CORT expressed "depressive-like" behavior compared to controls, with decreased struggling behavior and increased immobility in the FST. To investigate the effects of treatment on hippocampal postnatal cell proliferation and survival in the offspring, males and females from treated dams were injected with BrdU (50 mg/kg) on postnatal day 21 and perfused either 24 h (cell proliferation) or 21 days (cell survival) later. Furthermore, male and female offspring from each litter were tested in adulthood on various behavioral tests, including the forced swim test, open field test, resistance to capture test and elevated plus maze. Intriguingly, male, but not female, offspring of CORT-treated dams exhibited decreased postnatal cell proliferation in the dentate gyrus. Both male and female offspring of CORT-treated dams showed higher resistance to capture and greater locomotor activity as assessed in the open field test. As high levels of CORT may be a characteristic of stress and/or depression, these findings support a model of 'CORT-induced' post-partum stress and possibly depression and demonstrate that the offspring of affected dams can exhibit changes in postnatal neurogenesis and behavior in adulthood.

  17. Clonidine versus captopril for treatment of postpartum very high blood pressure: study protocol for a randomized controlled trial (CLONCAP).

    Science.gov (United States)

    Noronha-Neto, Carlos; Katz, Leila; Coutinho, Isabela C; Maia, Sabina B; Souza, Alex Sandro Rolland; Amorim, Melania Maria Ramos

    2013-07-30

    The behavior of arterial blood pressure in postpartum of women with hypertension and pregnancy and the best treatment for very high blood pressure in this period still need evidence. The Cochrane systematic review assessing prevention and treatment of postpartum hypertension found only two trials (120 patients) comparing hydralazine with nifedipine and labetalol for the treatment of severe hypertension and did not find enough evidence to know how best to treat women with hypertension after birth. Although studies have demonstrated the effectiveness of treatment with captopril, side effects were reported. Because of these findings, new classes of antihypertensive drugs began to be administered as an alternative therapy. Data on the role of clonidine in this particular group of patients, its effects in the short and long term are still scarce in the literature. To determine the effectiveness of clonidine, compared to captopril, for the treatment of postpartum very high blood pressure in women with hypertension in pregnancy. The study is a triple blind randomized controlled trial including postpartum women with diagnosis of hypertension in pregnancy presenting very high blood pressure, and exclusion criteria will be presence of heart disease, smoking, use of illicit drugs, any contraindication to the use of captopril or clonidine and inability to receive oral medications.Eligible patients will be invited to participate and those who agree will be included in the study and receive captopril or clonidine according to a random list of numbers. The subjects will receive the study medication every 20 minutes until blood pressure is over 170 mmHg of systolic blood pressure and 110 mmHg diastolic blood pressure. A maximum of six pills a day for very high blood pressure will be administered. In case of persistent high blood pressure levels, other antihypertensive agents will be used.During the study the women will be subject to strict control of blood pressure and urine

  18. Postpartum Preeclampsia

    Science.gov (United States)

    ... are one of the most common methods of treatment.Screening in PregnancyRead Article >>Pregnancy and ChildbirthScreening in PregnancyWhen you are pregnant, genetic screenings can determine your baby’s risk for having Down syndrome, trisomy 18, and spina…Recovering from Delivery (Postpartum ...

  19. Gemcitabine and docetaxel in relapsed and unresectable high-grade osteosarcoma and spindle cell sarcoma of bone.

    Science.gov (United States)

    Palmerini, E; Jones, R L; Marchesi, E; Paioli, A; Cesari, M; Longhi, A; Meazza, C; Coccoli, L; Fagioli, F; Asaftei, S; Grignani, G; Tamburini, A; Pollack, S M; Picci, P; Ferrari, S

    2016-04-20

    Few new compounds are available for relapsed osteosarcoma. We retrospectively evaluated the activity of gemcitabine (G) plus docetaxel (D) in patients with relapsed high-grade osteosarcoma and high-grade spindle cell sarcoma of bone (HGS). Patients receiving G 900 mg/m(2) d 1, 8; D 75 mg/m(2) d 8, every 21 days were eligible. Primary end-point: progression-free survival (PFS) at 4 months; secondary end-point: overall survival (OS) and response rate. Fifty-one patients were included, with a median age of 17 years (8-71), 26 (51%) were pediatric patients. GD line of treatment: 2nd in 14 patients, ≥3rd in 37. 25 (49%) patients had metastases limited to lungs, 26 (51%) multiple sites. 40 (78%) osteosarcoma, 11 (22%) HGS. Eight (16%) patients achieved surgical complete response (sCR2) after GD. Four-month PFS rate was 46%, and significantly better for patients with ECOG 0 (ECOG 0: 54% vs ECOG 1: 43% vs ECOG 2: 0%; p = 0.003), for patients undergoing metastasectomy after GD (sCR2 75% vs no-sCR2 40 %, p = 0.02) and for osteosarcoma (osteosarcoma 56% vs HGS 18%; p = 0.05), with no differences according to age, line of treatment, and pattern of metastases. Forty-six cases had RECIST measurable disease: 6 (13%) patients had a partial response (PR), 20 (43%) had stable disease (SD) and 20 (43%) had progressive disease (PD). The 1-year OS was 30%: 67% for PR, 54% for SD and 20% for PD (p = 0.005). GD is an active treatment for relapsed high-grade osteosarcoma, especially for ECOG 0 patients, and should be included in the therapeutic armamentarium of metastatic osteosarcoma.

  20. Gemcitabine and docetaxel in relapsed and unresectable high-grade osteosarcoma and spindle cell sarcoma of bone

    International Nuclear Information System (INIS)

    Palmerini, E.; Jones, R. L.; Marchesi, E.; Paioli, A.; Cesari, M.; Longhi, A.; Meazza, C.; Coccoli, L.; Fagioli, F.; Asaftei, S.; Grignani, G.; Tamburini, A.; Pollack, S. M.; Picci, P.; Ferrari, S.

    2016-01-01

    Few new compounds are available for relapsed osteosarcoma. We retrospectively evaluated the activity of gemcitabine (G) plus docetaxel (D) in patients with relapsed high-grade osteosarcoma and high-grade spindle cell sarcoma of bone (HGS). Patients receiving G 900 mg/m 2 d 1, 8; D 75 mg/m 2 d 8, every 21 days were eligible. Primary end-point: progression-free survival (PFS) at 4 months; secondary end-point: overall survival (OS) and response rate. Fifty-one patients were included, with a median age of 17 years (8–71), 26 (51 %) were pediatric patients. GD line of treatment: 2nd in 14 patients, ≥3rd in 37. 25 (49 %) patients had metastases limited to lungs, 26 (51 %) multiple sites. Histology: 40 (78 %) osteosarcoma, 11 (22 %) HGS. Eight (16 %) patients achieved surgical complete response (sCR2) after GD. Four-month PFS rate was 46 %, and significantly better for patients with ECOG 0 (ECOG 0: 54 % vs ECOG 1: 43 % vs ECOG 2: 0 %; p = 0.003), for patients undergoing metastasectomy after GD (sCR2 75 % vs no-sCR2 40 %, p = 0.02) and for osteosarcoma (osteosarcoma 56 % vs HGS 18 %; p = 0.05), with no differences according to age, line of treatment, and pattern of metastases. Forty-six cases had RECIST measurable disease: 6 (13 %) patients had a partial response (PR), 20 (43 %) had stable disease (SD) and 20 (43 %) had progressive disease (PD). The 1-year OS was 30 %: 67 % for PR, 54 % for SD and 20 % for PD (p = 0.005). GD is an active treatment for relapsed high-grade osteosarcoma, especially for ECOG 0 patients, and should be included in the therapeutic armamentarium of metastatic osteosarcoma

  1. The effects of clinical aromatherapy for anxiety and depression in the high risk postpartum woman - a pilot study.

    Science.gov (United States)

    Conrad, Pam; Adams, Cindy

    2012-08-01

    The aim of this study was to determine if aromatherapy improves anxiety and/or depression in the high risk postpartum woman and to provide a complementary therapy tool for healthcare practitioners. The pilot study was observational with repeated measures. Private consultation room in a Women's center of a large Indianapolis hospital. 28 women, 0-18 months postpartum. The treatment groups were randomized to either the inhalation group or the aromatherapy hand m'technique. Treatment consisted of 15 min sessions, twice a week for four consecutive weeks. An essential oil blend of rose otto and lavandula angustifolia @ 2% dilution was used in all treatments. The non-randomized control group, comprised of volunteers, was instructed to avoid aromatherapy use during the 4 week study period. Allopathic medical treatment continued for all participants. All subjects completed the Edinburgh Postnatal Depression Scale (EPDS) and Generalized Anxiety Disorder Scale (GAD-7) at the beginning of the study. The scales were then repeated at the midway point (two weeks), and at the end of all treatments (four weeks). Analysis of Variance (ANOVA) was utilized to determine differences in EPDS and/or GAD-7 scores between the aromatherapy and control groups at baseline, midpoint and end of study. No significant differences were found between aromatherapy and control groups at baseline. The midpoint and final scores indicated that aromatherapy had significant improvements greater than the control group on both EPDS and GAD-7 scores. There were no adverse effects reported. The pilot study indicates positive findings with minimal risk for the use of aromatherapy as a complementary therapy in both anxiety and depression scales with the postpartum woman. Future large scale research in aromatherapy with this population is recommended. Copyright © 2012 Elsevier Ltd. All rights reserved.

  2. Tandem autologous-allo-SCT is feasible in patients with high-risk relapsed non-Hodgkin's lymphoma.

    Science.gov (United States)

    Crocchiolo, R; Castagna, L; Fürst, S; El-Cheikh, J; Faucher, C; Oudin, C; Granata, A; Bouabdallah, R; Coso, D; Chabannon, C; Balzarotti, M; Santoro, A; Blaise, D

    2013-02-01

    Allo-SCT is used to exploit GVL effect in high-risk relapsed non-Hodgkin's lymphoma (NHL). Here, we retrospectively analyzed 34 high-risk NHL patients who underwent auto-SCT followed closely by reduced-intensity allo-SCT ('tandem auto-allo') from January 2002 to November 2010. The search for an allogeneic donor was started at the beginning of salvage regimen. Median patients' age was 47 (27-68) years; histotypes were: diffuse large B-cell n=5, follicular n=14, transformed follicular n=4, mantle-cell n=5, plasmocytoid lymphoma n=1, anaplastic large T-cell n=2, peripheral T-cell n=3. Donors were HLA-identical siblings (n=29) or 10/10-matched unrelated individuals (n=5). Median interval between auto-SCT and allo-SCT was 77 days (36-197). At a median follow-up of 46 (8-108) months since allo-SCT, 5-year OS is 77% (61-93) and PFS is 68% (51-85). Disease relapse or progression occurred in six patients, 100-day TRM was 0%, 2-year TRM incidence was 6%. In conclusion, tandem transplantation is feasible in high-risk NHL patients having a HLA-identical donor. This approach could represent a suitable therapeutic option for those patients with high-risk NHL potentially benefitting from further therapy after auto-SCT. Donor searches should be started promptly whenever such an approach is chosen.

  3. Use of radioimmunoassay technique for the determination of post-partum ovaric activity in high and low milk production in dairy cows

    International Nuclear Information System (INIS)

    Villalba, P.; Paneluisa, S.; Arcos, E.

    1993-01-01

    The principal objective of this study was to determinate the post-partum ovarian activity in milking cows of high and low production in one farm of ecuadorian highland. For this experiment was necessary to use 48 animals between second and sith calving, the milk samples were collected according one pre-stablished protocol and the same was: one sample 5th or 6th days, twice a week until the cows were pregnacy and 180 days after parturitium if the cow is open. Additional data were compiled in each farm and both the results of the progesterone by RIA were used to determinate the diferents reproductive parameters in the post-partum of the cows. The most of reproductives parameters in the post-partum of the cows in the both group didn't have significance but the conception rate, services per conception, number of pregnacy cows and percentaje of non visibles heats had one high significance between the treatments

  4. Postpartum Depression

    DEFF Research Database (Denmark)

    Smith-Nielsen, Johanne

    Background: In three academic articles, this PhD thesis investigates maternal postpartum depression (PPD) as a risk factor for the infant-mother attachment and infant development. Previous studies have been contradictory with respect to the question of whether PPD can have long term effects...... on offspring. This may be due to not differing between when PPD is only occurring in the postpartum period and when effects are also due to ongoing or recurrent depression. However, it may also be due to viewing maternal depression as a unitary construct, and not considering underlying maternal psychological...... difficulties which may moderate potential adverse effects. The present thesis investigates two potential maternal moderators of risk:. Comorbid personality disorder and adult attachment insecurity. Moreover, the question of early environmental effects of PPD versus effects of later or ongoing depression...

  5. Postpartum Depression - Multiple Languages

    Science.gov (United States)

    ... Русский (Russian) Bilingual PDF Health Information Translations Postpartum Depression - English PDF Postpartum Depression - Русский (Russian) PDF Postpartum Depression - English MP3 ...

  6. Postpartum Depression Facts

    Science.gov (United States)

    ... Where can I find more information? Share Postpartum Depression Facts Download PDF Download ePub Download Mobi Order ... for herself or her family. What is postpartum depression? Postpartum depression is a mood disorder that can ...

  7. Low serum levels of High-Density Lipoprotein cholesterol (HDL-c) as an indicator for the development of severe postpartum depressive symptoms

    Science.gov (United States)

    Ramachandran Pillai, Raji; Wilson, Anand Babu; Premkumar, Nancy R.; Kattimani, Shivanand; Sagili, Haritha

    2018-01-01

    Postpartum depression (PPD) is a psychiatric complication of childbirth affecting 10–20% of new mothers and has negative impact on both mother and infant. Serum lipid levels have been related to depressive disorders, but very limited literatures are available regarding the lipid levels in women with postpartum depression. The present study is aimed to examine the association of serum lipids with the development of postpartum depressive symptoms. This is a cross sectional study conducted at a tertiary care hospital in South India. Women who came for postpartum check-up at 6th week post-delivery were screened for PPD (September 2014-October 2015). Women with depressive symptoms were assessed using EPDS (Edinburgh Postnatal Depression Scale). The study involved 186 cases and 250 controls matched for age and BMI. Serum levels of lipid parameters were estimated through spectrophotometry and the atherogenic indices were calculated in all the subjects. Low serum levels of Total Cholesterol (TC) and High Density Lipoprotein cholesterol (HDL-c) were significantly low in PPD women with severe depressive symptoms. The study recorded a significant negative correlation between HDL-c and the EPDS score in PPD women (r = -0.140, p = 0.05). Interestingly, the study also observed a significant negative correlation between Body Mass Index (BMI) and EPDS scores in case group (r = -0.146, p = 0.047), whereas a positive correlation between the same in controls (r = 0.187, p = 0.004). Our study demonstrated that low levels of serum HDL-c is correlated with the development of severe depressive symptoms in postpartum women. Study highlights the role of lipids in the development of postpartum depressive symptoms. PMID:29444162

  8. Low serum levels of High-Density Lipoprotein cholesterol (HDL-c as an indicator for the development of severe postpartum depressive symptoms.

    Directory of Open Access Journals (Sweden)

    Raji Ramachandran Pillai

    Full Text Available Postpartum depression (PPD is a psychiatric complication of childbirth affecting 10-20% of new mothers and has negative impact on both mother and infant. Serum lipid levels have been related to depressive disorders, but very limited literatures are available regarding the lipid levels in women with postpartum depression. The present study is aimed to examine the association of serum lipids with the development of postpartum depressive symptoms. This is a cross sectional study conducted at a tertiary care hospital in South India. Women who came for postpartum check-up at 6th week post-delivery were screened for PPD (September 2014-October 2015. Women with depressive symptoms were assessed using EPDS (Edinburgh Postnatal Depression Scale. The study involved 186 cases and 250 controls matched for age and BMI. Serum levels of lipid parameters were estimated through spectrophotometry and the atherogenic indices were calculated in all the subjects. Low serum levels of Total Cholesterol (TC and High Density Lipoprotein cholesterol (HDL-c were significantly low in PPD women with severe depressive symptoms. The study recorded a significant negative correlation between HDL-c and the EPDS score in PPD women (r = -0.140, p = 0.05. Interestingly, the study also observed a significant negative correlation between Body Mass Index (BMI and EPDS scores in case group (r = -0.146, p = 0.047, whereas a positive correlation between the same in controls (r = 0.187, p = 0.004. Our study demonstrated that low levels of serum HDL-c is correlated with the development of severe depressive symptoms in postpartum women. Study highlights the role of lipids in the development of postpartum depressive symptoms.

  9. Thrombocalc: implementation and uptake of personalized postpartum venous thromboembolism risk assessment in a high-throughput obstetric environment.

    Science.gov (United States)

    O'Shaughnessy, Fergal; Donnelly, Jennifer C; Cooley, Sharon M; Deering, Mary; Raman, Ajita; Gannon, Geraldine; Hickey, Jane; Holland, Alan; Hayes, Niamh; Bennett, Kathleen; Ní Áinle, Fionnuala; Cleary, Brian J

    2017-11-01

    Venous thromboembolism risk assessment (VTERA) is recommended in all pregnant and postpartum women. Our objective was to develop, pilot and implement a user-friendly electronic VTERA tool. We developed "Thrombocalc", an electronic VTERA tool using Microsoft EXCEL ™ . Thrombocalc was designed as a score-based tool to facilitate rapid assessment of all women after childbirth. Calculation of a total score estimated risk of venous thromboembolism in line with consensus guidelines. Recommendations for thromboprophylaxis were included in the VTERA output. Implementation was phased. Uptake of the VTERA tool was assessed prospectively by monitoring the proportion of women who gave birth in our institution and had a completed risk assessment. Factors affecting completion and accuracy of risk assessments were also assessed. Thrombocalc was used prospectively to risk-assess 8380 women between September 2014 and December 2015. Compliance with this tool increased dramatically throughout the study period; over 92% of women were risk-assessed in the last quarter of data collection. Compliance was not adversely affected if delivery took place out of working hours [adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI) 0.93-1.14]. Risk assessment was less likely in the case of cesarean deliveries (aOR 0.66, 95% CI 0.60-0.73) and stillborn infants (aOR 0.48, 95% CI 0.29-0.79). Misclassification of risk factors led to approximately 207 (2.5%) inaccurate thromboprophylaxis recommendations. Our electronic, score-based VTERA tool provides a highly effective mechanism for rapid assessment of individual postpartum venous thromboembolism risk in a high-throughput environment. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  10. Postpartum management of diabetes pregnancy.

    Science.gov (United States)

    Hossain, Nazli

    2016-09-01

    Diabetes mellitus has assumed the role of an epidemic. Previously considered a disease of affluent developed countries, it has become more common in developing countries. Pakistan is included among the countries with a high prevalence of diabetes. In this scenario, postpartum management of a woman with diabetes mellitus becomes more important as in this period counseling and educating a woman is essential. Counselling includes life style modifications to prevent future risks involving all the systems of the body. This review article discusses management of diabetes mellitus in postpartum period, guidelines for postpartum screening of women with gestational diabetes mellitus, risks involved in future life and stresses upon the need of local population based studies. Primary care providers and gynaecologists must realize the importance of postpartum screening for diabetes mellitus and provide relevant information to women as well.

  11. Family history, not lack of medication use, is associated with the development of postpartum depression in a high-risk sample.

    Science.gov (United States)

    Kimmel, Mary; Hess, Edward; Roy, Patricia S; Palmer, Jennifer Teitelbaum; Meltzer-Brody, Samantha; Meuchel, Jennifer M; Bost-Baxter, Emily; Payne, Jennifer L

    2015-02-01

    We sought to determine clinical predictors of postpartum depression (PPD), including the role of medication, in a sample of women followed prospectively during and after pregnancy. Women with a history of mood disorder were recruited and evaluated during each trimester and 1 week, 1 month, and 3 months postpartum. DSM-IV criteria for a major depressive episode were assessed by a psychiatric interview at each time point. Sixty-three women with major depression and 30 women with bipolar disorder entered the study and 75.4 % met DSM-IV criteria for a MDE during pregnancy, postpartum, or both. We modeled depression in a given time period (second trimester, third trimester, or 1 month postpartum) as a function of medication use during the preceding period (first, second, or third trimester). The odds of being depressed for those who did not use medication in the previous period was approximately 2.8 times that of those who used medication (OR 2.79, 95 % CI 1.38-5.66, p = 0.0048). Of 38 subjects who were psychiatrically well during the third trimester, 39.5 % (N = 15) met the criteria for a MDE by 4 weeks postpartum. In women who developed PPD, there was a high rate of a family history of PPD (53.3 %) compared to women who did not develop PPD (11.8 %, p = 0.02). While the use of psychiatric medications during pregnancy reduced the odds of being depressed overall, the use of psychiatric medications during pregnancy may not protect against PPD in women at high risk, particularly those with a family history of PPD.

  12. Predictors of postpartum depression.

    Science.gov (United States)

    Katon, Wayne; Russo, Joan; Gavin, Amelia

    2014-09-01

    To examine sociodemographic factors, pregnancy-associated psychosocial stress and depression, health risk behaviors, prepregnancy medical and psychiatric illness, pregnancy-related illnesses, and birth outcomes as risk factors for post-partum depression (PPD). A prospective cohort study screened women at 4 and 8 months of pregnancy and used hierarchical logistic regression analyses to examine predictors of PPD. The study sample include 1,423 pregnant women at a university-based high risk obstetrics clinic. A score of ≥10 on the Patient Health Questionnaire-9 (PHQ-9) indicated clinically significant depressive symptoms. Compared with women without significant postpartum depressive symptoms, women with PPD were significantly younger (pdepressive symptoms (pdepression case finding for pregnant women.

  13. High signal intensity of anterior pituitary gland on T1-weighted MR imaging in normal postpartum women

    International Nuclear Information System (INIS)

    Kim, Myung Soon; Yang, Hak Seok; Chung, In Bai

    1995-01-01

    The purpose of this study is to evaluate the signal intensity and size of anterior pituitary gland in postpartum women, and to compare with those of control group. In 34 postpartum women (18-43 years, mean: 27 years) and another 35 control nonpregnant women (20-29 years, mean: 24 years), midsagittal T1-weighted MR images were obtained. The signal intensity and height of the anterior pituitary gland were compared between the post-partum and normal control groups. In postpartum women, the signal intensity of the anterior pituitary gland relative to the pons was higher than that of the control group. Pituitary gland height of postpartum women was higher (5-11. 8mm, mean 8.18 ± 1.8mm) than that of control group (2-9mm, mean: 6.2 ± 1.7mm). It is concluded that the hyperintensity of the anterior pituitary gland on T1-weighted image is a normal finding in postpartum women, which is useful in differentiation from pituitary abnormality

  14. High signal intensity of anterior pituitary gland on T1-weighted MR imaging in normal postpartum women

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Myung Soon; Yang, Hak Seok; Chung, In Bai [Wonju College of Medicine, Yonsei University, Wonju (Korea, Republic of)

    1995-01-15

    The purpose of this study is to evaluate the signal intensity and size of anterior pituitary gland in postpartum women, and to compare with those of control group. In 34 postpartum women (18-43 years, mean: 27 years) and another 35 control nonpregnant women (20-29 years, mean: 24 years), midsagittal T1-weighted MR images were obtained. The signal intensity and height of the anterior pituitary gland were compared between the post-partum and normal control groups. In postpartum women, the signal intensity of the anterior pituitary gland relative to the pons was higher than that of the control group. Pituitary gland height of postpartum women was higher (5-11. 8mm, mean 8.18 {+-} 1.8mm) than that of control group (2-9mm, mean: 6.2 {+-} 1.7mm). It is concluded that the hyperintensity of the anterior pituitary gland on T1-weighted image is a normal finding in postpartum women, which is useful in differentiation from pituitary abnormality.

  15. HOW DOES FINGOLIMOD (GILENYA® FIT IN THE TREATMENT ALGORITHM FOR HIGHLY ACTIVE RELAPSING-REMITTING MULTIPLE SCLEROSIS?

    Directory of Open Access Journals (Sweden)

    Franz eFazekas

    2013-05-01

    Full Text Available Multiple sclerosis (MS is a neurological disorder characterised by inflammatory demyelination and neurodegeneration in the central nervous system (CNS. Until recently, disease modifying treatment was based on agents requiring parenteral delivery, thus limiting long-term compliance. Basic treatments such as beta-interferon provide only moderate efficacy, and although therapies for second-line treatment and highly active MS are more effective, they are associated with potentially severe side effects. Fingolimod (Gilenya® is the first oral treatment of MS and has recently been approved as single disease-modifying therapy in highly active relapsing-remitting multiple sclerosis (RRMS for adult patients with high disease activity despite basic treatment (beta-interferon and for treatment-naïve patients with rapidly evolving severe RRMS. At a scientific meeting that took place in Vienna on November 18th, 2011, experts from 10 Central and Eastern European countries discussed the clinical benefits and potential risks of fingolimod for MS, suggested how the new therapy fits within the current treatment algorithm and provided expert opinion for the selection and management of patients.

  16. Monitoring minimal residual disease in children with high-risk relapses of acute lymphoblastic leukemia: prognostic relevance of early and late assessment.

    Science.gov (United States)

    Eckert, C; Hagedorn, N; Sramkova, L; Mann, G; Panzer-Grümayer, R; Peters, C; Bourquin, J-P; Klingebiel, T; Borkhardt, A; Cario, G; Alten, J; Escherich, G; Astrahantseff, K; Seeger, K; Henze, G; von Stackelberg, A

    2015-08-01

    The prognosis for children with high-risk relapsed acute lymphoblastic leukemia (ALL) is poor. Here, we assessed the prognostic importance of response during induction and consolidation treatment prior to hematopoietic stem cell transplantation (HSCT) aiming to evaluate the best time to assess minimal residual disease (MRD) for intervention strategies and in future trials in high-risk ALL relapse patients. Included patients (n=125) were treated uniformly according to the ALL-REZ BFM (Berlin-Frankfurt-Münster) 2002 relapse trial (median follow-up time=4.8 years). Patients with MRD ⩾10(-3) after induction treatment (76/119, 64%) or immediately preceding HSCT (19/71, 27%) had a significantly worse probability of disease-free survival 10 years after relapse treatment begin, with 26% (±6%) or 23% (±7%), respectively, compared with 58% (±8%) or 48% (±7%) for patients with MRD treatment reduced MRD to treatment can be used to quantify the activity of different induction treatment strategies in phase II trials. MRD persistence at ⩾10(-3) before HSCT reflects a disease highly resistant to conventional intensive chemotherapy and requiring prospective controlled investigation of new treatment strategies and drugs.

  17. Modifiable factors influencing relapses and disability in multiple sclerosis

    NARCIS (Netherlands)

    D'hooghe, M. B.; Nagels, G.; Bissay, V.; De Keyser, J.

    A growing body of literature indicates that the natural course of multiple sclerosis can be influenced by a number of factors. Strong evidence suggests that relapses can be triggered by infections, the postpartum period and stressful life events. Vaccinations against influenza, hepatitis B and

  18. Improved survival of multiple myeloma patients with late relapse after high-dose treatment and stem cell support, a population-based study of 348 patients in Denmark in 1994-2004

    DEFF Research Database (Denmark)

    Vangsted, Annette Juul; Klausen, Tobias W; Andersen, Niels F

    2010-01-01

    To analyse if patients with early relapse after high-dose chemotherapy with stem cell support (HDT) benefit from new treatment strategies in a population-based setting.......To analyse if patients with early relapse after high-dose chemotherapy with stem cell support (HDT) benefit from new treatment strategies in a population-based setting....

  19. Immediate Postpartum Mood Assessment and Postpartum Depressive Symptoms

    Science.gov (United States)

    Miller, Michelle L.; Kroska, Emily B.; Grekin, Rebecca

    2016-01-01

    Background Negative affect (NA) and positive affect (PA) in the early postpartum period have been associated with postpartum depressive symptoms, but the exact relationship is not well understood. This study aimed to determine if NA and PA in the immediate postpartum period predicted postpartum depressive symptoms over and above well-established predictors (previous trauma, history of depression). Methods Participants were prospectively recruited from a Mother-Baby Unit at a large Midwestern academic medical center in the United States from April 2011 to April 2014. Participants (N = 526) completed the Daily Experiences Questionnaire (DEQ), a self-report measure which assessed NA and PA, within three days post-delivery. Participants then reported their depressive symptoms at two weeks (n = 364) and twelve weeks postpartum (n = 271). Results Hierarchical regression analyses indicated that low PA and high NA after birth significantly predicted depressive symptoms early (at 2 weeks) and later (at 12 weeks) in the postpartum period, over and above previous traumatic experiences and history of depression. Limitations The sample was relatively homogenous, and data were from self-report instruments. Conclusions The current study found NA and PA in the days immediately after birth predicted depressive symptoms at multiple time points in the postpartum period. Because the perinatal period places women at a higher risk for depressive symptomatology, prevention and early intervention are critical. Measuring affect in hospitals immediately after birth may provide a more normalized set of items that is predictive of later depression, which will allow physicians to identify those at highest risk for developing depressive symptoms. PMID:27716540

  20. Immediate postpartum mood assessment and postpartum depressive symptoms.

    Science.gov (United States)

    Miller, Michelle L; Kroska, Emily B; Grekin, Rebecca

    2017-01-01

    Negative affect (NA) and positive affect (PA) in the early postpartum period have been associated with postpartum depressive symptoms, but the exact relationship is not well understood. This study aimed to determine if NA and PA in the immediate postpartum period predicted postpartum depressive symptoms over and above well-established predictors (previous trauma, history of depression). Participants were prospectively recruited from a Mother-Baby Unit at a large Midwestern academic medical center in the United States from April 2011 to April 2014. Participants (N=526) completed the Daily Experiences Questionnaire (DEQ), a self-report measure which assessed NA and PA, within three days post-delivery. Participants then reported their depressive symptoms at two weeks (n=364) and twelve weeks postpartum (n=271). Hierarchical regression analyses indicated that low PA and high NA after birth significantly predicted depressive symptoms early (at 2 weeks) and later (at 12 weeks) in the postpartum period, over and above previous traumatic experiences and history of depression. The sample was relatively homogenous, and data were from self-report instruments. The current study found NA and PA in the days immediately after birth predicted depressive symptoms at multiple time points in the postpartum period. Because the perinatal period places women at a higher risk for depressive symptomatology, prevention and early intervention are critical. Measuring affect in hospitals immediately after birth may provide a more normalized set of items that is predictive of later depression, which will allow physicians to identify those at highest risk for developing depressive symptoms. Copyright © 2016 Elsevier B.V. All rights reserved.

  1. High-dose therapy followed by bone marrow transplantation for relapsed follicular non-Hodgkin's lymphoma

    NARCIS (Netherlands)

    Schouten, IC; Raemaekers, JJM; Kluin-Nelemans, HC; vanKamp, H; Mellink, WAM; vantVeer, MB

    1996-01-01

    Purpose: To analyze whether, in addition to survival, and disease-free survival progression-free interval after transplantation would be longer than the last progression-free interval before transplantation, supporting the argument that high-dose therapy may change the biologic behavior of the

  2. Tick-Borne Relapsing Fever Outbreak Among a High School Football Team at an Outdoor Education Camping Trip, Arizona, 2014.

    Science.gov (United States)

    Jones, Jefferson M; Hranac, Carter R; Schumacher, Mare; Horn, Kim; Lee, Darlene M; Terriquez, Joel; Engelthaler, David M; Peoples, Marie; Corrigan, Jennifer; Replogle, Adam; Souders, Nina; Komatsu, Kenneth K; Nieto, Nathan C

    2016-09-07

    During August 2014, five high school students who had attended an outdoor education camp were hospitalized with a febrile illness, prompting further investigation. Ten total cases of tick-borne relapsing fever (TBRF) were identified-six cases confirmed by culture or visualization of spirochetes on blood smear and four probable cases with compatible symptoms (attack rate: 23%). All patients had slept in the campsite's only cabin. Before the camp, a professional pest control company had rodent proofed the cabin, but no acaricides had been applied. Cabin inspection after the camp found rodents and Ornithodoros ticks, the vector of TBRF. Blood samples from a chipmunk trapped near the cabin and from patients contained Borrelia hermsii with identical gene sequences (100% over 630 base pairs). Health departments in TBRF endemic areas should consider educating cabin owners and pest control companies to apply acaricides during or following rodent proofing, because ticks that lack rodents for a blood meal might feed on humans. © The American Society of Tropical Medicine and Hygiene.

  3. Is High Dose Therapy Superior to Conventional Dose Therapy as Initial Treatment for Relapsed Germ Cell Tumors? The TIGER Trial

    Directory of Open Access Journals (Sweden)

    Darren R. Feldman, Robert Huddart, Emma Hall, Jörg Beyer, Thomas Powles

    2011-01-01

    Full Text Available Metastatic germ cell tumours (GCTs are usually cured with cisplatin based chemotherapy and standard treatment algorithms are established. However when this treatment fails and the disease relapses, standard treatment is much more uncertain. Both conventional dose therapy (CDT and high dose therapy (HDT are widely used, due to the lack of conclusive data supporting one specific approach. A recent retrospective analysis focusing on this population suggested a significant benefit for HDT. Retrospective analyses are prone to bias, and therefore while this data is provocative it is by no mean conclusive. For this reason the international community is supporting a prospective randomised trial in this area comparing CDT(TIP with sequential HDT (TICE. The planned open labelled randomised phase III study (TIGER is due to open in 2011 and will recruit 390 patients to detect a 13% difference in 2 year progression free survival (primary endpoint. It is hoped that this large study will conclusively resolve the uncertainty which currently exists.

  4. Efficacy of Cladribine Tablets in high disease activity subgroups of patients with relapsing multiple sclerosis: A post hoc analysis of the CLARITY study.

    Science.gov (United States)

    Giovannoni, Gavin; Soelberg Sorensen, Per; Cook, Stuart; Rammohan, Kottil W; Rieckmann, Peter; Comi, Giancarlo; Dangond, Fernando; Hicking, Christine; Vermersch, Patrick

    2018-04-01

    In the CLARITY (CLAdRIbine Tablets treating multiple sclerosis orallY) study, Cladribine Tablets significantly improved clinical and magnetic resonance imaging (MRI) outcomes (vs placebo) in patients with relapsing-remitting multiple sclerosis. Describe two clinically relevant definitions for patients with high disease activity (HDA) at baseline of the CLARITY study (utility verified in patients receiving placebo) and assess the treatment effects of Cladribine Tablets 3.5 mg/kg compared with the overall study population. Outcomes of patients randomised to Cladribine Tablets 3.5 mg/kg or placebo were analysed for subgroups using HDA definitions based on high relapse activity (HRA; patients with ⩾2 relapses during the year prior to study entry, whether on DMD treatment or not) or HRA plus disease activity on treatment (HRA + DAT; patients with ⩾2 relapses during the year prior to study entry, whether on DMD treatment or not, PLUS patients with ⩾1 relapse during the year prior to study entry while on therapy with other DMDs and ⩾1 T1 Gd+ or ⩾9 T2 lesions). In the overall population, Cladribine Tablets 3.5 mg/kg reduced the risk of 6-month-confirmed Expanded Disability Status Scale (EDSS) worsening by 47% vs placebo. A risk reduction of 82% vs placebo was seen in both the HRA and HRA + DAT subgroups (vs 19% for non-HRA and 18% for non-HRA + DAT), indicating greater responsiveness to Cladribine Tablets 3.5 mg/kg in patients with HDA. There were consistent results for other efficacy endpoints. The safety profile in HDA patients was consistent with the overall CLARITY population. Patients with HDA showed clinical and MRI responses to Cladribine Tablets 3.5 mg/kg that were generally better than, or at least comparable with, the outcomes seen in the overall CLARITY population.

  5. A Counselor's Primer on Postpartum Depression.

    Science.gov (United States)

    Pfost, Karen S.; And Others

    1990-01-01

    Notes that women are particularly vulnerable to depression during the postpartum period. Distinguishes postpartum depression from normal postpartum adjustment, postpartum blues, and postpartum psychosis. Describes biological, psychodynamic, and diathesis-stress perspectives on postpartum depression. Encourages counselors to fashion individualized…

  6. Postpartum hysterectomy

    Directory of Open Access Journals (Sweden)

    Katja Juvan-Kramer

    2006-01-01

    Full Text Available Background: Emergency postpartum hysterectomy (PH is generally performed in the situation of lifethreatening haemorrhage. Incidence according to the literature is between 1/300 and 1/5000 labours. The leading cause in developed world is placenta accreta. Besides standard methods (aplication of drugs, revision of uterus, bimanual compression of uterus etc., conservative surgical methods and embolization of vessels are increasingly used. We wanted to establish the incidence of PH in the Ljubljana Maternity Hospital, use of conservative surgical methods and matching of histological and operative diagnosis. We wanted to check the possibilities for embolization of vessels.Methods: Retrospective analysis of PH in the years 1992–2002 in the Ljubljana Maternity Hospital was done and the incidence of PH was calculated. We analysed patients regarding indications for PH, sort of operation and matching of histological and operative diagnose. We checked the possibilities for embolization of uterine vessels.Results: In the mentioned period 20 labours ended with PH (incidence 1/3124 labours. 17 patients were multiparas, PH was done after caesarean section in 9 cases. The most common indication was rupture of the uterus (6 cases, followed by inflammation of the uterus (5 cases and atony (4 cases. Among conservative methods, application of 15-metil PGF2alpha and oxytocin were most commonly used, the next two were manual exploration of uterine cavity and uterine packing. None of conservative surgical methods were used. Histological and operative diagnosis matched in 16 cases. There were no maternal and neonatal deaths.Conclusions: The incidence of PH in the Ljubljana Maternity Hospital is low. The leading two causes are uterine rupture and inflammation of uterus. None of conservative surgical methods were used. There are good possibilities for embolization of uterine vessels.

  7. Bipolar Spectrum Disorder During Pregnancy and the Postpartum Period

    NARCIS (Netherlands)

    R. Wesseloo (Richard)

    2018-01-01

    markdownabstractDuring the postpartum period, women are at high risk for both first-onset and recurrent mood disorder episodes. This thesis focuses on the treatment and course of mood disorders during pregnancy and the postpartum period, with a main focus on bipolar disorder and postpartum

  8. Postpartum Depression: An Overview.

    Science.gov (United States)

    Albright, Angela

    1993-01-01

    Occurring in about 12 percent of postpartum women, postpartum depression has been focus of considerable research. Variables that have been correlated with postpartum depression range from biological causes, to lack of social support, to relationship with husband, to attributional styles, to psychodynamic explanations. There is need for more…

  9. Melatonin treatment at dry-off improves reproductive performance postpartum in high-producing dairy cows under heat stress conditions.

    Science.gov (United States)

    Garcia-Ispierto, I; Abdelfatah, A; López-Gatius, F

    2013-08-01

    The aim of this study was to determine the effect of melatonin treatment during the early dry-off period on subsequent reproductive performance and milk production in high-producing dairy cows under heat stress conditions. In experiment I, addressing the pharmacokinetics of melatonin treatment in lactating dairy cows, doses of untreated, 3, 6, 9 or 12 implants/animal (18-mg melatonin each implant) were given as subcutaneous implants on gestation day 120-20 multiparous lactating dairy cows (four cows/dose group). Experiment II was performed during the warm season on 25 heifers and 114 high milk-producing Holstein-Friesian cows. Animals were randomly assigned to a control (C) or melatonin group (M). Animals in the M group received nine implants (heifers) or 12 (cows) of melatonin on day 220 of gestation. In experiment I, cows in the 12 implants group showed a higher maximum melatonin concentration (Cmax ) and area under the concentration curve from treatment day 0 to day 49 (AUC0-49d ) than those in the remaining groups, among which there were no significant differences in this variable. In experiment II, the likelihood of repeat breeding syndrome (pregnancy loss (first trimester) were 0.36 and 0.19 times lower in treated than control animals, respectively. Plasma prolactin levels decreased significantly (p = 0.01) after melatonin treatment and recovered during the postpartum compared to control cows. No significant effects on milk production were observed in the subsequent lactation. Significant differences in days open between groups (means 123 ± 71.9 and 103 ± 43, respectively, for C and M; p = 0.02) were registered. In conclusion, melatonin treatment in the early dry-off period improves the reproductive performance of dairy cattle, reducing the number of days open, repeat breeding syndrome and pregnancy loss. © 2012 Blackwell Verlag GmbH.

  10. High-risk human papillomavirus clearance in pregnant women: trends for lower clearance during pregnancy with a catch-up postpartum

    OpenAIRE

    Nobbenhuis, M A E; Helmerhorst, T J M; van den Brule, A J C; Rozendaal, L; Bezemer, P D; Voorhorst, F J; Meijer, C J L M

    2002-01-01

    We followed 353 women referred with abnormal cervical cytology in a non-intervention cohort study. In 91 pregnant women we compared high-risk human papilloma virus rates in the subsequent trimesters and postpartum in comparison to 262 non-pregnant women. High-risk human papilloma virus clearance was compared with 179 high-risk human papilloma virus positive non-pregnant women. Our main questions were: (1) do high-risk human papilloma virus rates change during pregnancy?; and (2) is there any ...

  11. Maintenance of smoking cessation in the postpartum period: which interventions work best in the long-term?

    Science.gov (United States)

    Su, Anny; Buttenheim, Alison M

    2014-04-01

    Smoking during pregnancy has been linked to a variety of adverse outcomes for both maternal and child health. Decades of studies have sought to increase cessation antepartum and reduce relapse postpartum. A number of effective interventions exist to significantly reduce smoking rates during pregnancy; however, less is known about how to prevent relapse in the postpartum period. This review investigates interventions to prevent relapse in the long-term postpartum period. We focus specifically on nonspontaneous quitters (individuals who quit smoking as a result of an external intervention) to reveal differences in long-term response to interventions for this population compared to spontaneous quitters. A systematic literature search yielded 32 relevant studies of pharmacological, behavioral, and incentives-based interventions. Results were compiled, analyzed, and compared in order to evaluate success factors in maintaining cessation postpartum. Though intervention groups showed consistently higher quit rates during pregnancy than control groups, none of the intervention types were effective at preventing relapse in the longer-term postpartum period. One study maintained significantly higher abstinence in the longer-term period postpartum using a mix of behavioral and incentives strategies. Additional research in this area is needed to identify optimal intervention strategies to reduce long-term postpartum relapse, particularly for nonspontaneous quitters.

  12. [Postpartum thyroiditis. A review].

    Science.gov (United States)

    Hurtado-Hernández, Z; Segura-Domínguez, A

    2013-01-01

    Postpartum thyroiditis (PPT) is a transient thyroid dysfunction of autoimmune origin that can occur in the first year postpartum in women who have not been previously diagnosed with thyroid disease. It may start with clinical thyrotoxicosis followed by hypothyroidism and the subsequent recovery of thyroid function, or may just appear as isolated thyrotoxicosis or hypothyroidism. PPT recurs in high percentage of patients after subsequent pregnancies. Many women develop permanent hypothyroidism sometime during the 3 to 10 year period after an episode of PPT. It is important for family physicians to be familiar with this disease, due to its high prevalence in order to make a correct diagnosis and therapeutic intervention. Family doctors also play a crucial role in the monitoring of these patients, given the negative implications of established hypothyroidism on reproduction in the female population during their reproductive years. This article reviews the principle characteristics of PPT along with its diagnosis and treatment. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  13. Relapse prevention and smoking cessation.

    Science.gov (United States)

    Davis, J R; Glaros, A G

    1986-01-01

    A multicomponent smoking relapse prevention treatment based on Marlatt and Gordon's (1980) model of the relapse process was developed and evaluated. Behavior-analytic methods were used to develop assessment instruments, training situations, and coping responses. The prevention components were presented in the context of a basic broad-spectrum stop-smoking program, and were compared with the basic program plus discussion control, and the basic program alone. Smoking-related dependent variables generally did not differ between groups at any time from pre-treatment to 12 month follow-up. Only the subjects in the relapse prevention condition improved problem-solving and social skills needed to cope with high-risk situations. These subjects also tended to take longer to relapse and smoke fewer cigarettes at the time of relapse. Subjects above the median level of competence on measures of social skill at post-treatment remained abstinent significantly longer. Maintenance of non-smoking was found to be related to the degree of competence with which individuals deal with high-risk situations. Results are discussed in relation to models of compliance with therapeutic regimens.

  14. An Ultra-High Field Study of Cerebellar Pathology in Early Relapsing-Remitting Multiple Sclerosis Using MP2RAGE.

    Science.gov (United States)

    Fartaria, Mário João; OʼBrien, Kieran; Şorega, Alexandra; Bonnier, Guillaume; Roche, Alexis; Falkovskiy, Pavel; Krueger, Gunnar; Kober, Tobias; Bach Cuadra, Meritxell; Granziera, Cristina

    2017-05-01

    The aim of this study was to study focal cerebellar pathology in early stages of multiple sclerosis (MS) using ultra-high-field magnetization-prepared 2 inversion-contrast rapid gradient-echo (7T MP2RAGE). Twenty early-stage relapsing-remitting MS patients underwent an MP2RAGE acquisition at 7 T magnetic resonance imaging (MRI) (images acquired at 2 different resolutions: 0.58 × 0.58 × 0.58 mm, 7T_0.58, and 0.75 × 0.75 × 0.90 mm, 7T_0.75) and 3 T MRI (1.0 × 1.0 × 1.2 mm, 3T_1.0). Total cerebellar lesion load and volume and mean cerebellar lesion volume were compared across images using a Wilcoxon signed-rank test. Mean T1 relaxation times in lesions and normal-appearing tissue as well as contrast-to-noise ratio (CNR) measurements were also compared using a Wilcoxon signed-rank test. A multivariate analysis was applied to assess the contribution of MRI metrics to clinical performance in MS patients. Both 7T_0.58 and 7T_0.75 MP2RAGE showed significantly higher lesion load compared with 3T_1.0 MP2RAGE (P < 0.001). Plaques that were judged as leukocortical in 7T_0.75 and 3T_1.0 MP2RAGEs were instead identified as WM lesions in 7T_0.58 MP2RAGE. Cortical lesion CNR was significantly higher in MP2RAGEs at 7 T than at 3 T. Total lesion load as well as total and mean lesion volume obtained at both 7 T and 3 T MP2RAGE significantly predicted attention (P < 0.05, adjusted R = 0.5), verbal fluency (P < 0.01, adjusted R = 0.6), and motor performance (P = 0.01, adjusted R = 0.7). This study demonstrates the value of 7 T MP2RAGE to study the cerebellum in early MS patients. 7T_0.58 MP2RAGE provides a more accurate anatomical description of white and gray matter pathology compared with 7T_0.75 and 3T_1.0 MP2RAGE, likely due to the improved spatial resolution, lower partial volume effects, and higher CNR.

  15. Postpartum Substance Use and Depressive Symptoms: A Review

    Science.gov (United States)

    Chapman, Shawna L. Carroll; Wu, Li-Tzy

    2013-01-01

    National survey data suggest that new mothers have high prevalences of alcohol and illicit drug use. Depression correlates with substance use, and new mothers with postpartum depression (PPD) may be at high risk for substance use. Understanding postpartum substance use and its relationship to PPD can inform future research and intervention. A literature search was conducted resulting in 12 studies published from 1999–2012 examining postpartum alcohol use, drug use, or combined postpartum depression and substance use. Postpartum alcohol (prevalence range 30.1%−49%) and drug use (4.5%–8.5%) were lower than use among not pregnant, not postpartum women (41.5%–57.5%; 7.6%–10.6%, respectively) but higher than use among pregnant women (5.4%–11.6%; 3.7%–4.3%, respectively). Correlates of postpartum problem drinking were being unemployed, unmarried, and a cigarette smoker. Prevalence of drug use was highest among white new mothers, followed by Blacks and Hispanics, but Black new mothers appeared at greater risk of drug use. No identified studies examined correlates of postpartum drug use beyond race/ethnicity. Postpartum depressive symptoms were prevalent among postpartum substance users and those with a substance use history (19.7%–46%). The postpartum period is a critical time. Prevalent substance use and the scarcity of studies warrant research to identify means to reduce maternal substance use. PMID:23879459

  16. Tryptophan pathway alterations in the postpartum period and in acute postpartum psychosis and depression.

    Science.gov (United States)

    Veen, Cato; Myint, Aye Mu; Burgerhout, Karin M; Schwarz, Markus J; Schütze, Gregor; Kushner, Steven A; Hoogendijk, Witte J; Drexhage, Hemmo A; Bergink, Veerle

    2016-01-01

    Women are at very high risk for the first onset of acute and severe mood disorders the first weeks after delivery. Tryptophan breakdown is increased as a physiological phenomenon of the postpartum period and might lead to vulnerability for affective psychosis (PP) and severe depression (PD). The aim of the current study was to investigate alterations in tryptophan breakdown in the physiological postpartum period compared to patients with severe postpartum mood disorders. We included 52 patients (29 with PP, 23 with PD), 52 matched healthy postpartum women and 29 healthy non-postpartum women. Analyzes of serum tryptophan metabolites were performed using LC-MS/MS system for tryptophan, kynurenine, 3-hydroxykynurenine, kynurenic acid and 5-hydroxyindoleacetic acid. The first two months of the physiological postpartum period were characterized by low tryptophan levels, increased breakdown towards kynurenine and a downstream shift toward the 3-OH-kynurenine arm, away from the kynurenic acid arm. Kynurenine was significantly lower in patients with PP and PD as compared to healthy postpartum women (p=0.011 and p=0.001); the remaining tryptophan metabolites demonstrated few differences between patients and healthy postpartum women. Low prevalence of the investigated disorders and strict exclusion criteria to obtain homogenous groups, resulted in relatively small sample sizes. The high kynurenine levels and increased tryptophan breakdown as a phenomenon of the physiological postpartum period was not present in patients with severe postpartum mood disorders. No differences were observed in the levels of the 'neurotoxic' 3-OH-kynurenine and the 'neuroprotective' kynurenic acid arms between patients and healthy postpartum women. Copyright © 2015 Elsevier B.V. All rights reserved.

  17. The influence of genital tract status in postpartum period on the subsequent reproductive performance in high producing dairy cows.

    Science.gov (United States)

    López-Helguera, I; López-Gatius, F; Garcia-Ispierto, I

    2012-04-15

    The aim of the present study was to characterize the early postpartum period in clinically healthy dairy cows by ultrasonography (US), endometrial cytology (EC), and white blood cell counts, and determine possible relationships between postpartum findings and subsequent reproductive performance. Fifty-three dairy cows were examined on Days 15 to 21 (Visit 1), 22 to 28 (Visit 2), and 29 to 35 (Visit 3) postpartum. The clinical examination included: examination of vaginal fluid, EC, transrectal palpation and ultrasonography of the genital tract (cervical diameter, endometrial thickness, presence of a corpus luteum [CL] or intrauterine fluid [IUF] and its echogenicity). Luteal activity (presence of a CL in a single visit), return to cyclicity (presence of a CL in 2 consecutive visits), and conception rate at 70 and 120 days postpartum were considered as the dependent variables in four consecutive binary logistic regression analyses. Factors affecting leukocyte counts were established by general linear model (GLM) repeated measures analysis of variance. Based on the odds ratio (OR), the likelihood of luteal activity was higher in multiparous than primiparous cows (OR = 3.75) and tended to diminish in cows showing increased endometrial thickness in Visit 1 (V1) (OR = 0.06). The likelihood of returning to cyclicity decreased for each centimeter increase in cervical diameter in V1 (OR = 0.14) and that of conception on Day 70 was lower in cows showing the presence of echogenic or anechogenic IUF in V1 (OR = 0.09 or OR = 0.13, respectively) compared with cows lacking IUF. Effects of parity and IUF were observed on neutrophil counts. Positive EC results were unrelated to the cumulative conception rate at 70 and 120 days in milk, whereas cows returning a positive EC result in V1 showed a greater likelihood of increased endometrial thickness. In conclusion, measuring cervical diameter, endometrial thickness, and detecting the echogenicity of IUF by ultrasonography from Days 15

  18. POSTPARTUM DEPRESSION – THE CENTRAL PROBLEM OF MENTAL HEALTH OF EARLY MOTHERHOOD

    Directory of Open Access Journals (Sweden)

    N. A. Kornetov

    2015-01-01

    Full Text Available Perinatal mental health of the mother occupies a central position in healthcare, the same as caring for a newborn baby. Maternal depression is the lead pathology of postpartum period. Despite the high prevalence and importance to the overall development of children, most cases of depression are unappreciated, unrecognized and untreated. Inattention to issues which are related to physical and mental health of women, leads to severe negative social and economic consequences for society. Statistical comparison of the total number of pregnant women, the number of births in the United States in 2007, excluding cases of fetal loss, including still-births and miscarriages with similar Russian data allowed to calculate the approximate prevalence of postpartum depression in the same period. Presumable probability of postpartum depression is 15% in different regions of the world, and the diagnostic criteria of DSM-IV for postpartum depression are representative for comparison. Considering these assumptions, according to 2007 each year about 260,000 out of 1 mln. 600,000 of Russian women in childbirth may suffer from post-natal depression. The results have a probabilistic character. For the mothers the consequences of unrecognized and untreated depression after childbirth are the most frequent. It should be seen as a depressive episode or recurrent depressive disorder which has a singular coloring due to the appearance in the peak period of reproductive age of women. Postpartum depression may increase the possibility of occurrence of relapse of a depressive disorder as well as the transition to a state of chronic depression. Alcoholism or drug use is a common complication of depression; the risk of suicide increases, especially during the time of reducing the severity of the most severe symptoms of depression, though it is below the prevalence of suicide among the population. Particular attention should be paid to such symptoms as instability in mood and

  19. Postpartum Maternal Weight Changes: Implications for Military Women

    National Research Council Canada - National Science Library

    Abrams, Barbara

    2002-01-01

    .... Multivariate analysis suggested that high level of maternal weight gain during pregnancy, history of weight cycling, postpartum depression, and financial insecurity were associated with increased weight after birth...

  20. Carbetocin versus oxytocin after caesarean section: similar efficacy but reduced pain perception in women with high risk of postpartum haemorrhage.

    Science.gov (United States)

    De Bonis, Maria; Torricelli, Michela; Leoni, Licia; Berti, Paolo; Ciani, Valentina; Puzzutiello, Rosa; Severi, Filiberto Maria; Petraglia, Felice

    2012-06-01

    To compare the effectiveness of carbetocin with oxytocin with respect to maintain adequate uterine tone and to reduce the incidence and severity of postpartum haemorrhage. Moreover safety, adverse effects and the need of additional medications were evaluated. Prospective controlled clinical trial. We compared the effect of a single dose of carbetocin (n = 55) with oxytocin infusion (n = 55) in a women population undergoing to elective caesarean section with regional subarachnoid anaesthesia with at least one risk factor for postpartum haemorrhage. The mean ± SD of postoperative pain in the day of surgery in carbetocin group was significantly lower than in oxytocin group and remained significant till the third day after caesarean section. In the day of surgery and the first day after surgery, women of carbetocin group who needed analgesic drugs were significantly lower than women of oxytocin group. The differences of diuresis and of diuretic drugs need were not statistically significant between the two groups. A single carbetocin injection is efficacious and safe on the maintenance of uterine tone and on the limitation of blood losses, in peri- and in postoperative period. In addition, carbetocin was able to reduce pain perception during postoperative days improving quality life of women.

  1. Intravenous iron isomaltoside 1000 administered by high single-dose infusions or standard medical care for the treatment of fatigue in women after postpartum haemorrhage: study protocol for a randomised controlled trial.

    Science.gov (United States)

    Holm, Charlotte; Thomsen, Lars Lykke; Norgaard, Astrid; Langhoff-Roos, Jens

    2015-01-14

    Postpartum haemorrhage can lead to iron deficiency with and without anaemia, the clinical consequences of which include physical fatigue. Although oral iron is the standard treatment, it is often associated with gastrointestinal side effects and poor compliance. To date, no published randomised controlled studies have compared the clinical efficacy and safety of standard medical care with intravenous administration of iron supplementation after postpartum haemorrhage.The primary objective of this study is to compare the efficacy of an intravenous high single-dose of iron isomaltoside 1000 with standard medical care on physical fatigue in women with postpartum haemorrhage. In a single centre, open-labelled, randomised trial, women with postpartum haemorrhage exceeding 700 mL will be allocated to either a single dose of 1,200 mg of iron isomaltoside 1000 or standard medical care. Healthy parturients with a singleton pregnancy will be included within 48 hours after delivery.Participants will complete structured questionnaires that focus on several dimensions of fatigue and mental health (Multidimensional Fatigue Inventory, Edinburgh Postnatal Depression Scale and the Postpartum Questionnaire), at inclusion and at follow-up visits after three days, one week, three weeks, eight weeks, and 12 weeks postpartum. The primary endpoint is the aggregated change in physical fatigue score within 12 weeks postpartum, as measured by a subscale of the Multidimensional Fatigue Inventory. The primary objective will be considered to have been met if an intravenous high single dose of iron isomaltoside 1000 is shown to be superior to standard medical care in women after postpartum haemorrhage regarding physical fatigue.For claiming superiority, we set the minimal clinically relevant difference between the mean scores at 1.8, and the assumed standard deviation at 4.2. Hence, 87 participants per treatment group are needed in order to demonstrate superiority; to provide an extra margin

  2. Postpartum haemorrhage: prevention.

    Science.gov (United States)

    Chelmow, David

    2011-04-04

    Loss of more than 500 mL of blood following childbirth is usually caused by failure of the uterus to contract fully after delivery of the placenta, and occurs in over 10% of deliveries, with a 1% mortality rate worldwide. Other causes of postpartum haemorrhage include retained placental tissue, lacerations to the genital tract, and coagulation disorders. Uterine atony is more likely in women who have had a general anaesthetic or oxytocin, an over-distended uterus, a prolonged or precipitous labour, or who are of high parity. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of non-drug interventions and of drug interventions to prevent primary postpartum haemorrhage? We searched: Medline, Embase, The Cochrane Library, and other important databases up to March 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 40 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review we present information relating to the effectiveness and safety of the following interventions: active management of the third stage of labour, carboprost injection, controlled cord traction, ergot compounds (ergometrine/methylergotamine), immediate breastfeeding, misoprostol (oral, rectal, sublingual, or vaginal), oxytocin, oxytocin plus ergometrine combinations, prostaglandin E2 compounds, and uterine massage.

  3. Postpartum Depression and Child Development.

    Science.gov (United States)

    Murray, Lynne, Ed.; Cooper, Peter J., Ed.

    Only recently has the research on postpartum depression dealt with the disorder's effects on child development. This book explores the impact of postpartum depression on mother-infant interaction and child development, its treatment, and postpartum psychosis. The chapters are: (1) "The Nature of Postpartum Depressive Disorders" (Michael…

  4. Five-year follow-up of survival and relapse in patients who received cryotherapy during high-dose chemotherapy for stem cell transplantation shows no safety concerns.

    Science.gov (United States)

    Svanberg, A; Ohrn, K; Birgegård, G

    2012-11-01

    We have previously published a randomised controlled study of the efficacy of cryotherapy in preventing acute oral mucositis after high-dose chemotherapy for stem cell transplantation. The present study is a 5-year follow-up safety study of survival in these patients. In the previously published study oral cryotherapy (cooling of the oral cavity) during high-dose chemotherapy significantly reduced mucositis grade and opiate use in the treated group. All patients were followed up for at least 5 years with regard to relapse and death rates. Baseline data, transplant complications and mucositis data were compared. Significantly more patients (25/39) who received oral cryotherapy were alive after 5 years compared to 15/39 in the control group (P= 0.025). Relapse rates were similar. The only baseline difference was a lower proportion of patients in complete remission at transplantation in the control group (6 vs. 13, P= 0.047). This 5-year follow-up study gave no support for safety concerns with cryotherapy. © 2012 Blackwell Publishing Ltd.

  5. Clinical Trials and Tribulations: Lessons Learned from Recruiting Pregnant Ex-Smokers for Relapse Prevention

    OpenAIRE

    Lopez, Elena N.; Simmons, Vani Nath; Quinn, Gwendolyn P.; Meade, Cathy D.; Chirikos, Thomas N.; Brandon, Thomas H.

    2008-01-01

    The development of smoking cessation and relapse-prevention interventions for pregnant and postpartum women is a public health priority. However, researchers have consistently reported substantial difficulty in accruing this population into clinical trials. The problem is particularly acute for relapse-prevention studies, which must recruit women who have already quit smoking because of their pregnancy. Although an important target for tobacco control efforts, these individuals represent an e...

  6. Limited Uptake of Planned Intrauterine Devices During the Postpartum Period.

    Science.gov (United States)

    Salcedo, Jennifer; Moniaga, Natalie; Harken, Tabetha

    2015-08-01

    The primary objective of this study was to determine the percentage of women with a documented plan for postpartum intrauterine device (IUD) insertion who had a device inserted within 8 weeks of delivery. The secondary objective was to determine factors associated with successful initiation of postpartum IUDs as planned. We conducted a retrospective chart review of women who had at least one prenatal visit and delivered a viable pregnancy at our academic medical center. Methods of planned and established postpartum contraceptive methods were recorded, as well as demographic information and documented reasons for failure to initiate planned intrauterine contraception. A total of 110 women planned postpartum IUD placement. Of these women, 84 (76%) presented for at least one postpartum appointment. Only 22.6% (95% confidence interval 13.7-31.5) of those presenting for postpartum follow-up underwent IUD placement within 8 weeks of delivery. Women planning postpartum IUD insertion were just as likely as women with no planned postpartum contraceptive method to fail to establish contraception within 8 weeks (P = 0.55). Failure to establish planned postpartum intrauterine contraception occurs frequently, even in a setting with a high rate of postpartum follow-up.

  7. Vitamin A nutritional status in high- and low-income postpartum women and its effect on colostrum and the requirements of the term newborn.

    Science.gov (United States)

    Gurgel, Cristiane Santos Sânzio; Grilo, Evellyn C; Lira, Larissa Q; Assunção, Débora G F; Oliveira, Priscila G; Melo, Larisse R M de; de Medeiros, Silvia V; Pessanha, Luanna C; Dimenstein, Roberto; Lyra, Clélia O

    To evaluate the vitamin A status in serum and colostrum of postpartum women with different socioeconomic status, comparing the colostrum retinol supply with the vitamin A requirement of the newborn. Cross-sectional study conducted with 424 postpartum women. Vitamin A maternal dietary intake was estimated using a food frequency questionnaire. Colostrum and serum retinol levels were measured by high performance liquid chromatography (HPLC). Serum retinol concentrations <20μg/dL were indicative of vitamin A deficiency (VAD). Vitamin A levels provided by colostrum <400μgRAE/day were considered as insufficient for term newborns. The mean maternal vitamin A intake during pregnancy was 872.2±639.2μgRAE/day in low-income women and 1169.2±695.2μgRAE/day for high-income women (p<0.005). The prevalence of vitamin A deficiency was 6.9% (n=18) in the low-income group and 3.7% (n=6) in the high-income group. The estimated mean retinol intake by infants of the high- and low-income mothers were 343.3μgRAE/day (85.8% AI) and 427.2μgRAE/day (106.8% AI), respectively. Serum vitamin A deficiency was considered a mild public health problem in both populations; however, newborns of low-income women were more likely to receive lower retinol levels through colostrum when compared with newborns of high-income mothers. Copyright © 2017 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  8. [Relapse: causes and consequences].

    Science.gov (United States)

    Thomas, P

    2013-09-01

    Relapse after a first episode of schizophrenia is the recurrence of acute symptoms after a period of partial or complete remission. Due to its variable aspects, there is no operational definition of relapse able to modelise the outcome of schizophrenia and measure how the treatment modifies the disease. Follow-up studies based on proxys such as hospital admission revealed that 7 of 10 patients relapsed after a first episode of schizophrenia. The effectiveness of antipsychotic medications on relapse prevention has been widely demonstrated. Recent studies claim for the advantages of atypical over first generation antipsychotic medication. Non-adherence to antipsychotic represents with addictions the main causes of relapse long before some non-consensual factors such as premorbid functioning, duration of untreated psychosis and associated personality disorders. The consequences of relapse are multiple, psychological, biological and social. Pharmaco-clinical studies have demonstrated that the treatment response decreases with each relapse. Relapse, even the first one, will contribute to worsen the outcome of the disease and reduce the capacity in general functionning. Accepting the idea of continuing treatment is a complex decision in which the psychiatrist plays a central role besides patients and their families. The development of integrated actions on modifiable risk factors such as psychosocial support, addictive comorbidities, access to care and the therapeutic alliance should be promoted. Relapse prevention is a major goal of the treatment of first-episode schizophrenia. It is based on adherence to the maintenance treatment, identification of prodromes, family active information and patient therapeutical education. Copyright © 2013 L’Encéphale. Published by Elsevier Masson SAS.. All rights reserved.

  9. High dietary ratio of omega-6 to omega-3 polyunsaturated acids during pregnancy and prevalence of post-partum depression.

    Science.gov (United States)

    da Rocha, Camilla M M; Kac, Gilberto

    2012-01-01

    Observational studies suggest association between low concentrations of omega-3 family fatty acids and greater risk for post-partum depression (PPD). The objective was to investigate the effect of unbalanced dietary intake of omega-6/omega-3 ratio >9:1 in the prevalence for PPD. The study comprises a prospective cohort with four waves of follow-up during pregnancy and one following delivery. PPD was evaluated according to the Edinburgh Post-partum Depression Scale (PPD ≥ 11) in 106 puerperae between 2005 and 2007, in Rio de Janeiro, Brazil. Independent variables included socio-demographic, obstetric, pre-pregnancy body mass index (BMI) and dietary intake data, which were obtained by means of a food frequency questionnaire in the first trimester of pregnancy. Statistical analysis involved calculation of PPD prevalence and multivariate Poisson regression with robust variance. PPD prevalence amounted to 26.4% [n = 28; confidence interval (CI) 95%: 18.0-34.8], and higher prevalences of PPD were observed in women who consumed an omega-6/omega-3 ratio >9:1 (60.0%) and in those with pre-pregnancy BMI <18.5 kg/m(2) (66.7%). These variables held as factors associated to PPD in the multivariate model, elevating the chances of occurrence of the outcome in 2.50 (CI 95%: 1.21-5.14) and 4.01 times (CI 95%: 1.96-8.20), respectively. Analyses were adjusted for age, schooling, pre-pregnancy BMI, lipids consumption and time elapsed since delivery. It verified an association between omega-6/omega-3 ratio above 9:1, the levels recommended by the Institute of Medicine, and the prevalence of PPD. These results add to the evidence regarding the importance of omega-6 and omega-3 fatty acids in the regulation of mental health mechanisms. © 2010 Blackwell Publishing Ltd.

  10. Patients with primary diffuse large B-cell lymphoma of female genital tract have high risk of central nervous system relapse.

    Science.gov (United States)

    Cao, Xin-xin; Li, Jian; Zhang, Wei; Duan, Ming-hui; Shen, Ti; Zhou, Dao-bin

    2014-06-01

    The objective of this study was to evaluate retrospectively the clinical characteristics, treatments, and outcomes of patients with primary diffuse large B-cell lymphoma (DLBCL) of the female genital tract. The basic characteristics, treatments, and outcomes of six patients diagnosed with primary DLBCL of the female genital tract, including the ovary, uterine cervix, and vagina, treated in our hospital between 2000 and 2012, were analyzed retrospectively. Seven of 323 (2.2 %) newly diagnosed DLBCLs were diagnosed as primary female genital tract DLBCL. Six patients with complete medical data were included in the analysis. The median age at diagnosis was 52.5 years (range 20-65). The presenting symptoms included abnormal vaginal bleeding, increased vaginal discharge, abdominal fullness, and abdominal pain. Two patients had stage IE disease and four patients had stage IIE disease. Treatment included chemotherapy only in five patients, and combined chemotherapy and localized radiation in one patient. After a median follow-up of 58 months, four patients showed relapse in the central nervous system and two had died from progressive disease. The median progression-free survival was 27 months and the median overall survival for this group has not been reached. Patients with primary female genital tract DLBCL may have poor outcomes and a high risk of central nervous system relapse. Central nervous system prophylaxis might be considered in addition to systemic chemotherapy for DLBCL of the female genital tract.

  11. Low-dose-rate brachytherapy for the treatment of localised prostate cancer in men with a high risk of disease relapse.

    Science.gov (United States)

    Laing, Robert; Uribe, Jennifer; Uribe-Lewis, Santiago; Money-Kyrle, Julian; Perna, Carla; Chintzoglou, Stylianos; Khaksar, Sara; Langley, Stephen E M

    2018-04-01

    To report clinical outcomes of 125 I low-dose-rate prostate brachytherapy (LDR-PB) as monotherapy or combined with androgen-deprivation therapy (ADT) and/or external beam radiotherapy (EBRT) in high-risk localised prostate cancer. Analysis of clinical outcomes from a prospective cohort of patients treated with LDR-PB alone or combined treatment in a single institution. Men with a high risk of disease relapse were identified by the National Institute for Health and Care Excellence (NICE) criteria or by the National Comprehensive Cancer Network (NCCN) criteria. Relapse-free survival (RFS), overall survival (OS), prostate cancer-specific survival (PCSS), and metastases-free survival (MFS), were analysed together with patient-reported symptom scores and physician-reported adverse events. The NICE and NCCN criteria identified 267 and 202 high-risk patients, respectively. NICE-defined patients had significantly lower pre-treatment PSA levels, Gleason scores LDR-PB monotherapy. At 9 years after implantation RFS was 89% and 87% in the NICE and NCCN groups, respectively (log-rank P = 0.637), and OS 93% and 94%, respectively (log-rank P = 0.481). All of the survival estimates were similar between LDR-PB monotherapy and combined therapies. Cox proportional hazards regression confirmed RFS was similar between the treatment types. Treatment-related toxicity was also similar between the treatment methods. LDR-PB is effective at controlling localised prostate cancer in patients with a high risk of disease relapse. As the present study was not randomised, it is not possible to define those patients who need the addition of ADT and/or EBRT. However, the NICE criteria appear suitable to define treatment options where patients could benefit from LDR-PB as monotherapy or combined treatment. This choice should be discussed with the patient taking into account comorbidities and presence of multiple high-risk factors. © 2018 The Authors BJU International © 2018 BJU International

  12. [Research and control of relapse tuberculosis cases].

    Science.gov (United States)

    Yamagishi, Fumio; Toyota, Makoto

    2009-12-01

    With this symposium, we focused on the relapse of tuberculosis in Japan. Out of 19,893 tuberculosis patients registered in 2007 in Japan, 7.48% were classified as relapse cases. Relapse cases have the risk of acquired drug resistance. But we have few analyses of the proportion of relapse tuberculosis cases with standard short course regimens for six months, factors contributing to tuberculosis relapse and the proportion of drug resistance among relapse TB cases in Japan. Therefore we analyzed the relapse tuberculosis cases in two rural areas and three urban areas. We also analyzed the proportion of drug resistance among relapse cases with the data of drug susceptibility survey of Ryoken. 1. Research of relapse tuberculosis cases: Makoto TOYOTA (Kochi City Public Health Center). To clarify the relapse rate and factors contributing to tuberculosis relapse, we investigated the relapse tuberculosis cases in the municipality where the proportion of elderly tuberculosis patients was high. Out of 902 tuberculosis patients registered in Kochi City Public Health Center during 10 years, 20 pulmonary tuberculosis patients were confirmed relapse cases with initial registered records. Pretreatment cavitations, sputum culture positivity at 2 months, medical miss-management (e.g. number of doses, duration of therapy) and poor adherence were considered to be factors contributing to tuberculosis relapse. Out of 20 relapse cases, 12 cases were detected with symptoms, while only 3 cases were detected by examination in law. 2. A clinical study on relapse cases of pulmonary tuberculosis: Shuichi TAKIKAWA (National Hospital Organization Nishibeppu National Hospital). The relapse of pulmonary tuberculosis was investigated. In the cases with a treatment history before short course chemotherapy, drug resistance rate was high, and thus it needs to be cautious of drug resistance at the time of the retreatment. In the cases with a treatment history of short course chemotherapy, relapse cases

  13. Clinical factors related to schizophrenia relapse.

    Science.gov (United States)

    Porcelli, Stefano; Bianchini, Oriana; De Girolamo, Giovanni; Aguglia, Eugenio; Crea, Luciana; Serretti, Alessandro

    2016-01-01

    Relapses represent one of the main problems of schizophrenia management. This article reviews the clinical factors associated with schizophrenia relapse. A research of the last 22 years of literature data was performed. Two-hundred nineteen studies have been included. Three main groups of factors are related to relapse: factors associated with pharmacological treatment, add-on psychotherapeutic treatments and general risk factors. Overall, the absence of a maintenance therapy and treatment with first generation antipsychotics has been associated with higher risk of relapse. Further, psychotherapy add-on, particularly with cognitive behaviour therapy and psycho-education for both patients and relatives, has shown a good efficacy for reducing the relapse rate. Among general risk factors, some could be modified, such as the duration of untreated psychosis or the substance misuse, while others could not be modified as male gender or low pre-morbid level of functioning. Several classes of risk factors have been proved to be relevant in the risk of relapse. Thus, a careful assessment of the risk factors here identified should be performed in daily clinical practice in order to individualise the relapse risk for each patient and to provide a targeted treatment in high-risk subjects.

  14. Oxytocin course over pregnancy and postpartum period and the association with postpartum depressive symptoms.

    Science.gov (United States)

    Jobst, Andrea; Krause, Daniela; Maiwald, Carina; Härtl, Kristin; Myint, Aye-Mu; Kästner, Ralph; Obermeier, Michael; Padberg, Frank; Brücklmeier, Benedikt; Weidinger, Elif; Kieper, Susann; Schwarz, Markus; Zill, Peter; Müller, Norbert

    2016-08-01

    During the postpartum period, women are at higher risk of developing a mental disorder such as postpartum depression (PPD), a disorder that associates with mother-infant bonding and child development. Oxytocin is considered to play a key role in mother-infant bonding and social interactions and altered oxytocin plasma concentrations were found to be associated with PPD. In the present study, we evaluated oxytocin plasma levels and depressive symptoms during pregnancy and the postpartum period in healthy women. We evaluated 100 women twice during pregnancy (weeks 35 and 38) and three times in the postpartum period (within 2 days and 7 weeks and 6 months after delivery) by measuring oxytocin plasma levels with enzyme-linked immunosorbent assay (ELISA) and assessing depressive symptoms with the Montgomery-Asberg Depression Rating Scale. Oxytocin plasma levels significantly increased from the 35th week of gestation to 6 months postpartum in all women. However, levels decreased from the 38th week of gestation to 2 days after delivery in participants with postpartum depressive symptoms, whereas they continuously increased in the group without postpartum depressive symptoms; the difference between the course of oxytocin levels in the two groups was significant (Δt2-t3: t = 2.14; p = 0.036*). Previous depressive episodes and breastfeeding problems predicted postpartum depressive symptoms. Our results indicate that alterations in the oxytocin system during pregnancy might be specific for women who develop postpartum depressive symptoms. Future studies should investigate whether oxytocin plasma levels might have predictive value in women at high risk for PPD.

  15. Relapsed childhood acute lymphoblastic leukemia in the Nordic countries

    DEFF Research Database (Denmark)

    Oskarsson, Trausti; Söderhäll, Stefan; Arvidson, Johan

    2016-01-01

    Relapse is the main reason for treatment failure in childhood acute lymphoblastic leukemia. Despite improvements in the up-front therapy, survival after relapse is still relatively poor, especially for high-risk relapses. The aims of this study were to assess outcomes following acute lymphoblastic...... leukemia relapse after common initial Nordic Society of Paediatric Haematology and Oncology protocol treatment; to validate currently used risk stratifications, and identify additional prognostic factors for overall survival. Altogether, 516 of 2735 patients (18.9%) relapsed between 1992 and 2011 and were...

  16. Sleep disturbance and neurobehavioral performance among postpartum women.

    Science.gov (United States)

    Insana, Salvatore P; Williams, Kayla B; Montgomery-Downs, Hawley E

    2013-01-01

    Sleep disturbances cause neurobehavioral performance and daytime functioning impairments. Postpartum women experience high levels of sleep disturbance. Thus, the study objective was to describe and explore the relation between neurobehavioral performance and sleep among women during the early postpartum period. Longitudinal field-based study. There were 70 primiparous women and nine nulliparous women in a control group. None. During their first 12 postpartum weeks, 70 primiparous women wore continuous wrist actigraphy to objectively monitor their sleep. Each morning they self-administered the psychomotor vigilance test (PVT) to index their neurobehavioral performance. Nine nulliparous women in a control group underwent the same protocol for 12 continuous weeks. Postpartum PVT mean reciprocal (1/RT) reaction time did not differ from that of women in the control group at postpartum week 2, but then worsened over time. Postpartum slowest 10% 1/RT PVT reaction time was significantly worse than that of women in the control group at all weeks. Despite improvements in postpartum sleep, neurobehavioral performance continued to worsen from week 2 through the end of the study. Across the first 12 postpartum weeks, PVT measures were more frequently associated with percent sleep compared with total sleep time, highlighting the deleterious consequences of sleep disruption on maternal daytime functioning throughout the early postpartum period. Worsened maternal neurobehavioral performance across the first 12 postpartum weeks may have been influenced by the cumulative effects of sleep disturbance. These results can inform future work to identify the particular sleep profiles that could be primary intervention targets to improve daytime functioning among postpartum women, and indicate need for further research on the effectiveness of family leave policies. The time when postpartum women return to control-level daytime functioning is unknown.

  17. ERCC2 2251A>C genetic polymorphism was highly correlated with early relapse in high-risk stage II and stage III colorectal cancer patients: A preliminary study

    Directory of Open Access Journals (Sweden)

    Lee Su-Chen

    2008-02-01

    Full Text Available Abstract Background Early relapse in colorectal cancer (CRC patients is attributed mainly to the higher malignant entity (such as an unfavorable genotype, deeper tumor invasion, lymph node metastasis and advance cancer stage and poor response to chemotherapy. Several investigations have demonstrated that genetic polymorphisms in drug-targeted genes, metabolizing enzymes, and DNA-repairing enzymes are all strongly correlated with inter-individual differences in the efficacy and toxicity of many treatment regimens. This preliminary study attempts to identify the correlation between genetic polymorphisms and clinicopathological features of CRC, and evaluates the relationship between genetic polymorphisms and chemotherapeutic susceptibility of Taiwanese CRC patients. To our knowledge, this study discusses, for the first time, early cancer relapse and its indication by multiple genes. Methods Six gene polymorphisms functional in drug-metabolism – GSTP1 Ile105Val, ABCB1 Ile1145Ile, MTHFR Ala222Val, TYMS double (2R or triple (3R tandem repeat – and DNA-repair genes – ERCC2 Lys751Gln and XRCC1 Arg399Gln – were assessed in 201 CRC patients using a polymerase chain reaction-restriction fragment-length polymorphism (PCR-RFLP technique and DNA sequencing. Patients were diagnosed as either high-risk stage II (T2 and 3 N0 M0 or III (any T N1 and 2 M0 and were administered adjuvant chemotherapy regimens that included 5-fluorouracil (5FU and leucovorin (LV. The correlations between genetic polymorphisms and patient clinicopathological features and relapses were investigated. Results In this study, the distributions of GSTP1 (P = 0.003, ABCB1 (P = 0.001, TYMS (P ERCC2 (P XRCC1 (P = 0.006 genotypes in the Asian population, with the exception of MTHFR (P = 0.081, differed significantly from their distributions in a Caucasian population. However, the unfavorable genotype ERCC2 2251A>C (P = 0.006, tumor invasion depth (P = 0.025, lymph node metastasis (P = 0

  18. Maternal Postpartum Role Collapse as a Theory of Postpartum Depression

    Science.gov (United States)

    Amankwaa, Linda Clark

    2005-01-01

    The purpose of this paper is to discuss the development of a theory of maternal postpartum role collapse. The influences of traditional role theory and symbolic interactionism are presented. The development of the maternal postpartum role collapse theory emerged from the study of postpartum depression among African-American women (Amankwaa, 2000).…

  19. A Phase I Study of CPI-613 in Combination with High-Dose Cytarabine and Mitoxantrone for Relapsed or Refractory Acute Myeloid Leukemia.

    Science.gov (United States)

    Pardee, Timothy S; Anderson, Rebecca G; Pladna, Kristin M; Isom, Scott; Ghiraldeli, Lais P; Miller, Lance D; Chou, Jeff W; Jin, Guangxu; Zhang, Wei; Ellis, Leslie R; Berenzon, Dmitriy; Howard, Dianna S; Hurd, David D; Manuel, Megan; Dralle, Sarah; Lyerly, Susan; Powell, Bayard L

    2018-05-01

    Purpose: CPI-613, a lipoate analogue that inhibits pyruvate dehydrogenase (PDH) and α-ketogluterate dehydrogenase (KGDH), has activity in patients with myeloid malignancies. This study explored the role of mitochondrial metabolism in chemotherapy response and determined the MTD, efficacy, and safety of CPI-613 combined with high-dose cytarabine and mitoxantrone in patients with relapsed or refractory acute myeloid leukemia. Experimental Design: The role of mitochondrial response to chemotherapy was assessed in cell lines and animal models. A phase I study of CPI-613 plus cytarabine and mitoxantrone was conducted in patients with relapsed or refractory AML. Results: Exposure to chemotherapy induced mitochondrial oxygen consumption that depended on PDH. CPI-613 sensitized AML cells to chemotherapy indicating that mitochondrial metabolism is a source of resistance. Loss of p53 did not alter response to CPI-613. The phase I study enrolled 67 patients and 62 were evaluable for response. The overall response rate was 50% (26CR+5CRi/62). Median survival was 6.7 months. In patients over 60 years old, the CR/CRi rate was 47% (15/32) with a median survival of 6.9 months. The response rate for patients with poor-risk cytogenetics also was encouraging with 46% (11/24 patients) achieving a CR or CRi. RNA sequencing analysis of a subset of baseline bone marrow samples revealed a gene expression signature consistent with the presence of B cells in the pretreatment marrow of responders. Conclusions: The addition of CPI-613 to chemotherapy is a promising approach in older patients and those with poor-risk cytogenetics. Clin Cancer Res; 24(9); 2060-73. ©2018 AACR . ©2018 American Association for Cancer Research.

  20. Postpartum Depression Among Igbo Women In An Urban Mission ...

    African Journals Online (AJOL)

    Context: Postpartum depression adversely affects mothers, their newborn infants, their partners and the society. Its timely diagnosis is highly desirable. Objective: To assess the prevalence and associated sociodemographic variables of Postpartum depression among women of Igbo Ethnic origin attending an urban mission ...

  1. Analysis of renal impairment in MM-003, a phase III study of pomalidomide + low - dose dexamethasone versus high - dose dexamethasone in refractory or relapsed and refractory multiple myeloma

    Science.gov (United States)

    Weisel, Katja C.; Dimopoulos, Meletios A.; Moreau, Philippe; Lacy, Martha Q.; Song, Kevin W.; Delforge, Michel; Karlin, Lionel; Goldschmidt, Hartmut; Banos, Anne; Oriol, Albert; Alegre, Adrian; Chen, Christine; Cavo, Michele; Garderet, Laurent; Ivanova, Valentina; Martinez-Lopez, Joaquin; Knop, Stefan; Yu, Xin; Hong, Kevin; Sternas, Lars; Jacques, Christian; Zaki, Mohamed H.; Miguel, Jesus San

    2016-01-01

    Pomalidomide + low-dose dexamethasone is effective and well tolerated for refractory or relapsed and refractory multiple myeloma after bortezomib and lenalidomide failure. The phase III trial MM-003 compared pomalidomide + low-dose dexamethasone with high-dose dexamethasone. This subanalysis grouped patients by baseline creatinine clearance ≥ 30 − < 60 mL/min (n=93, pomalidomide + low-dose dexamethasone; n=56, high-dose dexamethasone) or ≥ 60 mL/min (n=205, pomalidomide + low-dose dexamethasone; n=93, high-dose dexamethasone). Median progression-free survival was similar for both subgroups and favored pomalidomide + low-dose dexamethasone versus high-dose dexamethasone: 4.0 versus 1.9 months in the group with baseline creatinine clearance ≥ 30 − < 60 mL/min (P<0.001) and 4.0 versus 2.0 months in the group with baseline creatinine clearance ≥ 60 mL/min (P<0.001). Median overall survival for pomalidomide + low-dose dexamethasone versus high-dose dexamethasone was 10.4 versus 4.9 months (P=0.030) and 15.5 versus 9.2 months (P=0.133), respectively. Improved renal function, defined as an increase in creatinine clearance from < 60 to ≥ 60 mL/min, was similar in pomalidomide + low-dose dexamethasone and high-dose dexamethasone patients (42% and 47%, respectively). Improvement in progression-free and overall survival in these patients was comparable with that in patients without renal impairment. There was no increase in discontinuations of therapy, dose modifications, and adverse events in patients with moderate renal impairment. Pomalidomide at a starting dose of 4 mg + low-dose dexamethasone is well tolerated in patients with refractory or relapsed and refractory multiple myeloma, and of comparable efficacy if moderate renal impairment is present. This trial was registered with clinicaltrials.gov identifier 01311687 and EudraCT identifier 2010-019820-30. PMID:27081177

  2. Postpartum cerebral angiopathy: atypical features and treatment with intracranial balloon angioplasty

    Energy Technology Data Exchange (ETDEWEB)

    Song, J.K. [Center for Endovascular Surgery, Hyman-Newman Inst. for Neurology and Neurosurgery, New York, NY (United States); Cacayorin, E.D. [Interventional Neuroradiology, Dept. of Radiology, Univ. of Texas Medical School, Houston, TX (United States); Fisher, S.; Seifert, T.D.; Alexandrov, A.V.; Malkoff, M.D.; Grotta, J.C.; Campbell, M.S. [Div. of Stroke Neurology, Dept. of Neurology, Univ. of Texas Medical School, Houston, TX (United States)

    2004-12-01

    Postpartum cerebral angiopathy (PCA) is an uncommon cause of ischemic and hemorrhagic stroke in young women. It is usually clinically benign and not relapsing. We describe a patient with non-hemorrhagic PCA who had an atypical progressive neurological deficit from bilateral hemisphere watershed ischemia despite treatment with aggressive medical therapy and intracranial balloon angioplasty. (orig.)

  3. Postpartum cerebral angiopathy: atypical features and treatment with intracranial balloon angioplasty

    International Nuclear Information System (INIS)

    Song, J.K.; Cacayorin, E.D.; Fisher, S.; Seifert, T.D.; Alexandrov, A.V.; Malkoff, M.D.; Grotta, J.C.; Campbell, M.S.

    2004-01-01

    Postpartum cerebral angiopathy (PCA) is an uncommon cause of ischemic and hemorrhagic stroke in young women. It is usually clinically benign and not relapsing. We describe a patient with non-hemorrhagic PCA who had an atypical progressive neurological deficit from bilateral hemisphere watershed ischemia despite treatment with aggressive medical therapy and intracranial balloon angioplasty. (orig.)

  4. Relapsing polychondritis: commentary

    Directory of Open Access Journals (Sweden)

    R.D. Altman

    2011-09-01

    Full Text Available Relapsing Polychondritis (RP is a multisystem disease of unknown etiology characterized by episodic inflammation of cartilage and potentially progressive degeneration of cartilaginous tissue, such as auricular, nasal and laryngotracheobronchial cartilage. However, many other proteoglycan- rich structures may be involved, such as inner ear, eyes, blood vessels, heart and kidneys (1- 4. RP was first described by Jacksh-Wartenhorst in 1923, who named it “polychondropathia” (5. Pearson et al. (6 introduced the term “relapsing polychondritis” in 1960...

  5. Imaging of postpartum complications

    International Nuclear Information System (INIS)

    Rooholamini, S.A.; Au, A.H.; Hansen, G.C.; Kioumehr, F.; Yaghmai, I.

    1991-01-01

    The purpose of this paper is to evaluate the efficacy of various imaging modalities in the detection of postpartum complications. Nineteen cases of postpartum complications, studied radiologically, form the basis of this exhibit. Plain abdominal radiography, US, CT, and MR imaging were performed alone or in combination. The abnormalities detected included uterine rupture, intramural uterine hematoma, hematomas of the broad ligaments and the abdominal rectus muscles, ovarian vein thrombosis, HELLP syndrome, pyometrium, retained placenta and blood clots, periappendiceal abscess, superior sagittal sinus thrombosis, and cerebral edema. Representative cases will be illustrated; and the effective value of each technique will be stressed

  6. Post-partum acute kidney injury

    Directory of Open Access Journals (Sweden)

    Naresh Pahwa

    2014-01-01

    Full Text Available To determine the risk factors, course of hospital stay and mortality rate among women with post-partum acute kidney injury (AKI, we studied (of 752 patients with AKI admitted to a tertiary care center during the study period between November 2009 and August 2012 27 (3.59% women with post-partum AKI. The data regarding age, parity, cause of renal failure, course of hospital stay and requirement of dialysis were recorded. Sepsis was the major cause (70.3% of post-partum AKI. Other causes included disseminated intravascular coagulation (55.5%, pre-eclampsia/eclampsia (40.7%, ante- and post-partum hemorrhage (40.7% and 22.2% and hemolytic anemia and elevated liver enzymes and low platelet count syndrome (29.6%; most patients had more than one cause of AKI. We found a very high prevalence (18.5% of cortical necrosis in our study patients. A significant correlation was also found between the creatinine level on admission and the period of onset of disease after delivery. In conclusion, several factors are involved in causing post-partum AKI in our population, and sepsis was the most common of them.

  7. Educational needs of women in relation to postpartum religious orders

    Directory of Open Access Journals (Sweden)

    Marjan Beigi

    2017-01-01

    Full Text Available Introduction: Religious orders are one of the educational needs of the postpartum period. This study was conducted to determine the educational needs of postpartum religious orders.Materials and Methods: This cross-sectional study was conducted among 421 postpartum women and 15 specialists. Quota random sampling was conducted from January to March 2014 in Isfahan, Iran. Data analysis was performed using the Statistical Package for the Social Sciences software and statistical methods.Results: From the perspective of women and specialists, the results showed that the educational needs of women in postpartum religious orders is high.Conclusion: Considering the high educational need in the field of postpartum religious orders, it is necessary to integrate education in prenatal and postnatal health education programs.

  8. High FDG uptake areas on pre-radiotherapy PET/CT identify preferential sites of local relapse after chemoradiotherapy for locally advanced oesophageal cancer

    Energy Technology Data Exchange (ETDEWEB)

    Calais, Jeremie; Lemarignier, Charles; Vera, Pierre [Henri Becquerel Cancer Center and Rouen University Hospital, Nuclear Medicine Department, Rouen (France); University of Rouen, QuantIF-LITIS (Equipe d' Accueil 4108-FR CNRS 3638), Faculty of Medicine, Rouen (France); Dubray, Bernard [University of Rouen, QuantIF-LITIS (Equipe d' Accueil 4108-FR CNRS 3638), Faculty of Medicine, Rouen (France); Centre Henri Becquerel and Rouen University Hospital, Department of Radiotherapy and Medical Physics, Rouen (France); Nkhali, Lamyaa; Thureau, Sebastien; Modzelewski, Romain; Gardin, Isabelle [Henri Becquerel Cancer Center and Rouen University Hospital, Nuclear Medicine Department, Rouen (France); University of Rouen, QuantIF-LITIS (Equipe d' Accueil 4108-FR CNRS 3638), Faculty of Medicine, Rouen (France); Centre Henri Becquerel and Rouen University Hospital, Department of Radiotherapy and Medical Physics, Rouen (France); Di Fiore, Frederic [Rouen University Hospital, Department of Gastroenterology, Rouen (France); Rouen University Hospital, Department of Oncology, Henri Becquerel Cancer Center, IRON, Rouen (France); Michel, Pierre [Rouen University Hospital, Department of Gastroenterology, Rouen (France)

    2015-05-01

    The high failure rates in the radiotherapy (RT) target volume suggest that patients with locally advanced oesophageal cancer (LAOC) would benefit from increased total RT doses. High 2-deoxy-2-[{sup 18}F]fluoro-D-glucose (FDG) uptake (hotspot) on pre-RT FDG positron emission tomography (PET)/CT has been reported to identify intra-tumour sites at increased risk of relapse after RT in non-small cell lung cancer and in rectal cancer. Our aim was to confirm these observations in patients with LAOC and to determine the optimal maximum standardized uptake value (SUV{sub max}) threshold to delineate smaller RT target volumes that would facilitate RT dose escalation without impaired tolerance. The study included 98 consecutive patients with LAOC treated by chemoradiotherapy (CRT). All patients underwent FDG PET/CT at initial staging and during systematic follow-up in a single institution. FDG PET/CT acquisitions were coregistered on the initial CT scan. Various subvolumes within the initial tumour (30, 40, 50, 60, 70, 80 and 90 % SUV{sub max} thresholds) and in the subsequent local recurrence (LR, 40 and 90 % SUV{sub max} thresholds) were pasted on the initial CT scan and compared[Dice, Jaccard, overlap fraction (OF), common volume/baseline volume, common volume/recurrent volume]. Thirty-five patients had LR. The initial metabolic tumour volume was significantly higher in LR tumours than in the locally controlled tumours (mean 25.4 vs 14.2 cc; p = 0.002). The subvolumes delineated on initial PET/CT with a 30-60 % SUV{sub max} threshold were in good agreement with the recurrent volume at 40 % SUV{sub max} (OF = 0.60-0.80). The subvolumes delineated on initial PET/CT with a 30-60 % SUV{sub max} threshold were in good to excellent agreement with the core volume (90 % SUV{sub max}) of the relapse (common volume/recurrent volume and OF indices 0.61-0.89). High FDG uptake on pretreatment PET/CT identifies tumour subvolumes that are at greater risk of recurrence after CRT in

  9. Efficacy of a Nurse-Delivered Intervention to Prevent and Delay Postpartum Return to Smoking: The Quit for Two Trial.

    Science.gov (United States)

    Pollak, Kathryn I; Fish, Laura J; Lyna, Pauline; Peterson, Bercedis L; Myers, Evan R; Gao, Xiaomei; Swamy, Geeta K; Brown-Johnson, Angela; Whitecar, Paul; Bilheimer, Alicia K; Pletsch, Pamela K

    2016-10-01

    Most pregnant women who quit smoking return to smoking postpartum. Trials to prevent this return have been unsuccessful. We tested the efficacy of a nurse-delivered intervention in maintaining smoking abstinence after delivery among pregnant women who quit smoking that was tailored on their high risk of relapse (eg, had strong intentions to return). We recruited 382 English-speaking spontaneous pregnant quitters from 14 prenatal clinics and randomized them to receive either a smoking abstinence booklet plus newsletters about parenting and stress (control) or a nurse-delivered smoking abstinence intervention that differed in intensity for the high and low risk groups. Our primary outcome was smoking abstinence at 12 months postpartum. Using intent-to-treat analyses, there was a high rate of biochemically validated smoking abstinence at 12 months postpartum but no arm differences ( 36% [95% confidence interval [CI]: 29-43] vs. 35% [95% CI: 28-43], P = .81). Among women at low risk of returning to smoking, the crude abstinence rate was significantly higher in the control arm (46%) than in the intervention arm (33%); among women at high risk of returning to smoking, the crude abstinence rate was slightly lower but not different in the control arm (31%) than in the intervention arm (37%). Low-risk women fared better with a minimal intervention that focused on parenting skills and stress than when they received an intensive smoking abstinence intervention. The opposite was true for women who were at high risk of returning to smoking. Clinicians might need to tailor their approach based on whether women are at high or low risk of returning to smoking. Results suggest that high-risk and low-risk women might benefit from different types of smoking relapse interventions. Those who are lower risk of returning to smoking might benefit from stress reduction that is devoid of smoking content, whereas those who are higher risk might benefit from smoking relapse prevention. © The

  10. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... Clinicians Publications for Your Patients MS Navigator Program Programs and Services for Your Patients Contact Us Clinical Fellows ... Relapsing-remitting MS (RRMS) Relapsing-remitting ...

  11. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... for You and Your Practice Publications for Clinicians Publications for Your Patients MS Navigator Program Programs and Services for Your Patients ... Relapsing-remitting MS (RRMS) Relapsing-remitting MS ( ...

  12. Hormones and postpartum cardiomyopathy.

    NARCIS (Netherlands)

    Clapp, C.; Thebault, S.C.; Martinez de la Escalera, G.M.

    2007-01-01

    Prolactin, a hormone fundamental for lactation, was recently shown to mediate postpartum cardiomyopathy, a life-threatening disease in late-term and lactating mothers. The detrimental effect of prolactin results from myocardial upregulation of cathepsin-D, which in turn cleaves prolactin to a 16 kDa

  13. Prevalence of pre- and postpartum depression in Jamaican women

    Directory of Open Access Journals (Sweden)

    Kulkarni Santosh

    2005-11-01

    Full Text Available Abstract Background Maternal depression during pregnancy has been studied less than depression in postpartum period. The aims of this study were to find out the prevalence of prepartum and postpartum depression and the risk factors associated in a cohort of Afro-Jamaican pregnant women in Jamaica. Methods The Zung self-rating depression scale instrument was administered to 73 healthy pregnant women at 28 weeks gestation and at 6 weeks postpartum for quantitative measurement of depression. Blood samples were collected at 8, 28, 35 weeks gestation and at day 1 and 6 weeks postpartum to study the thyroid status. Results Study demonstrated depression prevalence rates of 56% and 34% during prepartum and postpartum period, respectively. 94% women suffering depression in both periods were single. There were significant variations in both FT3 and TT4 concentrations which increased from week 8 to week 28 prepartum (p th week (p 3, TT4 and TSH there were no significant between group differences in concentrations. The major determinants of postpartum depression were moderate and severe prepartum depression and change in TT4 hormone concentrations. Conclusion High prevalence of depression was found during pre- and postpartum periods. Single mothers, prepartum depression and changes in TT4 were factors found to be significantly associated with postpartum depression.

  14. Daclizumab high-yield process reduced the evolution of new gadolinium-enhancing lesions to T1 black holes in patients with relapsing-remitting multiple sclerosis.

    Science.gov (United States)

    Radue, E-W; Sprenger, T; Vollmer, T; Giovannoni, G; Gold, R; Havrdova, E; Selmaj, K; Stefoski, D; You, X; Elkins, J

    2016-02-01

    In the SELECT study, treatment with daclizumab high-yield process (DAC HYP) versus placebo reduced the frequency of gadolinium-enhancing (Gd(+) ) lesions in patients with relapsing-remitting multiple sclerosis (RRMS). The objective of this post hoc analysis of SELECT was to evaluate the effect of DAC HYP on the evolution of new Gd(+) lesions to T1 hypointense lesions (T1 black holes). SELECT was a randomized double-blind study of subcutaneous DAC HYP 150 or 300 mg or placebo every 4 weeks. Magnetic resonance imaging (MRI) scans were performed at baseline and weeks 24, 36 and 52 in all patients and monthly between weeks 4 and 20 in a subset of patients. MRI scans were evaluated for new Gd(+) lesions that evolved to T1 black holes at week 52. Data for the DAC HYP groups were pooled for analysis. Daclizumab high-yield process reduced the number of new Gd(+) lesions present at week 24 (P = 0.005) or between weeks 4 and 20 (P = 0.014) that evolved into T1 black holes at week 52 versus placebo. DAC HYP treatment also reduced the percentage of patients with Gd(+) lesions evolving to T1 black holes versus placebo. Treatment with DAC HYP reduced the evolution of Gd(+) lesions to T1 black holes versus placebo, suggesting that inflammatory lesions that evolved during DAC HYP treatment are less destructive than those evolving during placebo treatment. © 2016 EAN.

  15. A Phase I Study of Pulse High-Dose Vorinostat (V) plus Rituximab (R), Ifosphamide, Carboplatin, and Etoposide (ICE) in Patients with Relapsed Lymphoma

    Science.gov (United States)

    Budde, Lihua E.; Zhang, Michelle M.; Shustov, Andrei R.; Pagel, John M.; Gooley, Ted A.; Oliveira, George R.; Chen, Tara L.; Knudsen, Nancy L.; Roden, Jennifer E.; Kammerer, Britt E.; Frayo, Shani L.; Warr, Thomas A.; Boyd, Thomas E.; Press, Oliver W.; Gopal, Ajay K.

    2013-01-01

    SUMMARY Given the poor outcomes of relapsed aggressive lymphomas and preclinical data suggesting that ≥2.5 μM concentrations of vorinostat synergize with both etoposide and platinums, we hypothesized that pulse high-dose vorinostat could safely augment the anti-tumour activity of (R)ICE [(rituximab), ifosphamide, carboplatin, etoposide] chemotherapy. We conducted a phase I dose escalation study using a schedule with oral vorinostat ranging from 400 mg/d to 700 mg bid for 5 days in combination with the standard (R)ICE regimen (days 3, 4 and 5). Twenty-nine patients (median age 56 years, median 2 prior therapies, 14 chemoresistant [of 27 evaluable], 2 prior transplants) were enrolled and treated. The maximally tolerated vorinostat dose was defined as 500 mg twice daily × 5 days. Common dose limiting toxicities included infection (n=2), hypokalaemia (n=2), and transaminitis (n=2). Grade 3 related gastrointestinal toxicity was seen in 9 patients. The median vorinostat concentration on day 3 was 4.5 μM (range 4.2–6.0 μM) and in vitro data confirmed the augmented antitumour and histone acetylation activity at these levels. Responses were observed in 19 of 27 evaluable patients (70%) including 8 complete response/unconfirmed complete response. High-dose vorinostat can be delivered safely with (R)ICE, achieves potentially synergistic drug levels, and warrants further study, although adequate gastrointestinal prophylaxis is warranted. PMID:23356514

  16. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... MS Relapsing-remitting MS (RRMS) Share this page Facebook Twitter Email Relapsing-remitting MS (RRMS) Relapsing-remitting ... Here Start Here Colophon Stay Informed Join Us Facebook Twitter LinkedIn YouTube Pinterest MS Connection About the ...

  17. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... Relapsing-remitting MS (RRMS) Share this page Facebook Twitter Email Relapsing-remitting MS (RRMS) Relapsing-remitting MS ( ... Start Here Colophon Stay Informed Join Us Facebook Twitter LinkedIn YouTube Pinterest MS Connection About the Society ...

  18. Multiple Sclerosis Relapses: Epidemiology, Outcomes and Management. A Systematic Review.

    Science.gov (United States)

    Kalincik, Tomas

    2015-01-01

    Relapses (episodic exacerbations of neurological signs or symptoms) are a defining feature of relapsing-remitting multiple sclerosis (MS), the most prevalent MS phenotype. While their diagnostic value relates predominantly to the definition of clinically definite MS, their prognostic value is determined by their relatively high associated risk of incomplete remission resulting in residual disability. The mechanisms governing a relapse incidence are unknown, but numerous modifiers of relapse risk have been described, including demographic and clinical characteristics, many of which represent opportunities for improved disease management. Also relapse phenotypes have been associated with patient and disease characteristics and an individual predisposition to certain phenotypic presentations may imply individual neuroanatomical disease patterns. While immunomodulatory therapies and corticosteroids represent the mainstay of relapse prevention and acute management, respectively, their effect has only been partial and further search for more efficient relapse therapies is warranted. Other areas of research include pathophysiology and determinants of relapse incidence, recurrence and phenotypes, including the characteristics of the relapsing and non-relapsing multiple sclerosis variants and their responsiveness to therapies. © 2015 S. Karger AG, Basel.

  19. Pleural effusions in the postpartum period

    International Nuclear Information System (INIS)

    Stark, P.; Pollack, M.S.

    1986-01-01

    We report on the high frequency of pleural effusions in the immediate postpartum period. Forty-four out of 45 women who examined within 24-48 h after delivery showed evidence of pleural fluid. Under these circumstances, this pleural abnormality should not be considered an indicator of serious cardiopulmonary disease. (orig.) [de

  20. Postpartum Mood Disorders: Recognizing the symptoms

    OpenAIRE

    Misri, Shaila; Burgmann, Allan J.F.

    1992-01-01

    Adjusting to the role of mother, a creative and joyous change for most women, combines with simultaneous physiological and psychological changes to develop into psychiatric problems in some women. Three common syndromes during the postpartum period are postpartum blues, postpartum depression, and postpartum psychosis. Any postpartum condition should be diagnosed rapidly to prevent short- and long-term disorders.

  1. High efficacy and safety of low-dose CD19-directed CAR-T cell therapy in 51 refractory or relapsed B acute lymphoblastic leukemia patients.

    Science.gov (United States)

    Pan, J; Yang, J F; Deng, B P; Zhao, X J; Zhang, X; Lin, Y H; Wu, Y N; Deng, Z L; Zhang, Y L; Liu, S H; Wu, T; Lu, P H; Lu, D P; Chang, A H; Tong, C R

    2017-12-01

    Refractory or relapsed B lymphoblastic leukemia (B-ALL) patients have a dismal outcome with current therapy. We treated 42 primary refractory/hematological relapsed (R/R) and 9 refractory minimal residual disease by flow cytometry (FCM-MRD + ) B-ALL patients with optimized second generation CD19-directed CAR-T cells. The CAR-T-cell infusion dosages were initially ranged from 0.05 to 14 × 10 5 /kg and were eventually settled at 1 × 10 5 /kg for the most recent 20 cases. 36/40 (90%) evaluated R/R patients achieved complete remission (CR) or CR with incomplete count recovery (CRi), and 9/9 (100%) FCM-MRD + patients achieved MRD - . All of the most recent 20 patients achieved CR/CRi. Most cases only experienced mild to moderate CRS. 8/51 cases had seizures that were relieved by early intervention. Twenty three of twenty seven CR/CRi patients bridged to allogeneic hematopoietic stem cell transplantation (allo-HCT) remained in MRD - with a median follow-up time of 206 (45-427) days, whereas 9 of 18 CR/CRi patients without allo-HCT relapsed. Our results indicate that a low CAR-T-cell dosage of 1 × 10 5 /kg, is effective and safe for treating refractory or relapsed B-ALL, and subsequent allo-HCT could further reduce the relapse rate.

  2. High-dose therapy and autologous bone marrow transplantation for Hodgkin's disease patients with relapses potentially treatable by radical radiation therapy

    International Nuclear Information System (INIS)

    Pezner, Richard D.; Nademanee, Auayporn; Forman, Stephen J.

    1995-01-01

    Purpose: A retrospective review evaluated the results of autologous bone marrow transplantation (A-BMT) for patients with relapsed Hodgkin's disease (HD) who were potentially treatable by radical radiation therapy (RRT). Methods and Materials: Evaluated patient cases met the following criteria: initial treatment with chemotherapy (with or without involved field radiation therapy 20 Gy to spinal cord); HD at time of salvage therapy limited to lymph nodes, Waldeyer's ring, liver, spleen, direct extension sites, and/or one lung. Results: There were 23 A-BMT patients treated between 1986 and 1991 who fulfilled the criteria. Three (13%) patients died from treatment-related complications and eight (35%) developed nonfatal Grade 3-4 complications. The 3-year actuarial disease-free survival rate was 61%. The 3-year disease-free survival rate was 55% for the nine patients with at least one prior disease-free interval (DFI) > 12 months, 67% for nine patients with DFI 0.10). These results are comparable to retrospective studies of RRT results in selected relapsed HD patients. Conclusions: Long-term disease-free survival is frequently possible with either A-BMT or RRT appropriately selected relapsed HD patients. In considering treatment options, important prognostic factors include initial stage of disease, number of prior relapses, DFI, and extent of relapsed disease

  3. Development of Ethanol Withdrawal-Related Sensitization and Relapse Drinking in Mice Selected for High or Low Ethanol Preference

    Science.gov (United States)

    Lopez, Marcelo F.; Grahame, Nicholas J.; Becker, Howard C.

    2010-01-01

    Background Previous studies have shown that high alcohol consumption is associated with low withdrawal susceptiblility, while at the same time, other studies have shown that exposure to ethanol vapor increases alcohol drinking in rats and mice. In the present studies, we sought to shed light on this seeming contradiction by using mice selectively bred for High- (HAP) and Low- (LAP) Alcohol Preference, first, assessing these lines for differences in signs of ethanol withdrawal and second, for differences in the efficacy of intermittent alcohol vapor exposure on elevating subsequent ethanol intake. Methods Experiment 1 examined whether these lines of mice differed in ethanol withdrawal-induced CNS hyperexcitability and the development of sensitization to this effect following intermittent ethanol vapor exposure. Adult HAP and LAP lines (replicates 1 and 2), and the C3H/HeNcr inbred strain (included as a control genotype for comparison purposes) received intermittent exposure to ethanol vapor and were evaluated for ethanol withdrawal-induced seizures assessed by scoring handling-induced convulsions (HIC). Experiment 2 examined the influence of chronic intermittent ethanol exposure on voluntary ethanol drinking. Adult male and female HAP-2 and LAP-2 mice, along with male C57BL/6J (included as comparative controls) were trained to drink 10% ethanol using a limited access (2 hr/day) 2-bottle choice paradigm. After stable baseline daily intake was established, mice received chronic intermittent ethanol vapor exposure in inhalation chambers. Ethanol intake sessions resumed 72 hr after final ethanol (or air) exposure for 5 consecutive days. Results Following chronic ethanol treatment, LAP mice exhibited overall greater withdrawal seizure activity compared to HAP mice. In Experiment 2, chronic ethanol exposure/withdrawal resulted in a significant increase in ethanol intake in male C57BL/6J, and modestly elevated intake in HAP-2 male mice. Ethanol intake for male control mice

  4. Proton Therapy as Salvage Treatment for Local Relapse of Prostate Cancer Following Cryosurgery or High-Intensity Focused Ultrasound

    International Nuclear Information System (INIS)

    Holtzman, Adam L.; Hoppe, Bradford S.; Letter, Haley P.; Bryant, Curtis; Nichols, Romaine C.; Henderson, Randal H.; Mendenhall, William M.; Morris, Christopher G.; Williams, Christopher R.; Li, Zuofeng; Mendenhall, Nancy P.

    2016-01-01

    Purpose: Local recurrence of prostate cancer after cryosurgery (CS) and high-intensity focused ultrasound (HIFU) is an emerging problem for which optimal management is unknown. Proton therapy (PT) may offer advantages over other local therapeutic options. This article reviews a single institution's experience using PT for salvage of local recurrent disease after HIFU or CS. Methods and Materials: We reviewed the medical records of 21 consecutive patients treated with salvage PT following a local recurrence of prostate cancer after CS (n=12) or HIFU (n=9) between January 2007 and July 2014. Patients were treated to a median dose of 74 Gy(relative biological effectiveness [RBE]; range: 74-82 Gy[RBE]) and 8 patients received androgen deprivation therapy with radiation therapy. Patients were evaluated for quality of life (QOL) by using the Expanded Prostate Index Composite questionnaire and toxicity by using Common Terminology Criteria for Adverse Events, version 3.0, weekly during treatment, every 6 months for 2 years after treatment, and then annually. Results: Median follow-up was 37 months (range: 6-95 months). The 3-year biochemical progression-free survival (bPFS) rate was 77%. The 3-year grade 3 toxicity rate was 17%; however, 2 of these patients had pre-existing grade 3 GU toxicities from their HIFU/CRYO prior to PT. At 1 year, bowel summary, urinary incontinence, and urinary obstructive QOL scores declined, but only the bowel QOL score at 12 months met the minimally important difference threshold. Conclusions: PT achieved a high rate of bPFS with acceptable toxicity and minimal changes in QOL scores compared with baseline pre-PT functions. Although most patients have done fairly well, the study size is small, follow-up is short, and early results suggest that outcomes with PT for salvage after HIFU or CS failure are inferior to outcomes with PT given in the de novo setting with respect to disease control, toxicity, and QOL.

  5. Proton Therapy as Salvage Treatment for Local Relapse of Prostate Cancer Following Cryosurgery or High-Intensity Focused Ultrasound

    Energy Technology Data Exchange (ETDEWEB)

    Holtzman, Adam L. [University of Florida Health Proton Therapy Institute, University of Florida College of Medicine, Jacksonville, Florida (United States); Hoppe, Bradford S., E-mail: bhoppe@floridaproton.org [University of Florida Health Proton Therapy Institute, University of Florida College of Medicine, Jacksonville, Florida (United States); Letter, Haley P.; Bryant, Curtis; Nichols, Romaine C.; Henderson, Randal H.; Mendenhall, William M.; Morris, Christopher G. [University of Florida Health Proton Therapy Institute, University of Florida College of Medicine, Jacksonville, Florida (United States); Williams, Christopher R. [Department of Surgery, University of Florida College of Medicine, Jacksonville, Florida (United States); Li, Zuofeng; Mendenhall, Nancy P. [University of Florida Health Proton Therapy Institute, University of Florida College of Medicine, Jacksonville, Florida (United States)

    2016-05-01

    Purpose: Local recurrence of prostate cancer after cryosurgery (CS) and high-intensity focused ultrasound (HIFU) is an emerging problem for which optimal management is unknown. Proton therapy (PT) may offer advantages over other local therapeutic options. This article reviews a single institution's experience using PT for salvage of local recurrent disease after HIFU or CS. Methods and Materials: We reviewed the medical records of 21 consecutive patients treated with salvage PT following a local recurrence of prostate cancer after CS (n=12) or HIFU (n=9) between January 2007 and July 2014. Patients were treated to a median dose of 74 Gy(relative biological effectiveness [RBE]; range: 74-82 Gy[RBE]) and 8 patients received androgen deprivation therapy with radiation therapy. Patients were evaluated for quality of life (QOL) by using the Expanded Prostate Index Composite questionnaire and toxicity by using Common Terminology Criteria for Adverse Events, version 3.0, weekly during treatment, every 6 months for 2 years after treatment, and then annually. Results: Median follow-up was 37 months (range: 6-95 months). The 3-year biochemical progression-free survival (bPFS) rate was 77%. The 3-year grade 3 toxicity rate was 17%; however, 2 of these patients had pre-existing grade 3 GU toxicities from their HIFU/CRYO prior to PT. At 1 year, bowel summary, urinary incontinence, and urinary obstructive QOL scores declined, but only the bowel QOL score at 12 months met the minimally important difference threshold. Conclusions: PT achieved a high rate of bPFS with acceptable toxicity and minimal changes in QOL scores compared with baseline pre-PT functions. Although most patients have done fairly well, the study size is small, follow-up is short, and early results suggest that outcomes with PT for salvage after HIFU or CS failure are inferior to outcomes with PT given in the de novo setting with respect to disease control, toxicity, and QOL.

  6. A Phase I Trial of High-Dose Lenalidomide and Melphalan as Conditioning for Autologous Stem Cell Transplantation in Relapsed or Refractory Multiple Myeloma.

    Science.gov (United States)

    Mark, Tomer M; Guarneri, Danielle; Forsberg, Peter; Rossi, Adriana; Pearse, Roger; Perry, Arthur; Pekle, Karen; Tegnestam, Linda; Greenberg, June; Shore, Tsiporah; Gergis, Usama; Mayer, Sebastian; Van Besien, Koen; Ely, Scott; Jayabalan, David; Sherbenou, Daniel; Coleman, Morton; Niesvizky, Ruben

    2017-06-01

    Autologous stem cell transplantation (ASCT) conditioned with high-dose chemotherapy has long been established as the standard of care for eligible patients with newly diagnosed multiple myeloma. Despite recent therapeutic advances, high-dose melphalan (HDM) remains the chemotherapy regimen of choice in this setting. Lenalidomide (LEN) in combination with low-dose dexamethasone is recognized as a standard of care for patients with relapsed or refractory multiple myeloma (RRMM), and there is growing support for the administration of LEN as maintenance therapy post-ASCT. In view of the above, the present phase I clinical trial was designed to evaluate the safety and tolerability of high-dose LEN (HDLEN) in patients with RRMM, and to determine the maximum tolerated dose of HDLEN when added to HDM before ASCT. Despite administering HDLEN at doses of up to 350 mg/day, the maximum tolerated dose could not be determined, owing to an insufficient number of dose-limiting toxicities in the 21 patients enrolled in the trial. Conditioning with HDLEN plus HDM was associated with a favorable tolerability profile. Adverse events following ASCT were as expected with HDM. Median progression-free and overall survival were 10 months and 22 months, respectively, in this population of heavily pretreated patients. Our findings suggest that HDLEN in combination with HDM may offer significant potential as a conditioning regimen before ASCT in patients with RRMM. These preliminary findings are now being evaluated further in an ongoing phase II clinical trial. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

  7. Linking High Risk Postpartum Women with a Technology Enabled Health Coaching Program to Reduce Diabetes Risk and Improve Wellbeing: Program Description, Case Studies, and Recommendations for Community Health Coaching Programs.

    Science.gov (United States)

    Athavale, Priyanka; Thomas, Melanie; Delgadillo-Duenas, Adriana T; Leong, Karen; Najmabadi, Adriana; Harleman, Elizabeth; Rios, Christina; Quan, Judy; Soria, Catalina; Handley, Margaret A

    2016-01-01

    Background . Low-income minority women with prior gestational diabetes mellitus (pGDM) or high BMIs have increased risk for chronic illnesses postpartum. Although the Diabetes Prevention Program (DPP) provides an evidence-based model for reducing diabetes risk, few community-based interventions have adapted this program for pGDM women. Methods . STAR MAMA is an ongoing randomized control trial (RCT) evaluating a hybrid HIT/Health Coaching DPP-based 20-week postpartum program for diabetes prevention compared with education from written materials at baseline. Eligibility includes women 18-39 years old, ≥32 weeks pregnant, and GDM or BMI > 25. Clinic- and community-based recruitment in San Francisco and Sonoma Counties targets 180 women. Sociodemographic and health coaching data from a preliminary sample are presented. Results . Most of the 86 women included to date (88%) have GDM, 80% were identified as Hispanic/Latina, 78% have migrant status, and most are Spanish-speaking. Women receiving the intervention indicate high engagement, with 86% answering 1+ calls. Health coaching callbacks last an average of 9 minutes with range of topics discussed. Case studies presented convey a range of emotional, instrumental, and health literacy-related supports offered by health coaches. Discussion . The DPP-adapted HIT/health coaching model highlights the possibility and challenge of delivering DPP content to postpartum women in community settings. This trial is registered with ClinicalTrials.gov NCT02240420.

  8. Regional homogeneity changes between heroin relapse and non-relapse patients under methadone maintenance treatment: a resting-state fMRI study

    OpenAIRE

    Chang, Haifeng; Li, Wei; Li, Qiang; Chen, Jiajie; Zhu, Jia; Ye, Jianjun; Liu, Jierong; Li, Zhe; Li, Yongbin; Shi, Ming; Wang, Yarong; Wang, Wei

    2016-01-01

    Background Methadone maintenance treatment (MMT) is recognized as one of the most effective treatments for heroin addiction but its effect is dimmed by the high incidence of heroin relapse. However, underlying neurobiology mechanism of heroin relapse under MMT is still largely unknown. Here, we took advantage of a resting-state fMRI technique by analysis of regional homogeneity (ReHo), and tried to explore the difference of brain function between heroin relapsers and non-relapsers in MMT. Met...

  9. Mother's perceptions of postpartum stress and satisfaction.

    Science.gov (United States)

    Horowitz, J A; Damato, E G

    1999-01-01

    To examine mothers' postpartum perceptions of stress and satisfaction. Methodologic triangulation with quantitative and qualitative data in a nonexperimental design. A convenience sample of 95 women was obtained during normally scheduled postpartum appointments at a health maintenance organization. The self-administered questionnaire included the Mothers' Information Tool (MIT), What Being the Parent of a Baby Is Like (WPL-R), and the Brief Symptom Inventory (BSI). Open-ended MIT items revealed mothers' perceptions of stress and satisfaction. The WPL-R provided maternal satisfaction scores, and the BSI yielded Global Stress Index scores. Content analysis identified the following categories: Roles, Tasks, Resources, and Relationships. Subcategories identified as areas of stress were Work/School, Sleep/Rest, Adjustment/Own Needs, Health/Body Image, Organization of Life, Child Care, Day Care, Housework, Future Challenges, Finances, Housing, Time, Partner, and Family. Subcategories identified as areas of satisfaction were Participating in Relationships, Sharing the Future, Being Proud to Be a Mother, Enjoying a Healthy Baby, and Caring for a Child. Levels of stress and satisfaction of mothers who scored high and low on quantitative measures were compared. The outcomes contribute to the knowledge concerning postpartum women's perceptions of the mothering experience and suggest approaches to nursing assessment and intervention to prevent postpartum adjustment difficulties.

  10. Maternal postpartum distress and childhood overweight.

    Directory of Open Access Journals (Sweden)

    Teresa A Ajslev

    Full Text Available OBJECTIVE: We investigated associations between maternal postpartum distress covering anxiety, depression and stress and childhood overweight. METHODS: We performed a prospective cohort study, including 21,121 mother-child-dyads from the Danish National Birth Cohort (DNBC. Maternal distress was measured 6 months postpartum by 9 items covering anxiety, depression and stress. Outcome was childhood overweight at 7-years-of age. Multiple logistic regression analyses were performed and information on maternal age, socioeconomic status, pre-pregnancy BMI, gestational weight gain, parity, smoking during pregnancy, paternal BMI, birth weight, gestational age at birth, sex, breastfeeding and finally infant weight at 5 and 12 month were included in the analyses. RESULTS: We found, that postpartum distress was not associated with childhood risk of overweight, OR 1.00, 95%CI [0.98-1.02]. Neither was anxiety, depression, or stress exposure, separately. There were no significant differences between the genders. Adjustment for potential confounders did not alter the results. CONCLUSION: Maternal postpartum distress is apparently not an independent risk factor for childhood overweight at 7-years-of-age. However, we can confirm previous findings of perinatal determinants as high maternal pre-pregnancy BMI, and smoking during pregnancy being risk factors for childhood overweight.

  11. Social settings and addiction relapse.

    Science.gov (United States)

    Walton, M A; Reischl, T M; Ramanthan, C S

    1995-01-01

    Despite addiction theorists' acknowledgment of the impact of environmental factors on relapse, researchers have not adequately investigated these influences. Ninety-six substance users provided data regarding their perceived risk for relapse, exposure to substances, and involvement in reinforcing activities. These three setting attributes were assessed in their home, work, and community settings. Reuse was assessed 3 months later. When controlling for confounding variables, aspects of the home settings significantly distinguished abstainers from reusers; perceived risk for relapse was the strongest predictor of reuse. Exposure to substances and involvement in reinforcing activities were not robust reuse indicators. The work and community settings were not significant determinants of reuse. These findings offer some initial support for the utility of examining social settings to better understand addiction relapse and recovery. Identification of setting-based relapse determinants provides concrete targets for relapse prevention interventions.

  12. Postpartum deaths: piglet, placental, and umbilical characteristics.

    Science.gov (United States)

    Rootwelt, V; Reksen, O; Farstad, W; Framstad, T

    2013-06-01

    The fetal growth of the piglet is highly dependent on its placenta, and the newborn piglet birth weight is highly associated with postpartum death. However, there is little information available in the literature on the assessment of the placenta in relation to postpartum death in piglets. The aim of this study was to evaluate the impact of the placental area and placental weight, status of the umbilical cord, and piglet birth characteristics, such as blood parameters, vitality score, and birth weight on postpartum death. All live born piglets in litters from 26 Landrace-Yorkshire sows were monitored during farrowing and the status of each was recorded, including placental area and placental weight and blood variables obtained from the piglets and umbilical veins. Out of the 386 live-born piglets, 16.8% died before weaning at 5 wk. Among these, 78.5% died within the first 3 d of life. Mean blood concentration of lactate was increased in piglets that did not survive to weaning (P = 0.003). Concentrations of hemoglobin and hematocrit were decreased (P vitality score vs. piglets born with an intact umbilical cord (P = 0.021), and they had an increased probability of dying before weaning (P = 0.050). Mean birth weight, body mass index, placental area (P live litter size. Blood concentrations of IgG and albumin recorded at d 1 were decreased in piglets that died before weaning (P < 0.01), and blood concentration of albumin was positively associated with placental area (P < 0.001). We conclude that placental area and placental weight, status of the umbilical cord, birth weight, body mass index, blood concentrations of lactate, hemoglobin, and hematocrit recorded at birth, and blood concentrations of IgG and albumin recorded at d 1 were associated with postpartum death in this study. These results may indicate that there is an upper uterine limitation of litter size and that placental area and placental weight influence postpartum survival.

  13. Patterns of failure following high-dose chemotherapy and stem cell rescue for relapsed/refractory non-Hodgkin's lymphoma: implications for the use of adjuvant involved field radiotherapy

    International Nuclear Information System (INIS)

    Mundt, Arno J.; Williams, Stephanie F.; Hallahan, Dennis; Weichselbaum, Ralph R.

    1996-01-01

    Purpose: Recent data have suggested a benefit to involved-field radiotherapy (IFRT) in conjunction with high-dose chemotherapy (HDCT) and autologous stem cell rescue (SCR) in patients with metastatic breast cancer, advanced neuroblastoma and relapsed/refractory Hodgkin's disease. The purpose of this study is to determine whether a similar role exists for IFRT in patients with relapsed/refractory Non-Hodgkin's Lymphoma (NHL) undergoing HDCT. Methods/Materials: Forty-nine adult patients with refractory (17) or relapsed (32) NHL underwent HDCT with SCR between 9/90 and 9/95. The most common histology was diffuse large cell (42.8%). Initial stages were I (3), II (23), III (5) and IV (18). All patients had a history of conventional chemotherapy (median regimens 2, range 1-3), 17 (34.7%) had previous RT. Treatment consisted of conventional dose induction chemotherapy followed by high-dose intensification with cytoxan, busulfan and either ara-C or VP-16. Seven patients (14.3%) received IFRT (median dose 34.5 Gy, range 20-45 Gy) to eleven sites of persistent disease following HDCT (HDCT+IFRT). Patients treated with RT to sites of progressive disease following HDCT (salvage RT) were not included in the HDCT+IFRT group. No patient received total body irradiation (TBI). One hundred sixty four sites were identified. Sites were designated as amenable or not to IFRT and divided into those achieving a complete response to induction (IndCR) and those which did not (non-IndCR). An amenable site is defined as disease localized to either an organ or nodal chain and encompassable within a standard RT portal. Relapse sites were designated as in previous (involved) sites (present prior to HDCT) or in new (uninvolved) sites. Median followup was 19.7 months (range, 1-57.3 months). Results: The 4-year actuarial progression-free (PFS), cause-specific (CSS) and overall (OS) survivals of the entire group were 36.4%, 45.9% and 34.9%, respectively. Excluding toxic deaths, 20 (47.6%) patients

  14. PSYCHOLOGICAL CORRELATES OF POSTPARTUM DEPRESSION

    Directory of Open Access Journals (Sweden)

    Anida Fazlagić

    2011-12-01

    Full Text Available Manual of Mental Disorders (DSM-IV, postpartum depression may include any nonpsychotic depressive disorder during the first four weeks of postpartum, according to research criteria during the first year after birth. The exact cause of postpartum depression is not yet known, and most researchers believe that postpartum depression is a bio-psycho-social problem. So far, the biological aspect of the disease is explained by changing the levels of estrogen and progesterone during pregnancy, and by decrease of hormone levels after birth. Psychological correlates are often associated with low selfesteem, pessimism as a personality trait, bad strategies of coping with stress, mood swings and emotional reactions. The social aspect of the disease is associated with the existential conditions of pregnant woman, support of partners and education level. This paper will include issues like hereditary causes and possible psychological factors of postpartum depression prevention. Nowadays, it is estimated that on average 15% of women, regardless of the pregnancy outcome, are suffering from postpartum depression. However, this information includes only those women who were diagnosed with postpartum depression and who themselves reported about it. Almost every woman receives basic care during pregnancy to prevent complications in the physiological level. This paper has shown possible psychological factors of postpartum depression prevention, the impact of optimism, self-esteem and coping skills.

  15. Postpartum depression in older women.

    Science.gov (United States)

    Strelow, Brittany; Fellows, Nicole; Fink, Stephanie R; OʼLaughlin, Danielle J; Radke, Gladys; Stevens, Joy; Tweedy, Johanna M

    2018-03-01

    Postpartum depression, which affects 10% to 20% of women in the United States, can significantly harm the health and quality of life for mother, child, and family. This article reviews the risk factors, pathophysiology, clinical manifestations, diagnosis, and treatment of postpartum depression with specific focus on women of advanced maternal age.

  16. Determinants of Child Attachment in the Years Postpartum in a High-Risk Sample of Immigrant Women.

    Science.gov (United States)

    Lecompte, Vanessa; Rousseau, Cécile

    2017-10-07

    Our goal was to examine maternal mental health and associated stresses in a sample of high-risk immigrant mothers, and its association with child insecure attachment in the years following childbirth. Mothers and their child (Mage = 37 months) were recruited through a Health and Social Service organization in the Parc-Extension neighborhood in Montreal, Quebec. Mothers completed the Hopkins Symptoms Checklist (HSCL-25), the Multidimensional Scale of Perceived Social Support (MPSS) and a sociodemographic questionnaire that included questions on premature delivery and birth weight. Attachment behaviors were coded out of a videotaped free play sequence using the Preschool and Early School-Age Attachment Rating Scales (PARS). Analysis revealed high levels of clinical anxiety and depression, low social support and low attachment security. Significant mean differences and associations were found between anxiety, depression, social support, preterm delivery and child attachment. These results underscore the importance of screening for anxiety and depression early in the postnatal years, in order to prevent associated consequences such as child insecure attachment. Results also highlight the importance of building positive social networks, especially with immigrant populations.

  17. Postpartum haemorrhage: prevention

    OpenAIRE

    Chelmow, David

    2008-01-01

    Loss of more than 500 mL of blood is usually caused by failure of the uterus to contract fully after delivery of the placenta, and occurs in over 10% of deliveries with a 1% mortality rate worldwide. Other causes of postpartum haemorrhage include retained placental tissue, lacerations to the genital tract and coagulation disorders.Uterine atony is more likely in women who have had a general anaesthetic or oxytocin, an over-distended uterus, a prolonged or precipitous labour, or who are of ...

  18. Postpartum haemorrhage: prevention

    OpenAIRE

    Chelmow, David

    2011-01-01

    Loss of more than 500 mL of blood is usually caused by failure of the uterus to contract fully after delivery of the placenta, and occurs in over 10% of deliveries, with a 1% mortality worldwide. Other causes of postpartum haemorrhage include retained placental tissue, lacerations to the genital tract, and coagulation disorders.Uterine atony is more likely in women who have had a general anaesthetic or oxytocin, an over-distended uterus, a prolonged or precipitous labour, or who are of hig...

  19. Maternity Care Update: Postpartum Care.

    Science.gov (United States)

    Smith, Andrew; Barr, Wendy B; Bassett-Novoa, Erin; LeFevre, Nicholas

    2018-04-01

    Family physicians are uniquely situated to play a major role in postpartum care. Postpartum issues that should be monitored and addressed include reproductive and contraceptive planning, breastfeeding counseling and support, and maternal mental health. All women should be screened for postpartum depression using a validated tool at the postpartum visit and/or at well-child visits. Patients with positive screening results should be offered support and treatment. Women are more likely to breastfeed if they are provided with breastfeeding support and counseling routinely during the prenatal and postpartum periods. All women should be asked about their reproductive life plans, counseled about potential risks associated with short and prolonged interpregnancy intervals, and offered contraception. Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.

  20. High-dose chemotherapy and auto-SCT for relapsed and refractory Hodgkin's lymphoma patients refractory to first-line salvage chemotherapy but responsive to second-line salvage chemotherapy.

    Science.gov (United States)

    Rauf, Muhammad Shahzad; Maghfoor, Irfan; Elhassan, Tusneem Ahmed M; Akhtar, Saad

    2015-01-01

    Relapsed or primary refractory Hodgkin's lymphoma (HL) patients refractory to first-line salvage chemotherapy (first salvage) and unable to undergo high-dose chemotherapy (HDC) and autologous stem cell transplant (auto-SCT) have very poor outcome. Some patients are offered second-line salvage chemotherapy (second salvage), if they are responsive and may receive HDC auto-SCT. We identified 31 patients (18 males, 13 females) from 1996-2012 who received second salvage prior to auto-SCT. Median age at auto-SCT is 22 years. Patients were grouped as (1) relapsed-refractory (Rel:Ref): patients with prior complete response (CR) and on relapse found refractory to first salvage and received second salvage and (2) refractory-refractory (Ref:Ref): patients refractory to both primary treatment and first salvage and received second salvage. Median follow-up is 63 months (18-170). Disease status after second salvage prior to HDC was CR 16 %, partial response (PR) 71 % and stable disease 13 %. After HDC auto-SCT, CR:PR: progressive disease was observed in 18 (58 %): four (12 %): nine (29 %) patients, respectively. Five-year overall survival (OS) for whole group is 57 % (Rel:Ref vs. Ref:Ref, 73 % vs. 48 %, p = 0.48). Progression-free survival (PFS) for whole group is 52 % (Rel:Ref vs. Ref:Ref, 73 % vs. 40 % respectively, p = 0.11). Second-line salvage is a valid approach with no long-term side effects for those HL patients who do not respond to first-line salvage chemotherapy and they can be candidate of HDC and stem cell transplant with a high ORR, the PFS and OS in relapse-refractory and refractory-refractory group of patients.

  1. Relationship between the pre- and postpartum body condition scores and periparturient indices and fertility in high-yielding dairy cows

    Directory of Open Access Journals (Sweden)

    Stefańska Barbara

    2016-03-01

    Full Text Available Introduction: The aim of this study was to investigate the relationship between body condition score (BCS determined on the dry-off day, calving day, and in the first month of lactation, its changes during the dry period and early lactation, and periparturient indices and fertility in high-producing dairy cows. Material and Methods: The experiment was conducted in two herds: A and B, located in Western Poland. The studies were conducted on 116 and 108 Polish Holstein-Friesian dairy cows respectively, with an average milk yield of >10 000 kg/305-day lactation. The experiment included the dry period (-56 d to the calving day, the calving day, and early lactation (from +1 to +56 d. The experimental factor was BCS (0 to 5-point scale. The BCS was performed by one person on day -56, on parturition day (in the first 12 h after calving and on day 30 of lactation. Results: A decrease in BCS (≥-0.25 in herd A during the dry period accelerated the planned calving period by 7.3 d. In the group of cows with BCS 3.50 in the first month of lactation (30 d resulted in the extension of uterine involution period (56 d. Improvement of BCS during the dry period shortened the anoestrus (60 d in herd A and the period of insemination service (60 d in herd B. However, in this group (IM BCS ≥ 0.25 of cows the day of the highest artificial insemination index (2.50 in herd B was analysed. Conclusion: The body condition on the dry-off day and at calving, as well as its deterioration in the first month of lactation, have a considerable effect on fertility indices in dairy cows, thus confirming the advisability of its regular monitoring during routine operations connected with the management of a dairy cattle herd.

  2. An unusual presentation of postpartum ovarian vein thrombosis

    International Nuclear Information System (INIS)

    Hakim, Fayaz A.; Khan, Nadra N.; Qushmaq, Khalid A.; Al-Shami, Sadiq Y.

    2007-01-01

    Ovarian vein thrombosis is a rare but potentially serious complication following childbirth. The majority of patients present during the first week postpartum, with fever and right lower quadrant abdominal pain. We report an unusual case of postpartum ovarian vein thrombosis who presented with fever, low backache, and painful thighs. A high index of suspicion is crucial to diagnose and treat this condition in order to avoid serious consequences. (author)

  3. Relapsing Polychondritis Following Alopecia Areata

    Directory of Open Access Journals (Sweden)

    John C. Starr

    2010-01-01

    Full Text Available A case of alopecia areata followed by relapsing polychondritis is presented. Similar cases from the literature are reviewed and speculation about the relationship of these diseases is offered. Although the occurrence of these diseases together could be coincidental, an association seems immunologically plausible. Thus, relapsing polychondritis might be an unusual systemic manifestation of alopecia areata.

  4. Costs and effectiveness of fingolimod versus alemtuzumab in the treatment of highly active relapsing-remitting multiple sclerosis in the UK: re-treatment, discount, and disutility.

    Science.gov (United States)

    Montgomery, Stephen M; Kusel, Jeanette; Nicholas, Richard; Adlard, Nicholas

    2017-09-01

    Patients with relapsing-remitting multiple sclerosis (RRMS) treated with disease modifying therapies (DMTs) who continue to experience disease activity may be considered for escalation therapies such as fingolimod, or may be considered for alemtuzumab. Previous economic modeling used Markov models; applying one alternative technique, discrete event simulation (DES) modeling, allows re-treatment and long-term adverse events (AEs) to be included in the analysis. A DES was adapted to model relapse-triggered re-treatment with alemtuzumab and the effect of including ongoing quality-adjusted life year (QALY) decrements for AEs that extend beyond previous 1-year Markov cycles. As the price to the NHS of fingolimod in the UK is unknown, due to a confidential patient access scheme (PAS), a variety of possible discounts were tested. The interaction of re-treatment assumptions for alemtuzumab with the possible discounts for fingolimod was tested to determine which DMT resulted in lower lifetime costs. The lifetime QALY results were derived from modeled treatment effect and short- and long-term AEs. Most permutations of fingolimod PAS discount and alemtuzumab re-treatment rate resulted in fingolimod being less costly than alemtuzumab. As the percentage of patients who are re-treated with alemtuzumab due to experiencing a relapse approaches 100% of those who relapse whilst on treatment, the discount required for fingolimod to be less costly drops below 5%. Consideration of treatment effect alone found alemtuzumab generated 0.2 more QALYs/patient; the inclusion of AEs up to a duration of 1 year reduced this advantage to only 0.14 QALYs/patient. Modeling AEs with a lifetime QALY decrement found that both DMTs generated very similar QALYs with the difference only 0.04 QALYs/patient. When the model captured alemtuzumab re-treatment and long-term AE decrements, it was found that fingolimod is cost-effective compared to alemtuzumab, assuming application of only a modest level of

  5. Relapse to cocaine seeking in an invertebrate.

    Science.gov (United States)

    Amaning-Kwarteng, Akua O; Asif-Malik, Aman; Pei, Yue; Canales, Juan J

    2017-06-01

    Addiction is characterised by cycles of compulsive drug taking, periods of abstinence and episodes of relapse. The extinction/reinstatement paradigm has been extensively used in rodents to model human relapse and explore underlying mechanisms and therapeutics. However, relapse to drug seeking behaviour has not been previously demonstrated in invertebrates. Here, we used a cocaine conditioned place preference (CPP) paradigm in the flatworm, planarian, followed by extinction and reinstatement of drug seeking. Once baseline preference was established for one of two distinctly textured environments (i.e. compartments with a coarse or smooth surface), planarian received pairings of cocaine (5μM) in the non-preferred, and vehicle in the most preferred, environment, and were tested for conditioning thereafter. Cocaine produced robust CPP, measured as a significant increase in the time spent in the cocaine-paired compartment. Subsequently, planarian underwent extinction training, reverting back to their original preference within three sessions. Brief exposure to cocaine (5μM) or methamphetamine (5μM) reinstated cocaine-seeking behaviour. By contrast, the high affinity dopamine transporter inhibitor, (N-(n-butyl)-3α-[bis (4-fluorophenyl) methoxy]-tropane) (JHW007), which in rodents exhibits a neurochemical and behavioural profile distinct from cocaine, was ineffective. The present findings demonstrate for the first time reinstatement of extinguished cocaine seeking in an invertebrate model and suggest that the long-term adaptations underlying drug conditioning and relapse are highly conserved through evolution. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Activated mesenchymal stem cell administration inhibits chronic alcohol drinking and suppresses relapse-like drinking in high-alcohol drinker rats.

    Science.gov (United States)

    Ezquer, Fernando; Quintanilla, María Elena; Morales, Paola; Ezquer, Marcelo; Lespay-Rebolledo, Carolyne; Herrera-Marschitz, Mario; Israel, Yedy

    2017-10-18

    Neuroinflammation has been reported to follow chronic ethanol intake and may perpetuate alcohol consumption. Present studies determined the effect of human mesenchymal stem cells (hMSCs), known for their anti-inflammatory action, on chronic ethanol intake and relapse-like ethanol intake in a post-deprivation condition. Rats were allowed 12-17 weeks of chronic voluntary ethanol (10% and 20% v/v) intake, after which a single dose of activated hMSCs (5 × 10 5 ) was injected into a brain lateral ventricle. Control animals were administered vehicle. After assessing the effect of hMSCs on chronic ethanol intake for 1 week, animals were deprived of ethanol for 2 weeks and thereafter an ethanol re-access of 60 min was allowed to determine relapse-like intake. A single administration of activated hMSCs inhibited chronic alcohol consumption by 70% (P 80 mg/dl. The single hMSC administration reduced relapse-like blood ethanol levels to 20 mg/dl. Chronic ethanol intake increased by 250% (P chronic ethanol intake, an effect that was fully abolished by the administration of hMSCs. This study supports the neuroinflammation-chronic ethanol intake hypothesis and suggest that mesenchymal stem cell administration may be considered in the treatment of alcohol use disorders. © 2017 Society for the Study of Addiction.

  7. Postpartum behaviour as predictor of weight change from before pregnancy to one year postpartum

    NARCIS (Netherlands)

    Althuizen, E.; Poppel, M.N.M.; Vries, de J.H.M.; Seidell, J.C.; Mechelen, van W.

    2011-01-01

    Background - Postpartum weight retention affects many women and increases the risk of becoming overweight. The research objective was to study modifiable factors contributing to weight change at one year postpartum. Methods - In this prospective cohort, postpartum behavior, such as physical

  8. Postpartum Teens’ Breakfast Consumption is Associated with Snack and Beverage Intake and Body Mass Index

    OpenAIRE

    Haire-Joshu, Debra; Schwarz, Cynthia; Budd, Elizabeth L; Yount, Byron W; Lapka, Christina

    2011-01-01

    Addressing high risk dietary patterns among postpartum teens may help reduce weight retention and prevent intergenerational obesity. The objective of this study was to describe the relationship between breakfast consumption and outcomes of snack and beverage intake and body mass index (BMI) among postpartum teens. During 2007–2009, 1,330 postpartum teens across 27 states participated in a cross-sectional, baseline assessment of a group-randomized, nested cohort study. Participants were enroll...

  9. Treatment of multiple sclerosis relapses with high-dose methylprednisolone reduces the evolution of contrast-enhancing lesions into persistent black holes.

    Science.gov (United States)

    Di Gregorio, Maria; Gaetani, Lorenzo; Eusebi, Paolo; Floridi, Piero; Picchioni, Antonella; Rosi, Giovanni; Mancini, Andrea; Floridi, Chiara; Baschieri, Francesca; Gentili, Lucia; Sarchielli, Paola; Calabresi, Paolo; Di Filippo, Massimiliano

    2018-03-01

    The MRI evidence of persistent black holes (pBHs) on T1-weighted images reflects brain tissue loss in multiple sclerosis (MS). The evolution of contrast-enhancing lesions (CELs) into pBHs probably depends on the degree and persistence of focal brain inflammation. The aim of our retrospective study was to evaluate the effect of a single cycle of intravenous methylprednisolone (IVMP), as for MS relapse treatment, on the risk of CELs' evolution into pBHs. We selected 57 patients with CELs on the baseline MRI scan. We evaluated the evolution of CELs into pBHs on a follow-up MRI scan performed after ≥ 6 months in patients exposed and not exposed to IVMP for the treatment of relapse after the baseline MRI. In our cohort, 182 CELs were identified in the baseline MRI and 57 of them (31.3%) evolved into pBHs. In the multivariate analysis, the exposure of CELs to IVMP resulted to be a significant independent protective factor against pBHs' formation (OR 0.28, 95% CI 0.11-0.766, p = 0.005), while ring enhancement pattern and the fact of being symptomatic were significant risk factors for CELs' conversion into pBHs (OR 6.42, 95% CI 2.55-17.27, p < 0.001 and OR 13.19, 95% CI 1.56-288.87, p = 0.037). The exposure of CELs to a cycle of IVMP as for relapse treatment is associated with a lower risk of CELs' evolution into pBHs. Future studies are required to confirm the potential independent protective effect of IVMP on CELs' evolution into pBHs.

  10. Breastfeeding reduces postpartum weight retention

    DEFF Research Database (Denmark)

    Baker, Jennifer Lyn; Gamborg, Michael; Heitmann, Berit L

    2008-01-01

    BACKGROUND: Weight gained during pregnancy and not lost postpartum may contribute to obesity in women of childbearing age. OBJECTIVE: We aimed to determine whether breastfeeding reduces postpartum weight retention (PPWR) in a population among which full breastfeeding is common and breastfeeding...... duration is long. DESIGN: We selected women from the Danish National Birth Cohort who ever breastfed (>98%), and we conducted the interviews at 6 (n = 36 030) and 18 (n = 26 846) mo postpartum. We used regression analyses to investigate whether breastfeeding (scored to account for duration and intensity......) reduced PPWR at 6 and 18 mo after adjustment for maternal prepregnancy body mass index (BMI) and gestational weight gain (GWG). RESULTS: GWG was positively (P postpartum. Breastfeeding was negatively associated with PPWR in all women but those...

  11. Postpartum Depression: An Interactional View.

    Science.gov (United States)

    Kraus, Mary Ann; Redman, E. Scott

    1986-01-01

    Postpartum depression is conceptualized as a predictable developmental, family crisis, which occurs when the natural difficulties of childbirth are benignly mishandled. Tactics are illustrated for interdicting maladaptive interpersonal spirals, including normalizing conflicting complaints; reframing depression as positive but costly; regulating…

  12. Interventions to Improve Rate of Diabetes Testing Postpartum in Women With Gestational Diabetes Mellitus.

    Science.gov (United States)

    Hamel, Maureen S; Werner, Erika F

    2017-02-01

    Gestational diabetes mellitus (GDM) is one of the most common medical complications of pregnancy. In the USA, four million women are screened annually for GDM in pregnancy in part to improve pregnancy outcomes but also because diagnosis predicts a high risk of future type 2 diabetes mellitus (T2DM). Therefore, among women with GDM, postpartum care should be focused on T2DM prevention. This review describes the current literature aimed to increase postpartum diabetes testing among women with GDM. Data suggest that proactive patient contact via a health educator, a phone call, or even postal mail is associated with higher rates of postpartum diabetes testing. There may also be utility to changing the timing of postpartum diabetes testing. Despite the widespread knowledge regarding the importance of postpartum testing for women with GDM, testing rates remain low. Alternative testing strategies and large randomized trials addressing postpartum testing are warranted.

  13. Psychometric properties of the postpartum depression screening scale beyond the postpartum period.

    Science.gov (United States)

    Vogeli, Jo M; Hooker, Stephanie A; Everhart, Kevin D; Kaplan, Peter S

    2018-04-01

    Accurate postpartum depression screening measures are needed to identify mothers with depressive symptoms both in the postpartum period and beyond. Because it had not been tested beyond the immediate postpartum period, the reliability and validity of the Postpartum Depression Screening Scale (PDSS) and its sensitivity, specificity, and predictive value for diagnoses of major depressive disorder (MDD) were assessed in a diverse community sample of 238 mothers of 4- to 15-month-old infants. Mothers (N = 238; M age = 30.2, SD = 5.3) attended a lab session and completed the PDSS, the Beck Depression Inventory-II (BDI-II), and a structured clinical interview (SCID) to diagnose MDD. The reliability, validity, specificity, sensitivity, and predictive value of the PDSS to identify maternal depression were assessed. Confirmatory factor analysis supported the construct validity of five but not seven content subscales. The PDSS total and subscale scores demonstrated acceptable to high reliability (α = 0.68-0.95). Discriminant function analysis showed the scale correctly provided diagnostic classification at a rate higher than chance alone. Sensitivity and specificity for major depressive disorder (MDD) diagnosis were good and comparable to those of the BDI-II. Even in mothers who were somewhat more diverse and had older infants than those in the original normative study, the PDSS appears to be a psychometrically sound screener for identifying depressed mothers in the 15 months after childbirth. © 2018 Wiley Periodicals, Inc.

  14. Perceptions of Electronic Cigarettes Among Medicaid-Eligible Pregnant and Postpartum Women.

    Science.gov (United States)

    Fallin, Amanda; Miller, Alana; Assef, Sara; Ashford, Kristin

    2016-01-01

    To describe perceptions and beliefs about electronic cigarette (e-cigarette) use during pregnancy among pregnant and newly postpartum women. An exploratory, qualitative descriptive study. University-affiliated prenatal clinics. Twelve pregnant or recently postpartum women who reported use of tobacco and electronic cigarettes. Semistructured focus groups were audio recorded and professionally transcribed. The transcripts were coded to consensus and analyzed with MAXQDA software (version 11) using content analysis. Four overarching themes emerged: (a) Attraction to E-Cigarettes as a Harm Reduction Strategy, (b) Uncertainty Regarding the Health Effects of E-Cigarettes; (c) Ambivalence Regarding Novel Product Characteristics; and (d) Behaviors Reflected Dual Use and Often Complete Relapse to Traditional Cigarettes. Pregnant women are initially attracted to e-cigarettes as a harm reduction strategy, but they often return to traditional cigarettes in the postpartum period. Nurses should counsel pregnant women on the adverse effects of fetal exposure to nicotine. Evidence-based nursing interventions are needed to prevent relapse during the postpartum period. Copyright © 2016 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  15. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... in RRMS; however, each person's experience with RRMS will be unique. Following a relapse, the new symptoms ... and worsening, you and your MS care provider will likely want to consider a more aggressive treatment ...

  16. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... course – is characterized by clearly defined attacks of new or increasing neurologic symptoms. These attacks – also called ... either active (with relapses and/or evidence of new MRI activity) or not active , as well as ...

  17. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... defined attacks of new or increasing neurologic symptoms. These attacks – also called relapses or exacerbations – are followed ... as well as the nerve fibers themselves. During these inflammatory attacks, activated immune cells cause small, localized ...

  18. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... Treating MS Comprehensive Care Find an MS Care Provider Medications Managing Relapses Rehabilitation Complementary & Alternative Medicines For Clinicians Resources & Support Library & Education Programs Find Support Advanced Care ...

  19. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... without symptoms of which the person is aware. What happens in RRMS? Relapsing-remitting MS is defined ... a different mechanism of action in order to control the disease activity more effectively and help prevent ...

  20. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... Rule Out For Clinicians Treating MS Comprehensive Care Find an MS Care Provider Medications Managing Relapses Rehabilitation ... Medicines For Clinicians Resources & Support Library & Education Programs Find Support Advanced Care Needs Resources for Specific Populations ...

  1. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... the periods of remission. At different points in time, RRMS can be further characterized as either active ( ... increase in disability over a specified period of time following a relapse) or not worsening . An increase ...

  2. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... attacks of inflammation (relapses) in the CNS, progressive forms of MS involve much less of this type ... and memory or information processing). People with progressive forms of MS are more likely to experience gradually ...

  3. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... Team Make the Most of Your Doctor Visits Advance Medical Directives d Find an MS Care Provider ... in RRMS; however, each person's experience with RRMS will be unique. Following a relapse, the new symptoms ...

  4. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... as shown by the arrows, often occur as part of a relapse. However, new MRI lesions indicating ... course of your disease at different points in time helps you and your MS care provider discuss ...

  5. Personality and risk for postpartum depressive symptoms.

    Science.gov (United States)

    Iliadis, S I; Koulouris, P; Gingnell, M; Sylvén, S M; Sundström-Poromaa, I; Ekselius, L; Papadopoulos, F C; Skalkidou, A

    2015-06-01

    Postpartum depression (PPD) is a common childbirth complication, affecting 10-15 % of newly delivered mothers. This study aims to assess the association between personality factors and PPD. All pregnant women during the period September 2009 to September 2010, undergoing a routine ultrasound at Uppsala University Hospital, were invited to participate in the BASIC study, a prospective study designed to investigate maternal well-being. Depressive symptoms were assessed with the Edinburgh Postnatal Depression Scale (EPDS) while the Depression Self-Rating Scale (DSRS) was used as a diagnostic tool for major depression. Personality traits were evaluated using the Swedish Universities Scale of Personality (SSP). One thousand thirty-seven non-depressed pregnant women were included in the study. Non-depressed women reporting high levels of neuroticism in late pregnancy were at high risk of developing postpartum depressive symptoms (PPDSs) at 6 weeks and 6 months after delivery, even after adjustment for confounders (adjusted odds ratio (aOR) = 3.4, 95 % confidence interval (CI) 1.8-6.5 and adjusted odds ratio (aOR) = 3.9, 95 % CI 1.9-7.9). The same was true for a DSRS-based diagnosis of major depression at 6 months postpartum. Somatic trait anxiety and psychic trait anxiety were associated with increased risk for PPDS at 6 weeks (aOR = 2.1, 95 % CI 1.2-3.5 and aOR = 1.9, 95 % CI 1.1-3.1), while high scores of mistrust were associated with a twofold increased risk for PPDS at 6 months postpartum (aOR 1.9, 95 % CI 1.1-3.4). Non-depressed pregnant women with high neuroticism scores have an almost fourfold increased risk to develop depressive symptoms postpartum, and the association remains robust even after controlling for most known confounders. Clinically, this could be of importance for health care professionals working with pregnant and newly delivered women.

  6. Evaluation of reproductive tract infection during early post-partum period and its relationship with subsequent reproductive performance in high milk producing dairy cows.

    Science.gov (United States)

    Senosy, W; Uchiza, M; Tameoka, N; Izaike, Y; Osawa, T

    2012-04-01

    Clinically normal Holstein-Friesian cows (n = 43) were used to establish a relationship between the evaluations of the uterine condition by vaginoscopy, Metricheck, endometrial cytology (EC) and ultrasonography (US) during post-partum period (pp), and subsequent reproductive performance. The uterine status of the selected cows was evaluated by EC, Metricheck, US and vaginoscopy on a weekly basis from the third week (W3) to the seventh week (W7) pp. The animals were bred after a voluntary waiting period of 45-60 days pp and diagnosed for pregnancy status at 45 days after breeding by US. First service conception rate (FSCR) of bred animals was 32.6% (14/43). There was no significant difference in polymorphonuclear leucocyte percentage between conceived and non-conceived cows during different weeks post-partum. First service conception rate in animals with normal vaginal discharge as detected by Metricheck was significantly low when compared to those of abnormal discharge during W3 (2.3% vs 30.3%; p reproductive performance of dairy cattle. © 2011 Blackwell Verlag GmbH.

  7. Report of a Phase II Study of Clofarabine and Cytarabine in De Novo and Relapsed and Refractory AML Patients and in Selected Elderly Patients at High Risk for Anthracycline Toxicity

    Science.gov (United States)

    Cooper, Barry; Holmes, Houston; Vance, Estil; Berryman, Robert Brian; Maisel, Christopher; Li, Sandy; Saracino, Giovanna; Tadic-Ovcina, Mirjana; Fay, Joseph

    2011-01-01

    Purpose. To determine the efficacy and safety of clofarabine and cytarabine (Ara-C) in adult patients with relapsed or refractory acute myeloid leukemia (AML) and in elderly patients with untreated AML and heart disease. Patients and Methods. Patients with relapsed/refractory AML and older patients for whom there was a concern over toxicity from additional anthracyclines received 5 days of clofarabine, 40 mg/m2 per day i.v. over 1 hour, followed 4 hours later by Ara-C, 1,000 mg/m2 per day i.v. over 2 hours. Results. Thirty patients were enrolled. The median age was 67 years (range, 38–82 years) and 18 (60%) had received at least one prior therapy. Eleven (37%) patients had a history of cardiovascular disease and were considered to be at high risk for anthracycline toxicity. High-risk cytogenetic abnormalities were present in 14 (47%) patients. The overall response rate (complete remission [CR] plus partial remission) was 53%, including a CR in 14 patients (47%). Responses were observed in all cytogenetic risk groups and in patients who had received up to five prior therapies. The median disease-free survival interval was 9.5 months. The 30-day mortality rate was 20% (de novo AML, 8%; relapsed/refractory AML, 28%). Of the 14 patients achieving a CR, half were able to proceed to curative hematopoietic stem cell transplantation. Conclusions. Clofarabine in combination with Ara-C is effective in both untreated and previously treated patients with AML. In addition, it represents a useful remission induction strategy to serve as a bridge to transplantation in older patients with AML. PMID:21273514

  8. Economic costs associated with an MS relapse

    LENUS (Irish Health Repository)

    O'Connell, K.

    2014-09-01

    This was an prospective audit composed of medical chart review and patient questionnaire. Relapses were stratified into 3 groups: low, moderate and high intensity. Age, gender, MS subtype, disease duration, expanded disability status scale (EDSS) score, disease modifying therapy (DMT) use and employment status were recorded. Direct costs included GP visits, investigations, clinic visit, consultations with medical staff, medication and admission costs. Indirect costs assessed loss of earnings, partner\\'s loss of earnings, childcare, meals and travel costs.

  9. Outcome following late marrow relapse in childhood acute lymphoblastic leukemia

    International Nuclear Information System (INIS)

    Chessells, J.; Leiper, A.; Rogers, D.

    1984-01-01

    Thirty-four children with acute lymphoblastic leukemia, who developed bone marrow relapse after treatment was electively stopped, received reinduction, consolidation, continuing therapy, and intrathecal (IT) methotrexate (MTX). Sixteen children who relapsed within six months of stopping treatment had a median second-remission duration of 26 weeks; all next relapses occurred in the bone marrow. In 18 children who relapsed later, the median duration of second remission was in excess of two years, but after a minimum of four years follow-up, 16 patients have so far relapsed again (six in the CNS). CNS relapse occurred as a next event in four of 17 children who received five IT MTX injections only and in two of 14 children who received additional regular IT MTX. Although children with late marrow relapses may achieve long second remissions, their long-term out-look is poor, and regular IT MTX does not afford adequate CNS prophylaxis. It remains to be seen whether more intensive chemotherapy, including high-dose chemoradiotherapy and bone marrow transplantation, will improve the prognosis in this group of patients

  10. Use of radioimmunoassay technique for the determination of post-partum ovaric activity in high and low milk production in dairy cows. Actividad ovarica post-parto en vacas de alta y baja produccion lechera usando la tecnica de radioimmunoanalisis (RIA)

    Energy Technology Data Exchange (ETDEWEB)

    Villalba, P [Comision Ecuatoriana de Energia Atomica, Quito (Ecuador); Paneluisa, S; Arcos, E [Facultad de Medicina Veterinaria y Zootecnia, Universidad Central del (Ecuador)

    1993-07-01

    The principal objective of this study was to determinate the post-partum ovarian activity in milking cows of high and low production in one farm of ecuadorian highland. For this experiment was necessary to use 48 animals between second and sith calving, the milk samples were collected according one pre-stablished protocol and the same was: one sample 5th or 6th days, twice a week until the cows were pregnacy and 180 days after parturitium if the cow is open. Additional data were compiled in each farm and both the results of the progesterone by RIA were used to determinate the diferents reproductive parameters in the post-partum of the cows. The most of reproductives parameters in the post-partum of the cows in the both group didn't have significance but the conception rate, services per conception, number of pregnacy cows and percentaje of non visibles heats had one high significance between the treatments.

  11. Mind the Gap: Assessing the Disconnect Between Postpartum Health Information Desired and Health Information Received.

    Science.gov (United States)

    Guerra-Reyes, Lucia; Christie, Vanessa M; Prabhakar, Annu; Siek, Katie A

    Seeking and receiving health information are critical aspects of prenatal and postpartum care; however, many informational sources lack postpartum content. This study explores the gaps between information desired and information received postpartum and identifies the sources women use for health information seeking, with an emphasis on emergent online and mobile phone-based resources. Participants were recruited from our community partners' client base for a cross-sectional study. Mothers (n = 77) of a child 48 months or younger completed a survey on health information seeking, health information needs, and technology use. Postpartum health information gaps were defined as topics about which a participant indicated that she wanted information, but did not receive information. Bivariate analyses assessed the association between demographic characteristics, sources of health information used during pregnancy, and postpartum information gaps. Health care providers, Internet-based resources, and mobile applications were common sources of health information during pregnancy. Mental and sexual health were the most common types of postpartum health information gaps. In bivariate analyses, higher income and education were associated with postpartum information gaps in mental health and sexual health, respectively (p higher levels of education and income and postpartum health information gaps were observed in bivariate analyses. Health educators have the opportunity to capitalize on high rates of Internet information seeking by providing health information online. Health care providers must incorporate mental and sexual health into routine postpartum care. Copyright © 2016 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  12. A Unique Case of Relapsing Polychondritis Presenting with Acute Pericarditis

    Directory of Open Access Journals (Sweden)

    John V. Higgins

    2013-01-01

    Full Text Available Relapsing polychondritis (RP is an inflammatory disease of the cartilaginous tissue primarily affecting the cartilaginous structures of the ear, nose, joints, and the respiratory system. Cardiovascular complications of RP are associated with high morbidity and mortality and occur most commonly as valvular disease. Pericarditis is a less common complication, occurring in 4% of patients with RP and has not previously been described at presentation. We describe a case of relapsing polychondritis with acute pericarditis at presentation.

  13. Tips for Postpartum Dads and Partners

    Science.gov (United States)

    ... Blues: Partners Interview with Wade Bowen Coping with Suicide & Loss Tips for Postpartum Dads and Partners Pregnancy and postpartum mood and anxiety disorders affect the whole family. Here are some tips ...

  14. Depression in pregnancy and postpartum period.

    Science.gov (United States)

    Sood, Mamta; Sood, A K

    2003-01-01

    This prospective study was carried out in a service hospital, with the aim to study the prevalence and incidence of depression in pregnancy and postpartum period. Eighty Four consecutive patients attending the antenatal outpatient in the Obstetrics & Gynaecology department in their last trimester of pregnancy were recruited for the study. They were assessed on Beck Depression Inventory thrice viz. during third trimester of pregnancy, within 3 days of delivery (early postpartum period) & within 4-8 weeks of delivery (late postpartum period).The prevalence of depression was 8.3%, 20% and 12.8% respectively at three ratings. The incidence was 16% and 10% in the early & late postpartum period respectively. Further analysis revealed that depression in pregnancy correlated significantly with depression in early postpartum period, but not with late postpartum period. Depression in early postpartum period correlated with depression in late postpartum period.These findings have implications for early detection and care of women at risk for developing depression.

  15. Postpartum Depression After Mild and Severe Preeclampsia

    NARCIS (Netherlands)

    Hoedjes, Meeke; Berks, Durk; Vogel, Ineke; Franx, Arie; Bangma, Meike; Darlington, Anne-Sophie E.; Visser, Willy; Duvekot, Johannes J.; Habbema, J. Dik F.; Steegers, Eric A. P.; Raat, Hein

    2011-01-01

    Objective: To describe the prevalence of postpartum depressive symptoms after preeclampsia, to assess the extent to which the prevalence of postpartum depressive symptoms differs after mild and severe preeclampsia, and to investigate which factors contribute to such differences. Methods: Women

  16. Maternal postpartum distress and childhood overweight

    DEFF Research Database (Denmark)

    Adeltoft, Teresa Ajslev; Andersen, Camilla S; Ingstrup, Katja Glejsted

    2010-01-01

    We investigated associations between maternal postpartum distress covering anxiety, depression and stress and childhood overweight.......We investigated associations between maternal postpartum distress covering anxiety, depression and stress and childhood overweight....

  17. Critical views on postpartum care expressed by new mothers

    Directory of Open Access Journals (Sweden)

    Waldenström Ulla

    2007-11-01

    Full Text Available Abstract Background Women's evaluation of hospital postpartum care has consistently been more negative than their assessment of other types of maternity care. The need to further explore what is wrong with postpartum care, in order to stimulate changes and improvements, has been stressed. The principal aim of this study was to describe women's negative experiences of hospital postpartum care, expressed in their own words. Characteristics of the women who spontaneously gave negative comments about postpartum care were compared with those who did not. Methods Data were taken from a population-based prospective longitudinal study of 2783 Swedish-speaking women surveyed at three time points: in early pregnancy, at two months, and at one year postpartum. At the end of the two follow-up questionnaires, women were asked to add any comment they wished. Content analysis of their statements was performed. Results Altogether 150 women gave negative comments about postpartum care, and this sample was largely representative of the total population-based cohort. The women gave a diverse and detailed description of their experiences, for instance about lack of opportunity to rest and recover, difficulty in getting individualised information and breastfeeding support, and appropriate symptom management. The different statements were summarised in six categories: organisation and environment, staff attitudes and behaviour, breastfeeding support, information, the role of the father and attention to the mother. Conclusion The findings of this study underline the need to further discuss and specify the aims of postpartum care. The challenge of providing high-quality follow-up after childbirth is discussed in the light of a development characterised by a continuous reduction in the length of hospital stay, in combination with increasing public demands for information and individualised care.

  18. [Vaginal misoprostol in the prevention of postpartum hemorrhage].

    Science.gov (United States)

    Quiroga Díaz, Ricardo; Esparza Arechiga, Miguel; Batiza Reséndiz, Víctor; Coronado López, Oscar; Hernández Ayup, Samuel; Martínez Cuervo, Jesús

    2002-11-01

    To show the advantages of the use of vaginal misoprostol, a prostaglandine E1 analogue, in the prevention of the post-partum haemorrhage. This was a prospective, observational, comparative study. The study included 400 patients with high risk of postpartum haemorrhage at our center between January 1999 and may 2001. Patients were divided in two groups. In group I (208 patients) misoprostol was used in a dose of 800 ugr and in group II (192 patients) in whom misoprostol was not used. Both groups were treated initially with our conventional oxytocin protocol. We evaluated the use of additional oxytocin or ergotamine, haemoglobin levels pre and post-partum, the amount of blood loss, and the need for blood transfusion or hysterectomy. The need for additional oxytocin or ergotamine was reduced to less than 10% in group I when compared to group II; the drop in haemoglobin levels and the amount of blood loss were also less in group I (p: 0.03). In this group only one patient needed for blood transfusion and no patient needed hysterectomy. In group II six patients need a blood transfusion and there was the need for two hysterectomies. The use of vaginal misoprostol is effective to control the postpartum bleeding, reducing the blood loss after birth in women with high risk of post-partum haemorrhage as well as the need for blood transfusion. It's use has mild side effects and is of low cost.

  19. Regional homogeneity changes between heroin relapse and non-relapse patients under methadone maintenance treatment: a resting-state fMRI study.

    Science.gov (United States)

    Chang, Haifeng; Li, Wei; Li, Qiang; Chen, Jiajie; Zhu, Jia; Ye, Jianjun; Liu, Jierong; Li, Zhe; Li, Yongbin; Shi, Ming; Wang, Yarong; Wang, Wei

    2016-08-18

    Methadone maintenance treatment (MMT) is recognized as one of the most effective treatments for heroin addiction but its effect is dimmed by the high incidence of heroin relapse. However, underlying neurobiology mechanism of heroin relapse under MMT is still largely unknown. Here, we took advantage of a resting-state fMRI technique by analysis of regional homogeneity (ReHo), and tried to explore the difference of brain function between heroin relapsers and non-relapsers in MMT. Forty MMT patients were included and received a 12-month follow-up. All patients were given baseline resting-state fMRI scans by using a 3.0 T GE Signa Excite HD whole-body MRI system. Monthly self-report and urine test were used to assess heroin relapse or non-relapse. Subjective craving was measured with visual analog scale. The correlation between ReHo and the degree of heroin relapse was analyzed. Compared with the non-relapsers, ReHo values were increased in the bilateral medial orbitofrontal cortex, right caudate, and right cerebellum of the heroin relapsers while those in the left parahippocampal gyrus, left middle temporal gyrus, right lingual gyrus, and precuneus were decreased in heroin relapsers. Importantly, altered ReHo in the right caudate were positively correlated with heroin relapse rates or subjective craving response. Using the resting-state fMRI technique by analysis of ReHo, we provided the first resting-state fMRI evidence that right caudate may serve as a potential biomarker for heroin relapse prediction and also as a promising target for reducing relapse risk.

  20. Counseling postpartum women about contraception.

    Science.gov (United States)

    Kennedy, K

    1992-10-01

    Only 5 studies have examines resumption of intercourse after childbirth and coital frequency. These studies conducted in Chile, England, the Philippines, Scotland, and Thailand found that 4 to almost 8 weeks is the average duration between childbirth and resumption of intercourse. Yet, they also showed sizable variation in this duration. In Thailand, the first postpartum intercourse occurred between 3 and 21 weeks. Further, during this study, one mother had not yet resumed intercourse. A study in metropolitan Cebu, in the Philippines, included 3080 women. The mean intercourse resumption interval was 4-6 weeks, yet at 2 years 80 women still had not had postpartum intercourse. This study found 10 factors predicting resumption of intercourse: husband present, not breast feeding, resumption of menstruation, young age, some education, children younger than 7 years old, uncrowded home, nuclear family, urba residence, and trained health worker delivering baby. Mean coital frequency among the Thai women was once per week, but this does not indicate typical frequency. In fact, one woman averaged intercourse 3 times/week, while another had her first postpartum intercourse 6 weeks after delivery and not gain until 8 weeks later. Family planning counselors can use coital frequency studies to guide them when advising postpartum women. For example, a women who does not have intercourse frequently and is at 6-12 months postpartum could use the lactational amenorrhea method and condoms. More frequent intercourse and resumption of menstruation requires a more reliable family planning method. A 1988 study found that for the first 6 months postpartum women who breast feed have a lower coital frequency, longer delay before intercourse resumption, reduced sexual interest and enjoyment, more pain during intercourse, and are somewhat more depressed than those who bottle feed.

  1. Mitoxantrone, etoposide and cytarabine following epigenetic priming with decitabine in adults with relapsed/refractory acute myeloid leukemia or other high-grade myeloid neoplasms: a phase 1/2 study.

    Science.gov (United States)

    Halpern, A B; Othus, M; Huebner, E M; Buckley, S A; Pogosova-Agadjanyan, E L; Orlowski, K F; Scott, B L; Becker, P S; Hendrie, P C; Chen, T L; Percival, M-E M; Estey, E H; Stirewalt, D L; Walter, R B

    2017-12-01

    DNA methyltransferase inhibitors sensitize leukemia cells to chemotherapeutics. We therefore conducted a phase 1/2 study of mitoxantrone, etoposide and cytarabine following 'priming' with 5-10 days of decitabine (dec/MEC) in 52 adults (median age 55 (range: 19-72) years) with relapsed/refractory acute myeloid leukemia (AML) or other high-grade myeloid neoplasms. During dose escalation in cohorts of 6-12 patients, all dose levels were well tolerated. As response rates appeared similar with 7 and 10 days of decitabine, a 7-day course was defined as the recommended phase 2 dose (RP2D). Among 46 patients treated at/above the RP2D, 10 (22%) achieved a complete remission (CR), 8 without measurable residual disease; five additional patients achieved CR with incomplete platelet recovery, for an overall response rate of 33%. Seven patients (15%) died within 28 days of treatment initiation. Infection/neutropenic fever, nausea and mucositis were the most common adverse events. While the CR rate compared favorably to a matched historic control population (observed/expected CR ratio=1.77), CR rate and survival were similar to two contemporary salvage regimens used at our institution (G-CLAC (granulocyte colony-stimulating factor (G-CSF); clofarabine; cytarabine) and G-CLAM (G-CSF; cladribine; cytarabine; mitoxantrone)). Thus, while meeting the prespecified efficacy goal, we found no evidence that dec/MEC is substantially better than other cytarabine-based regimens currently used for relapsed/refractory AML.

  2. Factores psicosociales asociados a un alto, medio y bajo riesgo de síntomas depresivos en el posparto inmediato Psychosocial factors associated to low, medium and high risk of depressive symptoms in the immediate postpartum period

    Directory of Open Access Journals (Sweden)

    Cynthia Inés Paolini

    2012-03-01

    ", "positive medium risk" and "positive high risk". Cut-off scores were 9 and 19 points. RESULTS: out of the total psychosocial variables analyzed, statistically significant differences were found among the three groups regarding family violence, migration, previous history of depression, depressive symptoms during pregnancy and increasing number of life events. CONCLUSIONS: the setting of two cut-off scores in EPDS allows the early detection of women with depressive symptoms. It is suggested the usefulness of cut-off value of 19 for early detection of women at high risk to developing postpartum depression.

  3. Microbiological diagnosis of postpartum endometritis

    Directory of Open Access Journals (Sweden)

    N. A. Korobkov

    2013-01-01

    Full Text Available The objective of the study was to compare the uterus microflora in healthy women and in the patients with postpartum endometritis using the method of quantitative assessment of contamination of the material. Further examination revealed polymicrobial etiology of the postpartum endometritis. The leading role in the etiological structure belongs to opportunistic microorganisms: enterococci, enterobacteria (preferably Enterococcus faecalis and Proteus mirabilis, and non-spore forming anaerobes (predominantly - Peptostreptococcus spp. аnd Bacteroides spp., located in the uterus, in most cases, a bulk quantity as aerobically-anaerobic associations.

  4. Modeling postpartum depression in rats: theoretic and methodological issues

    Science.gov (United States)

    Ming, LI; Shinn-Yi, CHOU

    2016-01-01

    The postpartum period is when a host of changes occur at molecular, cellular, physiological and behavioral levels to prepare female humans for the challenge of maternity. Alteration or prevention of these normal adaptions is thought to contribute to disruptions of emotion regulation, motivation and cognitive abilities that underlie postpartum mental disorders, such as postpartum depression. Despite the high incidence of this disorder, and the detrimental consequences for both mother and child, its etiology and related neurobiological mechanisms remain poorly understood, partially due to the lack of appropriate animal models. In recent decades, there have been a number of attempts to model postpartum depression disorder in rats. In the present review, we first describe clinical symptoms of postpartum depression and discuss known risk factors, including both genetic and environmental factors. Thereafter, we discuss various rat models that have been developed to capture various aspects of this disorder and knowledge gained from such attempts. In doing so, we focus on the theories behind each attempt and the methods used to achieve their goals. Finally, we point out several understudied areas in this field and make suggestions for future directions. PMID:27469254

  5. Modeling postpartum depression in rats: theoretic and methodological issues

    Directory of Open Access Journals (Sweden)

    Ming LI

    2018-06-01

    Full Text Available The postpartum period is when a host of changes occur at molecular, cellular, physiological and behavioral levels to prepare female humans for the challenge of maternity. Alteration or prevention of these normal adaptions is thought to contribute to disruptions of emotion regulation, motivation and cognitive abilities that underlie postpartum mental disorders, such as postpartum depression. Despite the high incidence of this disorder, and the detrimental consequences for both mother and child, its etiology and related neurobiological mechanisms remain poorly understood, partially due to the lack of appropriate animal models. In recent decades, there have been a number of attempts to model postpartum depression disorder in rats. In the present review, we first describe clinical symptoms of postpartum depression and discuss known risk factors, including both genetic and environmental factors. Thereafter, we discuss various rat models that have been developed to capture various aspects of this disorder and knowledge gained from such attempts. In doing so, we focus on the theories behind each attempt and the methods used to achieve their goals. Finally, we point out several understudied areas in this field and make suggestions for future directions.

  6. High rate of complete responses to immune checkpoint inhibitors in patients with relapsed or refractory Hodgkin lymphoma previously exposed to epigenetic therapy

    Directory of Open Access Journals (Sweden)

    Lorenzo Falchi

    2016-11-01

    Full Text Available Abstract Options for patients with relapsed or refractory (R/R classical Hodgkin lymphoma (cHL after brentuximab vedotin (Bv and autologous stem cell transplantation (ASCT are limited. Immune checkpoint inhibitors (ICI are active in this population but rarely induce complete response (CR. Ten patients with R/R cHL after ASCT and Bv received pembrolizumab (n = 8 or nivolumab (n = 2. Five had been previously exposed to 5-azacitidine on a phase 1 study. Among nine evaluable patients, seven (78% achieved CR, one partial response, and one reduction of tumor burden. All five patients who had received 5-azacitidine prior to ICI achieved CR, while only two of four who did not receive prior 5-azacitidine achieved CR. At a median follow-up of 9.9 months [0.5–14.3], eight patients are alive and five are still receiving treatment. We documented an unprecedented CR rate after ICI in patients with R/R cHL. We hypothesize that hypomethylating agents might have an immune priming effect and enhance the efficacy of ICI.

  7. Depression relapse and ethological measures

    NARCIS (Netherlands)

    Hale, WWH; Jansen, JHC; Bouhuys, AL; vandenHoofdakker, RH

    1997-01-01

    Within the framework of interactional theories on depression, the question is raised whether depression relapse can be predicted by observable behavior of remitted patients and their interviewer during an interaction (i.e. discharge interview). Thirty-four patients were interviewed at hospital

  8. Neurocognitive Predictors of Drug Relapse

    NARCIS (Netherlands)

    R. Marhe (Reshmi)

    2013-01-01

    textabstractWorldwide, about 35 million people, that is 0.8% of the world’s adult population, use heroin and/or cocaine and more than 10-13% of these drug users are or will become drug dependent (UNODC, World Drug Report, 2012). Drug dependency is characterized as a chronic relapsing disorder

  9. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... Treating MS d Comprehensive Care Developing a Healthcare Team Make the Most of Your Doctor Visits Advance Medical Directives d Find an MS Care Provider Partners in MS Care d Managing Relapses Plasmapheresis d Rehabilitation Functional Electrical Stimulation (FES) ...

  10. Relapsing-Remitting MS (RRMS)

    Medline Plus

    Full Text Available ... Become an MS Activist Take Action Current Advocacy Issues Advocacy Results Advocacy News d Raise Awareness d ... MS are more likely to experience gradually worsening problems with walking and mobility, along with whatever other symptoms they may have. Diagnosing relapsing-remitting MS (RRMS) Learn More Learn More ... Room MS Prevalence ...

  11. Reducing postpartum hemorrhage in Africa

    DEFF Research Database (Denmark)

    Lazarus, Jeff; Lalonde, A

    2005-01-01

    Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in sub-Saharan Africa. This is being addressed by leading professional organizations, which point to the importance of a skilled attendant at birth. But they also emphasize that the active management of the third stage of labor...

  12. Adolescent Motherhood and Postpartum Depression

    Science.gov (United States)

    Birkeland, Robyn; Thompson, J. Kevin; Phares, Vicky

    2005-01-01

    Adolescent mothers undergo unique personal and social challenges that may contribute to postpartum functioning. In this exploratory investigation completed within a risk and resilience framework, 149 adolescent mothers, ages 15 to 19, who participated in school-based teen parents' programs, completed measures of parental stress (social isolation…

  13. Impact of prior treatment and depth of response on survival in MM-003, a randomized phase 3 study comparing pomalidomide plus low-dose dexamethasone versus high-dose dexamethasone in relapsed/refractory multiple myeloma

    Science.gov (United States)

    San Miguel, Jesus F.; Weisel, Katja C.; Song, Kevin W.; Delforge, Michel; Karlin, Lionel; Goldschmidt, Hartmut; Moreau, Philippe; Banos, Anne; Oriol, Albert; Garderet, Laurent; Cavo, Michele; Ivanova, Valentina; Alegre, Adrian; Martinez-Lopez, Joaquin; Chen, Christine; Renner, Christoph; Bahlis, Nizar Jacques; Yu, Xin; Teasdale, Terri; Sternas, Lars; Jacques, Christian; Zaki, Mohamed H.; Dimopoulos, Meletios A.

    2015-01-01

    Pomalidomide is a distinct oral IMiD® immunomodulatory agent with direct antimyeloma, stromal-support inhibitory, and immunomodulatory effects. The pivotal, multicenter, open-label, randomized phase 3 trial MM-003 compared pomalidomide + low-dose dexamethasone vs high-dose dexamethasone in 455 patients with refractory or relapsed and refractory multiple myeloma after failure of bortezomib and lenalidomide treatment. Initial results demonstrated significantly longer progression-free survival and overall survival with an acceptable tolerability profile for pomalidomide + low-dose dexamethasone vs high-dose dexamethasone. This secondary analysis describes patient outcomes by treatment history and depth of response. Pomalidomide + low-dose dexamethasone significantly prolonged progression-free survival and favored overall survival vs high-dose dexamethasone for all subgroups analyzed, regardless of prior treatments or refractory status. Both univariate and multivariate analyses showed that no variable relating to either the number (≤ or > 3) or type of prior treatment was a significant predictor of progression-free survival or overall survival. No cross-resistance with prior lenalidomide or thalidomide treatment was observed. Patients achieving a minimal response or better to pomalidomide + low-dose dexamethasone treatment experienced a survival benefit, which was even higher in those achieving at least a partial response (17.2 and 19.9 months, respectively, as compared with 7.5 months for patients with less than minimal response). These data suggest that pomalidomide + low-dose dexamethasone should be considered a standard of care in patients with refractory or relapsed and refractory multiple myeloma regardless of prior treatment. ClinicalTrials.gov: NCT01311687; EudraCT: 2010-019820-30. PMID:26160879

  14. Sarcocystis nesbitti causes acute, relapsing febrile myositis with a high attack rate: description of a large outbreak of muscular sarcocystosis in Pangkor Island, Malaysia, 2012.

    Directory of Open Access Journals (Sweden)

    Claire M Italiano

    2014-05-01

    Full Text Available BACKGROUND: From the 17th to 19th January 2012, a group of 92 college students and teachers attended a retreat in a hotel located on Pangkor Island, off the west coast of Peninsular Malaysia. Following the onset of symptoms in many participants who presented to our institute, an investigation was undertaken which ultimately identified Sarcocystis nesbitti as the cause of this outbreak. METHODOLOGY/PRINCIPAL FINDINGS: All retreat participants were identified, and clinical and epidemiological information was obtained via clinical review and self-reported answers to a structured questionnaire. Laboratory, imaging and muscle biopsy results were evaluated and possible sources of exposure, in particular water supply, were investigated. At an average of 9-11 days upon return from the retreat, 89 (97% of the participants became ill. A vast majority of 94% had fever with 57% of these persons experiencing relapsing fever. Myalgia was present in 91% of patients. Facial swelling from myositis of jaw muscles occurred in 9 (10% patients. The median duration of symptoms was 17 days (IQR 7 to 30 days; range 3 to 112. Out of 4 muscle biopsies, sarcocysts were identified in 3. S. nesbitti was identified by PCR in 3 of the 4 biopsies including one biopsy without observed sarcocyst. Non-Malaysians had a median duration of symptoms longer than that of Malaysians (27.5 days vs. 14 days, p = 0.001 and were more likely to experience moderate or severe myalgia compared to mild myalgia (83.3% vs. 40.0%, p = 0.002. CONCLUSIONS/SIGNIFICANCE: The similarity of the symptoms and clustered time of onset suggests that all affected persons had muscular sarcocystosis. This is the largest human outbreak of sarcocystosis ever reported, with the specific Sarcocystis species identified. The largely non-specific clinical features of this illness suggest that S. nesbitti may be an under diagnosed infection in the tropics.

  15. Sarcocystis nesbitti causes acute, relapsing febrile myositis with a high attack rate: description of a large outbreak of muscular sarcocystosis in Pangkor Island, Malaysia, 2012.

    Science.gov (United States)

    Italiano, Claire M; Wong, Kum Thong; AbuBakar, Sazaly; Lau, Yee Ling; Ramli, Norlisah; Syed Omar, Sharifah Faridah; Kahar Bador, Maria; Tan, Chong Tin

    2014-05-01

    From the 17th to 19th January 2012, a group of 92 college students and teachers attended a retreat in a hotel located on Pangkor Island, off the west coast of Peninsular Malaysia. Following the onset of symptoms in many participants who presented to our institute, an investigation was undertaken which ultimately identified Sarcocystis nesbitti as the cause of this outbreak. All retreat participants were identified, and clinical and epidemiological information was obtained via clinical review and self-reported answers to a structured questionnaire. Laboratory, imaging and muscle biopsy results were evaluated and possible sources of exposure, in particular water supply, were investigated. At an average of 9-11 days upon return from the retreat, 89 (97%) of the participants became ill. A vast majority of 94% had fever with 57% of these persons experiencing relapsing fever. Myalgia was present in 91% of patients. Facial swelling from myositis of jaw muscles occurred in 9 (10%) patients. The median duration of symptoms was 17 days (IQR 7 to 30 days; range 3 to 112). Out of 4 muscle biopsies, sarcocysts were identified in 3. S. nesbitti was identified by PCR in 3 of the 4 biopsies including one biopsy without observed sarcocyst. Non-Malaysians had a median duration of symptoms longer than that of Malaysians (27.5 days vs. 14 days, p = 0.001) and were more likely to experience moderate or severe myalgia compared to mild myalgia (83.3% vs. 40.0%, p = 0.002). The similarity of the symptoms and clustered time of onset suggests that all affected persons had muscular sarcocystosis. This is the largest human outbreak of sarcocystosis ever reported, with the specific Sarcocystis species identified. The largely non-specific clinical features of this illness suggest that S. nesbitti may be an under diagnosed infection in the tropics.

  16. Parental acceptance, postpartum depression, and maternal sensitivity: mediating and moderating processes.

    Science.gov (United States)

    Crockenberg, Susan C; Leerkes, Esther M

    2003-03-01

    Mothers (n = 92), fathers (n = 84), and their infants (60% male) participated in a longitudinal study of postpartum depression and maternal sensitivity. Mothers completed questionnaire measures of remembered parental acceptance, depressive symptoms, and infant distress to novelty and limits. Mothers and partners reported on marital aggression and avoidance. Maternal sensitivity was observed in the laboratory at 6 months. Characteristics of mothers, partners, and infants combined to predict postpartum depression and maternal sensitivity. Remembered parental rejection predicted postpartum depressive symptoms with prenatal depression controlled; self-esteem mediated this effect. Paternal acceptance buffered against postpartum depression when infants were highly reactive and when partners were aggressive. Paternal acceptance reduced the impact of postpartum depression on maternal sensitivity; having an aggressive marital partner exacerbated the effect.

  17. Recurrence due to Relapse or Reinfection With Mycobacterium tuberculosis: A Whole-Genome Sequencing Approach in a Large, Population-Based Cohort With a High HIV Infection Prevalence and Active Follow-up

    Science.gov (United States)

    Guerra-Assunção, José Afonso; Houben, Rein M. G. J.; Crampin, Amelia C.; Mzembe, Themba; Mallard, Kim; Coll, Francesc; Khan, Palwasha; Banda, Louis; Chiwaya, Arthur; Pereira, Rui P. A.; McNerney, Ruth; Harris, David; Parkhill, Julian; Clark, Taane G.; Glynn, Judith R.

    2015-01-01

    Background. Recurrent tuberculosis is a major health burden and may be due to relapse with the original strain or reinfection with a new strain. Methods. In a population-based study in northern Malawi, patients with tuberculosis diagnosed from 1996 to 2010 were actively followed after the end of treatment. Whole-genome sequencing with approximately 100-fold coverage was performed on all available cultures. Results of IS6110 restriction fragment-length polymorphism analyses were available for cultures performed up to 2008. Results. Based on our data, a difference of ≤10 single-nucleotide polymorphisms (SNPs) was used to define relapse, and a difference of >100 SNPs was used to define reinfection. There was no evidence of mixed infections among those classified as reinfections. Of 1471 patients, 139 had laboratory-confirmed recurrences: 55 had relapse, and 20 had reinfection; for 64 type of recurrence was unclassified. Almost all relapses occurred in the first 2 years. Human immunodeficiency virus infection was associated with reinfection but not relapse. Relapses were associated with isoniazid resistance, treatment before 2007, and lineage-3 strains. We identified several gene variants associated with relapse. Lineage-2 (Beijing) was overrepresented and lineage-1 underrepresented among the reinfecting strains (P = .004). Conclusions. While some of the factors determining recurrence depend on the patient and their treatment, differences in the Mycobacterium tuberculosis genome appear to have a role in both relapse and reinfection. PMID:25336729

  18. Causes of postpartum anoestrus in cattle in the tropics

    International Nuclear Information System (INIS)

    Hansel, W.; Alila, H.W.

    1984-01-01

    Prolonged postpartum anoestrus is a major cause of economic losses in cattle in most tropical countries. The length of the period from parturition to first oestrus varies greatly in cattle in the tropics and is influenced by many factors, including endocrine events, management, nutrition, heat and humidity, genetic-environmental interactions, diseases and internal and external parasites. Results of recent research on endocrinology of the postpartum cow are particularly relevant to the problem in tropical cattle. Development of a pulsatile pattern of pituitary luteinizing hormone (LH) secretion is necessary for induction of the first postpartum oestrus, and many cows undergo a short episode of elevated plasma progesterone levels immediately before the first oestrus. Adrenal corticosteroids inhibit development of the pulsatile pattern of LH secretion. The concept is developed that elevated levels of cortisol, resulting from the stresses of heat, high humidity, malnutrition, parasites and diseases to which tropical cattle are often exposed, contribute to anoestrus. Techniques developed for oestrous cycle synchronization of cyclic cattle have been found to induce first oestrus and a fertile ovulation in a significant percentage of anoestrous lactating beef cattle. These treatments involve short-term (6-7 day) progesterone treatments, followed by single injections of prostaglandin Fsub(2α) and insemination 80 hours later. Some success has also been achieved in shortening the postpartum interval by pulsatile administration of gonadotropin-releasing hormone which, in turn, causes pulsatile release of LH, and by administering progestational compounds for short periods of time. Improved management, particularly oestrus detection and insemination at the optimum time, could contribute greatly to reducing the postpartum interval in tropical cattle. Nutritional factors that result in reduced haemoglobin levels (trace mineral deficiencies and parasite infestations) also cause

  19. Relapse and Craving in Alcohol-Dependent Individuals: A Comparison of Self-Reported Determinants.

    Science.gov (United States)

    Snelleman, Michelle; Schoenmakers, Tim M; van de Mheen, Dike

    2018-06-07

    Negative affective states and alcohol-related stimuli increase risk of relapse in alcohol dependence. In research and in clinical practice, craving is often used as another important indicator of relapse, but this lacks a firm empirical foundation. The goal of the present study is to explore and compare determinants for relapse and craving, using Marlatt's (1996) taxonomy of high risk situations as a template. We conducted semi-structured interviews with 20 alcohol-dependent patients about their most recent relapse and craving episodes. Interview transcripts were carefully reviewed for their thematic content, and codes capturing the thematic content were formulated. In total, we formulated 42 relapse-related codes and 33 craving-related codes. Descriptions of craving episodes revealed that these episodes vary in frequency and intensity. The presence of alcohol-related stimuli (n = 11) and experiencing a negative emotional state (n = 11) were often occurring determinants of craving episodes. Both negative emotional states (n = 17) and testing personal control (n = 11) were viewed as important determinants of relapses. Craving was seldom mentioned as a determinant for relapse. Additionally, participants reported multiple determinants preceding a relapse, whereas craving episodes were preceded by only one determinant. Patient reports do not support the claim that craving by itself is an important proximal determinant for relapse. In addition, multiple determinants were present before a relapse. Therefore, future research should focus on a complexity of different determinants.

  20. Postpartum Depression among Women in Uyo, Akwa-Ibom State ...

    African Journals Online (AJOL)

    Abstract. Background Postpartum depression is a common psychiatric complication of childbearing among women. The increasing rate in addition to poor clinical diagnosis is attributable to poor health care services and inadequate medical attention. The implication is the high morbidity with adverse social and medical ...

  1. Prevention of relapsing backache

    Directory of Open Access Journals (Sweden)

    Raspe, Heiner

    2006-05-01

    Full Text Available Background: The condition of non-specific back pain is characterized by high prevalence, non satisfactory therapeutic options and severe socioeconomic consequences. Therefore prevention seems an attractive option to downsize the problem. However, the construction of effective preventive measures is complicated by the obscure aetiology of the condition, the multidimensionality of risk and prognostic factors (bio psychosocial model! and the variability of its natural as well as clinical course. This led to the development of a wide variety of preventive measures: e. g. exercise programs, educational measures (including back school, ergonomic modification of the work environment, mechanical supports (e. g. back belts as well as multidisciplinary interventions. For two reasons the workplace seems to be a suitable setting for prevention. First, because a number of strong risk factors are associated with working conditions and second, because it allows addressing a large proportion of the adult population. Against this background the assessment at hand sets out to answer the following questions: What is the amount and methodological quality of the available scientific literature on the effectiveness of back pain prevention in the workplace environment? What are effective measures for the prevention of back pain and its consequences in the workplace environment and how effective are they? Is back pain prevention in the workplace environment cost-effective? Is there a need for more research? As primary outcomes for effectiveness the assessment will focus on time lost from work and the frequency and duration of episodes with back pain. The preventive measures assessed belong to the following categories: exercise programs, educational and information measures, multidimensional interventions, back belts, lifting teams and ergonomic interventions. Methods: The assessment is based on a systematic review of the published literature according to the

  2. CHANGING PRESCRIBING CULTURE - A FOCUS ON CODEINE POSTPARTUM.

    Science.gov (United States)

    Al-Adhami, Noor; Whitfield, Karen; North, Angela

    2016-09-01

    To eliminate the prescribing of codeine and codeine combination products postpartum to improve safety in breast fed infants.Concerns have been raised over the use of codeine and codeine combination products during breast feeding after the death of a neonate whose mother had been prescribed codeine postpartum. High concentrations of morphine were found in the infant's blood and this was attributed to the mother being a CYP2D6 ultrafast metaboliser.1 METHODS: The evidence surrounding the safety of codeine and codeine combination products in children, during the postpartum period and specifically for breast fed infants was collated. The evidence was presented to key stakeholders including obstetricians, midwives, safety and quality representatives, nurse unit managers and acute pain team representatives. Postpartum analgesia was discussed and an agreed protocol developed. Training and education sessions were undertaken to obstetric medical and nursing staff. The evidence that was presented to key stakeholders included:▸ Reports over the safety concerns surrounding the use of codeine and codeine combination products during breast feeding▸ Guidelines and contraindications about the use of codeine in children that had been issued by international regulatory bodies (US Food and Drug Administration and European Medicines Agency).▸ Recommendations from the Australian Medicines Handbook to avoid in breast feeding2 ▸ Recommendations from Hale's Medications and Mothers Milk that reported limited data and had made a recent re-classification from L3 (limited data-probably compatible) to L4 (limited data-possibly hazardous).3 Before presenting the evidence to key stakeholders and undertaking training to nursing and medical staff, more than 90% of postpartum women were prescribed a codeine containing product as part of their 'as required' analgesic regimen.Since the intervention, codeine combination products have now been almost completely eliminated on medication

  3. Modern tactics of observation the postpartum purulent-septic complications

    Directory of Open Access Journals (Sweden)

    O. M. Slinko

    2014-04-01

    , laboratory, and additional methods (procalcitonin study contribute to the earliest possible diagnosis of purulent -septic complications in the postpartum period . 3. Upon receipt of objective data for developing postpartum purulent- septic complications of a woman in labor is subject to immediate transfer to specialized hospitals of the 3rd levels of care. Optimal time transfer is 2-3 days postpartum. 4. Identifying patients with medium and high risk of developing of the pyo-septic complications should be performed on the stage and antenatal clinic surveillance in the family doctor. postpartum purulent-septic complications; diagnosis' treatment; gynecological department of Zaporozhye Regional Clinical Hospital

  4. Postpartum depression, suicidality, and mother-infant interactions.

    Science.gov (United States)

    Paris, Ruth; Bolton, Rendelle E; Weinberg, M Katherine

    2009-10-01

    To date, few studies have examined suicidality in women with postpartum depression. Reports of suicidal ideation in postpartum women have varied (Lindahl et al. Arch Womens Ment Health 8:77-87, 2005), and no known studies have examined the relationship between suicidality and mother-infant interactions. This study utilizes baseline data from a multi-method evaluation of a home-based psychotherapy for women with postpartum depression and their infants to examine the phenomenon of suicidality and its relationship to maternal mood, perceptions, and mother-infant interactions. Overall, women in this clinical sample (n = 32) had wide ranging levels of suicidal thinking. When divided into low and high groups, the mothers with high suicidality experienced greater mood disturbances, cognitive distortions, and severity of postpartum symptomotology. They also had lower maternal self-esteem, more negative perceptions of the mother-infant relationship, and greater parenting stress. During observer-rated mother-infant interactions, women with high suicidality were less sensitive and responsive to their infants' cues, and their infants demonstrated less positive affect and involvement with their mothers. Implications for clinical practice and future research directions are discussed.

  5. Pengobatan Perilaku Kognitif untuk Depresi Postpartum

    Directory of Open Access Journals (Sweden)

    Bina Melvia Girsang

    2013-08-01

    Full Text Available Sebagian besar wanita mengalami gangguan emosional setelah melahirkan seperti depresi, mudah marah, terutama mudah frustasi serta emosional. Gangguan mood selama periode postpartum paling sering terjadi pada wanita primipara dan multipara. Penelitian ini bertujuan menilai pengaruh penerapan pengobatan perilaku kognitif (cognitive behavior therapy untuk mengatasi depresi postpartum di ruang kebidanan Rumah Sakit Bhayangkara Palembang. Penelitian ini menggunakan desain studi kuasi eksperimen dengan non equivalent control group. Sampel yang diambil dengan metode purposive sampling berjumlah 30 ibu postpartum yang terdiri dari 15 orang kelompok perlakuan dan 15 orang kelompok kontrol. Penelitian ini menemukan rata-rata perbedaan depresi pada ibu postpartum yang diintervensi dengan ibu postpartum yang tidak diintervensi adalah 0,15, standar deviasi adalah 0,724, dan pada nilai t sebesar 3,56, dan nilai p = 0,003. Ada perbedaan depresi postpartum pada ibu yang dilakukan intervensi terapi pengobatan perilaku kognitif dan yang tidak. Temuan ini memerlukan penerapan penyuluhan kesehatan khususnya melalui terapi cognitive behavior dengan memberikan informasi tentang pencegahan depresi postpartum pada saat pemeriksaan kehamilan trimester I, II, dan III dan setelah tiga hari melahirkan untuk mencegah dan mengatasi depresi postpartum. In general, most women experience postpartum emotional disturbances, depression, irritable, easily frustrated and emotional especially. Mood disorders during the postpartum period is one of the most common disorders in both primiparous and multiparous women. This study aimed to analyze the effect of the application of cognitive behavioral intervention therapy (CBT in overcoming postpartum depression in Space Obstetrics Hospital Bhayangkara, Palembang. This study was conducted with a quasi experiment (quasi-experimental, using the draft non equivalent control group. The sample study of postpartum mothers 30 respectively 15

  6. The Cost of Relapse in Schizophrenia.

    Science.gov (United States)

    Pennington, Mark; McCrone, Paul

    2017-09-01

    Schizophrenia is a chronic and debilitating mental illness characterised by periods of relapse that require resource intensive management. Quantifying the cost of relapse is central to the evaluation of the cost effectiveness of treating schizophrenia. We aimed to undertake a comprehensive search of the available literature on the cost of relapse. We performed a search on multiple databases (MEDLINE, Embase, PsycINFO and Health Management Information Consortium) for any study reporting a cost of relapse or data from which such a cost could be calculated. Costs are reported in 2015 international dollars. We found 16 studies reporting costs associated with relapse over a defined period of time and identified a cost associated with hospitalisation for relapse in 43 studies. Eight clinical decision analyses also provided cost estimates. Studies from the US report excess costs of relapse of $6033-$32,753 (2015 Purchasing Power Parity dollars [PPP$]) over periods of 12-15 months. European studies report excess costs of $8665-$18,676 (2015 PPP$) over periods of 6-12 months. Estimates of the cost of hospitalisation for relapse are more diverse, and associated with marked differences in typical length of stay across jurisdictions. Wide ranges in the estimated cost of relapse may reflect differences in sample section and relapse definition as well as practice styles and differences in resource costs. Selection of the most appropriate cost estimate should be guided by the definition of relapse and the analysis setting.

  7. Depression During Pregnancy and Postpartum.

    Science.gov (United States)

    Becker, Madeleine; Weinberger, Tal; Chandy, Ann; Schmukler, Sarah

    2016-03-01

    Depression is a common complication of pregnancy and the postpartum period. There are multiple risk factors for peripartum mood disorders, most important of which is a prior history of depression. Both depression and antidepressant medications confer risk upon the infant. Maternal depression has been associated with preterm birth, low birth weight, fetal growth restriction, and postnatal cognitive and emotional complications. Antidepressant exposure has been associated with preterm birth, reductions in birth weight, persistent pulmonary hypertension, and postnatal adaptation syndrome (PNAS) as well as a possible connection with autism spectrum disorder. Paroxetine has been associated with cardiac malformations. Most antidepressant medications are excreted in low levels in breast milk and are generally compatible with breastfeeding. The use of antidepressants during pregnancy and postpartum must be weighed against the risk of untreated depression in the mother.

  8. A simple risk scoring system for prediction of relapse after inpatient alcohol treatment.

    Science.gov (United States)

    Pedersen, Mads Uffe; Hesse, Morten

    2009-01-01

    Predicting relapse after alcoholism treatment can be useful in targeting patients for aftercare services. However, a valid and practical instrument for predicting relapse risk does not exist. Based on a prospective study of alcoholism treatment, we developed the Risk of Alcoholic Relapse Scale (RARS) using items taken from the Addiction Severity Index and some basic demographic information. The RARS was cross-validated using two non-overlapping samples, and tested for its ability to predict relapse across different models of treatment. The RARS predicted relapse to drinking within 6 months after alcoholism treatment in both the original and the validation sample, and in a second validation sample it predicted admission to new treatment 3 years after treatment. The RARS can identify patients at high risk of relapse who need extra aftercare and support after treatment.

  9. Relapse Prevention: An Overview of Marlatts Cognitive- Behavioral Model

    Directory of Open Access Journals (Sweden)

    2008-11-01

    Full Text Available Relapse prevention(RPis an important component of alcoholism treatment. The RP model proposed by Marlatt and Gordon suggests that both immediate determinants (e.g.,high- risk situations, coping skills, outcome expectancies, and the abstinence violation effect and covert antecedents (e.g., lifestyle factor and urges and cravings can contribute to relapse.The RP model also incorporates numerous specific and global intervention strategies that allow therapist and client to address each step of the relapse process. Specific interventions include identifying specific high-risk situations for each client and enhancing the client's skills for coping with those situations, increasing the client's self- efficacy, eliminating myths regarding alcohol's effects, managing lapses, and restructuring the client's perceptions of the relapse process. Global strategies comprise balancing the client's lifestyle and helping him or her develop positive addictions, employing stimulus control techniques and urgemanagement techniques, and developing relapse road maps. Several studies have provided theoretical and practical support for the RP model.

  10. Temporal changes in incidence and pattern of central nervous system relapses in children with acute lymphoblastic leukaemia treated on four consecutive Medical Research Council Trials, 1985–2001

    Science.gov (United States)

    Krishnan, Shekhar; Wade, Rachel; Moorman, Anthony V; Mitchell, Chris; Kinsey, Sally E; Eden, TOB; Parker, Catriona; Vora, Ajay; Richards, Sue; Saha, Vaskar

    2009-01-01

    Despite the success of contemporary treatment protocols in childhood acute lymphoblastic leukaemia (ALL), relapse within the central nervous system (CNS) remains a challenge. To better understand this phenomenon, we have analysed the changes in incidence and pattern of CNS relapses in 5564 children enrolled on four successive MRC-ALL trials between 1985 and 2001. Changes in the incidence and pattern of CNS relapses were examined and the relationship with patient characteristics assessed. Factors affecting post-relapse outcome were determined. Overall, relapses declined by 49%. Decreases occurred primarily in non-CNS and combined relapses with a progressive shift towards later (≥30 months from diagnosis) relapses (p<0·0001). Although isolated CNS relapses declined, the proportional incidence and timing of relapse remained unchanged. Age and presenting white cell count were risk factors for CNS relapse. On multivariate analysis, the time to relapse and the trial period influenced post-relapse outcomes. Relapse trends differed within biological subtypes. In ETV6-RUNX1 ALL, relapse patterns mirrored overall trends while in High Hyperdiploidy ALL, these appear to have plateaued over the latter two trial periods. Intensive systemic and intrathecal chemotherapy have decreased the overall CNS relapse rates and changed the patterns of recurrence. The heterogeneity of therapeutic response in the biological subtypes suggests room for further optimisation using currently available chemotherapy. PMID:20016529

  11. Heterogeneity of postpartum depression: a latent class analysis

    NARCIS (Netherlands)

    Putnam, K.; Robertson-Blackmore, E.; Sharkey, K.; Payne, J.; Bergink, V.; Munk-Olsen, T.; Deligiannidis, K.; Altemus, M.; Newport, J.; Apter, G.; Devouche, E.; Vikorin, A.; Magnusson, P.; Lichtenstein, P.; Penninx, B.W.J.H.; Buist, A.; Bilszta, J.; O'Hara, M.; Stuart, S.; Brock, R.; Roza, S.; Tiemeier, H.; Guille, C.; Epperson, C.N.; Kim, D.; Schmidt, P.; Martinez, P.; Wisner, K.L.; Stowe, Z.; Jones, I.; Rubinow, D.; Sullivan, P.; Meltzer-Brody, S.

    2015-01-01

    Background: Maternal depression in the postpartum period confers substantial morbidity and mortality, but the definition of postpartum depression remains controversial. We investigated the heterogeneity of symptoms with the aim of identifying clinical subtypes of postpartum depression. Methods: Data

  12. Relationship Between Postpartum Depression and Psychological and Biological Variables in the Initial Postpartum Period.

    Science.gov (United States)

    Marín-Morales, Dolores; Toro-Molina, Susana; Peñacoba-Puente, Cecilia; Losa-Iglesias, Marta; Carmona-Monge, Francisco Javier

    2018-06-01

    Objectives The aims of this study were to evaluate the predictive relationship between psychological symptomatology 24 h postpartum and depression 4 months postpartum, and analyze the relationship between estradiol and postpartum mood. Methods Two hundred women participated in an assessment 24 h postpartum and gave a blood sample for estradiol analysis. One hundred eleven of these women completed the second assessment 4 months postpartum. The Beck Depression Inventory II and the Scale of State-Trait Anxiety were used to assess psychological symptoms. Results At 24 h postpartum, symptoms of depression, trait anxiety, and state anxiety were all significantly correlated with each other. Depression at 24 h postpartum was the only significant independent predictor of depression at 4 months postpartum, explaining 28.7% of the variance. No statistically significant relationship was found between levels of estradiol and mood. Symptoms of depression immediately postpartum thus appear to be a predictor of postpartum depression. Conclusions for Practice These results suggest that early postpartum psychological evaluation of the mother, and intervention as warranted, might prevent or lessen postpartum depression.

  13. An assessment of hair cortisol among postpartum Brazilian mothers and infants from a high-risk community in São Paulo: Intra-individual stability and association in mother-infant dyads.

    Science.gov (United States)

    Liu, Cindy H; Fink, Günther; Brentani, Helena; Brentani, Alexandra

    2017-11-01

    This study examined maternal-infant synchrony of hair cortisol at 12 months after birth and the intra-individual stability of maternal hair cortisol in the postpartum period. Participants were selected from an ongoing São Paulo birth cohort project, where families are considered to be "high-risk" due to their chronic stress experiences, with the majority living in slums (favelas). Cortisol was collected through 3-cm segments of hair samples, with values representing approximate levels of cortisol from 9 to 12 months for mothers and children and 6 to 12 months for mothers. Maternal and infant cortisol values reflecting chronic stress 9-12 months after birth were highly correlated (r = .61, p cortisol levels (6-9 months) and child cortisol levels at 9-12 months (r = .51, p cortisol values showed stability over time (r = .79, p cortisol in other mother-child dyads, suggesting stronger synchrony under high-risk contexts where families are faced with challenging circumstances. © 2017 Wiley Periodicals, Inc.

  14. Obstetric Emergencies: Shoulder Dystocia and Postpartum Hemorrhage.

    Science.gov (United States)

    Dahlke, Joshua D; Bhalwal, Asha; Chauhan, Suneet P

    2017-06-01

    Shoulder dystocia and postpartum hemorrhage represent two of the most common emergencies faced in obstetric clinical practice, both requiring prompt recognition and management to avoid significant morbidity or mortality. Shoulder dystocia is an uncommon, unpredictable, and unpreventable obstetric emergency and can be managed with appropriate intervention. Postpartum hemorrhage occurs more commonly and carries significant risk of maternal morbidity. Institutional protocols and algorithms for the prevention and management of shoulder dystocia and postpartum hemorrhage have become mainstays for clinicians. The goal of this review is to summarize the diagnosis, incidence, risk factors, and management of shoulder dystocia and postpartum hemorrhage. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Postpartum depression: the role of self-esteem, social support and age

    African Journals Online (AJOL)

    These findings underscores the importance of assessing postpartum women for depression. There is ... Thus integration into social networks and provision of high levels of social support are key to mental health, well-being and improved ...

  16. Inside a Postpartum Nursing Center: Tradition and Change

    Directory of Open Access Journals (Sweden)

    Yueh-Chen Yeh, RN, MSN, PhD

    2016-06-01

    Conclusions: Social changes have an influence on traditional postpartum ritual practices so a postpartum nursing center becomes a choice for postpartum women. Thus, health care professionals should value their own functions and roles at the postpartum nursing center since the new mothers regard them as the primary support resource to help them recover from giving birth. Therefore, they need to re-examine their practices from the postpartum women's perspective to provide better support and sensitive care to postpartum women and their families.

  17. Perinatal western-type diet and associated gestational weight gain alter postpartum maternal mood.

    Science.gov (United States)

    Bolton, Jessica L; Wiley, Melanie G; Ryan, Bailey; Truong, Samantha; Strait, Melva; Baker, Dana Creighton; Yang, Nancy Y; Ilkayeva, Olga; O'Connell, Thomas M; Wroth, Shelley W; Sánchez, Cristina L; Swamy, Geeta; Newgard, Christopher; Kuhn, Cynthia; Bilbo, Staci D; Simmons, Leigh Ann

    2017-10-01

    The role of perinatal diet in postpartum maternal mood disorders, including depression and anxiety, remains unclear. We investigated whether perinatal consumption of a Western-type diet (high in fat and branched-chain amino acids [BCAA]) and associated gestational weight gain (GWG) cause serotonin dysregulation in the central nervous system (CNS), resulting in postpartum depression and anxiety (PPD/A). Mouse dams were fed one of four diets (high-fat/high BCAA, low-fat/high BCAA, high-fat, and low-fat) prior to mating and throughout gestation and lactation. Postpartum behavioral assessments were conducted, and plasma and brain tissues assayed. To evaluate potential clinical utility, we conducted preliminary human studies using data from an extant sample of 17 primiparous women with high GWG, comparing across self-reported postpartum mood symptoms using the Edinburgh Postnatal Depression Scale (EPDS) for percent GWG and plasma amino acid levels. Mouse dams fed the high-fat/high BCAA diet gained more weight per kcal consumed, and BCAA-supplemented dams lost weight more slowly postpartum. Dams on BCAA-supplemented diets exhibited increased PPD/A-like behavior, decreased dopaminergic function, and decreased plasma tyrosine and histidine levels when assessed on postnatal day (P)8. Preliminary human data showed that GWG accounted for 29% of the variance in EPDS scores. Histidine was also lower in women with higher EPDS scores. These findings highlight the role of perinatal diet and excess GWG in the development of postpartum mood disorders.

  18. Prevalence of and Risk Factors for Depressive Symptoms in Korean Women throughout Pregnancy and in Postpartum Period.

    Science.gov (United States)

    Park, Jeong-Hwan; Karmaus, Wilfried; Zhang, Hongmei

    2015-09-01

    Prenatal depression is a significant predictor for postpartum depression. However, there is a lack of research on risk factors for Korean women related to prenatal depression and the relationship between prenatal depression during the three trimesters and postpartum depression. Therefore, aims of this study were (1) to identify the prevalence of depression during all three trimesters and the postpartum period, (2) to evaluate the relationship between prenatal depression in each trimester and postpartum depression, and (3) to identify the relationship and differences in prenatal depression based on sociodemographic factors in Korean women. One hundred and fifty three Korean women were recruited from three maternity clinics in Korea. Prenatal and postpartum depressions were evaluated in the first, second (24-26 weeks), third (32-34 weeks) trimester and 4 weeks postpartum with the Edinburgh Postnatal Depression Scale-Korean. The prevalence of depression in the prenatal and postpartum period ranged from 40.5% to 61.4%. Depression in the second and the third trimester was significantly correlated with depression in the postpartum period. Unemployment and household income were risk factors for prenatal depression in the first and second trimesters. To assist women suffering from postpartum depression and prevent its effects, women should be screened for prenatal depression during all three trimesters. For Korean women with high risk factors for prenatal depression, we suggest that the Korean government establish healthcare policies related to depression screening as routine prenatal care and mental health referral systems. Copyright © 2015. Published by Elsevier B.V.

  19. Longitudinal change in sleep and daytime sleepiness in postpartum women.

    Directory of Open Access Journals (Sweden)

    Ashleigh J Filtness

    Full Text Available Sleep disruption strongly influences daytime functioning; resultant sleepiness is recognised as a contributing risk-factor for individuals performing critical and dangerous tasks. While the relationship between sleep and sleepiness has been heavily investigated in the vulnerable sub-populations of shift workers and patients with sleep disorders, postpartum women have been comparatively overlooked. Thirty-three healthy, postpartum women recorded every episode of sleep and wake each day during postpartum weeks 6, 12 and 18. Although repeated measures analysis revealed there was no significant difference in the amount of nocturnal sleep and frequency of night-time wakings, there was a significant reduction in sleep disruption, due to fewer minutes of wake after sleep onset. Subjective sleepiness was measured each day using the Karolinska Sleepiness Scale; at the two earlier time points this was significantly correlated with sleep quality but not to sleep quantity. Epworth Sleepiness Scores significantly reduced over time; however, during week 18 over 50% of participants were still experiencing excessive daytime sleepiness (Epworth Sleepiness Score ≥12. Results have implications for health care providers and policy makers. Health care providers designing interventions to address sleepiness in new mothers should take into account the dynamic changes to sleep and sleepiness during this initial postpartum period. Policy makers developing regulations for parental leave entitlements should take into consideration the high prevalence of excessive daytime sleepiness experienced by new mothers, ensuring enough opportunity for daytime sleepiness to diminish to a manageable level prior to reengagement in the workforce.

  20. The Relationship between the Level of Religious Attitudes and Postpartum Blues among Pregnant Women

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    Tahereh Mokhtaryan

    2016-04-01

    Full Text Available Postpartum blues, as a transient phenomenon of mood changes, generally begins 1 to 3 days after the child birth.1 This phenomenon is accompanied with symptoms such as unstable moods, ranging from euphoria to sadness, high sensitivity, crying for no reason, restlessness, poor concentration, anxiety, irritability, and anger.2 Prevalence of postpartum blues has been estimated 44.3% in Hong- Kong,3 31.3% in Nigeria,2 and 58% in India.4 In Iran, 22.3% of women suffer from weak postpartum blues, 10.8% have medium, and 21.1% suffer from severe postpartum blues.5 Interaction between different biological, psychological and social factors could affect the postpartum blues.6 Some researchers have indicated that there is a reverse relationship between religion related beliefs and spiritual attitudes, participation in religious activities and reduction of pregnancy and postpartum anxiety and depression.7 Also, according to another study, 57% of the doctors believe that praying could enhance the healing effect of treatment.8 However, some other studies reject this idea.9-10 In this cross-sectional study conducted in selected prenatal clinics of Tehran University of Medical Sciences in 2013, 176 healthy pregnant women aged 18-35 years old participated. For assessment of postpartum blues, standard questionnaire of Edinburg Postnatal Depression Scale (EPDS11 and Religious Attitude Scale (RAS-R containing 25 questions with a Cronbach’s alpha of 0.954 in Iran were used.12

  1. Topotecan in the treatment of relapsed small cell lung cancer

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    Elisabeth Quoix

    2008-12-01

    Full Text Available Elisabeth QuoixService de Pneumologie, Hôpitaux Universitaires, Strasbourg, FranceAbstract: Small cell lung cancer (SCLC represents about 15% to 20% of all lung cancers. Chemotherapy is the cornerstone of the treatment, cisplatin–etoposide combination being the most used combination as first-line therapy. Despite high initial chemosensitivity, most SCLC patients will experience relapse sooner or later. Unfortunately, second-line chemotherapy does not result in a high response rate like first-line therapy, most patients having developed wide chemoresistance. This chemoresistance is far more important in refractory patients, ie, those who never responded to first-line therapy or who relapsed within 3 months after the end of chemotherapy, than in sensitive patients, ie, those who relapse more than 3 months after the end of chemotherapy. Topotecan, a topoisomerase I inhibitor, is the most studied drug in this second-line setting and has proved its efficacy as a single agent and in combination. A phase III trial comparing oral topotecan to best supportive care (BSC in relapsed SCLC demonstrated a significant survival benefit as well as a better quality of life. Although the usual schedule is 1.5 mg/m2, days 1–5 intravenously, it is not convenient for patients with relapsed SCLC, especially those who are refractory because of their short survival expectation. Oral topotecan is of similar efficacy and much more convenient with limited stay in a treatment unit and has a comparable toxicity profile for these patients with short expected survival. Combination of topotecan with platinum salts or taxanes does not seem to improve further the outcome of the patients and thus single-agent therapy with topotecan is the standard treatment for relapsed SCLC.Keywords: topotecan, small cell lung cancer, chemoresistance

  2. Traditional Belief and Practice on Postpartum Recovery among Mothers in East Coast of Peninsular Malaysia

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    Abdul Ghani Radiah

    2018-01-01

    Full Text Available Postpartum care is highly important to prevent maternal and infant morbidity. In Malaysia, there are several traditional postpartum care practices by mothers. Different states adopted different ways to perform those practices. In spite of long and established practices in Malaysia, its effect and safety profile is not well understood. This study aims to gain an understanding of the traditional practices that Malay women follow in relation to postpartum care and the rationales underpinning such practices. A cross sectional study (n=100 was conducted using self-administered questionnaire consists of demographic information, practice of postpartum care and knowledge of postpartum care. Data was analyzed using Statistical Package Social Software (2.0. The findings shown that, there was no significant association of socio-demographic data with confinement period (p>0.05. For postpartum dietary practice, there were only association between age and encourage more water intake (p=0.047, p<0.05 and also between number of children and prohibit greasy food (p=0.032, p<0.05. For association between socio-demographic data and postpartum physical practice, there was only association between age and body scrub (p=0.046, p<0.05. The most significant factor that influenced postpartum care practice and its knowledge was family tradition with 83% and 97%, respectively. Traditional postpartum care practice is still significant and dominant among mothers in Kuantan, Pahang. This information is important for health care professional to educate women and provide strategies to help them to integrate their beliefs and the practices recommended in contemporary health care practice.

  3. Maternal childhood trauma, postpartum depression, and infant outcomes: Avoidant affective processing as a potential mechanism.

    Science.gov (United States)

    Choi, Karmel W; Sikkema, Kathleen J; Vythilingum, Bavi; Geerts, Lut; Faure, Sheila C; Watt, Melissa H; Roos, Annerine; Stein, Dan J

    2017-03-15

    Women who have experienced childhood trauma may be at risk for postpartum depression, increasing the likelihood of negative outcomes among their children. Predictive pathways from maternal childhood trauma to child outcomes, as mediated by postpartum depression, require investigation. A longitudinal sample of South African women (N=150) was followed through pregnancy and postpartum. Measures included maternal trauma history reported during pregnancy; postpartum depression through six months; and maternal-infant bonding, infant development, and infant physical growth at one year. Structural equation models tested postpartum depression as a mediator between maternal experiences of childhood trauma and children's outcomes. A subset of women (N=33) also participated in a lab-based emotional Stroop paradigm, and their responses to fearful stimuli at six weeks were explored as a potential mechanism linking maternal childhood trauma, postpartum depression, and child outcomes. Women with childhood trauma experienced greater depressive symptoms through six months postpartum, which then predicted negative child outcomes at one year. Mediating effects of postpartum depression were significant, and persisted for maternal-infant bonding and infant growth after controlling for covariates and antenatal distress. Maternal avoidance of fearful stimuli emerged as a potential affective mechanism. Limitations included modest sample size, self-report measures, and unmeasured potential confounders. Findings suggest a mediating role of postpartum depression in the intergenerational transmission of negative outcomes. Perinatal interventions that address maternal trauma histories and depression, as well as underlying affective mechanisms, may help interrupt cycles of disadvantage, particularly in high-trauma settings such as South Africa. Copyright © 2017. Published by Elsevier B.V.

  4. Traditional Postpartum Practices Among Malaysian Mothers: A Review.

    Science.gov (United States)

    Fadzil, Fariza; Shamsuddin, Khadijah; Wan Puteh, Sharifa Ezat

    2016-07-01

    To briefly describe the postpartum practices among the three major ethnic groups in Malaysia and to identify commonalities in their traditional postpartum beliefs and practices. This narrative review collated information on traditional postpartum practices among Malaysian mothers through a literature search for published research papers on traditional postpartum practices in Malaysia. This review shows that Malaysian mothers have certain postpartum practices that they considered to be important for preventing future ill health. Despite the perceived differences in intra-ethnic postpartum practices, most Malaysian mothers, although from different ethnicities, share similarities in their postpartum regimens and practices in terms of beliefs and adherence to food taboos, use of traditional postpartum massage and traditional herbs, and acknowledgment of the role of older female family members in postpartum care. Health care providers should be aware of multiethnic traditional postpartum practices and use the commonalities in these practices as part of their postpartum care regimen.

  5. Measurement of illumination exposure in postpartum women

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    Stein Martin T

    2003-05-01

    Full Text Available Abstract Background Low levels of light exposure at critical times are thought to cause seasonal affective disorder. Investigators, in studies demonstrating the usefulness of bright light therapy, also have implicated light's role in non-seasonal depression. The precise cause of postpartum depression has not been delineated, but it seemed possible that new mothers would spend reduced time in daylight. The goal of this study was to examine the levels of illumination experienced by postpartum mothers and to discover any relationship between light exposure and mood levels experienced during the postpartum period. Methods Fifteen postpartum women, who did not have any baseline indication of depression, wore a wrist device (Actillume for 72 hours to measure their exposure to light. At the end of the recording period, they completed a self-reported measure of mood. The mean light exposure of these postpartum women (expressed as the 24-hour average logarithm of illumination in lux was compared with that of a representative sample of women of comparable age, residence, and seasonal months of recording. Mood levels were then rank-ordered and tested for correlation with light exposure levels. Results There was no significant difference between the amount of light [log10lux] experienced by postpartum (1.01 SD 0.236 and control women (1.06 SD 0.285. Mood was not correlated with illumination in the postpartum sample. Conclusions Postpartum women in San Diego did not receive reduced light, nor was low mood related to low illumination.

  6. Use of Postpartum Care: Predictors and Barriers

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    Jessica N. DiBari

    2014-01-01

    Full Text Available This study aimed to identify actual and perceived barriers to postpartum care among a probability sample of women who gave birth in Los Angeles County, California in 2007. Survey data from the 2007 Los Angeles Mommy and Baby (LAMB study (N = 4,075 were used to identify predictors and barriers to postpartum care use. The LAMB study was a cross-sectional, population-based study that examined maternal and child health outcomes during the preconception, prenatal, and postpartum periods. Multivariable analyses identified low income, being separated/divorced and never married, trying hard to get pregnant or trying to prevent pregnancy, Medi-Cal insurance holders, and lack of prenatal care to be risk factors of postpartum care nonuse, while Hispanic ethnicity was protective. The most commonly reported barriers to postpartum care use were feeling fine, being too busy with the baby, having other things going on, and a lack of need. Findings from this study can inform the development of interventions targeting subgroups at risk for not obtaining postpartum care. Community education and improved access to care can further increase the acceptability of postpartum visits and contribute to improvements in women’s health. Postpartum care can serve as a gateway to engage underserved populations in the continuum of women’s health care.

  7. Post-partum reproductive performance of the Icelandic dairy cow

    International Nuclear Information System (INIS)

    Eldon, J.; Olafsson, T.; Thorsteinsson, T.

    1990-01-01

    The aim of the studies was to monitor the reproductive performance of Icelandic dairy cow herds with and without histories of fertility problems under normal farming conditions. Artificial inseminations and calvings were recorded, pregnancy was diagnosed by rectal palpation, and progesterone concentration was measured by radioimmunoassay in sequential samples of milk. Blood samples were collected at regular intervals and the concentrations of glucose, urea, calcium and magnesium were determined. Clinical ketosis and low glucose were found in one third of the cows on problem farms. The mean time of first post-partum ovulation was 49 days for cows with ketosis, compared with 34 days for cows free of ketosis. Cows in the normal herds ovulated considerably later than is reported for many other breeds of dairy cows; however, the time of first post-partum AI, the time of conception and the conception rate were similar to those reported for other breeds. The effects of season and herd were statistically significant for the time of first post-partum ovulation, AI and conception; the effect of area was highly significant for the time of ovulation. Progesterone profiles showed that over 50% of the first post-partum ovarian cycles were short and had low progesterone concentrations. Season had significant effects on the length of the interval from calving to first post-partum ovulation, AI and conception, on the conception rate to first AI and consequently on the number of AIs per conception, and on the blood levels of glucose, urea and calcium. (author). 28 refs, 3 figs, 3 tabs

  8. Stability of depressive symptoms over 3 months post-partum.

    Science.gov (United States)

    Abdollahi, Fatemeh; Zarghami, Mehran; Sazlina, Shariff-Ghazali; Lye, Munn-Sann

    2017-02-01

    Prolonged depression during the post-partum period is associated with maternal and infant mortality and morbidity. Less attention has been given to factors that predict the persistence of depression beyond the first 3 months post-partum. From a longitudinal cohort of 2279 women who attended Mazandaran's primary health centres in 2009, 478 women with an Edinburgh Postnatal Depression Scale (EPDS) score of 12 or greater in the third trimester of pregnancy were recruited. Persistently depressed women (depressed at all three occasions: during pregnancy, and at 2 and 12 weeks post-partum) were compared with those without depression to determine demographic, cultural, obstetric and biopsychosocial predictors for persistence of depression. Data were analysed using chi-square test, t-test and logistic regression models. The stability of depression was found in 193 (46.2 %) of 418 depressed cases who were followed up over the study period. Of those mothers who scored more than the threshold of 12 during the third trimester of pregnancy, 277 (66.3%) and 221 (52.9%) had high EPDS at 2 and 12 weeks post-partum. Psychological distress (based upon the General Health Questionnaire), low maternal parental self-efficacy (based upon the Parental Expectation Survey) and perceived social isolation (based upon the Network Orientation Scale) were independent predictors of persistent depression. Fewer depressed mothers in this study were found to recover during the first 3 months after giving birth. Psychosocial factors predicted sustained depression from pregnancy to 3 months post-partum. The findings highlight the significance of support in enhancing maternal mental health. © 2015 Wiley Publishing Asia Pty Ltd.

  9. CAR-T cells and allogeneic hematopoietic stem cell transplantation for relapsed/refractory B-cell acute lymphoblastic leukemia.

    Science.gov (United States)

    Liu, Jun; Zhang, Xi; Zhong, Jiang F; Zhang, Cheng

    2017-10-01

    Relapsed/refractory acute lymphoblastic leukemia (ALL) has a low remission rate after chemotherapy, a high relapse rate and poor long-term survival even when allogeneic hematopoietic stem cell transplantation (allo-HSCT) is performed. Chimeric antigen receptors redirected T cells (CAR-T cells) can enhance disease remission with a favorable outcome for relapsed/refractory ALL, though some cases quickly relapsed after CAR-T cell treatment. Thus, treatment with CAR-T cells followed by allo-HSCT may be the best way to treat relapsed/refractory ALL. In this review, we first discuss the different types of CAR-T cells. We then discuss the treatment of relapsed/refractory ALL using only CAR-T cells. Finally, we discuss the use of CAR-T cells, followed by allo-HSCT, for the treatment of relapsed/refractory ALL.

  10. Sigmoid Volvulus Complicating Postpartum Period

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    Kelsey E. Ward

    2017-01-01

    Full Text Available Background. Sigmoid volvulus is a rare complication of pregnancy and the puerperium. Case. A 19-year-old patient, gravida 1 para 0 at 41 0/7 weeks of gestation, admitted for late-term induction of labor underwent an uncomplicated primary low transverse cesarean delivery for arrest of descent. Her postoperative period was complicated by sudden onset of abdominal pain and the ultimate diagnosis of sigmoid volvulus. Conclusion. Prompt surgical evaluation of an acute abdomen in the postpartum period is essential; delayed diagnosis and treatment can lead to significant maternal morbidity and mortality.

  11. Treatment-related mortality in relapsed childhood acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Oskarsson, Trausti; Söderhäll, Stefan; Arvidson, Johan

    2018-01-01

    BACKGROUND: Treatment of relapsed childhood acute lymphoblastic leukemia (ALL) is particularly challenging due to the high treatment intensity needed to induce and sustain a second remission. To improve results, it is important to understand how treatment-related toxicity impacts survival...

  12. Predictors of marijuana relapse in the human laboratory: robust impact of tobacco cigarette smoking status.

    Science.gov (United States)

    Haney, Margaret; Bedi, Gillinder; Cooper, Ziva D; Glass, Andrew; Vosburg, Suzanne K; Comer, Sandra D; Foltin, Richard W

    2013-02-01

    Few marijuana smokers in treatment achieve sustained abstinence, yet factors contributing to high relapse rates are unknown. Study 1: data from five inpatient laboratory studies assessing marijuana intoxication, withdrawal, and relapse were combined to assess factors predicting the likelihood and severity of relapse. Daily, nontreatment-seeking marijuana smokers (n = 51; 10 ± 5 marijuana cigarettes/day) were enrolled. Study 2: to isolate the effects of cigarette smoking, marijuana intoxication, withdrawal, and relapse were assessed in daily marijuana and cigarette smokers (n = 15) under two within-subject, counter-balanced conditions: while smoking tobacco cigarettes as usual (SAU), and after at least 5 days without cigarettes (Quit). Study 1: 49% of participants relapsed the first day active marijuana became available. Tobacco cigarette smokers (75%), who were not abstaining from cigarettes, were far more likely to relapse than non-cigarette smokers (odds ratio: 19, p marijuana administration and those with more negative affect and sleep disruption during marijuana withdrawal were more likely to have severe relapse episodes (p 87%) relapsed to marijuana whether in the SAU or Quit phase. Tobacco cigarette smoking did not significantly influence relapse, nor did it affect marijuana intoxication or most symptoms of withdrawal relative to tobacco cessation. Daily marijuana smokers who also smoke cigarettes have high rates of marijuana relapse, and cigarette smoking versus recent abstinence does not directly influence this association. These data indicate that current cigarette smoking is a clinically important marker for increased risk of marijuana relapse. Copyright © 2013 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

  13. Preventing urinary incontinence during pregnancy and postpartum

    DEFF Research Database (Denmark)

    Wesnes, Stian Langeland; Lose, Gunnar

    2013-01-01

    focus is on pelvic floor muscle training to prevent UI. However, several other modifiable risk factors are likely to contribute to prevention of UI during pregnancy and postpartum. This review investigated modifiable risk factors for UI during pregnancy and postpartum and also reviewed randomized...... (grade B) and postpartum (grade C). Women should be advised to perform pelvic floor muscle training during pregnancy and postpartum (grade A) and to use perineal warm packs during delivery (grade B). Cesarean section to prevent UI cannot be recommended (grade D). If lifestyle recommendations......: women should be advised not to smoke before or during pregnancy (grade B), aim at normal weight before pregnancy (grade B), and aim at regaining prepregnancy weight postpartum (grade B). Occasional low-intensity training should be advocated (grade B), and constipation should be avoided during pregnancy...

  14. Best Practices in Management of Postpartum Pain.

    Science.gov (United States)

    Fahey, Jenifer O

    Pain has been documented as a major concern for women in the postpartum period. Management of postpartum pain, however, is a relatively neglected area of clinical research. As a result, evidence to support interventions to alleviate the discomforts associated with childbirth is sparse. This paucity of research on postpartum pain management is particularly surprising given that in the United States alone nearly 4 million women give birth each year. Inadequate pain relief in the hours to months following childbirth can interfere with maternal-newborn bonding and feeding and, by impeding mobility, can increase the risk of postpartum complications. In addition, pain that is not adequately managed may increase the risk of chronic pain that lasts beyond the postpartum period. In this article, the more common causes of pain following childbirth are reviewed and recommendations for pain management based on available evidence are outlined. Considerations for pain management in lactating women and for hospital discharge are discussed.

  15. Treatment and outcome of patients with relapsed clear cell sarcoma of the kidney: a combined SIOP and AIEOP study.

    Science.gov (United States)

    Gooskens, S L; Furtwängler, R; Spreafico, F; van Tinteren, H; de Kraker, J; Vujanic, G M; Leuschner, I; Coulomb-L'Herminé, A; Godzinski, J; Schleiermacher, G; Stoneham, S; Bergeron, C; Pritchard-Jones, K; Graf, N; van den Heuvel-Eibrink, M M

    2014-07-15

    Clear cell sarcoma of the kidney (CCSK) is an uncommon paediatric renal tumour. Relapses occur in about 15% of the patients. Since detailed clinical information on relapsed CCSK is scarce, the current study aims to describe outcome of patients with relapsed CCSK treated according to recent European protocols. We analysed prospectively collected data of all CCSK patients who developed a relapse after complete remission at the end of primary treatment, entered onto SIOP and AIEOP trials between 1992 and 2012. Thirty-seven of 237 CCSK patients (16%) treated according to SIOP and AIEOP protocols developed a relapse. Median time from initial diagnosis to relapse was 17 months (range, 5.5 months - 6.6 years). Thirt-five out of thirty-seven relapses (95%) were metastatic; the most common sites of relapse were the brain (n=13), lungs (n=7) and bone (n=5). Relapse treatment consisted of chemotherapy (n=30), surgery (n=19) and/or radiotherapy (n=18), followed by high-dose chemotherapy and autologous bone marrow transplantation (ABMT) in 14 patients. Twenty-two out of thirty-seven patients (59%) achieved a second complete remission (CR); 15 of whom (68%) developed a second relapse. Five-year event-free survival (EFS) after relapse was 18% (95% CI: 4%-32%), and 5-year overall survival (OS) was 26% (95% CI: 10%-42%). In this largest series of relapsed CCSK patients ever described, overall outcome is poor. Most relapses are metastatic and brain relapses are more common than previously recognised. Intensive treatment aiming for local control, followed by high dose chemotherapy and ABMT, seems to be of benefit to enhance survival. Novel development of targeted therapy is urgently required.

  16. AROMATHERAPY IN POSTPARTUM AND PUERPERIUM: A SYSTEMATIC, EVIDENCE-BASED REVIEW

    OpenAIRE

    Muñoz-Mahmud, Blanca; Zabaleta-Domínguez, Janina; Gómez-Gamboa, Encarna; Arranz-Betegon, Ángela

    2018-01-01

    IntroductionThe early abandonment of breastfeeding is closely related to tiredness and postpartum depression. The side effects of drugs have led to a high demand among users for natural therapies as an alternative. ObjectivesTo determine the effects of aromatherapy in postpartum mothers, in relation to mood and the impact on breastfeeding. Material and MethodsA literature review was carried out with searches of the Medline, Pubmed, Cochrane, LILACS, Google Scholar and Web of Science databases...

  17. Increasing Incidence in Relapsing-Remitting MS and High Rates among Young Women in Finland: A Thirty-Year Follow-Up

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    Marja-Liisa Sumelahti

    2014-01-01

    Full Text Available Object. Gender and disease course specific incidences were studied in high- and medium-risk regions of MS in Finland. Methods. Age- and gender-specific incidences with 95% CIs were calculated in 10-year periods from 1981 to 2010. Poser diagnostic criteria were used and compared with the McDonald criteria from 2001 to 2010. Association between age and diagnostic delay over time was assessed by using the Kruskal-Wallis test. Results. 1419 (89% RRMS and 198 (11% PPMS cases were included. RRMS incidence increased with the female to male ratio (F/M from 4,2/105 (F/M 1.9 to 9,7 (2.3, while that of PPMS decreased from 1,2 (1.6 to 0,7 (1.2. The use of McDonald criteria did not change the conclusion. The decreasing diagnostic delay and age at diagnosis in RRMS were associated within the 10-year periods and contrasted those in PPMS. Increasing female risk in RRMS was observed in the high-risk region. Conclusion. Increasing RRMS incidence and high female ratios shown in each age group indicate gender-specific influences acting already from childhood. A more precise definition of the risk factors and their action in MS is needed to provide a better understanding of underlying pathological processes and a rationale for the development of new preventive and treatment strategies.

  18. EFEKTIVITAS TERAPI MUSIK TERHADAP PENCEGAHAN POSTPARTUM BLUES PADA IBU PRIMIPARA DI RUANG KEBIDANAN RSUP CIPTO MANGUNKUSUMO JAKARTA PUSAT

    Directory of Open Access Journals (Sweden)

    Suryani Manurung

    2012-11-01

    Full Text Available Background: Rehabilitative the mother and baby health becomes priority to health development at Indonesian. The rehabilitative implementation was concern to physical health and psychological. The psychological problem of mothers postpartum primipara there are the postpartum blues evidence which becomes a factor indirectly contribute to mother health. The research result before the postpartum blues evidence very high almost 75-80%. This research purposed to know music therapy effectiveness in prevents postpartum blues on postpartum prim Para's mother. Methods: This research utilize quasi experiment's design, pretest-posttest with control group and intervention group. Intervention group listened to instrumental music which is Mozart classical music type: Eine Kleine Nacht musik with frequency 20-40 cps hertz's in 15-20 minutes duration, sounding off in 2 times a day, on 8.00 WIB a.m and on 14.00 WIB p.m along 3 days. The sample in this observational is postpartum primipara's mother which was nursed at midwifery room RSCM Jakarta Pusat, with total each controls group and intervention group are 18 person. Results: The tests result of logistics regression and double linear regression prove there are available influence music therapy to postpartum blues' prevention. On mother which sounding off musical therapy decreased postpartum blues evidence score as 1,80. Meanwhile mother that doesn't listened to musical therapy have opportunity to get postpartum blues evidence as 5,60 times against mother was sounding off by music therapies. Conclusion: The research conclusion is the implementation of listened in musical therapy so effective in postpartum blues prevention. This result study recommendate it is needs to sound off musical therapy to all post parium's mother as intervention relaxation therapy at health service center such as hospital, puskesmas and also the maternity clinic. Key words: postpartum blues, music therapy, EPDS (Edinburgh postnatal

  19. Thoughts on the Postpartum Situation

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    Jennifer Scuro

    2018-06-01

    Full Text Available The event of childbirth carries with it a dominant narrative: that a pregnant woman happily gives birth to a baby. This appears to be quite a simple formulation—as if a natural fact, as if plain and common sense. Yet, the complexities masked by the mythological and whitewashed quality of this narrative, as I have already argued recently in The Pregnancy ≠ Childbearing Project: A Phenomenology of Miscarriage (Feb 2017, harms and even kills women. In this paper, I expand on the problem of what I term “dismemberment after birth” as it operates invisibly in the “postpartum situation.” The dominant narrative, combined with a pervasive cultural misogynoir— manifesting specifically as an antagonism toward black women and women of color—as medicalized and ableist establishment of care, renders women without resource if they cannot maintain the desires and embodiments required of a contented and successful maternity. The naturalized assumptions about the narrative move from the birth event to “having a baby” are disrupted here with hope of opening up an opportunity to validate and diversify the more non-linear narratives. As an afterthought to these disruptions, I offer an additional challenge to anti-natalist thinking in its limited insight into the postpartum situation.

  20. Cortico-amygdala coupling as a marker of early relapse risk in cocaine-addicted individuals

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    Meredith J Mchugh

    2014-02-01

    Full Text Available Addiction to cocaine is a chronic condition characterized by high rates of early relapse. This study builds on efforts to identify neural markers of relapse risk by studying resting state functional connectivity (rsFC in neural circuits arising from the amygdala; a brain region implicated in relapse-related processes including craving and reactivity to stress following acute and protracted withdrawal from cocaine. Whole-brain resting-state fMRI connectivity (6 min was assessed in 45 cocaine-addicted individuals and 22 healthy controls. Cocaine-addicted individuals completed scans in the final week of a residential treatment episode. To approximate preclinical models of relapse-related circuitry separate seeds were derived for the left and right basolateral (BLA and corticomedial (CMA amygdala. Participants also completed the Iowa Gambling Task, Wisconsin Card Sorting Test, Cocaine Craving Questionnaire, Obsessive Compulsive Cocaine Use scale, Temperament and Character Inventory and the NEO-PI-R. Relapse within the first 30 days post-treatment (n = 24 was associated with reduced rsFC between the left CMA and ventromedial prefrontal cortex/rostral anterior cingulate cortex (vmPFC/rACC relative to cocaine-addicted individuals who remained abstinent (non-relapse, n = 21. Non-relapse participants evidenced reduced rsFC between the bilateral BLA and visual processing regions (lingual gyrus/cuneus compared to controls and relapsed participants. Early relapse was associated with fewer years of education but unrelated to trait reactivity to stress, neurocognitive and clinical characteristics or cocaine use history. Findings suggest that rsFC within neural circuits implicated in preclinical models of relapse may provide a promising marker of relapse risk in cocaine-addicted individuals. Future efforts to replicate the current findings and alter connectivity within these circuits may yield novel interventions and improve treatment outcomes.

  1. Mathematical Models of Tuberculosis Reactivation and Relapse

    Directory of Open Access Journals (Sweden)

    Robert Steven Wallis

    2016-05-01

    Full Text Available The natural history of human infection with Mycobacterium tuberculosis (Mtb is highly variable, as is the response to treatment of active tuberculosis. There is presently no direct means to identify individuals in whom Mtb infection has been eradicated, whether by a bactericidal immune response or sterilizing antimicrobial chemotherapy. Mathematical models can assist in such circumstances by measuring or predicting events that cannot be directly observed. The 3 models discussed in this review illustrate instances in which mathematical models were used to identify individuals with innate resistance to Mtb infection, determine the etiology of tuberculosis in patients treated with tumor necrosis factor antagonists, and predict the risk of relapse in persons undergoing tuberculosis treatment. These examples illustrate the power of various types of mathematic models to increase knowledge and thereby inform interventions in the present global tuberculosis epidemic.

  2. Tumor relapse present in oncologic nasal repair

    International Nuclear Information System (INIS)

    Galvez Chavez, Julio Cesar; Sanchez Wals, Lenia; Monzon Fernandez, Abel Nicolas; Morales Tirado, Roxana

    2009-01-01

    Tumor relapse is one of the more fearsome complications of the oncologic course and also to obscure the life prognosis, causing the loss of many reconstructions and of exhausting the repairing surgical possibilities. The aim of this study was to determine the relapse frequency, the repercussion on the repair and the subsequent medical course of patients operated on malign nasal tumors

  3. Impact of a second FDG PET scan before adjuvant therapy for the early detection of residual/relapsing tumours in high-risk patients with oral cavity cancer and pathological extracapsular spread

    Energy Technology Data Exchange (ETDEWEB)

    Liao, Chun-Ta; Huang, Shiang-Fu; Chen, I-How; Kang, Chung-Jan [Chang Gung Memorial Hospital and Chang Gung University, Department of Otorhinolaryngology, Head and Neck Surgery, Taoyuan (China); Chang Gung Memorial Hospital and Chang Gung University, Head and Neck Oncology Group, Taoyuan (China); Fan, Kang-Hsing; Lin, Chien-Yu [Chang Gung Memorial Hospital and Chang Gung University, Head and Neck Oncology Group, Taoyuan (China); Chang Gung Memorial Hospital and Chang Gung University, Department of Radiation Oncology, Taoyuan (China); Wang, Hung-Ming [Chang Gung Memorial Hospital and Chang Gung University, Head and Neck Oncology Group, Taoyuan (China); Chang Gung Memorial Hospital and Chang Gung University, Department of Medical Oncology, Taoyuan (China); Ng, Shu-Hang [Chang Gung Memorial Hospital and Chang Gung University, Head and Neck Oncology Group, Taoyuan (China); Chang Gung Memorial Hospital and Chang Gung University, Department of Diagnostic Radiology, Taoyuan (China); Hsueh, Chuen; Lee, Li-Yu [Chang Gung Memorial Hospital and Chang Gung University, Head and Neck Oncology Group, Taoyuan (China); Chang Gung Memorial Hospital and Chang Gung University, Department of Pathology, Taoyuan (China); Lin, Chih-Hung [Chang Gung Memorial Hospital and Chang Gung University, Head and Neck Oncology Group, Taoyuan (China); Chang Gung Memorial Hospital and Chang Gung University, Department of Plastic and Reconstructive Surgery, Taoyuan (China); Yen, Tzu-Chen [Chang Gung Memorial Hospital and Chang Gung University, Head and Neck Oncology Group, Taoyuan (China); Chang Gung Memorial Hospital and Chang Gung University, Department of Nuclear Medicine and Molecular Imaging Center, Taoyuan (China)

    2012-06-15

    Extracapsular spread (ECS) to the cervical lymph nodes is a major adverse prognostic factor in oral cavity squamous cell carcinoma (OSCC). We prospectively examined the value of FDG PET immediately before postoperative radiotherapy/concurrent chemoradiotherapy (pre-RT/CCRT PET) to detect residual/relapsing disease in the early postsurgical follow-up period in high-risk OSCC patients with ECS. We examined 183 high-risk OSCC patients with ECS who underwent preoperative FDG PET/CT for staging purposes. Of these patients, 29 underwent a second pre-RT/CCRT FDG PET/CT scan. The clinical utility of the second FDG PET/CT was examined using Kaplan-Meier curve analysis. Patients who underwent the second FDG PET/CT scan had baseline clinicopathological characteristics similar to those who did not undergo a second scan. Of the patients who underwent the second scan, seven (24 %) had unexpected, newly discovered lesions. Five eventually died of the disease, and two had no evidence of recurrence after a change in RT field and dose. In an event-based analysis at 2 months, rates of neck control (6/29 vs. 6/154, p = 0.001), distant metastases (3/29 vs. 4/154, p = 0.046), and disease-free survival (7/29 vs. 10/154, p = 0.003) were significantly higher in patients who received a second PET scan than in those who did not. The second pre-RT/CCRT PET scan was of particular benefit for detecting new lesions in OSCC patients with both ECS and lymph node standardized uptake value (SUV) of {>=}5.2 in the first PET scan. The present findings support the clinical value of pre-RT/CCRT FDG PET for defining treatment strategy in OSCC patients with both ECS and high nodal SUV, even when FDG PET had already been performed during the initial staging work-up. (orig.)

  4. Translational Phase I Trial of Vorinostat (Suberoylanilide Hydroxamic Acid) Combined with Cytarabine and Etoposide in Patients with Relapsed, Refractory, or High-Risk Acute Myeloid Leukemia

    Science.gov (United States)

    Gojo, Ivana; Tan, Ming; Fang, Hong-Bin; Sadowska, Mariola; Lapidus, Rena; Baer, Maria R.; Carrier, France; Beumer, Jan H.; Anyang, Bean N.; Srivastava, Rakesh K.; Espinoza-Delgado, Igor; Ross, Douglas D.

    2015-01-01

    Purpose To determine the maximum-tolerated dose (MTD) of the histone deacetylase inhibitor vorinostat combined with fixed doses of cytarabine (ara-C or cytosine arabinoside) and etoposide in patients with poor-risk or advanced acute leukemia, to obtain preliminary efficacy data, describe pharmacokinetics, and in vivo pharmacodynamic effects of vorinostat in leukemia blasts. Experimental Design In this open-label phase I study, vorinostat was given orally on days one to seven at three escalating dose levels: 200 mg twice a day, 200 mg three times a day, and 300 mg twice a day. On days 11 to 14, etoposide (100 mg/m2) and cytarabine (1 or 2 g/m2 twice a day if ≥65 or vorinostat 200 mg twice a day. Of 21 patients enrolled, seven attained a complete remission (CR) or CR with incomplete platelet recovery, including six of 13 patients treated at the MTD. The median remission duration was seven months. No differences in percentage S-phase cells or multidrug resistance transporter (MDR1 or BCRP) expression or function were observed in vivo in leukemia blasts upon vorinostat treatment. Conclusions Vorinostat 200 mg twice a day can be given safely for seven days before treatment with cytarabine and etoposide. The relatively high CR rate seen at the MTD in this poor-risk group of patients with AML warrants further studies to confirm these findings. PMID:23403629

  5. Bangladesh women report postpartum health problems.

    Science.gov (United States)

    Goodburn, L

    1994-02-01

    The Bangladesh Rural Advancement Committee conducted operational research in Bangladesh to examine postpartum health problems. Researchers conducted focus groups, indepth interviews, and observation. More than 40% of the postpartum women had a delivery-related health problem by 2 weeks after delivery. 52% had signs or symptoms of anemia. Body needs after pregnancy, lactation, and blood loss during delivery exacerbate the nutritional anemia common to Bangladeshi women. 17% of the postpartum women had signs of infections. More than 50% had severe malnutrition, worsened by food taboos during the postpartum period. 60% of infant deaths occur in the neonatal period. The mortality risk is elevated in low birth weight (LBW) infants. In this study, more than 50% of the newborns were LBW infants. Many Bangladeshi mothers discard the colostrum and begin breast feeding several days after delivery. 11% of the postpartum women had breast problem (e.g., cracked nipples). Women believed that susceptibility to evil spirits accounted for their being more vulnerable to health problems during the postpartum. They feared leaving the household. These findings show a need for home visits to provide valuable postpartum care.

  6. Postpartum Depression Among Asian Indian Mothers.

    Science.gov (United States)

    Goyal, Deepika; Park, Van Ta; McNiesh, Susan

    2015-01-01

    To explore Asian Indian mothers' perspectives of postpartum depression (PPD) and mental health help-seeking behavior. Qualitative exploratory design. Using convenience sampling, postpartum mothers were recruited through flyers posted in public places and on social media sites. Postpartum depression risk was assessed with the Edinburgh Postnatal Depression Scale (EPDS) prior to qualitative interviews. Content analysis methods were used to extract themes from participant narratives. Twelve self-identified, married, Asian Indian mothers, aged between 29 and 40 years, living in Northern California, who gave birth to a healthy infant within the last 12 months, took part in this study. Scores on the EPDS indicated two participants were at an increased risk for developing PPD. Content analysis revealed two emerging themes: (1) Culture-specific postpartum practices and ceremonies and their role in maternal-infant postpartum recovery; and (2) Maternal mental health help-seeking behavior. Nurses taking care of women during the extended prenatal and postpartum period have the unique opportunity to build rapport with their patients which can offer a window of opportunity to educate and help dispel myths about PPD symptoms and treatment. To promote successful maternal-infant outcomes, PPD education should be initiated at the first prenatal appointment, continue during the pregnancy, and be incorporated into well-baby visits through the first postpartum year. Education should include signs and symptoms of PPD as well as importance of timely mental-health help-seeking.

  7. Relapse of imported Plasmodium vivax malaria is related to primaquine dose: a retrospective study

    Directory of Open Access Journals (Sweden)

    Townell Nicola

    2012-06-01

    Full Text Available Abstract Background Relapsing Plasmodium vivax infection results in significant morbidity for the individual and is a key factor in transmission. Primaquine remains the only licensed drug for prevention of relapse. To minimize relapse rates, treatment guidelines have recently been revised to recommend an increased primaquine dose, aiming to achieve a cumulative dose of ≥6 mg/kg, i.e. ≥420 mg in a 70 kg patient. The aims of this study were to characterize the epidemiology of P. vivax infection imported into Queensland Australia, to determine the rates of relapse, to investigate the use of primaquine therapy, and its efficacy in the prevention of relapse. Methods A retrospective study was undertaken of laboratory confirmed P. vivax infection presenting to the two major tertiary hospitals in Queensland, Australia between January 1999 and January 2011. Primaquine dosing was classified as no dose, low dose ( Results Twenty relapses occurred following 151 primary episodes of P. vivax infection (13.2%. Relapses were confirmed among 3/21 (14.2%, 9/50 (18.0%, 1/54 (1.9% and 7/18 (38.9% of patients administered no dose, low dose, high dose and unknown primaquine dose respectively. High dose primaquine therapy was associated with a significantly lower rate of relapse compared to patients who were prescribed low dose therapy (OR 11.6, 95% CI 1.5-519, p = 0.005. Conclusions Relapse of P. vivax infection is more likely in patients who received low dose primaquine therapy. This study supports the recommendations that high dose primaquine therapy is necessary to minimize relapse of P. vivax malaria.

  8. Alcohol consumption and symptoms as predictors for relapse of DSM-5 alcohol use disorder.

    Science.gov (United States)

    Tuithof, Marlous; ten Have, Margreet; van den Brink, Wim; Vollebergh, Wilma; de Graaf, Ron

    2014-07-01

    Alcohol consumption levels and alcohol use disorder (AUD) symptoms may serve as easily quantifiable markers for AUD relapse after remission and might help prevention workers identify at-risk individuals. We investigated the predictive value of alcohol consumption and AUD symptoms on relapse. Data are from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2). We selected 506 people in ≥12-month DSM-5 AUD remission at baseline and assessed their status at 3-year follow-up. AUD symptoms and drinking patterns were assessed using the Composite International Diagnostic Interview 3.0. Time since remission was assessed retrospectively at baseline and ranged from 1 to 48 years. Predictors for relapse were examined using Cox regression analysis. Cumulative AUD relapse rate was 5.6% at 5 years, 9.1% at 10 years and 12.0% at 20 years. Relapse was predicted by both medium (15-28/22-42 drinks weekly for women/men) and high (≥29/43) past alcohol intake, 6+ lifetime AUD symptoms, 'impaired control over use', and at-risk (≥8/15) current intake. The risk of relapse was especially high when medium or high past intake or 6+ lifetime symptoms coincided with current at-risk drinking. Only a minority of people in DSM-5 AUD remission relapsed, but the risk of relapse increased substantially with the presence of at least one of the risk factors. Moreover, at-risk current drinking coupled with other risk factors substantially increased the likelihood of relapse. Therefore, current drinking may provide an adequate reference point for relapse prevention. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. The Alcohol Relapse Risk Assessment: a scoring system to predict the risk of relapse to any alcohol use after liver transplant.

    Science.gov (United States)

    Rodrigue, James R; Hanto, Douglas W; Curry, Michael P

    2013-12-01

    Alcohol relapse after liver transplant heightens concern about recurrent disease, nonadherence to the immunosuppression regimen, and death. To develop a scoring system to stratify risk of alcohol relapse after liver transplant. Retrospective medical record review. All adult liver transplants performed from May 2002 to February 2011 at a single center in the United States. The incidence of return to any alcohol consumption after liver transplant. Thirty-four percent (40/118) of patients with a history of alcohol abuse/dependency relapsed to use of any alcohol after liver transplant. Nine of 25 hypothesized risk factors were predictive of alcohol relapse after liver transplant: absence of hepatocellular carcinoma, tobacco dependence, continued alcohol use after liver disease diagnosis, low motivation for alcohol treatment, poor stress management skills, no rehabilitation relationship, limited social support, lack of nonmedical behavioral consequences, and continued engagement in social activities with alcohol present. Each independent predictor was assigned an Alcohol Relapse Risk Assessment (ARRA) risk value of 1 point, and patients were classified into 1 of 4 groups by ARRA score: ARRA I = 0, ARRA II = 1 to 3, ARRA III = 4 to 6, and ARRA IV = 7 to 9. Patients in the 2 higher ARRA classifications had significantly higher rates of alcohol relapse and were more likely to return to pretransplant levels of drinking. Alcohol relapse rates are moderately high after liver transplant. The ARRA is a valid and practical tool for identifying pretransplant patients with alcohol abuse or dependency at elevated risk of any alcohol use after liver transplant.

  10. Physical activity and sedentary behavior during pregnancy and postpartum, measured using hip and wrist-worn accelerometers

    Directory of Open Access Journals (Sweden)

    Kathryn R. Hesketh

    2018-06-01

    Full Text Available Background: Physical activity in pregnancy and postpartum is beneficial to mothers and infants. To advance knowledge of objective physical activity measurement during these periods, this study compares hip to wrist accelerometer compliance; assesses convergent validity (correlation between hip- and wrist-worn accelerometry; and assesses change in physical activity from pregnancy to postpartum. Methods: We recruited women during pregnancy (n = 100; 2014–2015, asking them to wear hip and wrist accelerometers for 7 days during Trimester 2 (T2, Trimester 3 (T3, and 3-, 6-, 9- and 12-months postpartum. We assessed average wear-time and correlations (axis-specific counts/minute, vector magnitude counts/day and step counts/day at T2, T3, and postpartum. Results: Compliance was higher for wrist-worn accelerometers. Hip and wrist accelerometers showed moderate to high correlations (Pearson's r 0.59 to 0.84. Hip-measured sedentary and active time differed little between T2 and T3. Moderate-to-vigorous physical activity decreased at T3 and remained low postpartum. Light physical activity increased and sedentary time decreased throughout the postpartum period. Conclusions: Wrist accelerometers may be preferable during pregnancy and appear comparable to hip accelerometers. As physical activity declines during later pregnancy and may not rebound post birth, support for re-engaging in physical activity earlier in the postpartum period may benefit women. Keywords: Physical activity, Pregnancy, Postpartum, Sedentary behavior, Measurement

  11. Prevalence, rates and correlates of intimate partner violence among South African women during pregnancy and the postpartum period.

    Science.gov (United States)

    Groves, Allison K; Moodley, Dhayendre; McNaughton-Reyes, Luz; Martin, Sandra L; Foshee, Vangie; Maman, Suzanne

    2015-03-01

    Intimate partner violence (IPV) is a significant public health problem in South Africa. However, limited research exists on IPV during pregnancy and the postpartum period in South Africa. The purpose of this study is to describe the prevalence, rates and correlates of IPV among South African women during pregnancy and the first 9 months postpartum. Data are from a longitudinal study with women recruited during pregnancy between 2008 and 2010 at a public clinic in Durban. We used a modified version of the World Health Organization's IPV scale to estimate prevalence and rates of IPV during pregnancy, at 4 months postpartum and 9 months postpartum and we used logistic regression to assess the correlates of IPV during this time. More than 20 % of all women experienced at least one act of physical, psychological or sexual IPV during pregnancy. Nearly one-quarter of all women experienced at least one act of physical, psychological or sexual IPV during the first 9 months postpartum. Psychological IPV was the most prevalent type of IPV during pregnancy and the first 4 months postpartum. Age and previous violence within the relationship were associated with IPV during pregnancy and IPV during the postpartum period. The high levels of IPV during pregnancy and the postpartum period highlight the need to develop screening and intervention strategies specifically for this time. Further, women should be screened not only for physical violence but also psychological violence given that psychological violence may result in distinct negative consequences.

  12. Prevalence and rates of intimate partner violence among South African women during pregnancy and the postpartum period

    Science.gov (United States)

    Groves, Allison K.; Moodley, Dhayendre; McNaughton-Reyes, Luz; Martin, Sandra L.; Foshee, Vangie; Maman, Suzanne

    2014-01-01

    Objectives Intimate partner violence (IPV) is a significant public health problem in South Africa. However, limited research exists on IPV during pregnancy and the postpartum period in South Africa. The purpose of this study is to describe the prevalence, rates and correlates of IPV among South African women during pregnancy and the first nine months postpartum. Methods Data are from a longitudinal study with women recruited during pregnancy between 2008 and 2010 at a public clinic in Durban. We used a modified version of the World Health Organization’s IPV scale to estimate prevalence and rates of IPV during pregnancy, at four months postpartum and nine months postpartum and we used logistic regression to assess the correlates of IPV during this time. Results More than 20% of all women experienced at least one act of physical, psychological or sexual IPV during pregnancy. Nearly one-quarter of all women experienced at least one act of physical, psychological or sexual IPV during the first nine months postpartum. Psychological IPV was the most prevalent type of IPV during pregnancy and the first four months postpartum. Age and previous violence within the relationship were associated with IPV during pregnancy and IPV during the postpartum period. Conclusions The high levels of IPV during pregnancy and the postpartum period highlight the need to develop screening and intervention strategies specifically for this time. Further, women should be screened not only for physical violence but also psychological violence given that psychological violence may result in distinct negative consequences. PMID:24889116

  13. Predicting Relapse among Young Adults: Psychometric Validation of the Advanced Warning of Relapse (AWARE) Scale

    Science.gov (United States)

    Kelly, John F.; Hoeppner, Bettina B.; Urbanoski, Karen A.; Slaymaker, Valerie

    2011-01-01

    Objective Failure to maintain abstinence despite incurring severe harm is perhaps the key defining feature of addiction. Relapse prevention strategies have been developed to attenuate this propensity to relapse, but predicting who will, and who will not, relapse has stymied attempts to more efficiently tailor treatments according to relapse risk profile. Here we examine the psychometric properties of a promising relapse risk measure - the Advance WArning of RElapse scale (AWARE) scale (Miller and Harris, 2000) in an understudied but clinically important sample of young adults. Method Inpatient youth (N=303; Age 18-24; 26% female) completed the AWARE scale and the Brief Symptom Inventory-18 (BSI) at the end of residential treatment, and at 1-, 3-, and 6-months following discharge. Internal and convergent validity was tested for each of these four timepoints using confirmatory factor analysis and correlations (with BSI scores). Predictive validity was tested for relapse 1, 3, and 6 months following discharge, as was incremental utility, where AWARE scores were used as predictors of any substance use while controlling for treatment entry substance use severity and having spent time in a controlled environment following treatment. Results Confirmatory factor analysis revealed a single, internally consistent, 25-item factor that demonstrated convergent validity and predicted subsequent relapse alone and when controlling for other important relapse risk predictors. Conclusions The AWARE scale may be a useful and efficient clinical tool for assessing short-term relapse risk among young people and, thus, could serve to enhance the effectiveness of relapse prevention efforts. PMID:21700396

  14. Predicting relapse among young adults: psychometric validation of the Advanced WArning of RElapse (AWARE) scale.

    Science.gov (United States)

    Kelly, John F; Hoeppner, Bettina B; Urbanoski, Karen A; Slaymaker, Valerie

    2011-10-01

    Failure to maintain abstinence despite incurring severe harm is perhaps the key defining feature of addiction. Relapse prevention strategies have been developed to attenuate this propensity to relapse, but predicting who will, and who will not, relapse has stymied attempts to more efficiently tailor treatments according to relapse risk profile. Here we examine the psychometric properties of a promising relapse risk measure-the Advance WArning of RElapse (AWARE) scale (Miller & Harris, 2000) in an understudied but clinically important sample of young adults. Inpatient youth (N=303; Ages 18-24; 26% female) completed the AWARE scale and the Brief Symptom Inventory-18 (BSI) at the end of residential treatment, and at 1-, 3-, and 6-months following discharge. Internal and convergent validity was tested for each of these four timepoints using confirmatory factor analysis and correlations (with BSI scores). Predictive validity was tested for relapse 1, 3, and 6 months following discharge, as was incremental utility, where AWARE scores were used as predictors of any substance use while controlling for treatment entry substance use severity and having spent time in a controlled environment following treatment. Confirmatory factor analysis revealed a single, internally consistent, 25-item factor that demonstrated convergent validity and predicted subsequent relapse alone and when controlling for other important relapse risk predictors. The AWARE scale may be a useful and efficient clinical tool for assessing short-term relapse risk among young people and, thus, could serve to enhance the effectiveness of relapse prevention efforts. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Orexin Receptor Targets for Anti-Relapse Medication Development in Drug Addiction

    Directory of Open Access Journals (Sweden)

    Ronald E. See

    2011-06-01

    Full Text Available Drug addiction is a chronic illness characterized by high rates of relapse. Relapse to drug use can be triggered by re-exposure to drug-associated cues, stressful events, or the drug itself after a period of abstinence. Pharmacological intervention to reduce the impact of relapse-instigating factors offers a promising target for addiction treatment. Growing evidence has implicated an important role of the orexin/hypocretin system in drug reward and drug-seeking, including animal models of relapse. Here, we review the evidence for the role of orexins in modulating reward and drug-seeking in animal models of addiction and the potential for orexin receptors as specific targets for anti-relapse medication approaches.

  16. Gestational Weight Gain and Post-Partum Weight Loss Among Young, Low-Income, Ethnic Minority Women

    Science.gov (United States)

    ROTHBERG, Bonnie E. Gould; MAGRIPLES, Urania; KERSHAW, Trace S.; RISING, Sharon Schindler; ICKOVICS, Jeannette R.

    2010-01-01

    Objective Document weight change trajectories that lead to gestational weight gain or postpartum weight loss outside clinical recommendations established by Institute of Medicine (IOM). Methods Women aged 14-25 receiving prenatal care and delivering singleton infants at term (N=427). Medical record review and four structured interviews conducted: second and third trimester, 6- and 12-months postpartum. Longitudinal mixed modeling to evaluate weight change trajectories. Results Only 22% of participants gained gestational weight within IOM guidelines. 62% exceeded maximum recommendations -- more common among those overweight/obese (BMI≥25.0; phypertension; breastfeeding promoted postpartum weight loss (all p<.02). BMI by race interaction suggested healthier outcomes for Latinas (p=0.02). Conclusion Excessive pregnancy weight gain and inadequate postpartum weight loss are highly prevalent among young low-income ethnic minority women. Pregnancy and postpartum are critical junctures for weight management interventions. PMID:20974459

  17. Elevated Serum IL-17 Expression at Cessation Associated with Graves’ Disease Relapse

    Directory of Open Access Journals (Sweden)

    Jianhui Li

    2018-01-01

    Full Text Available Background. Antithyroid drug (ATD treatment occupies the cornerstone therapeutic modality of Graves’ disease (GD with a high relapse rate after discontinuation. This study aimed to assess potential risk factors for GD relapse especially serum interleukin-17 (IL-17 expression. Methods. Consecutive newly diagnosed GD patients who were scheduled to undergo ATD therapy from May 2011 to May 2014 were prospectively enrolled. Risk factors for GD relapse were analyzed by univariate and multivariate Cox proportional hazard analyses. The association between serum IL-17 expression at cessation and GD relapse was analyzed with relapse-free survival (RFS by the Kaplan–Meier survival analysis and log-rank test. Results. Of the 117 patients, 72 (61.5% maintained a remission for 12 months after ATD withdrawal and 45 (38.5% demonstrated GD relapse. The final multivariate Cox analysis indicated elevated IL-17 expression at cessation to be an independent risk factor for GD relapse within 12 months after ATD withdrawal (HR: 3.04, 95% CI: 1.14–7.67, p=0.021. Patients with higher expressions of IL-17 (≥median value at cessation demonstrated a significantly higher RFS than those with lower levels by the Kaplan–Meier analysis and log-rank test (p=0.028. Conclusions. This present study indicated elevated serum IL-17 expression at cessation to be a predictor for GD relapse within 12 months.

  18. Massive postpartum right renal hemorrhage.

    Science.gov (United States)

    Kiracofe, H L; Peterson, N

    1975-06-01

    All reported cases of massive postpartum right renal hemorrhage have involved healthy young primigravidas and blacks have predominated (4 of 7 women). Coagulopathies and underlying renal disease have been absent. Hematuria was painless in 5 of 8 cases. Hemorrhage began within 24 hours in 1 case, within 48 hours in 4 cases and 4 days post partum in 3 cases. Our first case is the only report in which hemorrhage has occurred in a primipara. Failure of closure or reopening of pyelovenous channels is suggested as the pathogenesis. The hemorrhage has been self-limiting, requiring no more than 1,500 cc whole blood replacement. Bleeding should stop spontaneously, and rapid renal pelvic clot lysis should follow with maintenance of adequate urine output and Foley catheter bladder decompression. To date surgical intervention has not been necessary.

  19. Physiotherapy in the postpartum problems

    Directory of Open Access Journals (Sweden)

    Witold Słomko

    2017-04-01

    Full Text Available Female after childbirth recovering at different rates, in theory, it is assumed that the confinement takes from 6 to 8 weeks. At this time maternal should return of the condition before pregnancy and childbirth. Sometimes that the return to full fitness is difficult, because of the problems typical for the postpartum. This article presents physiotherapeutic methods are effective in treating: diastasis of the rectus muscle of abdomen, stretch marks, difficult  healing scars after a cesarean section, lactating problems, incontinence. Appropriate treatment results prevention of these symptoms, although if they appear, it helps to fight them down. Kinesitherapy and physical therapy are used in the treatment. Also can be used massage and kinesiotaping.

  20. Preliminary Clinical Evaluation of Acupuncture Therapy in Patients With Postpartum Sciatica.

    Science.gov (United States)

    He, Bing-Shu; Li, Yang; Gui, Tong

    2018-03-01

    This study evaluated clinical outcomes following acupuncture treatment of postpartum sciatica. One hundred eleven women with postpartum sciatica were enrolled in an acupuncture group (n = 86) or a control group (n = 25), according to their preference. Participants in the acupuncture group attended acupuncture therapy sessions 3 times a week for 4 weeks, while participants in the control group were assigned to bed rest. Outcome measures included the Roland Disability Questionnaire for sciatica, a visual analog scale for leg pain, and patient-reported perceived recovery. In addition, participants were surveyed after treatment to assess the acceptability of acupuncture therapy. The outcome scores for disability and leg pain were significantly lower in the acupuncture group compared with the control group (P acupuncture improved their well-being after treatment. At one month after treatment, 98% of participants in the treatment group reported recovery compared with 24% of the control group participants (P acupuncture group believed that acupuncture had no significant interference with breast milk production. No adverse effects of acupuncture were reported. All participants in the acupuncture group stated they would choose acupuncture in case of relapse. However, the recurrence rate of sciatica in the acupuncture group (32%) was comparable to that of the control group (35%) at the one-year follow-up interview. Compared with bed rest, acupuncture might be an effective and acceptable strategy to relieve symptoms of postpartum sciatica. © 2018 by the American College of Nurse-Midwives.

  1. Perinatal stress, fatigue, depressive symptoms, and immune modulation in late pregnancy and one month postpartum.

    Science.gov (United States)

    Cheng, C Y; Pickler, R H

    2014-01-01

    Stress and fatigue are common complaints of pregnant and postpartum women as is depression. These symptoms may be related to immunomodulation. However, few studies have examined these relationships. The aim of this study was to examine the relationships among stress, fatigue, depression, and cytokines as markers of immune modulation in prenatal and postpartum women. Women completed questionnaires and gave blood samples during late pregnancy and again at 4-6 weeks postpartum. Blood was analyzed for cytokines as measures of immune modulation. Stress, fatigue, and depression were experienced at moderately high levels, with higher levels of fatigue and depression in the postpartum but higher stress in the prenatal period. Levels of several cytokines were increased in the postpartum over the prenatal period. Stress and depression were related in the prenatal period and stress, depression, and fatigue were related in the postpartum. While various cytokines were related to each other in both periods, only stress was related to MIP-1β, a cytokine that may be important for childbirth processes. More studies, especially longitudinal and interventional studies, are needed to increase our knowledge about etiology, patterns, symptoms, factors, and management of maternal distress. The search for reliable biomarkers for at-risk mothers remains a priority.

  2. Is Perceived Discrimination in Pregnancy Prospectively Linked to Postpartum Depression? Exploring the Role of Education.

    Science.gov (United States)

    Stepanikova, Irena; Kukla, Lubomir

    2017-08-01

    Objectives The role of perceived discrimination in postpartum depression is largely unknown. We investigate whether perceived discrimination reported in pregnancy contributes to postpartum depression, and whether its impact varies by education level. Methods Prospective data are a part of European Longitudinal Study of Pregnancy and Childhood, the Czech Republic. Surveys were collected in mid-pregnancy and at 6 months after delivery. Depression was measured using Edinburgh Postnatal Depression Scale. Generalized linear models were estimated to test the effects of perceived discrimination on postpartum depression. Results Multivariate models revealed that among women with low education, discrimination in pregnancy was prospectively associated with 2.43 times higher odds of postpartum depression (p discrimination was not linked to postpartum depression among women with high education. Conclusions Perceived discrimination is a risk factor for postpartum depression among women with low education. Screening for discrimination and socio-economic disadvantage during pregnancy could benefit women who are at risk for mental health problems.

  3. [Endocrinopathies during the postpartum period. Management].

    Science.gov (United States)

    Gallo-Vallejo, J L; Gallo-Vallejo, F J

    2015-03-01

    The various endocrinopathies that may occur during the postpartum period are described. The most important and common is gestational and pre-gestational diabetes, but other less common, and also very important ones, are mentioned such as hypopituitarism (Sheehan's syndrome and lymphocytic hypophysitis) and thyroid disorders, pre-existing (hyperthyroidism and hypothyroidism), or postpartum onset (postpartum thyroiditis and Graves' disease). After describing their characteristics, the emphasis is placed on the proper management of these endocrine diseases, some of them which exclusively appear during the postpartum period. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  4. Support of USARIEM Postpartum Soldier Research Study

    National Research Council Canada - National Science Library

    Dettori, Joseph

    1996-01-01

    It is estimated approximately 9% of Army women are pregnant at any one time. Shortly after delivery, postpartum soldiers are expected to return to full duty, meet body fat standards and pass the APFT...

  5. Fear of childbirth predicts postpartum depression

    DEFF Research Database (Denmark)

    Räisänen, Sari; Lehto, Soili M; Nielsen, Henriette Svarre

    2013-01-01

    To study how reproductive risks and perinatal outcomes are associated with postpartum depression treated in specialised healthcare defined according to the International Classification of Diseases (ICD)-10 codes, separately among women with and without a history of depression....

  6. Enhanced myometrial autophagy in postpartum uterine involution

    Directory of Open Access Journals (Sweden)

    Keng-Fu Hsu

    2014-09-01

    Conclusion: Autophagy of myocytes may play an important role in uterine involution. These results have implications for our understanding of myometrial functional adaptations during pregnancy and the physiological role of autophagy in the uterine remodeling events in the postpartum period.

  7. Immunotoxin – a new treatment option in patients with relapsed and refractory Hodgkin lymphoma

    Directory of Open Access Journals (Sweden)

    Novakovic Barbara Jezersek

    2015-12-01

    Full Text Available Background. Even though Hodgkin lymphoma is a highly curable disease, some of the patients have either a refractory disease or experience a relapse following a successful primary therapy. Durable responses and remissions in patients with relapsed or refractory disease may be achieved in approximately one-half with salvage chemotherapy followed by high dose chemotherapy (HDT and autologous hematopoietic cell rescue (SCT. On the other hand, patients who relapse after HDT and autologous SCT or those who have failed at least two prior multi-agent chemotherapy regimens and are not candidates for HDT have limited treatment options.

  8. Postpartum Inflammatory Sacroiliitis-A Case Report

    Directory of Open Access Journals (Sweden)

    Seniz Akcay Yalbuzdag

    2013-08-01

    Full Text Available During the pregnancy several changes occur in sacroiliac joint and pelvis which may predispose for sacroiliac joint strain and septic sacroiliitis. We describe a case of acute inflammatory sacroiliitis in a patient with HLA B27 positivity during postpartum period, and diagnosed psoriatic arthritis during the follow up period. We aimed to emphasize that inflammatory sacroiliitis should take place whithin differantial diagnose of postpartum low back pain.

  9. Risk factors for postpartum urinary incontinence

    OpenAIRE

    Lígia da Silva Leroy; Adélia Lúcio; Maria Helena Baena de Moraes Lopes

    2016-01-01

    Abstract OBJECTIVE: To investigate the risk factors for postpartum urinary incontinence (UI) and its characteristics. METHOD: This was a case-control study with 344 puerperal women (77 cases and 267 controls) with up to 90 days postpartum. In a single session, participants were given a questionnaire with sociodemographic and clinical data and two others that assessed urine leakage, leakage situations, and type of UI. RESULTS: Stress UI was present in 45.5% of the women, incidents of urine...

  10. Periodontal status during pregnancy and postpartum.

    Science.gov (United States)

    González-Jaranay, Maximino; Téllez, Luís; Roa-López, Antonio; Gómez-Moreno, Gerardo; Moreu, Gerardo

    2017-01-01

    Different studies have documented an association between periodontal disease and low birth-weight delivery. Hence, knowledge of periodontal status during pregnancy and postpartum is important in order to reduce the risks of both diseases. This study aimed to analyze periodontal status at successive stages of pregnancy and 3-6 weeks postpartum in women with initial periodontal alterations. Ninety-six pregnant women were examined at 8-10 weeks (pregnancy diagnosis, baseline), 21-23 weeks and 34-36 weeks of gestation and at 40 days postpartum to record plaque scores, clinically assessed gingival inflammation and probing depth (mean depth and % sites with depth >3 mm). Bivariate and multivariate analyses were performed. Type 1 (α) error was established at 0.05. Plaque Index increased (p = 0.043) throughout pregnancy (baseline, 42%±0.18); 21-23 weeks, 42.6%±0.14; 34-36 weeks, 45.6%±0.13 and decreased postpartum (44.8%±0-13). Gingival Index increased (ppregnancy (baseline, 56.7%±0.20; 21-23 weeks, 66.36%±0.17; 34-36 weeks, 74.5%±0.18) and decreased postpartum (59.3%±0.21). Probing Depth increased (ppregnancy (baseline, 2.51±0.05; 21-23 weeks, 2.63±0.053; 34-36 weeks 2.81±0.055) and decreased postpartum (2.54±0.049). Percentage of sites with Probing Depth >3 mm increased (ppregnancy (baseline, 17.6%±0.16; 21-23 weeks, 23.9%±0.17; 34-36 weeks, 31.1%±0.17) and decreased postpartum (21.2%±0.17) but remained significantly (pPeriodontal status deteriorates during gestation but improves postpartum.

  11. Advanced Maternal Age Worsens Postpartum Vascular Function

    Directory of Open Access Journals (Sweden)

    Jude S. Morton

    2017-06-01

    Full Text Available The age at which women experience their first pregnancy has increased throughout the decades. Pregnancy has an important influence on maternal short- and long-term cardiovascular outcomes. Pregnancy at an advanced maternal age increases maternal risk of gestational diabetes, preeclampsia, placenta previa and caesarian delivery; complications which predict worsened cardiovascular health in later years. Aging also independently increases the risk of cardiovascular disease; therefore, combined risk in women of advanced maternal age may lead to detrimental cardiovascular outcomes later in life. We hypothesized that pregnancy at an advanced maternal age would lead to postpartum vascular dysfunction. We used a reproductively aged rat model to investigate vascular function in never pregnant (virgin, previously pregnant (postpartum and previously mated but never delivered (nulliparous rats at approximately 13.5 months of age (3 months postpartum or equivalent. Nulliparous rats, in which pregnancy was spontaneously lost, demonstrated significantly reduced aortic relaxation responses (methylcholine [MCh] Emax: 54.2 ± 12.6% vs. virgin and postpartum rats (MCh Emax: 84.8 ± 3.5% and 84.7 ± 3.2% respectively; suggesting pregnancy loss causes a worsened vascular pathology. Oxidized LDL reduced relaxation to MCh in aorta from virgin and postpartum, but not nulliparous rats, with an increased contribution of the LOX-1 receptor in the postpartum group. Further, in mesenteric arteries from postpartum rats, endothelium-derived hyperpolarization (EDH-mediated vasodilation was reduced and a constrictive prostaglandin effect was apparent. In conclusion, aged postpartum rats exhibited vascular dysfunction, while rats which had pregnancy loss demonstrated a distinct vascular pathology. These data demonstrate mechanisms which may lead to worsened outcomes at an advanced maternal age; including early pregnancy loss and later life cardiovascular dysfunction.

  12. Metaplastic carcinoma. Breast. Relapse. Chemotherapy and Radiotherapy

    International Nuclear Information System (INIS)

    Marquez, A.; Terrasa, J.; Garcia, J.M.; Rifa, J.

    1996-01-01

    Metaplastic carcinoma of the breast is a rare tumor. The appearance of unexpected mesenchymal elements within the epithelial tumors is the squamous metaplasia. These tumors have a different clinical behaviour that classical breast carcinoma. We present a case of metaplastic mammary carcinoma with multiple relapses treated with a combination of chemotherapy and radiotherapy. The use of chemotherapy after local treatment has enhanced the relapse-free survival. The combined treatment modality seems to produce some benefit in the management of the local relapses of this neoplasms

  13. Contribution of placenta accreta to the incidence of postpartum hemorrhage and severe postpartum hemorrhage.

    Science.gov (United States)

    Mehrabadi, Azar; Hutcheon, Jennifer A; Liu, Shiliang; Bartholomew, Sharon; Kramer, Michael S; Liston, Robert M; Joseph, K S

    2015-04-01

    To quantify the contribution of placenta accreta to the rate of postpartum hemorrhage and severe postpartum hemorrhage. All hospital deliveries in Canada (excluding Quebec) for the years 2009 and 2010 (N=570,637) were included in a retrospective cohort study using data from the Canadian Institute for Health Information. Placenta accreta included placental adhesion to the uterine wall, musculature, and surrounding organs (accreta, increta, or percreta). Severe postpartum hemorrhage included postpartum hemorrhage with blood transfusion, hysterectomy, or other procedures to control bleeding (including uterine suturing and ligation or embolization of pelvic arteries). Rates, rate ratios, population-attributable fractions (ie, incidence of postpartum hemorrhage attributable to placenta accreta), and 95% confidence intervals (CIs) were estimated. Logistic regression was used to quantify associations between placenta accreta and risk factors. The incidence of placenta accreta was 14.4 (95% CI 13.4-15.4) per 10,000 deliveries (819 cases among 570,637 deliveries), whereas the incidence of placenta accreta with postpartum hemorrhage was 7.2 (95% CI 6.5-8.0) per 10,000 deliveries. Postpartum hemorrhage among women with placenta accreta was predominantly third-stage hemorrhage (41% of all cases). Although placenta accreta was strongly associated with postpartum hemorrhage (rate ratio 8.3, 95% CI 7.7-8.9), its low frequency resulted in a small population-attributable fraction (1.0%, 95% CI 0.93-1.16). However, the strong association between placenta accreta and postpartum hemorrhage with hysterectomy (rate ratio 286, 95% CI 226-361) resulted in a population-attributable fraction of 29.0% (95% CI 24.3-34.3). Placenta accreta is too infrequent to account for the recent temporal increase in postpartum hemorrhage but contributes substantially to the proportion of postpartum hemorrhage with hysterectomy.

  14. Postpartum illness in Fiji: a sociosomatic perspective.

    Science.gov (United States)

    Becker, A E

    1998-01-01

    The purpose of this study is to explore the apparent social mediation of a postpartum somatic illness, na tadoka ni vasucu, occurring among ethnic Fijian women. During their first two postpartum days, 85 consecutive newly delivered ethnic Fijian women were recruited for a prospective study on na tadoka ni vasucu at the Sigatoka District Hospital in Nadroga, Fiji. Subjects underwent translated structured interviews and responded to the Kellner Symptom Questionnaire and to visual analog scales to assess social supports and occurrence of mood symptoms or an episode of na tadoka ni vasucu in the postpartum period. Semistructured ethnographic interviews were also conducted with subjects who reported an episode of na tadoka ni vasucu. Data were collected in the initial postpartum days and again at 2 to 5 months postpartum; 82 women completed the study. Na tadoka ni vasucu is a somatic syndrome occurring in 9% (N = 7) of this sample. Both quantitative and narrative data demonstrate that this syndrome is associated with perceived inferior social supports. Despite its relatively infrequent occurrence and benign clinical course, the disorder is a subject of serious social concern within the Fijian community. Although na tadoka ni vasucu seems to be clinically trivial, because of its cultural salience it is nonetheless able to mobilize intensive social surveillance and care for the postpartum mother. The moral concern generated by this culturally marked disorder, as well as its association with perceived inferior social supports, suggest a dialectical relationship between somatic idiom and its social context.

  15. Periodontal status during pregnancy and postpartum.

    Directory of Open Access Journals (Sweden)

    Maximino González-Jaranay

    Full Text Available Different studies have documented an association between periodontal disease and low birth-weight delivery. Hence, knowledge of periodontal status during pregnancy and postpartum is important in order to reduce the risks of both diseases. This study aimed to analyze periodontal status at successive stages of pregnancy and 3-6 weeks postpartum in women with initial periodontal alterations.Ninety-six pregnant women were examined at 8-10 weeks (pregnancy diagnosis, baseline, 21-23 weeks and 34-36 weeks of gestation and at 40 days postpartum to record plaque scores, clinically assessed gingival inflammation and probing depth (mean depth and % sites with depth >3 mm. Bivariate and multivariate analyses were performed. Type 1 (α error was established at 0.05.Plaque Index increased (p = 0.043 throughout pregnancy (baseline, 42%±0.18; 21-23 weeks, 42.6%±0.14; 34-36 weeks, 45.6%±0.13 and decreased postpartum (44.8%±0-13. Gingival Index increased (p3 mm increased (p<0.001 throughout pregnancy (baseline, 17.6%±0.16; 21-23 weeks, 23.9%±0.17; 34-36 weeks, 31.1%±0.17 and decreased postpartum (21.2%±0.17 but remained significantly (p<0.02 higher than at baseline.Periodontal status deteriorates during gestation but improves postpartum.

  16. Incidence, trends and severity of primary postpartum haemorrhage in Australia: A population-based study using Victorian Perinatal Data Collection data for 764 244 births.

    Science.gov (United States)

    Flood, Margaret; McDonald, Susan J; Pollock, Wendy; Cullinane, Fiona; Davey, Mary-Ann

    2018-05-22

    Increasing incidence and severity of postpartum haemorrhage, together with postpartum haemorrhage-associated morbidities, have been reported in many high-resource countries. In-depth analysis of such factors in Victorian births since 2002 was lacking. Our aim was to determine the incidence and trends for primary postpartum haemorrhage (World Health Organization and International Classification of Diseases 10th revision, Australian Modification definitions) for all confinements in Victoria, Australia, for the years 2003-2013 and the incidence and trends for severe postpartum haemorrhage (≥1500 mL) for 2009-2013. In this population-based cross-sectional study de-identified data from the Victorian Perinatal Data Collection were analysed for confinements (excluding terminations) from 2003 to 2013 (n = 764 244). Perinatal information for all births ≥20 weeks (or of at least 400 g birthweight if gestation was unknown) were prospectively collected. One in five women (21.8%) who gave birth between 2009 and 2013 experienced a primary postpartum haemorrhage and one in 71 women (1.4%) experienced a severe primary postpartum haemorrhage. The increasing trends in incidence of primary postpartum haemorrhage, severe primary postpartum haemorrhage, blood transfusion, admission to an intensive care or high dependency unit and peripartum hysterectomy were significant (P primary postpartum haemorrhage. The highest incidence was experienced by women who had an unplanned caesarean section birth. Women who had a forceps birth had the highest incidence of severe primary postpartum haemorrhage. The incidence of primary postpartum haemorrhage, severe primary postpartum haemorrhage and associated maternal morbidities have increased significantly over time in Victoria. © 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  17. The Correlation Between Breastfeeding Success in the Early Postpartum Period and the Perception of Self-Efficacy in Breastfeeding and Breast Problems in the Late Postpartum.

    Science.gov (United States)

    Kılcı, Hanife; Çoban, Ayden

    2016-05-01

    The research was conducted to determine the correlation between breastfeeding success in the early postpartum period and the perception of self-efficacy in breastfeeding and breast problems in late postpartum. This analytic and cross-sectional research was carried out at Aydın Obstetrics and Gynecology and Children's Diseases Hospital. Three hundred twenty-seven primipara mothers who had delivered a single baby of healthy term at 37 or more gestational weeks with no previous experience with breastfeeding and who agreed to cooperate participated in the research. The mothers' mean gestational week of delivery was 39.25 ± 1.10 weeks, and it was found that 56.0% had delivered by cesarean section and 57.0% had started to breastfeed immediately after the birth. The mothers' LATCH mean score was 6.55 ± 0.86; their postnatal breastfeeding self-efficacy mean score was found to be 59.10 ± 7.21. Mothers who had high success in breastfeeding at early postpartum were found to experience fewer problems with their breasts (Z = -2.65, p postpartum period reduced breast problems and increased the perception of breastfeeding self-efficacy in the late postpartum period.

  18. Multiple-clone activation of hypnozoites is the leading cause of relapse in Plasmodium vivax infection.

    Directory of Open Access Journals (Sweden)

    Flávia Carolina F de Araujo

    Full Text Available BACKGROUND: Plasmodium vivax infection is characterized by a dormant hepatic stage, the hypnozoite that is activated at varying periods of time after clearance of the primary acute blood-stage, resulting in relapse. Differentiation between treatment failure and new infections requires characterization of initial infections, relapses, and clone multiplicity in vivax malaria infections. METHODOLOGY/PRINCIPAL FINDINGS: Parasite DNA obtained from primary/relapse paired blood samples of 30 patients with P. vivax infection in Brazil was analyzed using 10 molecular markers (8 microsatellites and MSP-1 blocks 2 and 10. Cloning of PCR products and genotyping was used to identify low-frequency clones of parasites. We demonstrated a high frequency of multiple-clone infections in both primary and relapse infections. Few alleles were identified per locus, but the combination of these alleles produced many haplotypes. Consequently, the majority of parasites involved in relapse showed haplotypes that were distinct from those of primary infections. Plasmodium vivax relapse was characterized by temporal variations in the predominant parasite clones. CONCLUSIONS/SIGNIFICANCE: The high rate of low frequency alleles observed in both primary and relapse infections, along with temporal variation in the predominant alleles, might be the source of reported heterologous hypnozoite activation. Our findings complicate the concept of heterologous activation, suggesting the involvement of undetermined mechanisms based on host or environmental factors in the simultaneous activation of multiple clones of hypnozoites.

  19. Salivary buffer effect in relation to late pregnancy and postpartum.

    Science.gov (United States)

    Laine, M; Pienihäkkinen, K

    2000-02-01

    We studied the salivary pH, buffer effect (BE), and flow rates of unstimulated and paraffin-stimulated saliva of 8 women in their late pregnancy and postpartum. Salivary samples were collected about 1 month prior to and about 2 months after delivery. In non-pregnant control women, two paraffin-stimulated salivary samples were collected 1 month apart. The salivary BE increased significantly from late pregnancy to postpartum without exception. The increase was 2.04 +/- 1.17 pH units (P pH) to 6.82 +/- 1.01 (final pH). This change was not due to variation in salivary flow rates, since both unstimulated and paraffin-stimulated flow rates remained unchanged. In control women the difference between the 2 BE measurements was only 0.13 +/- 0.47 pH units on average. We concluded that women with high postpartum BE values may have moderate or even low BE values in late pregnancy. In control women, individual variation was found to be low in all variables studied.

  20. Pharmacological interventions for alcohol relapse prevention

    African Journals Online (AJOL)

    Arun Kumar Agnihotri

    Health NHS Foundation Trust, Birmingham, UK ... ABSTRACT: Alcohol dependence is a chronic, debilitating disorder that is an important .... hours, or as long as alcohol remains in the blood. ... term and slightly improving days to relapse.

  1. Factors associated with relapse in schizophrenia

    African Journals Online (AJOL)

    increases the economic burden on health care systems because of its associated morbidity .... Depression in schizophrenia has been associated with higher rates of relapse ... The researchers approached the psychiatric nursing staff of mental.

  2. Treatment options for severe pulmonary embolism during pregnancy and the postpartum period: a systematic review.

    Science.gov (United States)

    Martillotti, G; Boehlen, F; Robert-Ebadi, H; Jastrow, N; Righini, M; Blondon, M

    2017-10-01

    Essentials The evidence on how to manage life-threatening pregnancy-related pulmonary embolism (PE) is scarce. We systematically reviewed all available cases of (sub)massive PE until December 2016. Thrombolysis in such severe PE was associated with a high maternal survival (94%). The major bleeding risk was much greater in the postpartum (58%) than antepartum period (18%). Background Massive pulmonary embolism (PE) during pregnancy or the postpartum period is a rare but dramatic event. Our aim was to systematically review the evidence to guide its management. Methods We searched Pubmed, Embase, conference proceedings and the RIETE registry for published cases of severe (submassive/massive) PE treated with thrombolysis, percutaneous or surgical thrombectomy and/or extracorporeal membrane oxygenation (ECMO), occurring during pregnancy or within 6 weeks of delivery. Main outcomes were maternal survival and major bleeding, premature delivery, and fetal survival and bleeding. Results We found 127 cases of severe PE (at least 83% massive; 23% with cardiac arrest) treated with at least one modality. Among 83 women with thrombolysis, survival was 94% (95% CI, 86-98). The risk of major bleeding was 17.5% during pregnancy and 58.3% in the postpartum period, mainly because of severe postpartum hemorrhages. Fetal deaths possibly related to PE or its treatment occurred in 12.0% of cases treated during pregnancy. Among 36 women with surgical thrombectomy, maternal survival and risk of major bleeding were 86.1% (95% CI, 71-95) and 20.0%, with fetal deaths possibly related to surgery in 20.0%. About half of severe postpartum PEs occurred within 24 h of delivery. Conclusions Published cases of thrombolysis for massive PE during pregnancy and the postpartum period suggest a high maternal and fetal survival (94% and 88%). In the postpartum period, given the high risk of major bleeding with thrombolysis, other therapeutic options (catheter [or surgical] thrombectomy, ECMO) may be

  3. Do pregnancy, postpartum period and lactation predispose to recurrent toxoplasmic retinochoroiditis?

    Science.gov (United States)

    Brydak-Godowska, Joanna; Borkowski, Piotr Karol; Rabczenko, Daniel; Moneta-Wielgoś, Joanna; Kęcik, Dariusz

    2015-02-23

    The aim of the study was a statistical analysis of the possible effects of pregnancy, postpartum period, and lactation on increased risk for reactivation of toxoplasmic retinochoroiditis. A retrospective study was undertaken of the clinical records of 661 patients referred with the diagnosis of acute toxoplasmic retinochoroiditis to the Department of Zoonoses and Tropical Diseases, Medical University of Warsaw and to the Department of Ophthalmology, Medical University of Warsaw in the years 1994-2014. This group of inpatients consisted of 213 women of child-bearing age (18 to 40 years). Reactivation of toxoplasmic retinochoroiditis was observed in 24 women aged 15 to 39 years who were pregnant, in the postpartum period, or lactating. To compare the rate of the relapses in pregnant/lactating patients vs. non-pregnant/non-lactating patients, the Fisher exact test was used. Calculations were performed with WinPepi software (Abramson JH (2004) WINPEPI (PEPI-for-Windows) for epidemiologists. Epidemiologic Perspectives & Innovations, 2005, 1: 6). A total of 28 reactivations of toxoplasmic retinochoroiditis were observed (16 episodes in pregnancy, 4 in the postpartum period, and 8 during lactation) in 24 women aged 15 to 39 years. In 3 women, multiple episodes were reported (in early pregnancy and the postpartum period in 2 women, and during 2 pregnancies and lactation in 1 woman). Statistical analysis showed that the risk of an episode of toxoplasmic retinochoroiditis is 7.4-fold higher in pregnancy compared to the non-pregnant/non-lactating women (p<0.0001). Women of childbearing age with toxoplasma ocular lesions should be informed by their doctors about possible active recurrences during pregnancy and should be followed carefully by an ophthalmologist when pregnant.

  4. Early life adversity influences stress response association with smoking relapse.

    Science.gov (United States)

    al'Absi, Mustafa; Lemieux, Andrine; Westra, Ruth; Allen, Sharon

    2017-11-01

    We examined the hypothesis that stress-related blunting of cortisol in smokers is particularly pronounced in those with a history of severe life adversity. The two aims of this study were first to examine hormonal, craving, and withdrawal symptoms during ad libitum smoking and after the first 24 h of abstinence in smokers who experienced high or low levels of adversity. Second, we sought to examine the relationship between adversity and hypothalamic-pituitary-adrenal (HPA) hormones to predict relapse during the first month of a smoking cessation attempt. Hormonal and self-report measures were collected from 103 smokers (49 women) during ad libitum smoking and after the first 24 h of abstinence. HPA hormones were measured during baseline rest and in response to acute stress in both conditions. All smokers were interested in smoking cessation, and we prospectively used stress response measures to predict relapse during the first 4 weeks of the smoking cessation attempt. The results showed that high adversity was associated with higher distress and smoking withdrawal symptoms. High level of early life adversity was associated with elevated HPA activity, which was found in both salivary and plasma cortisol. Enhanced adrenocorticotropic hormone (ACTH) stress response was evident in high-adversity but not in low-adversity relapsers. This study demonstrated that early life adversity is associated with stress-related HPA responses. The study also demonstrated that, among smokers who experienced a high level of life adversity, heightened ACTH and cortisol responses were linked with increased risk for smoking relapse.

  5. Relapsing polychondritis and airway involvement.

    Science.gov (United States)

    Ernst, Armin; Rafeq, Samaan; Boiselle, Phillip; Sung, Arthur; Reddy, Chakravarthy; Michaud, Gaetane; Majid, Adnan; Herth, Felix J F; Trentham, David

    2009-04-01

    To assess the prevalence and characteristics of airway involvement in relapsing polychondritis (RP). Retrospective chart review and data analysis of RP patients seen in the Rheumatology Clinic and the Complex Airway Center at Beth Israel Deaconess Medical Center from January 2004 through February 2008. RP was diagnosed in 145 patients. Thirty-one patients had airway involvement, a prevalence of 21%. Twenty-two patients were women (70%), and they were between 11 and 61 years of age (median age, 42 years) at the time of first symptoms. Airway symptoms were the first manifestation of disease in 17 patients (54%). Dyspnea was the most common symptom in 20 patients (64%), followed by cough, stridor, and hoarseness. Airway problems included the following: subglottic stenosis (n = 8; 26%); focal and diffuse malacia (n = 15; 48%); and focal stenosis in different areas of the bronchial tree in the rest of the patients. Twelve patients (40%) required and underwent intervention including balloon dilatation, stent placement, tracheotomy, or a combination of the above with good success. The majority of patients experienced improvement in airway symptoms after intervention. One patient died during the follow-up period from the progression of airway disease. The rest of the patients continue to undergo periodic evaluation and intervention. In this largest cohort described in the English language literature, we found symptomatic airway involvement in RP to be common and at times severe. The nature of airway problems is diverse, with tracheomalacia being the most common. Airway intervention is frequently required and in experienced hands results in symptom improvement.

  6. Monitoring treatment response and metastatic relapse in advanced bladder cancer by liquid biopsy analysis

    DEFF Research Database (Denmark)

    Birkenkamp-Demtröder, Karin; Christensen, Emil; Nordentoft, Iver Kristiansen

    2017-01-01

    of circulating tumour DNA (ctDNA) in plasma and urine to detect metastatic relapse after cystectomy and measure treatment efficacy. We exome sequenced tumour and germline DNA from patients with muscle-invasive bladder cancer and monitored ctDNA in 370 liquid biopsies throughout the disease courses by 84......DNA detection in plasma and diagnosis of relapse was 101 d after cystectomy (range 0-932 d). Early detection of metastatic relapse and treatment response using liquid biopsies represents a novel, highly sensitive tool for monitoring patients, supporting clinicians, and guiding treatment decisions. PATIENT...

  7. Chinese herbal medicine use in Taiwan during pregnancy and the postpartum period: a population-based cohort study.

    Science.gov (United States)

    Chuang, Chao-Hua; Chang, Pei-Jen; Hsieh, Wu-Shiun; Tsai, Yih-Jian; Lin, Shio-Jean; Chen, Pau-Chung

    2009-06-01

    Using Chinese herbal medicines during pregnancy and postpartum is common in the Chinese community. The purpose of this current study is to explore the use of Chinese herbal medicines by women during pregnancy and postpartum in Taiwan. It is an on-going prospective longitudinal study design. We used multistage stratified systematic sampling to recruit 24,200 pairs, postpartum women and newborns, from the Taiwan national birth register in 2005. Subjects underwent a home interview 6 months after their deliveries between June 2005 and July 2006. A structured questionnaire was successfully administered to 87.8% of the sampled population. At least one Chinese herbal medicine was used by 33.6% and 87.7% of the interviewed subjects during pregnancy and the postpartum period, respectively. An-Tai-Yin, Pearl powder, and Huanglian were the most commonly used during pregnancy, while Shen-Hua-Tang and Suz-Wu-Tang were the most commonly used by postpartum women. Pregnant women aged 20-34, with high education, threatened abortion, chronic disease, and primipara appeared to use more Chinese herbal medicines than others in the sample. Postpartum women with high education, primipara, normal spontaneous delivery, and breastfeeding were found to use more Chinese herbal medicines; but women with pregnancy-related illness used less. Chinese herbal medicines are frequently used by women during pregnancy and the postpartum period in Taiwan and those with high education and primipara used more such herbs. Due to limited safety information on these herbs, we would advise caution regarding their use either during pregnancy or postpartum breastfeeding period. Moreover, it is important for nurses/midwifes enquiring about such habits, and providing the adequate education to women during prenatal and postpartum care to prevent potential side effects.

  8. Postpartum education for contraception: a systematic review.

    Science.gov (United States)

    Lopez, Laureen M; Hiller, Janet E; Grimes, David A

    2010-05-01

    Contraceptive education is generally considered a standard component of postpartum care, but the effectiveness is seldom examined. Two-thirds of postpartum women may have unmet needs for contraception, and many adolescents become pregnant again within a year of giving birth. Women may prefer to discuss contraception prenatally or after hospital discharge. The objective of this systematic review was to assess the effects of educational interventions for postpartum mothers about contraceptive use. We searched computerized databases for randomized controlled trials that evaluated the effectiveness of postpartum contraceptive education. The intervention must have started within 1 month after delivery. The Mantel-Haenszel odds ratio was calculated with 95% confidence interval for the dichotomous outcomes. Eight trials met the inclusion criteria. Of 4 short-term interventions, 1 did not have sufficient data and 1 was statistically underpowered. The remaining 2 showed a positive effect on contraceptive use. Of 4 multifaceted programs, 2 showed fewer pregnancies or births among adolescents in the experimental group that had enhanced services, and 1 structured home-visiting program showed more contraceptive use. The effective interventions were conducted in Australia, Nepal, Pakistan, and the United States. Postpartum education about contraception led to more contraception use and fewer unplanned pregnancies. Short-term interventions were limited by self-reported outcomes or showing no effect for many comparisons. The longer-term programs were promising and not necessarily more costly than usual care. Health care providers can determine if 1 of these interventions suits their setting and level of resources. Obstetricians & Gynecologist, Family Physicians. After completing this educational activity, the participant should be better able to assess the importance of assessing delivery methods when examining intervention quality, evaluate the evidence from randomized trials on

  9. Physical activity patterns during pregnancy through postpartum

    Directory of Open Access Journals (Sweden)

    Evenson Kelly R

    2009-11-01

    Full Text Available Abstract Background Realizing the importance of regular physical activity, particularly in the prevention of chronic diseases and unhealthy weight gain, it is important to study how physical activity changes during and after pregnancy using prospective study designs. The aim of this study was to describe the mode, duration, intensity, and changes in physical activity during pregnancy through one year postpartum among a cohort of women. Methods This study was part of the third Pregnancy, Infection and Nutrition Postpartum Study at the University of North Carolina Hospitals. A cohort of 471 women was followed at 17-22 and 27-30 weeks' gestation and at 3 and 12 months postpartum. The participants reported the mode, frequency, duration, and intensity of all physical activities that increased their breathing and heart rate in the past week. Results Overall physical activity for the cohort decreased from 17-22 weeks to 27-30 weeks of gestation, but rebounded up at 3 months postpartum and remained stable at 12 months postpartum. The mean MET h/wk values for each time point were 24.7 (standard deviation, SD 26.8, 19.1 (SD 18.9, 25.7 (SD 29.3, and 26.7 (SD 31.5. In postpartum, women reported more care-giving and recreational activity and less indoor household activity, as compared to their activity level during pregnancy. Conclusion For health benefits and weight management, health care professionals are encouraged to provide pregnant and postpartum women with information on recommendations of physical activity, particularly regarding the minimum duration and intensity level.

  10. Postpartum haemorrhage: prevention and treatment.

    Science.gov (United States)

    Sentilhes, Loïc; Merlot, Benjamin; Madar, Hugo; Sztark, François; Brun, Stéphanie; Deneux-Tharaux, Catherine

    2016-11-01

    Postpartum hemorrhage (PPH) is one of the leading causes of maternal death and severe maternal morbidity worldwide and strategies to prevent and treat PPH vary among international authorities. Areas covered: This review seeks to provide a global overview of PPH (incidence, causes, risk factors), prevention (active management of the third stage of labor and prohemostatic agents), treatment (first, second and third-line measures to control PPH), by also underlining recommendations elaborated by international authorities and using algorithms. Expert commentary: When available, oxytocin is considered the drug of first choice for both prevention and treatment of PPH, while peripartum hysterectomy remains the ultimate life-saving procedure if pharmacological and resuscitation measures fail. Nevertheless, the level of evidence for preventing and treating PPH is globally low. The emergency nature of PPH makes randomized controlled trials (RCT) logistically difficult. Population-based observational studies should be encouraged as they can usefully strengthen the evidence base, particularly for components of PPH treatment that are difficult or impossible to assess through RCT.

  11. Relapsed or refractory pediatric acute lymphoblastic leukemia: current and emerging treatments.

    Science.gov (United States)

    Martin, Alissa; Morgan, Elaine; Hijiya, Nobuko

    2012-12-01

    Relapsed acute lymphoblastic leukemia (ALL) represents a major cause of morbidity and mortality in pediatrics. With contemporary chemotherapy, >85% of patients with newly diagnosed ALL survive. Unfortunately, 20% of these patients will relapse and for these children, outcomes remain poor despite our best known chemotherapy protocols. Most of these children will achieve a second complete remission, but maintaining this remission remains difficult. Because relapsed ALL is such a significant cause of morbidity and mortality, it is the focus of much research interest. Efforts have been made and continue to focus on understanding the underlying biology that drives relapse. The role of hematopoietic stem cell transplantation in relapsed ALL remains unclear, but many clinicians still favor this for high-risk patients given the poor prognosis with current chemotherapy alone. It is important to use new drugs with little cross-resistance in the treatment of relapsed ALL. New classes of agents are currently being studied. We also discuss prognostic factors and the biology of relapsed ALL.

  12. Venous thromboembolism risk and postpartum lying-in: Acculturation of Indian and Chinese women.

    Science.gov (United States)

    Melov, Sarah J; Hitos, Kerry

    2018-03-01

    many cultures have a set time of traditional rest in the postpartum period. There is limited information on how this activity may potentially increase the risk of venous thromboembolism (VTE). We aimed to investigate VTE risk by determining the prevalence of the cultural practice of postpartum "lying-in", quantifying activity and determining the factors that influence this tradition in women from China and the Indian subcontinent (India, Bangladesh, Pakistan and Sri Lanka) at an Australian tertiary referral hospital. we surveyed a prospective cohort of 150 women aged ≥ 18 years who self-identified culturally as from the Indian subcontinent or Chinese, at baseline (≥ 32 weeks gestation) and at follow-up (six to eight weeks postpartum). Demographic details collected included VTE risk factors such as caesarean section, lack of graduated compression stockings (GCS), postpartum haemorrhage greater than 1000mL, comorbidities and immobility. We quantified postpartum activities and investigated factors that might influence inactivity. there were 100 women identifying as from the Indian subcontinent and 50 women identifying as Chinese recruited at the baseline of over 32 weeks' gestation. Most of the study participants (85%) rested in the postpartum period for cultural reasons. Of the women surveyed, 51% rested in bed as much as possible in the postpartum period. We found a significant correlation between increased number of children and decreased overall immobility or rest (P = 0.03). Overall, 91% of participants had relative live-in help, and this significantly increased the risk of immobility by more than six-fold (odds ratio [OR], 6.17; 95% CI, 1.6-23.5; P = 0.008). Furthermore, a vaginal compared to a caesarean birth increased immobility risk by almost 3.5 times (OR, 3.4; 95% CI, 1.20-9.4; P = 0.021). acculturation is highly individualised, however postpartum rest remains prevalent in women who identify themselves culturally as from the Indian subcontinent or as

  13. Long-term follow-up of patients receiving allogeneic stem cell transplant for chronic lymphocytic leukaemia: mixed T-cell chimerism is associated with high relapse risk and inferior survival.

    Science.gov (United States)

    Thompson, Philip A; Stingo, Francesco; Keating, Michael J; Wierda, William G; O'Brien, Susan M; Estrov, Zeev; Ledesma, Celina; Rezvani, Katayoun; Qazilbash, Muzaffar; Shah, Nina; Parmar, Simrit; Popat, Uday; Anderlini, Paolo; Yago, Nieto; Ciurea, Stefan O; Kebriaei, Partow; Champlin, Richard; Shpall, Elizabeth J; Hosing, Chitra M

    2017-05-01

    There is limited information regarding the immunological predictors of post-allogeneic stem cell transplant (alloSCT) outcome in chronic lymphocytic leukaemia (CLL), such as mixed T-cell chimerism. We analysed 143 consecutive patients with relapsed/refractory CLL, transplanted between 2000 and 2012, to determine the prognostic relevance of mixed chimerism post-alloSCT and the ability of post-transplant immunomodulation to treat relapse. Mixed T-cell chimerism occurred in 50% of patients at 3 months and 43% at 6 months post-alloSCT; upon 3- and 6-month landmark analysis, this was associated with inferior progression-free survival (PFS) [Hazard ratio (HR) 1·93, P = 0·003 and HR 2·58, P CLL. © 2017 John Wiley & Sons Ltd.

  14. Comparing Effectiveness of Mindfulness-Based Relapse Prevention with Treatment as Usual on Impulsivity and Relapse for Methadone-Treated Patients: A Randomized Clinical Trial.

    Science.gov (United States)

    Yaghubi, Mehdi; Zargar, Fatemeh; Akbari, Hossein

    2017-07-01

    Impulsivity is one of the causes of relapse that can affect treatment outcomes. Studies have shown that addiction treatments can reduce impulsivity in drug-dependent individuals. Studies also have suggested that mindfulness is associated with impulsivity. However, no study has investigated the effectiveness of the mindfulness-based intervention on impulsivity in opioid-dependent individuals. This study aimed to compare the effectiveness of mindfulness-based relapse prevention (MBRP) with treatment as usual (TAU) in terms of impulsivity and relapse for methadone-treated patients. The present randomized controlled clinical trial was performed in Kashan, Iran, in 2015. The study population was opioid-dependent patients referred to Maintenance Treatment Centers. Seventy patients were selected by random sampling and were assigned in two groups (MBRP and TAU) randomly. The participants of two groups filled out Barratt impulsivity scale (BIS-11) as a pre-test and 8 weeks later as post-test and 2 months later as a follow-up. Both groups received methadone-therapy. The MBRP group received 8 sessions of group therapy, while the control group did not receive any group psychotherapy session. Finally, data from 60 patients were analyzed statistically. The MBRP group had decreased impulsivity significantly (P relapse frequency (P relapse probability. These findings suggest that MBRP is useful for opioid-dependent individuals with high-level impulsivity, and relapse prevention.

  15. Antidepressant-Like Effect of Lipid Extract of Channa striatus in Postpartum Model of Depression in Rats

    Directory of Open Access Journals (Sweden)

    Mohamed Saleem Abdul Shukkoor

    2017-01-01

    Full Text Available Postpartum depression affects 15% of women. Channa striatus, a freshwater fish, is consumed in local Malay population as a rejuvenating diet during postpartum period. This study evaluated the antidepressant-like effect of lipid extract of C. striatus fillet and its mechanism of action in female Sprague-Dawley rats in postpartum model of depression. The rats were ovariectomized and treated with high dose of progesterone and estradiol benzoate for 23 days to have hormone-simulated pregnancy. The day 24 and afterwards were considered as the postpartum period. During the postpartum period, lipid extract was administered at 125, 250, and 500 mg/kg through intraperitoneal route for 15 days. Fluoxetine (10 mg/kg was used as the positive control. On postpartum day 15, the animals were tested in forced swimming test (FST and open field test (OFT followed by biochemical analysis. Withdrawal of hormone administration during the postpartum period induced depressive-like behavior in FST. Administration of lipid extract reversed that depressive-like behavior at 125, 250, and 500 mg/kg in FST. In OFT, it decreased the exploratory activity. The mechanism of the antidepressant-like effect may be mediated through the decrease in plasma corticosterone, increase in plasma oxytocin, and decrease in nuclear factor-kappa B in prefrontal cortex of rats.

  16. Postpartum care and breast-feeding.

    Science.gov (United States)

    Acheson, L S; Danner, S C

    1993-09-01

    Scientific studies investigating the postpartum period are scarce, and observational studies greatly outnumber controlled trials. Many studies are biased in their assumptions about the social roles of women and men and in the interpretation of observations and treatment strategies. The published literature is fragmentary; few researchers have attempted a comprehensive, biopsychosocial system-oriented view of postpartum health. More research is needed on the occurrence and treatment of such common postpartum problems as urinary incontinence, sexual dysfunction, and back pain. Widespread application of what is already known about support for breast-feeding, prevention of fatigue and depression, contraception, and maintenance of healthy lifestyles will require innovations in healthcare delivery, professional practices, and social policy, particularly in the occupational arena. Many postpartum problems have been found to be iatrogenic and responsive to changes in the routine care of mothers and newborns. Finally, it is clear that women of lower education and socioeconomic status and those with less social support are consistently at higher risk for postpartum and parenting problems; great benefits are likely from interventions that enhance the well-being of these mothers and infants.

  17. Second hematopoietic SCT for leukemia relapsing after myeloablative T cell-depleted transplants does not prolong survival.

    Science.gov (United States)

    McIver, Z A; Yin, F; Hughes, T; Battiwalla, M; Ito, S; Koklanaris, E; Haggerty, J; Hensel, N F; Barrett, A John

    2013-09-01

    Patients with leukemia relapsing after allogeneic hematopoietic SCT have a dismal prognosis. A second SCT offers a further opportunity for cure, but has a high rate of treatment failure. To determine the utility of this option, we analyzed 59 consecutive patients relapsing after a myeloablative HLA-matched sibling T cell-depleted (TCD) SCT. Twenty-five patients (13 relapsing within 6 months and 12 relapsing between 6 and 170 months after the first SCT) received a T-replete second SCT. Thirty-eight patients relapsing early had a shorter survival than the 21 patients relapsing later (median 96 vs 298 days, P=0.0002). In patients relapsing early, the second SCT did not improve OS compared with patients receiving non-SCT treatments (median survival 109 vs 80 days, P=0.41). In patients relapsing late, despite an early trend in favor of second SCT, survival was comparable for patients receiving a second SCT compared with non retransplanted patients (median survival 363.5 vs 162 days, P=0.49). Disappointingly, our results do not demonstrate an important survival benefit for a second T-replete allogeneic SCT to treat relapse following a TCD SCT.

  18. Anxiety and depression in women and men from early pregnancy to 3-months postpartum.

    Science.gov (United States)

    Figueiredo, Bárbara; Conde, Ana

    2011-06-01

    To investigate high-anxiety and depression in women and men from early pregnancy to 3-months postpartum, 260 Portuguese couples (N = 520) filled in the State-Anxiety Inventory (STAI-S) and the Edinburgh Post-Natal Depression Scale (EPDS) at the first, second, and third pregnancy trimesters, childbirth, and 3-months postpartum. Rates for high-anxiety (STAI-S ≥ 45) in women (13.1%; 12.2%; 18.2%; 18.6%; 4.7%) and men (10.1%; 8.0%, 7.8%; 8.5%; 4.4%) and for depression (EPDS ≥ 10) in women (20.0%, 19.6%, 17.4%, 17.6%; 11.1%) and men (11.3%; 6.6%; 5.5%; 7.5%; 7.2%) were high. Rates for depression were higher than rates for high-anxiety only in women during early pregnancy and the postpartum, but not at the third pregnancy trimester and childbirth. Rates for high-anxiety and depression were higher in women than in men during pregnancy/childbirth, but not at 3-months postpartum. Rates for high-anxiety but not rates for depression were higher during pregnancy/childbirth compared to 3-months postpartum and only in women. Considering that 15.9% of the parents-to-be were highly anxious and/or depressed during pregnancy-comparing to 9.3% at 3-months postpartum-particular attention should be drawn to both women's and men's mental health early in pregnancy.

  19. Familiality of Psychiatric Disorders and Risk of Postpartum Psychiatric Episodes

    DEFF Research Database (Denmark)

    Bauer, Anna E; Maegbaek, Merete L; Liu, Xiaoqin

    2018-01-01

    OBJECTIVE: Postpartum psychiatric disorders are common and morbid complications of pregnancy. The authors sought to evaluate how family history of psychiatric disorders is associated with postpartum psychiatric disorders in proband mothers with and without a prior psychiatric history by assessing...

  20. Prevalence of autoimmune thyroid dysfunction in postpartum psychosis

    NARCIS (Netherlands)

    Bergink, Veerle; Kushner, Steven A.; Pop, Victor; Kuijpens, Hans; Lambregtse-van den Berg, Mijke P.; Drexhage, Roos C.; Wiersinga, Wilmar; Nolen, Willem A.; Drexhage, Hemmo A.

    Background Postpartum psychosis is a life-threatening psychiatric emergency, which often occurs without significant premorbid symptoms. Although many studies have postulated an involvement of the immune and endocrine systems in the onset of postpartum psychosis, the specific aetiological factors

  1. Ischemic neuropathy and rhabdomyolysis as presenting symptoms of postpartum cardiomyopathy

    NARCIS (Netherlands)

    Helmich, Rick C. G.; van Laarhoven, Hanneke W. M.; Schoonderwaldt, Hennie C.; Janssen, Mirian C. H.

    2009-01-01

    Rhabdomyolysis and peripheral neuropathy are two distinct disease entities which are rarely encountered in combination. We present a woman with rhabdomyolysis and peripheral neuropathy 3 weeks postpartum. Her symptoms were caused by bilateral femoral artery thrombosis due to postpartum

  2. Postpartum mental health in relation to sociocultural practices

    Directory of Open Access Journals (Sweden)

    Fatemeh Abdollahi

    2016-02-01

    Conclusions: Cultural practices could not be perceived as protective mechanisms that protect women from PPD in this traditional society. However, health professionals should be familiar with postpartum beliefs and practices that could support mothers in the postpartum period.

  3. The influence of psychological factors on post-partum weight retention at 9 months.

    Science.gov (United States)

    Phillips, Joanne; King, Ross; Skouteris, Helen

    2014-11-01

    Post-partum weight retention (PWR) has been identified as a critical pathway for long-term overweight and obesity. In recent years, psychological factors have been demonstrated to play a key role in contributing to and maintaining PWR. Therefore, the aim of this study was to explore the relationship between post-partum psychological distress and PWR at 9 months, after controlling for maternal weight factors, sleep quality, sociocontextual influences, and maternal behaviours. Pregnant women (N = 126) completed a series of questionnaires at multiple time points from early pregnancy until 9 months post-partum. Hierarchical regression indicated that gestational weight gain, shorter duration (6 months or less) of breastfeeding, and post-partum body dissatisfaction at 3 and 6 months are associated with higher PWR at 9 months; stress, depression, and anxiety had minimal influence. Interventions aimed at preventing excessive PWR should specifically target the prevention of body dissatisfaction and excessive weight gain during pregnancy. What is already known on this subject? Post-partum weight retention (PWR) is a critical pathway for long-term overweight and obesity. Causes of PWR are complex and multifactorial. There is increasing evidence that psychological factors play a key role in predicting high PWR. What does this study add? Post-partum body dissatisfaction at 3 and 6 months is associated with PWR at 9 months post-birth. Post-partum depression, stress and anxiety have less influence on PWR at 9 months. Interventions aimed at preventing excessive PWR should target body dissatisfaction. © 2013 The British Psychological Society.

  4. Addiction and Reward-related Genes Show Altered Expression in the Postpartum Nucleus Accumbens

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    Changjiu eZhao

    2014-11-01

    Full Text Available Motherhood involves a switch in natural rewards, whereby offspring become highly rewarding. Nucleus accumbens (NAC is a key CNS region for natural rewards and addictions, but to date no study has evaluated on a large scale the events in NAC that underlie the maternal change in natural rewards. In this study we utilized microarray and bioinformatics approaches to evaluate postpartum NAC gene expression changes in mice. Modular Single-set Enrichment Test (MSET indicated that postpartum (relative to virgin NAC gene expression profile was significantly enriched for genes related to addiction and reward in 5 of 5 independently curated databases (e.g., Malacards, Phenopedia. Over 100 addiction/reward related genes were identified and these included: Per1, Per2, Arc, Homer2, Creb1, Grm3, Fosb, Gabrb3, Adra2a, Ntrk2, Cry1, Penk, Cartpt, Adcy1, Npy1r, Htr1a, Drd1a, Gria1, and Pdyn. ToppCluster analysis found maternal NAC expression profile to be significantly enriched for genes related to the drug action of nicotine, ketamine, and dronabinol. Pathway analysis indicated postpartum NAC as enriched for RNA processing, CNS development/differentiation, and transcriptional regulation. Weighted Gene Coexpression Network Analysis identified possible networks for transcription factors, including Nr1d1, Per2, Fosb, Egr1, and Nr4a1. The postpartum state involves increased risk for mental health disorders and MSET analysis indicated postpartum NAC to be enriched for genes related to depression, bipolar disorder, and schizophrenia. Mental health related genes included: Fabp7, Grm3, Penk, and Nr1d1. We confirmed via quantitative PCR Nr1d1, Per2, Grm3, Penk, Drd1a, and Pdyn. This study indicates for the first time that postpartum NAC involves large scale gene expression alterations linked to addiction and reward. Because the postpartum state also involves decreased response to drugs, the findings could provide insights into how to mitigate addictions.

  5. Help-seeking patterns in women with postpartum severe mental illness: a report from southern India.

    Science.gov (United States)

    Thippeswamy, Harish; Desai, Geetha; Chandra, Prabha

    2018-03-21

    Postpartum severe mental illness (SMI) often presents with risks to mother-infant dyad and requires early assessment and interventions. The access to psychiatric care in low and middle income countries is complex. Help-seeking patterns in women with postpartum SMI has not been studied adequately. Hence, the present study was undertaken to examine the help-seeking pattern and reasons for delay in seeking psychiatry services among postpartum women with SMI. Successive patients with a diagnosis of postpartum SMI were recruited over a period of 2 years. Clinical variables including the risk evaluation, perceived delay in seeking care along with the reasons were assessed through clinical interviews using a proforma. Severity of illness was assessed using BPRS and "encounter" form was used to assess the help-seeking pattern. One hundred twenty-three women with postpartum SMI participated in the study. Acute polymorphic psychotic disorder was the most common clinical presentation. Psychiatrists were the most commonly (52.8%) sought care providers followed by faith healers (26%) and general medical practitioners (GMP) (21.1%) at the first level of help seeking. A past history of psychiatric illness was significantly higher among those who first contacted a psychiatrist, and BPRS scores were significantly high among those who contacted a GMP. Forty-four percent of subjects perceived a delay in seeking care from psychiatry services and the most common reason was lack of resources. There is a need to enhance awareness about postpartum SMI in the community. Faith healers need to be sensitized about the associated risks and the need for early referrals. Addressing the barriers to psychiatric care would help in early detection and treatment of postpartum SMI.

  6. Prevalence and factors associated with depressive symptoms among post-partum mothers in Nepal.

    Science.gov (United States)

    Giri, Rajendra Kumar; Khatri, Resham Bahadur; Mishra, Shiva Raj; Khanal, Vishnu; Sharma, Vidya Dev; Gartoula, Ritu Prasad

    2015-03-31

    Post-partum depression is a common complication of women after childbirth. The objective of this study was to determine the prevalence of and factors associated with depressive symptoms among post-partum mothers attending a child immunization clinic at a maternity hospital in Kathmandu, Nepal. This cross-sectional study was conducted among 346 post-partum mothers at six to ten weeks after delivery using systematic random sampling. Mothers were interviewed using a semi-structured questionnaire. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for depressive symptoms. Logistic regression analysis was used to calculate the association of post-partum depressive symptoms with socio-demographic and maternal factors. The prevalence of post-partum depressive symptoms among mothers was 30%. Mothers aged 20 to 29 years were less likely to have depressive symptoms (adjusted odds ratio (aOR) = 0.40; 95% CI: 0.21-0.76) compared to older mothers. Similarly, mothers with a history of pregnancy-induced health problems were more likely to have depressive symptoms (aOR = 2.16; CI: 1.00-4.66) and subjective feelings of stress (aOR = 3.86; CI: 1.84-4.66) than mothers who did not. The number of post-partum mothers experiencing depressive symptoms was high; almost one-third of the participants reported having them. Pregnancy-induced health problems and subjective feelings of stress during pregnancy in the post-partum period were found to be associated with depressive symptoms among these women. Screening of depressive symptoms should be included in routine antenatal and postnatal care services for early identification and prevention.

  7. Relapse Prevention: An Introduction to Marlatt’s Cognitive – Behavior Model

    Directory of Open Access Journals (Sweden)

    Farshad Nemati

    2002-10-01

    Full Text Available High rate of relapse after apparently successful treatment is a common problem facing with most approaches to treatment of drug dependency. This has led to the development of a variety of strategies for relapse prevention. Among these, Marlatt’s cognitive – behavioural model has received a good deal of attention. It is based on two major axes: Identification of warning sings and development of necessary skills for coping with risk situations. In fact, client’s perception relating to their abilities to cope with high - risk situations can lead to lapse. Relapes is a function of client’s reaction to this initial lapes.Since formal training for addiction counsellors typically includes instruction on Marlatt’s relapes taxonomy and intervention strategies have been designed based on his classification systems of high – risk stimuli, it is nececsary for addiction counsellors to become familiar with this system. This paper presents an overview of Marlatts taxonomy of high – risk situations for relapse and his approach to relapse prevention. Special attention is given to definition of relapse, stages of relaps and relapse prevention strategies.

  8. Cognitive impairment in relapsing remitting Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Saška Roškar

    2003-06-01

    Full Text Available The purpose of the study was to identify changes in cognitive abilities that affect patients with relapsing remitting form of multiple sclerosis (MS and to find out which instrument manifests them best. The performance of MS patients was compared to a matched group of healthy people using three neuropsychological tests: Wisconsin card sorting test (WCST, Stroop color and word test and Trail making test (TMT part B. Results on all three tests indicate general cognitive impairments in the group of patients. Compared to the group of healthy people patients with MS exhibited impaired ability of abstract reasoning (WCST, impaired cognitive flexibility and less resistance to irrelevant stimuli (Stroop color and word test, slowed information processing and impaired ability of shifting attention from one symbol to another (TMT. The largest differences between groups occured in Stroop color and word test as well as in TMT. The estimation of cognitive abilities of MS patients is of high importance and sistematicaly observing of changes in those abilities should be considered.

  9. A Motion Videogame for Opioid Relapse Prevention.

    Science.gov (United States)

    Abroms, Lorien C; Leavitt, Leah E; Van Alstyne, Judy M; Schindler-Ruwisch, Jennifer M; Fishman, Marc J; Greenberg, Daniel

    2015-12-01

    This study examined the feasibility and acceptability of a body motion-activated videogame, targeting the prevention of opioid relapse among youth in the context of outpatient treatment. Participants attended four weekly gameplay sessions. Surveys were conducted at baseline and following each week's gameplay and assessed satisfaction with gameplay, craving intensity, and self-efficacy to refuse opioids. Participants expressed a high level of satisfaction with the videogame throughout the 4 weeks and agreed with the statement that they would be more likely to attend treatment sessions if the game was present (mean=4.6; standard deviation [SD]=0.7) and would recommend the videogame to other people in treatment (mean=4.2; SD=0.8). All participants recommended playing the videogame as part of treatment at least weekly, with a third recommending playing daily. Self-reported cravings declined over the 4-week period from baseline (mean=12.7; SD=8.4) to Week 4 (mean=9.8; SD=8.3), although the decline was not significant. Although participants stated that they liked the game, one-third of participants had dropped out of the study by the fourth session of gameplay. Preliminary evidence indicates that a motion videogame for addiction recovery may be feasible and acceptable within the context of outpatient treatment, although additional efforts are needed to keep youth in treatment. Future studies are needed to assess the impact of the game on long-term abstinence, treatment adherence, and engagement.

  10. Online Recruitment: Feasibility, Cost, and Representativeness in a Study of Postpartum Women.

    Science.gov (United States)

    Leach, Liana S; Butterworth, Peter; Poyser, Carmel; Batterham, Philip J; Farrer, Louise M

    2017-03-08

    Online recruitment is feasible, low-cost, and can provide high-quality epidemiological data. However, little is known about the feasibility of recruiting postpartum women online, or sample representativeness. The current study investigates the feasibility of recruiting a population of postpartum women online for health research and examines sample representativeness. Two samples of postpartum women were compared: those recruited online as participants in a brief survey of new mothers (n=1083) and those recruited face-to-face as part of a nationally representative study (n=579). Sociodemographic, general health, and mental health characteristics were compared between the two samples. Obtaining a sample of postpartum women online for health research was highly efficient and low-cost. The online sample over-represented those who were younger (aged 25-29 years), were in a de facto relationship, had higher levels of education, spoke only English at home, and were first-time mothers. Members of the online sample were significantly more likely to have poor self-rated health and poor mental health than the nationally representative sample. Health differences remained after adjusting for sociodemographic differences. Potential exists for feasible and low-cost e-epidemiological research with postpartum populations; however, researchers should consider the potential influence of sample nonrepresentativeness. ©Liana S Leach, Peter Butterworth, Carmel Poyser, Philip J Batterham, Louise M Farrer. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 08.03.2017.

  11. Risk factors, cross-cultural stressors and postpartum depression among immigrant Chinese women in Japan.

    Science.gov (United States)

    Jin, Qiongai; Mori, Emi; Sakajo, Akiko

    2016-04-01

    The purpose of this mixed-method design study was to examine factors contributing to depression among immigrant Chinese women (primipara and multipara) (n = 22) delivering a child for the first time in Japan. Data were obtained just after hospital discharge by using the Edinburgh Postnatal Depression Scale (EPDS), the Social Support Scale, a new scale to measure cross-cultural stressors in the postpartum setting and a visual analogue scale for stress and a demographic survey. The average EPDS score was 9.0 (SD ± 3.7) at 1-3 weeks postpartum; yet, more than half of the subjects (n = 12; 54.5%) were high risk for depression (EPDS ≥ 10). Low household income and primiparous status were associated with depression scores. New mothers with depression also reported more general stress and more cross-cultural stress in the postpartum setting, although social support appeared to mediate cross-cultural stressors. Semi-structured interviews were held with two immigrant women at high risk for depression; these new mothers described additional stress because they could not follow Zuoyuezi, an important postpartum Chinese tradition, in the Japanese hospital. These findings suggest that immigrant Chinese women are at higher risk for postpartum depression when they give birth for the first time in Japan. © 2016 John Wiley & Sons Australia, Ltd.

  12. Risk For Postpartum Depression Among Immigrant Arabic Women in the United States: A Feasibility Study.

    Science.gov (United States)

    Alhasanat, Dalia; Fry-McComish, Judith; Yarandi, Hossein N

    2017-07-01

    Postpartum depression (PPD) affects approximately 14% of women in the United States and 10% to 37% of Arabic women in the Middle East. Evidence suggests that immigrant women experience higher rates, but information on PPD among immigrant women of Arabic descent in the United States is nonexistent. A cross-sectional descriptive feasibility study was conducted to assess the practicality of implementing a larger proposed research study to examine predictors of PPD in US immigrant women of Arabic descent residing in Dearborn, Michigan. Fifty women were recruited from an Arab community center and completed demographic data, the Arabic version of the Edinburgh Postpartum Depression Scale (EPDS), and the Postpartum Depression Predictors Inventory-Revised (PDPI-R). Among participants, 36% were considered at high risk for developing PPD. Lack of social support, antenatal anxiety, antenatal depression, maternity blues (feeling depressed during the first 4 weeks postpartum), and life stress were significantly related to risk for PPD. Multiple regression analysis revealed that social support (t = -3.77, P postpartum depressive symptoms. Findings of this study describe the prevalence of PPD in a sample of US immigrant women of Arabic descent and support the feasibility of a larger and more in-depth understanding of their immigration and acculturation experiences. Study participants reported high risk for PPD. Maternity blues and lack of social support were significant predictors to the risk for PPD. Future research tailored to this minority group is recommended. © 2017 by the American College of Nurse-Midwives.

  13. A Korean multicenter study of prenatal risk factors for overt diabetes during the postpartum period after gestational diabetes mellitus.

    Science.gov (United States)

    Shin, Na-Ri; Yoon, So-Yeon; Cho, Geum Joon; Choi, Suk-Joo; Kwon, Han-Sung; Hong, Soon Cheol; Kwon, Ja-Young; Oh, Soo-Young

    2016-03-01

    To identify prenatal risk factors for postpartum diabetes among pregnant women with gestational diabetes mellitus (GDM). In a retrospective study, baseline characteristics and data from a postpartum 75-g glucose tolerance test (GTT) were reviewed for patients with GDM who had delivered in four Korean tertiary institutions from 2006 to 2012. Clinical characteristics were compared between women with and those without postpartum diabetes. Cutoffs to predict postpartum diabetes and diagnostic values were calculated from receiver operating characteristic (ROC) curves. Of 1637 patients with GDM, 498 (30.4%) underwent a postpartum 75-g GTT. Postpartum diabetes was diagnosed in 40 (8.0%) patients and impaired glucose intolerance in 157 (31.5%). Women with postpartum diabetes had higher glycated hemoglobin (HbA1c) levels at GDM diagnosis (P=0.008) and higher 100-g GTT values (Pdiabetes were 0.058 for HbA1c level and 5.3 mmol/L (fasting), 10.9 mmol/L (1h), 10.2 mmol/L (2h), and 8.6 mmol/L (3h) for 100-g GTT. The highest sensitivity was observed for 3-h 100-g GTT (76.9%) and the highest positive predictive value was for HbA1c at diagnosis (15.2%). HbA1c level at GDM diagnosis and 100-g GTT values could be used to identify patients at high risk of postpartum diabetes who should undergo postpartum screening. Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  14. Prognostic value of comorbidity for auto-SCT eligibility and outcome in relapsed or refractory aggressive non-Hodgkin's lymphoma

    NARCIS (Netherlands)

    Plattel, W. J.; Kluin-Nelemans, H. C.; de Bock, G. H.; van Imhoff, G. W.

    Salvage reinduction therapy followed by high-dose chemotherapy (HDCT) and auto-SCT is the treatment of choice for fit patients with refractory or relapsed aggressive non-Hodgkin's lymphoma (NHL). We assessed the prognostic value of comorbidity at the time of relapse to predict receipt of auto-SCT

  15. The natural history of multiple sclerosis: a geographically based study 10: relapses and long-term disability.

    Science.gov (United States)

    Scalfari, Antonio; Neuhaus, Anneke; Degenhardt, Alexandra; Rice, George P; Muraro, Paolo A; Daumer, Martin; Ebers, George C

    2010-07-01

    The relationship of relapses to long-term disability in multiple sclerosis is uncertain. Relapse reduction is a common therapeutic target but clinical trials have shown dissociation between relapse suppression and disability accumulation. We investigated relationships between relapses and disability progression for outcomes of requiring assistance to walk, being bedridden and dying from multiple sclerosis [Disability Status Scale 6, 8, 10] by analysing 28 000 patient-years of evolution in 806-bout onset patients from the London Ontario natural history cohort. Having previously shown no effect of relapse frequency among progressive multiple sclerosis subtypes, here we examined these measures in the pre-progressive or relapsing-remitting phase. Survival was compared among groups stratified by (i) early relapses--number of attacks during the first 2 years of multiple sclerosis; (ii) length of first inter-attack interval; (iii) interval between onset and Disability Status Scale 3 (moderate disability); (iv) number of attacks from the third year of disease up to onset of progression; and (v) during the entire relapsing-remitting phase. Early clinical features can predict hard disability outcomes. Frequent relapses in the first 2 years and shorter first inter-attack intervals predicted shorter times to reach hard disability endpoints. Attack frequencies, in the first 2 years, of 1 versus >or=3, gave differences of 7.6, 12.8 and 20.3 years in times from disease onset to Disability Status Scale 6, 8 and 10, respectively. Time to Disability Status Scale 3 highly and independently predicted time to Disability Status Scale 6, 8 and 10. In contrast, neither total number of relapsing-remitting phase attacks nor of relapses experienced during the relapsing-remitting phase after the second year up to onset of progression showed a deleterious effect on times from disease onset, from progression onset and from Disability Status Scale 3 to these hard endpoints. The failure of a

  16. Bladder rupture caused by postpartum urinary retention.

    Science.gov (United States)

    Dueñas-García, Omar Felipe; Rico, Hugo; Gorbea-Sanchez, Viridiana; Herrerias-Canedo, Tomas

    2008-08-01

    Postpartum bladder rupture is an uncommon surgical emergency and a diagnostic challenge. A primigravida delivered a healthy newborn without complications at 39.4 weeks of gestation. The patient was admitted 80 hours postpartum with abdominal pain, oliguria, hematuria, and pain that worsened during the previous 4 hours. An inserted Foley catheter drained only a small amount of urine, and serum creatinine was elevated (3.5 mg/dL). A laparotomy was performed and revealed a 10-cm hole in the urinary bladder. The bladder was repaired and the patient was discharged 15 days after surgery. The follow-up cystoscopy revealed adequate healing of the bladder. Urinary retention can lead to serious complications, including bladder rupture. Postpartum bladder rupture due to urinary retention should be ruled out if there is a history of abdominal pain, oliguria, and elevated of serum creatinine.

  17. Social energy exchange theory for postpartum depression.

    Science.gov (United States)

    Posmontier, Bobbie; Waite, Roberta

    2011-01-01

    Postpartum depression (PPD), a significant health problem affecting about 19.4% of postpartum women worldwide, may result in long-term cognitive and behavior problems in children, spousal depression, widespread family dysfunction, and chronic and increasingly severe maternal depression. Although current theoretical frameworks provide a rich context for studying PPD,none provides a framework that specifically addresses the dynamic relationship of the inner personal experience with the social and cultural context of PPD. The authors propose the social energy exchange theory for postpartum depression to understand how PPD impedes this dynamic relationship and suggest it as a theoretical framework for the study of interventions that would target intra- and interpersonal disturbance within the social and cultural context.

  18. [Hypertension and pregnancy: Post-partum period].

    Science.gov (United States)

    Hugon-Rodin, Justine; Plu-Bureau, Geneviève

    2016-01-01

    Post-partum period is associated with specific characteristics in women with gestational disorders or preeclampsia. For breastfeeding women, the choice of antihypertensive treatment should take into account the impact on child health. The impact of breastfeeding on health mother must be also discussed. Moreover, for lactation inhibition, bromocriptine should not be used, especially in the context of gestational disorders. In post-partum period, the best contraceptive strategy is only-progestin contraception or non-hormonal contraceptives use. However, this choice will depend on the stabilization or normalization of blood pressure in early post-partum period. Finally, several consultations should be suggested: an information and announcement to explain the consequences of these gestational disorders and organize their multidisciplinary management and follow-up. A preconceptional consultation takes its place to anticipate potential recurrent preeclampsia or gestational hypertension and to schedule a future pregnancy in optimal conditions. Copyright © 2016. Published by Elsevier Masson SAS.

  19. Daily corticosteroids reduce infection-associated relapses in frequently relapsing nephrotic syndrome: a randomized controlled trial.

    Science.gov (United States)

    Gulati, Ashima; Sinha, Aditi; Sreenivas, Vishnubhatla; Math, Aparna; Hari, Pankaj; Bagga, Arvind

    2011-01-01

    Relapses of nephrotic syndrome often follow minor infections, commonly of the upper respiratory tract. Daily administration of maintenance prednisolone during intercurrent infections was examined to determine whether the treatment reduces relapse rates in children with frequently relapsing nephrotic syndrome. In a randomized controlled trial (nonblind, parallel group, tertiary-care hospital), 100 patients with idiopathic, frequently relapsing nephrotic syndrome eligible for therapy with prolonged low-dose, alternate-day prednisolone with or without levamisole were randomized to either receive their usual dose of alternate-day prednisolone daily for 7 days during intercurrent infections (intervention group) or continue alternate-day prednisolone (controls). Primary outcome was assessed by comparing the rates of infection-associated relapses at 12-month follow-up. Secondary outcomes were the frequency of infections and the cumulative amount of prednisolone received in both groups. Patients in the intervention group showed significantly lower infection-associated (rate difference, 0.7 episodes/patient per year; 95% confidence intervals [CI] 0.3, 1.1) and lower total relapse rates (0.9 episodes/patient per year, 95% CI 0.4, 1.4) without increase in steroid toxicity. Poisson regression, adjusted for occurrence of infections, showed that daily administration of prednisolone during infections independently resulted in 59% reduction in frequency of relapses (rate ratio, 0.41; 95% CI 0.3, 0.6). For every six patients receiving this intervention, one showed a reduction of relapse frequency to less than three per year. Daily administration of maintenance doses of prednisolone, during intercurrent infections, significantly reduces relapse rates and the proportion of children with frequently relapsing nephrotic syndrome.

  20. Antioxidant status and endocannabinoid concentration in postpartum depressive women

    Directory of Open Access Journals (Sweden)

    Mina Ranjbaran

    2015-02-01

    Conclusion: Women’s Job, husband’s job, wanted or unwanted pregnancy from husbands and marital period are associated to postpartum depression. In postpartum depression, TAC, AEA and 2-AG are reduced. So it can be concluded that both antioxidant system and endocannabinoid concentration involved in the development of postpartum depression.

  1. Postpartum care attendance at a rural district hospital in Zambia

    NARCIS (Netherlands)

    J. Lagro (Joep); A. Liche (Agnes); J. Mumba (John); R. Ntebeka (Ruth); J. van Roosmalen (Jos)

    2006-01-01

    textabstractPostpartum care is an important tool in both preventive and promotive maternal health care. We studied the postpartum care attendance rate in 540 women who delivered at a district hospital in Zambia. Forty-two percent of the women attended postpartum care within six weeks of delivery.

  2. Postpartum anoestrus in the suckled swamp buffalo

    International Nuclear Information System (INIS)

    Jainudeen, M.R.; Sharifuddin, W.; Yap, K.C.; Bakar Dahari, A.

    1984-01-01

    Postpartum anoestrus is a serious cause of infertility in the swamp buffalo. Our studies have revealed that it is due to a failure in the resumption of ovarian cyclicity. Parity was inversely related to the calving interval being longer in primiparous than multiparous suckled buffaloes. This effect may be partly due to the higher nutrient demands for growth as well as for lactation in the primiparous animal. The effects of suckling on ovarian and pituitary function of postpartum buffaloes were investigated with the aid of radioimmunoassays for progesterone and luteinizing hormone (LH) as well as rectal palpation and laparoscopic inspection of the ovaries. The incidence of postpartum anoestrus was higher in suckled than non-suckled buffaloes. Weaning buffalo calves at 30 d postpartum resulted in the resumption of normal ovarian cycles within 60 d postpartum. LH release in response to a single injection of a synthetic gonadotropin-releasing hormone (GnRH) indicated that pituitary responsiveness to GnRH was restored by Day 30 postpartum in suckled buffaloes whereas anoestrous buffaloes were able to release levels of LH comparable to that of the preovulatory surge. A progesterone-releasing intra-vaginal device (PRID) induced an anovulatory oestrus in the anoestrous suckled buffalo which was partially overcome by human chorionic gonadotropin (HCG) administered at the induced oestrus. However, a 72 h separation of the calf from its dam combined with PRID was the most effective substitute to weaning in initiating ovarian cycles in the suckled buffalo. Our data suggest that suckling inhibits ovarian function not by an effect on the pituitary gland but rather on GnRH release by the hypothalamus. (author)

  3. Patterns and Timing of Initial Relapse in Patients Subsequently Undergoing Transplantation for Hodgkin's Lymphoma

    International Nuclear Information System (INIS)

    Dhakal, Sughosh; Biswas, Tithi; Liesveld, Jane L.; Friedberg, Jonathan W.; Phillips, Gordon L.; Constine, Louis S.

    2009-01-01

    Purpose: To evaluate the patterns and timing of initial recurrence in patients with Hodgkin's lymphoma (HL) who subsequently underwent high-dose chemotherapy with autologous stem cell transplantation to enhance our understanding of the natural history of this disease and its modern treatment strategies and to direct approaches to disease surveillance. Methods and Materials: The records of 69 patients with HL who had undergone high-dose chemotherapy with autologous stem cell transplantation in our center between May 1992 and June 2006 were analyzed. The initial diagnosis had been made between April 1982 and January 2005 at a median patient age of 33 years (range, 19-65). The patients were segregated according to the initial stage (Stage I-II vs. III-IV). Results: Early-stage HL patients developed a relapse at a median of 2.1 years (range, 0.5-10.3), with 91% of relapses at the initial disease site, 71% of which (65% overall) were only in previously involved sites. Advanced-stage HL patients developed a relapse at a median of 1.5 years (range, 0.6-10.5), with 97% at the initial site, 71% of which (69% overall) were only in previously involved sites. Single-site relapses occurred in 47% of early- vs. 26% of advanced-stage patients, and extranodal relapses occurred in 12% of early- vs. 31% of advanced-stage patients. Conclusions: Almost all patients with HL who develop relapse and subsequently undergo high-dose chemotherapy with autologous stem cell transplantation initially developed recurrence in previously involved disease sites. Early-stage HL relapses often occurred in single sites, and advanced-stage disease relapses were more likely in multiple and extranodal sites. The interval to recurrence was brief, suggesting that the frequency of screening should be the greatest in the early post-therapy years.

  4. Role of routine imaging in detecting recurrent lymphoma; a review of 258 patients with relapsed aggressive non-Hodgkin and Hodgkin lymphoma

    DEFF Research Database (Denmark)

    El-Galaly, Tarec Christoffer; Mylam, Karen Juul; Bøgsted, Martin

    2014-01-01

    After first-line therapy, patients with Hodgkin and aggressive non-Hodgkin lymphomas are followed closely for early signs of relapse. The current follow-up practice with frequent use of surveillance imaging is highly controversial and warrants a critical evaluation. Therefore a retrospective...... multicenter study of relapsed Hodgkin and aggressive non-Hodgkin lymphomas (nodal T-cell and diffuse large B-cell lymphomas) was conducted. All included patients had been diagnosed during the period 2002-2011 and relapsed after achieving complete remission on first-line therapy. Characteristics and outcome...... of imaging-detected relapses were compared to other relapses. A total of 258 patients with recurrent lymphoma were included in the study. Relapse investigations were initiated outside preplanned visits in 52% of the patients. Relapse detection could be attributed to patient-reported symptoms alone...

  5. An Integrative Psychotherapy of Postpartum Adjustment

    Directory of Open Access Journals (Sweden)

    Carol Merle-Fishman

    2010-12-01

    Full Text Available Becoming a mother is a time of transition, transformation and sometimes trauma. The immediacy of meeting the needs of an infant, combined with the immediacy of becoming a mother, often collide to produce depression, anxiety and stress. Shame, confusion, isolation and cultural expectations often prevent women from seeking the postpartum support they need, which may result in long lasting depression, anxiety and unresolved trauma. Integrative Psychotherapy, Transactional Analysis and Attachment Theory offer ways to understand postpartum adjustment as well as methodologies for addressing this unique developmental event in the life of women.

  6. Postpartum perineal repair performed by midwives

    DEFF Research Database (Denmark)

    Kindberg, S; Stehouwer, M; Hvidman, L

    2008-01-01

    OBJECTIVE: To compare a continuous suture technique with interrupted stitches using inverted knots for postpartum perineal repair of second-degree lacerations and episiotomies. DESIGN: A double-blind randomised controlled trial. SETTING: A Danish university hospital with more than 4800 deliveries...... months postpartum. Pain was evaluated using a visual analogue scale and the McGill Pain Questionnaire. Wound healing was evaluated using the REEDA scale and by assessment of gaping wounds >0.5 cm. Analysis complied with the intention-to-treat principle. MAIN OUTCOME MEASURES: The primary outcome...

  7. [Unusual leukoencephalopathy of post-partum].

    Science.gov (United States)

    Hsaini, Y; Karouache, A; Bourazza, A

    2011-08-01

    Neurologic complications of post-partum are serious and usually secondary to eclampsia or stroke. We here report a 26-year-old female who presented with severe headaches, blurred vision, and repeated generalized seizures secondary to posterior reversible encephalopathy that occurred after a caesarean section for fetal death in utero. Outcome was favourable. Although uncommon, this neurologic complication of the post-partum should be discussed in the presence of any sign of encephalopathy occurring in the context of acute hypertension. Copyright © 2010 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  8. Patient Satisfaction With Postpartum Teaching Methods.

    Science.gov (United States)

    Wagner, Debra L; Washington, Cynthia

    2016-01-01

    Postpartum discharge instructions are a crucial part of a mother's birth experience. Finding the method to provide those discharge instructions in a manner that increases the mother's satisfaction with her hospital experience is important. This quasi-experimental study examined the relationship between new mothers' interaction with nurses providing postpartum instructions by the traditional and class methods and their satisfaction with discharge teaching. The results indicated new mothers were satisfied with both methods of discharge teaching; however, they were more likely to report stronger agreement with overall satisfaction with the traditional method of discharge teaching than with attending the discharge class.

  9. Second auto-SCT for treatment of relapsed multiple myeloma.

    Science.gov (United States)

    Gonsalves, W I; Gertz, M A; Lacy, M Q; Dispenzieri, A; Hayman, S R; Buadi, F K; Dingli, D; Hogan, W J; Kumar, S K

    2013-04-01

    High-dose therapy and auto-SCT remain integral in the initial treatment of multiple myeloma (MM), and are increasingly being applied for management of relapsed disease. We examined the outcomes in 98 patients undergoing salvage auto-SCT (auto-SCT2) for relapsed MM after receiving an initial transplant (auto-SCT1) between 1994 and 2009. The median age at auto-SCT2 was 60 years (range: 35-74). The median time between auto-SCT1 and auto-SCT2 was 46 months (range: 10-130). Treatment-related mortality was seen in 4%. The median PFS from auto-SCT2 was 10.3 (95% confidence interval (CI): 7-14) months and the median OS from auto-SCT2 was 33 months (95% CI: 28-51). In a multivariable analysis, shorter time to progression (TTP) after auto-SCT1, not achieving a CR after auto-SCT2, higher number of treatment regimens before auto-SCT2 and a higher plasma cell labeling index at auto-SCT2 predicted for shorter PFS. However, only a shorter TTP after auto-SCT1 predicted for a shorter OS post auto-SCT2. Hence, auto-SCT2 is an effective and feasible therapeutic option for MM patients relapsing after other treatments, especially in patients who had a TTP of at least 12 months after their auto-SCT1.

  10. Gender differences in alcohol and substance use relapse.

    Science.gov (United States)

    Walitzer, Kimberly S; Dearing, Ronda L

    2006-03-01

    This review explores gender differences in relapse and characteristics of relapse events in alcohol and substance use. For alcohol, relapse rates were similar across gender. Although negative mood, childhood sexual abuse, alcohol-related self-efficacy, and poorer coping strategies predicted alcohol relapse, gender did not moderate these effects. Gender did moderate the association between marriage and alcohol relapse. For women, marriage and marital stress were risk factors for alcohol relapse; among men, marriage lowered relapse risk. This gender difference in the role of marriage in relapse may be a result of partner differences in problem drinking. Alcoholic women are more likely to be married to heavy drinking partners than are alcoholic men; thus, alcoholic women may be put at risk of relapse by marriage and alcoholic men may be protected by marriage. There are fewer studies documenting gender differences in substance abuse relapse so conclusions are limited and tentative. In contrast to the lack of gender differences in alcohol relapse rates, women appear less likely to experience relapse to substance use, relative to men. Women relapsing to substance use appear to be more sensitive to negative affect and interpersonal problems. Men, in contrast, may be more likely to have positive experiences prior to relapse.

  11. Institutional violence and quality of service in obstetrics are associated with postpartum depression.

    Science.gov (United States)

    Souza, Karina Junqueira de; Rattner, Daphne; Gubert, Muriel Bauermann

    2017-07-20

    To investigate the association between institutional violence in obstetrics and postpartum depression (PP depression) and the potential effect of race, age, and educational level in this outcome. This is a cross-sectional study about the health care conditions for the maternal and child population of the Federal District, Brazil, carried out in 2011. The study has used a probabilistic sample of 432 women, whose children were aged up to three months, stratified by clusters. Indicators of institutional violence and demographic characteristics have been used in a logistic regression model to estimate the probability of occurrence of postpartum depression. The model has identified a high prevalence of postpartum depression, being it higher among non-white women and adolescent females, besides having a strong positive association between the several indicators of obstetric violence and postpartum depression. Positive interactions on a multiplicative scale have also been observed between: violence by negligence by health care professionals and race and age; physical violence from health care professionals and age; and, verbal violence from health care professionals and race. The indicators adopted to reflect institutional violence in obstetric care are positively associated with postpartum depression, which calls for a reflection on the need to make the health care protocols adequate to the precepts of the Brazilian humanization of childbirth care policies and changes in the obstetric care model.

  12. Institutional violence and quality of service in obstetrics are associated with postpartum depression

    Directory of Open Access Journals (Sweden)

    Karina Junqueira de Souza

    Full Text Available ABSTRACT OBJECTIVE To investigate the association between institutional violence in obstetrics and postpartum depression (PP depression and the potential effect of race, age, and educational level in this outcome. METHODS This is a cross-sectional study about the health care conditions for the maternal and child population of the Federal District, Brazil, carried out in 2011. The study has used a probabilistic sample of 432 women, whose children were aged up to three months, stratified by clusters. Indicators of institutional violence and demographic characteristics have been used in a logistic regression model to estimate the probability of occurrence of postpartum depression. RESULTS The model has identified a high prevalence of postpartum depression, being it higher among non-white women and adolescent females, besides having a strong positive association between the several indicators of obstetric violence and postpartum depression. Positive interactions on a multiplicative scale have also been observed between: violence by negligence by health care professionals and race and age; physical violence from health care professionals and age; and, verbal violence from health care professionals and race. CONCLUSIONS The indicators adopted to reflect institutional violence in obstetric care are positively associated with postpartum depression, which calls for a reflection on the need to make the health care protocols adequate to the precepts of the Brazilian humanization of childbirth care policies and changes in the obstetric care model.

  13. Postpartum Exercise among Nigerian Women: Issues Relating to Exercise Performance and Self-Efficacy.

    Science.gov (United States)

    Adeniyi, A F; Ogwumike, O O; Bamikefa, T R

    2013-01-01

    Physical exercise during postpartum period is beneficial to mothers, and the health gains are abundantly reported. This study characterises the postpartum exercise profile of a group of Nigerian women and reports how their exercise self-efficacies are influenced by sociodemographic characteristics. Participants were women attending the two largest postnatal clinics in Ibadan, south-western Nigeria. A self-developed questionnaire assessed the socio-demographic and exercise profile of participants, while the Exercise Self-Efficacy Scale assessed their exercise self-efficacy. About two-third (61.0%) of the participants were not aware that they could undertake physical exercise to enhance postpartum health, and 109 (47.8%) were not engaged in any exercise. Those who exercised did so for less than three days/week, and 89% of the women did not belong to any exercise support group. Exercise self-efficacy was significantly (P work hours/week, monthly income, and number of pregnancies. Most of the women were not aware they could engage in postpartum exercise, and about half were not undertaking it. More women with high compared to moderate exercise self-efficacy undertook the exercise. Efforts at increasing awareness, improving exercise self-efficacy and adoption of postpartum exercise are desirable among the Nigerian women.

  14. Postpartum Exercise among Nigerian Women: Issues Relating to Exercise Performance and Self-Efficacy

    Science.gov (United States)

    Adeniyi, A. F.; Ogwumike, O. O.; Bamikefa, T. R.

    2013-01-01

    Physical exercise during postpartum period is beneficial to mothers, and the health gains are abundantly reported. This study characterises the postpartum exercise profile of a group of Nigerian women and reports how their exercise self-efficacies are influenced by sociodemographic characteristics. Participants were women attending the two largest postnatal clinics in Ibadan, south-western Nigeria. A self-developed questionnaire assessed the socio-demographic and exercise profile of participants, while the Exercise Self-Efficacy Scale assessed their exercise self-efficacy. About two-third (61.0%) of the participants were not aware that they could undertake physical exercise to enhance postpartum health, and 109 (47.8%) were not engaged in any exercise. Those who exercised did so for less than three days/week, and 89% of the women did not belong to any exercise support group. Exercise self-efficacy was significantly (P exercise programme, age, employment, work hours/week, monthly income, and number of pregnancies. Most of the women were not aware they could engage in postpartum exercise, and about half were not undertaking it. More women with high compared to moderate exercise self-efficacy undertook the exercise. Efforts at increasing awareness, improving exercise self-efficacy and adoption of postpartum exercise are desirable among the Nigerian women. PMID:23844290

  15. EARLY POSTPARTUM PARENTAL PREOCCUPATION AND POSITIVE PARENTING THOUGHTS: RELATIONSHIP WITH PARENT-INFANT INTERACTION.

    Science.gov (United States)

    Kim, Pilyoung; Mayes, Linda; Feldman, Ruth; Leckman, James F; Swain, James E

    2013-01-01

    Parenting behaviors and parent-infant emotional bonding during the early postpartum months play a critical role in infant development. However, the nature and progression of parental thoughts and their relationship with interactive behaviors have received less research. The current study investigated the trajectory of parental thoughts and behaviors among primiparous mothers ( n = 18) and fathers ( n = 15) and multiparous mothers ( n = 13) and fathers ( n = 13), which were measured at the first and third postpartum month. At the third postpartum month, the relationship between parental thoughts and parental interactive behaviors also was tested. Mothers and fathers showed high levels of preoccupations and caregiving thoughts during the first postpartum month that significantly declined by the third postpartum month. In contrast, positive thoughts about parenting and the infant increased over the same time interval. Mothers presented higher levels of preoccupations and positive thoughts than did fathers, and first-time parents reported more intense preoccupations than did experienced parents. Although maternal sensitivity was inversely related to maternal anxious thoughts, paternal sensitivity was predicted by higher levels of anxious as well as caregiving and positive thoughts.

  16. Sexual risk during pregnancy and postpartum periods among HIV-infected and -uninfected South African women: Implications for primary and secondary HIV prevention interventions.

    Science.gov (United States)

    Joseph Davey, Dvora; Farley, Elise; Gomba, Yolanda; Coates, Thomas; Myer, Landon

    2018-01-01

    HIV acquisition in pregnancy and breastfeeding contributes significantly toward pediatric HIV infection. However, little is known about how sexual behavior changes during pregnancy and postpartum periods which will help develop targeted HIV prevention and transmission interventions, including pre-exposure prophylaxis (PrEP). Cross-sectional study in HIV-infected and uninfected pregnant and postpartum women in Cape Town, South Africa. Interviewers collected survey data on demographic, sexual behaviors, and alcohol use among pregnant and post-partum women. We report descriptive results of sexual behavior by trimester and postpartum period, and results of multivariable logistic regression stratified by pregnancy status. We enrolled 377 pregnant and postpartum women (56% pregnant, 40% HIV-infected). During pregnancy, 98% of women reported vaginal sex (8% anal sex, 44% oral sex) vs. 35% and 88% during the periods 0-6 and 7-12 months postpartum, respectively (p1 partner in the past 12-months compared to postpartum women (18% vs. 13%, respectively, p6-months postpartum (13 mean sex acts in first trimester; 17 mean sex acts >6-months postpartum). Pregnant women had increased odds of reporting condomless sex at last sex (aOR = 2.96;95%CI = 1.84-4.78) and ever having condomless sex in past 3-months (aOR = 2.65;95%CI = 1.30-5.44) adjusting for age, HIV status, and sex frequency compared to postpartum women. We identified that sexual behaviors and risk behaviors were high and changing during pregnancy and postpartum periods, presenting challenges to primary and secondary HIV prevention efforts, including PrEP delivery to pregnant and breastfeeding women.

  17. CA-125 AUC as a predictor for epithelial ovarian cancer relapse.

    Science.gov (United States)

    Mano, António; Falcão, Amílcar; Godinho, Isabel; Santos, Jorge; Leitão, Fátima; de Oliveira, Carlos; Caramona, Margarida

    2008-01-01

    The aim of the present work was to evaluate the usefulness of CA-125 normalized in time area under the curve (CA-125 AUC) to signalise epithelial ovarian cancer relapse. Data from a hundred and eleven patients were submitted to two different approaches based on CA-125 AUC increase values to predict patient relapse. In Criterion A total CA-125 AUC normalized in time value (AUC(i)) was compared with the immediately previous one (AUC(i-1)) using the formulae AUC(i) > or = F * AUC(i-1) (several F values were tested) to find the appropriate close related increment associated to patient relapse. In Criterion B total CA-125 AUC normalised in time was calculated and several cut-off values were correlated with patient relapse prediction capacity. In Criterion A the best accuracy was achieved with a factor (F) of 1.25 (increment of 25% from the previous status), while in Criterion B the best accuracies were achieved with cut-offs of 25, 50, 75 and 100 IU/mL. The mean lead time to relapse achieved with Criterion A was 181 days, while with Criterion B they were, respectively, 131, 111, 63 and 11 days. Based on our results we believe that conjugation and sequential application of both criteria in patient relapse detection should be highly advisable. CA-125 AUC rapid burst in asymptomatic patients should be firstly evaluated using Criterion A with a high accuracy (0.85) and with a substantial mean lead time to relapse (181 days). If a negative answer was obtained then Criterion B should performed to confirm the absence of relapse.

  18. [Central nervous system relapse in diffuse large B cell lymphoma: Risk factors].

    Science.gov (United States)

    Sancho, Juan-Manuel; Ribera, Josep-Maria

    2016-01-15

    Central nervous system (CNS) involvement by lymphoma is a complication associated, almost invariably, with a poor prognosis. The knowledge of the risk factors for CNS relapse is important to determine which patients could benefit from prophylaxis. Thus, patients with very aggressive lymphomas (such as lymphoblastic lymphoma or Burkitt's lymphoma) must systematically receive CNS prophylaxis due to a high CNS relapse rate (25-30%), while in patients with indolent lymphoma (such as follicular lymphoma or marginal lymphoma) prophylaxis is unnecessary. However, the question about CNS prophylaxis in patients with diffuse large B-cell lymphoma (DLBCL), the most common type of lymphoma, remains controversial. The information available is extensive, mainly based on retrospective and heterogeneous studies. There seems that immunochemotherapy based on rituximab reduces the CNS relapse rate. On the other hand, patients with increased serum lactate dehydrogenase plus more than one extranodal involvement seem to have a higher risk of CNS relapse, but a prophylaxis strategy based only on the presence of these 2 factors does not prevent all CNS relapses. Patients with involvement of testes or breast have high risk of CNS relapse and prophylaxis is mandatory. Finally, CNS prophylaxis could be considered in patients with DLBCL and renal or epidural space involvement, as well as in those cases with MYC rearrangements, although additional studies are necessary. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  19. PARATHYROID CANCER OCCURRING IN RELAPSING SECONDARY HYPERPARATHYROIDISM

    Directory of Open Access Journals (Sweden)

    I. V. Kotova

    2016-01-01

    Full Text Available We present a clinical case of parathyroid cancer in a patient with relapsing secondary hyperparathyroidism at 4 years after subtotal parathyroidectomy. Its unique character is related to the combination of relapsing secondary hyperparathyroidism, parathyromatosis, ectopic of an adenomatous hyperplastic parathyroid gland into the thyroid gland, and parathyroid cancer. Several most complicated aspects of parathyroid surgery are disclosed, such as the choice of strategy for surgical intervention in secondary hyperparathyroidism, complexity of morphological and cytological diagnostics of this disorder.

  20. Early postpartum maternal morbidity among rural women of Rajasthan, India: a community-based study.

    Science.gov (United States)

    Iyengar, Kirti

    2012-06-01

    The first postpartum week is a high-risk period for mothers and newborns. Very few community-based studies have been conducted on patterns of maternal morbidity in resource-poor countries in that first week. An intervention on postpartum care for women within the first week after delivery was initiated in a rural area of Rajasthan, India. The intervention included a rigorous system of receiving reports of all deliveries in a defined population and providing home-level postpartum care to all women, irrespective of the place of delivery. Trained nurse-midwives used a structured checklist for detecting and managing maternal and neonatal conditions during postpartum-care visits. A total of 4,975 women, representing 87.1% of all expected deliveries in a population of 58,000, were examined in their first postpartum week during January 2007-December 2010. Haemoglobin was tested for 77.1% of women (n=3,836) who had a postnatal visit. The most common morbidity was postpartum anaemia--7.4% of women suffered from severe anaemia and 46% from moderate anaemia. Other common morbidities were fever (4%), breast conditions (4.9%), and perineal conditions (4.5%). Life-threatening postpartum morbidities were detected in 7.6% of women--9.7% among those who had deliveries at home and 6.6% among those who had institutional deliveries. None had a fistula. Severe anaemia had a strong correlation with perinatal death [pcaste or tribe [p<0.000, AOR=2.47 (95% CI 1.83-3.33)], and parity of three or more [p<0.000, AOR=1.52 (95% CI 1.18-1.97)]. The correlation with antenatal care was not significant. Perineal conditions were more frequent among women who had institutional deliveries while breast conditions were more common among those who had a perinatal death. This study adds valuable knowledge on postpartum morbidity affecting women in the first few days after delivery in a low-resource setting. Health programmes should invest to ensure that all women receive early postpartum visits after

  1. Screening for postpartum depression and associated factors among women in China: A cross-sectional study

    Directory of Open Access Journals (Sweden)

    Xinli Chi

    2016-11-01

    Full Text Available AbstractAbstractObjectives: This study examined what percentage of Chinese mothers during a three-year postpartum period were screened for postpartum depression and explored the correlation between postpartum depression and various socio-demographic, psychological, and cultural factors. Study design: Cross-sectional survey.Methods: A total of 506 mothers 23 years of age and older who were within three years postpartum completed the online survey. The survey collected information such as family economic status, a history of depression, preparation for pregnancy, relationships with husbands and family members, adult attachment types (Adult Attachment Scale, AAS, and depression (The Center for Epidemiologic Studies Depression Scale, CESD.Results: Approximately 30% of mothers 1–3 years postpartum reported symptoms above the CESD cut-off score (≥16 scores associated with the risk for depression (28.0% in the first year, 30.8% in the second year, and 31.8% in the third year. Factors significantly associated with depression in participants in the correlation analysis were education level; family income; preparation for pregnancy; a history of depression; amount of time spent with their husbands; relationships with husbands, parents, and parents-in-law; and a close, dependent, and/or anxious attachment style. Multiple regression analyses revealed that a history of depression; less preparation for pregnancy; poorer relationships with husbands, parents, and parents-in-law; and a more anxious attachment style were strongly related to a higher risk of postpartum depression. Conclusions: The overall percentage of mothers after delivery who were vulnerable to depression in China remains high. Various factors were significant predictors of postpartum depression. The research findings have several valuable implications for intervention practices. For example, attachment styles and depression history in the assessments of perinatal depression could improve

  2. Pyomyoma as a Rare Source of Postpartum Sepsis

    Directory of Open Access Journals (Sweden)

    A. DeMaio

    2015-01-01

    Full Text Available Pyomyoma, also known as suppurative leiomyoma, is a rare clinical complication that occurs when a leiomyoma undergoes infarction and subsequent infection. A high index of suspicion is required to make the diagnosis and can be guided by a classic triad of symptoms that includes abdominal pain, sepsis without an obvious source, and a history of leiomyoma. In the vast majority of these cases, total abdominal hysterectomy is required to avoid severe morbidity and potential mortality. We present an unusual case of a postpartum pyomyoma that was successfully treated without the need for hysterectomy. With strong clinical suspicion, early diagnosis, and appropriate management, some affected patients may preserve fertility.

  3. Recurrent Silent Thyroiditis as a Sequela of Postpartum Thyroiditis

    Science.gov (United States)

    Kim, Paul

    2014-01-01

    Thyroiditis encompasses a group of disorders characterized by thyroid inflammation. Though clinically indistinguishable from silent thyroiditis, postpartum thyroiditis occurs in women within 12 months after delivery. Recurrent postpartum thyroiditis in subsequent pregnancies is common, but recurrent silent thyroiditis is rare. We reported a case of patient with recurrent episodes of thyroiditis, unrelated to pregnancy, after an episode of postpartum thyroiditis. It is of interest that postpartum thyroiditis and silent thyroiditis could occur closely to each other; however, the link between these disorders is not well established. This report is to remind physicians of the possibility of recurrent silent thyroiditis in women with a history of postpartum thyroiditis. PMID:24987536

  4. Postpartum psychiatric emergency visits: a nested case-control study.

    Science.gov (United States)

    Barker, Lucy Church; Kurdyak, Paul; Fung, Kinwah; Matheson, Flora I; Vigod, Simone

    2016-12-01

    Mental health conditions are one of the most common reasons for postpartum emergency department (ED) visits. Characteristics of women using the ED and their mental health service use before presentation are unknown. We characterized all women in Ontario, Canada (2006-2012), who delivered a live born infant and had a psychiatric ED visit within 1 year postpartum (n = 8728). We compared those whose ED visit was the first physician mental health contact since delivery to those who had accessed mental health services on specific indicators of marginalization hypothesized to be associated with lower likelihood of mental health contact prior to the ED visit. For 60.4 % of women, this was the first physician mental health contact since delivery. The majority were presenting with a mood or anxiety disorder, and only 13.6 % required hospital admission. These women were more likely to have material deprivation and residential instability than women with contact (Q5 vs. Q1 aORs 1.30, 95 % CI 1.12-1.50; 1.17, 95 % CI 1.01-1.36), to live in rural vs. urban areas (aOR 1.58, 95 % CI 1.38-1.80), and to be low vs. high income quintile (aOR 1.18, 95 % CI 1.01-1.38). The frequent use of ED services as the first point of contact for mental health concerns suggests that interventions to improve timely and equitable access to effective outpatient postpartum mental health care are needed. Marginalized women are at particularly high risk of not having accessed outpatient services prior to an ED visit, and therefore, future research and interventions will specifically need to consider the needs of this group.

  5. Clinical biochemistry and MRI follow up study in postpartum pituitary enlargement

    International Nuclear Information System (INIS)

    Chen Weipeng; Huang Shaoqiang; Lu Xiaofan; Cai Baimang; Liu Xuguang

    2004-01-01

    Objective: To investigate the relationship between enlargement of pituitary in postpartum females and the clinical biochemistry. Methods: In total 6 postpartum women were studied by MRI of pituitary and clinical biochemistry assessment, the data was collected especially in puerperium period. Results: Enlargement of pituitary gland was most remarkable in the first week of puerperium period, while endocrine changes including HCG, Progesterone, E 2 also reached considerable high peak in the same time especially the first and second day after labor. Prolactin also increased. βHCG, Progesterone, and E 2 rapidly decreased after the first week of puerperium period and the size of pituitary gland recovered to normal size. Conclusion: Postpartum enlargement of pituitary gland is physiological and related with internal environment change in gravitation, which is not to be misdiagnosed as a lesion

  6. [The treatment of postpartum depression with interpersonal psychotherapy and interpersonal counseling].

    Science.gov (United States)

    Stuart, Scott; Clark, Elizabeth

    2008-01-01

    Perinatal depression is a prevalent disorder with a high degree of morbidity for both mother and infant. There are now empirically validated treatments for both postpartum depression and depression during pregnancy. Among these is Interpersonal Psychotherapy (IPT), which has been shown to be effective for postpartum depression across the spectrum of mild to severe depression. In fact, the limited evidence of efficacy for medication and concern about medication side effects have led some to suggest that IPT should be the first line treatment for depressed breastfeeding women. There are similar concerns about medication usage during pregnancy. Recent clinical and research experience also suggest that Interpersonal Counseling (IPC) may be effective for selected postpartum women as well. IPC, an abbreviated form of IPT, appears to be effective for mild to moderate depression, and has the potential advantage of being more amenable to delivery in primary care or OB settings.

  7. High incidence of chronic graft-versus-host disease after myeloablative allogeneic stem cell transplantation for chronic lymphocytic leukemia in Sweden: graft-versus-leukemia effect protects against relapse.

    Science.gov (United States)

    Machaczka, Maciej; Johansson, Jan-Erik; Remberger, Mats; Hallböök, Helene; Lazarevic, Vladimir Lj; Wahlin, Björn Engelbrekt; Omar, Hamdy; Wahlin, Anders; Juliusson, Gunnar; Kimby, Eva; Hägglund, Hans

    2013-12-01

    Allogeneic hematopoietic stem cell transplantation (allo-SCT) is a potentially curative treatment option for eligible patients with chronic lymphocytic leukemia (CLL). However, it is known that cure of CLL is only possible if a graft-versus-leukemia effect is present. Between 1994 and 2007, 48 adults underwent allo-SCT for poor-risk CLL in Sweden. Of these, ten (21%) patients aged 24-53 years (median: 46 years) received myeloablative conditioning (MAC), based on TBI and cyclophosphamide. All MAC patients had refractory, poorly controlled CLL before allo-SCT (partial remission in 9/10 patients and progressive disease in one). The cumulative incidence of acute graft-versus-host disease (GVHD) grades II-IV was 30%. Nine patients developed chronic GVHD; extensive in four. Rates of nonrelapse mortality at 1, 3 and 10 years were 0, 10 and 20%, respectively. Two patients relapsed 36 and 53 months after transplantation. Six patients were still alive after a median follow-up time of 11.5 years (range 5.9-13.7). The probabilities of relapse-free and overall survival from 1, 3 and 5 years after transplantation were 100, 90 and 70%, and 100, 90 and 80%, respectively. Nevertheless, our analysis of long-term outcome after MAC allo-SCT for CLL suggests that younger patients with poorly controlled CLL may benefit from MAC allo-SCT.

  8. Single nucleotide polymorphisms in the promoter region of the IL1B gene influence outcome in multiple myeloma patients treated with high-dose chemotherapy independently of relapse treatment with thalidomide and bortezomib

    DEFF Research Database (Denmark)

    Vangsted, Annette J.; Klausen, Tobias W.; Abildgaard, Niels

    2011-01-01

    the impact on outcome of HDT, INF-α maintenance treatment, and treatment with thalidomide and bortezomib at relapse, in relation to the major identified functional polymorphisms in the promoter region of IL1B. The wild-type C-allele of IL1B C-3737T and non-carriage of the IL1B promoter haplotype TGT (−3737T...... carrying the wild-type C-allele of IL1B C-3737T (HR, 1.6 (1.1–2.4)). Furthermore, among INF-α treated patients, gene–gene interaction studies on IL1B C-3737T and NFКB1-94ins/del ATTG revealed a fourfold increase in TTF for homozygous carriers of wild-type alleles at both loci as compared to variant allele...... carriers at both loci. No relation to genotype and outcome was found for relapse patients treated with thalidomide or bortezomib. Our results indicate that a subpopulation of myeloma patients carrying the wild-type C-allele of IL1B C-3737T and non-carriers of the promoter haplotype TGT (−3737T, −1464G...

  9. A Shortened versus Standard Matched Postpartum Magnesium ...

    African Journals Online (AJOL)

    Magnesium sulphate is currently the most ideal drug for the treatment of eclampsia but its use in Nigeria is still limited due its cost and clinicians inexperience with the drug. The purpose of this study was to determine whether a shortened postpartum course of magnesium sulphate is as effective as the standard Pritchard ...

  10. POSTPARTUM CONTRACEPTIVE USE IN RURAL BAREILLY

    Directory of Open Access Journals (Sweden)

    Syed Esam Mahmood

    2011-12-01

    Full Text Available Background: Contraception is an important intervention to reduce burden of unwanted pregnancy and promote healthy living among women. Objectives: To find out the postpartum contraceptive usage and identify the different variables which affect the postpartum contraception among the rural females of Bareilly district. Methods: The cross sectional study was carried out in randomly selected villages of Bhojipura Block of Bareilly district, Uttar Pradesh. All women who had delivered within last one year were interviewed by house to house survey to collect data regarding socio-demographic characteristics and contraceptive use by structured questionnaire. A total of 123 women participated in the study. Chi- square test was used to analyze data. Results: Only 13.8% mothers adopted postpartum contraception. Lack of knowledge (32.5% and young infant being breastfed (28.5% were the common reasons of not using any contraceptive method. Contraceptive use was higher amongst females aged less than 30 years and those belonging to middle socioeconomic class and nuclear families. The significant influence of the women’ educational status on utilization of family planning methods was observed (p<0.05. Conclusions: Low percent of postpartum contraceptive use indicates the need for improving awareness among the study population.

  11. Prognosis and treatment after relapse of acute lymphoblastic leukemia and non-Hodgkin's lymphoma: 1985. A report from the Childrens Cancer Study Group

    International Nuclear Information System (INIS)

    Bleyer, W.A.; Sather, H.; Hammond, G.D.

    1986-01-01

    Acute lymphoblastic leukemia and non-Hodgkin's lymphoma constitute 42% to 45% of the cancers in infants, children, and adolescents: In 1985, an estimated 2025 children were newly diagnosed with these two cancers and 900 (43%) of the pediatric cancer deaths in the United States have been projected to be due to these diseases. The single most important obstacle to preventing these deaths is relapse, and prevention of relapse or salvage of the patient who has had a relapse continues to be a major therapeutic challenge. The most important initial step in the treatment of the child whose disease has relapsed is to determine, to the extent possible, the prognosis. In a child with non-Hodgkin's lymphoma, a relapse confers an extremely poor prognosis, regardless of site of relapse, tumor histology, or other original prognostic factors, prior therapy, or time to relapse. In the child with acute lymphoblastic leukemia in relapse, the prognosis depends on multiple factors. The primary therapy is chemotherapy or chemoradiotherapy with marrow grafting. Other options exist, including no therapy, or investigational therapy. The therapy selected should be predicated on the prognosis. In the child with an isolated central nervous system (CNS) relapse off therapy, minimum therapy should be administered, particularly if the relapse occurred without prior cranial irradiation. In the child whose relapse is more than 6 months off therapy, conventional therapy should be considered. Also, a patient with an isolated CNS relapse on therapy after prior cranial irradiation should be given moderate therapy. Bone marrow transplantation or high-dose chemoradiotherapy with autologous marrow rescue should be reserved in children with a second or subsequent extramedullary relapse, and possibly for those with a first isolated overt testicular relapse on therapy

  12. Advanced Life Support in Obstetrics (ALSO) and postpartum hemorrhage: A prospective intervention study in Tanzania

    DEFF Research Database (Denmark)

    Sorensen, Bjarke Lund; Rasch, Vibeke; Massawe, Siriel

    2011-01-01

    Objective. To evaluate the impact of Advanced Life Support in Obstetrics (ALSO) training on staff performance and the incidences of postpartum hemorrhage (PPH) at a regional hospital in Tanzania. Design. Prospective intervention study. Setting. A regional, referral hospital. Population. A total...... of 510 delivered women before and 505 after the intervention. Methods. All high- and midlevel providers involved in childbirth at the hospital attended a two day ALSO provider course. Staff management was observed and postpartum bleeding assessed at all vaginal deliveries for seven weeks before and seven...

  13. Clonidine versus Captopril for Severe Postpartum Hypertension: A Randomized Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Carlos Noronha Neto C

    Full Text Available Changes during the puerperium are still unclear, particularly in women with hypertension. The choice of antihypertensives, both to control very high blood pressure episodes and to keep blood pressure stable, also requires further elucidation. Currently, there are no clear data to guide the decision for the choice of postpartum antihypertensives. Captopril plays an important role in the treatment of very high blood pressure episodes and may be used postpartum. Clonidine has been used as an alternative in pregnant or postpartum women with contraindications to captopril, with satisfactory effect. The objective of the present study was to evaluate the effectiveness and safety of clonidine compared to captopril for treating severe postpartum hypertension.A randomized, drug-controlled, triple-blind clinical trial evaluating postpartum women receiving captopril or clonidine. Inclusion criteria consisted of: women with hypertensive disorders of pregnancy systolic blood pressure (SBP ≥180 mmHg and/or diastolic blood pressure (DBP ≥110 mmHg], requiring magnesium sulfate. Exclusion criteria were: heart disease, smoking, illicit drug use, contraindications to captopril, clonidine or oral medication, and having used captopril/clonidine previously. The primary outcome was the frequency of very high blood pressure episodes while in the obstetric intensive care unit. A total of 90 postpartum women met the study inclusion criteria, with 45 randomized to each group. There were fewer very high blood pressure episodes during hospitalization (2.1 ± 2.1 vs. 3.5 ± 4.7, p = 0.08, greater percentage reduction in SBP (14.0% ± 8.6% vs. 10.8% ± 8.8%, p = 0.08 and fewer women requiring sodium nitroprusside (2.3% vs. 13.3%; RR: 0.17; 95%CI: 0.02-1.39; p = 0.06 in the clonidine group compared to the captopril group; however, these differences were not significant. The groups were similar regarding daily mean SBP or DBP; however, on the third postpartum day, mean SBP

  14. [Postpartum hemorrhage and pregnancy induced hypertension during emergency lower segment cesarean section: dexmedetomidine to our rescue].

    Science.gov (United States)

    Hariharan, Uma

    Dexmedetomidine is a highly selective α-2 agonist which has recently revolutionized our anesthesia and intensive care practice. An obstetric patient presented for emergency cesarean delivery under general anesthesia, with pre-eclampsia and postpartum hemorrhage. In carefully selected cases with refractory hypertension and postpartum hemorrhage, dexmedetomidine can be used for improving overall patient outcome. It was beneficial in controlling both the blood pressure and uterine bleeding during cesarean section in our patient. Copyright © 2015 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  15. Effect of pre- and postpartum supplementation with lipid-encapsulated conjugated linoleic acid on reproductive performance and the growth hormone-insulin-like growth factor-I axis in multiparous high-producing dairy cows.

    Science.gov (United States)

    Csillik, Z; Faigl, V; Keresztes, M; Galamb, E; Hammon, H M; Tröscher, A; Fébel, H; Kulcsár, M; Husvéth, F; Huszenicza, Gy; Butler, W R

    2017-07-01

    The objective of the study was to evaluate the effect of prepartum and postpartum (PP) supplementation with 2 isomers of conjugated linoleic acid (CLA) on reproductive parameters and some related metabolic factors in dairy cows. High-producing, multiparous Holstein Friesian cows (n = 60) were allotted to 3 treatment groups: the CLA1 group (n = 20) was supplemented with 70 g of lipid-encapsulated CLA providing 7 g each of cis-9,trans-11 and trans-10,cis-12 CLA from d 21 (d 21) before expected calving until d 7 after artificial insemination (AI), that is, until 77 to 91 d PP; the CLA2 group (n = 20) was supplemented with the same amount of CLA beginning at calving until d 7 after AI; and the control group (n = 20) received an isocaloric, isonitrogenous, and isolipidic diet. Blood samples were taken weekly to measure glucose, insulin, insulin-like growth factor-I (IGF-I), and leptin. Liver biopsy was performed in 10 cows per group for growth hormone receptor 1A and IGF-I mRNA analyses. At d 49 to 63 PP, ovulation was synchronized with the Pre-Synch protocol followed by fixed-time AI. Milk progesterone was monitored from calving until d 35 post-AI. Cows returning to estrus following AI were inseminated. Supplementation with CLA before calving improved the recovery of plasma leptin levels in the early PP period (from the day of calving until wk 3 PP; treatment effect). Later PP (wk 5), plasma IGF-I, and leptin remained significantly higher in both CLA1 and CLA2 groups compared with control, although hepatocellular IGF-I mRNA was not different among groups. Plasma IGF-I levels remained higher in both CLA-treated groups on the day of AI. Growth hormone receptor 1A mRNA levels in hepatic tissue decreased in all groups, reaching a nadir in the first week PP. Days to first PP ovulation did not differ between groups; however, both supplemented groups conceived earlier compared with control (d 97 ± 19, d 97 ± 23, and d 113 ± 30 for CLA1, CLA2, and control, respectively

  16. Conditional Risk of Relapse in Surveillance for Clinical Stage I Testicular Cancer.

    Science.gov (United States)

    Nayan, Madhur; Jewett, Michael A S; Hosni, Ali; Anson-Cartwright, Lynn; Bedard, Philippe L; Moore, Malcolm; Hansen, Aaron R; Chung, Peter; Warde, Padraig; Sweet, Joan; O'Malley, Martin; Atenafu, Eshetu G; Hamilton, Robert J

    2017-01-01

    Patients on surveillance for clinical stage I (CSI) testicular cancer are counseled regarding their baseline risk of relapse. The conditional risk of relapse (cRR), which provides prognostic information on patients who have survived for a period of time without relapse, have not been determined for CSI testicular cancer. To determine cRR in CSI testicular cancer. We reviewed 1239 patients with CSI testicular cancer managed with surveillance at a tertiary academic centre between 1980 and 2014. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: cRR estimates were calculated using the Kaplan-Meier method. We stratified patients according to validated risk factors for relapse. We used linear regression to determine cRR trends over time. At orchiectomy, the risk of relapse within 5 yr was 42.4%, 17.3%, 20.3%, and 12.2% among patients with high-risk nonseminomatous germ cell tumor (NSGCT), low-risk NSGCT, seminoma with tumor size ≥3cm, and seminoma with tumor size testicular cancer is very low. Consideration should be given to adapting surveillance protocols to individualized risk of relapse based on cRR as opposed to static protocols based on baseline factors. This strategy could reduce the intensity of follow-up for the majority of patients. Our study is the first to provide data on the future risk of relapse during surveillance for clinical stage I testicular cancer, given a patient has been without relapse for a specified period of time. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  17. Longitudinal fluorescence in situ hybridization reveals cytogenetic evolution in myeloma relapsing after autologous transplantation

    Science.gov (United States)

    Merz, Maximilian; Jauch, Anna; Hielscher, Thomas; Mai, Elias K.; Seckinger, Anja; Hose, Dirk; Bertsch, Uta; Neben, Kai; Raab, Marc S.; Salwender, Hans; Blau, Igor W.; Lindemann, Hans-Walter; Schmidt-Wolf, Ingo; Scheid, Christof; Haenel, Mathias; Weisel, Katja; Goldschmidt, Hartmut; Hillengass, Jens

    2017-01-01

    To investigate cytogenetic evolution after upfront autologous stem cell transplantation for newly diagnosed myeloma we retrospectively analyzed fluorescence in situ hybridization results of 128 patients with paired bone marrow samples from the time of primary diagnosis and at relapse. High-risk cytogenetic abnormalities (deletion 17p and/or gain 1q21) occurred more frequently after relapse (odds ratio: 6.33; 95% confidence interval: 1.86–33.42; P<0.001). No significant changes were observed for defined IGH translocations [t(4;14); t(11;14); t(14;16)] or hyperdiploid karyotypes between primary diagnosis and relapse. IGH translocations with unknown partners occurred more frequently at relapse. New deletion 17p and/or gain 1q21 were associated with cytogenetic heterogeneity, since some de novo lesions with different copy numbers were present only in subclones. No distinct baseline characteristics were associated with the occurrence of new high-risk cytogenetic abnormalities after progression. Patients who relapsed after novel agent-based induction therapy had an increased risk of developing high-risk aberrations (odds ratio 10.82; 95% confidence interval: 1.65–127.66; P=0.03) compared to those who were treated with conventional chemotherapy. Survival analysis revealed dismal outcomes regardless of whether high-risk aberrations were present at baseline (hazard ratio, 3.53; 95% confidence interval: 1.53–8.14; P=0.003) or developed at relapse only (hazard ratio, 3.06; 95% confidence interval: 1.09–8.59; P=0.03). Our results demonstrate cytogenetic evolution towards high-risk disease after autologous transplantation and underline the importance of repeated genetic testing in relapsed myeloma (EudraCT number of the HD4 trial: 2004-000944-26). PMID:28495913

  18. Management of relapsed multiple myeloma: recommendations of the International Myeloma Working Group.

    Science.gov (United States)

    Laubach, J; Garderet, L; Mahindra, A; Gahrton, G; Caers, J; Sezer, O; Voorhees, P; Leleu, X; Johnsen, H E; Streetly, M; Jurczyszyn, A; Ludwig, H; Mellqvist, U-H; Chng, W-J; Pilarski, L; Einsele, H; Hou, J; Turesson, I; Zamagni, E; Chim, C S; Mazumder, A; Westin, J; Lu, J; Reiman, T; Kristinsson, S; Joshua, D; Roussel, M; O'Gorman, P; Terpos, E; McCarthy, P; Dimopoulos, M; Moreau, P; Orlowski, R Z; Miguel, J S; Anderson, K C; Palumbo, A; Kumar, S; Rajkumar, V; Durie, B; Richardson, P G

    2016-05-01

    The prognosis for patients multiple myeloma (MM) has improved substantially over the past decade with the development of new, more effective chemotherapeutic agents and regimens that possess a high level of anti-tumor activity. In spite of this important progress, however, nearly all MM patients ultimately relapse, even those who experience a complete response to initial therapy. Management of relapsed MM thus represents a vital aspect of the overall care for patients with MM and a critical area of ongoing scientific and clinical research. This comprehensive manuscript from the International Myeloma Working Group provides detailed recommendations on management of relapsed disease, with sections dedicated to diagnostic evaluation, determinants of therapy, and general approach to patients with specific disease characteristics. In addition, the manuscript provides a summary of evidence from clinical trials that have significantly impacted the field, including those evaluating conventional dose therapies, as well as both autologous and allogeneic stem cell transplantation. Specific recommendations are offered for management of first and second relapse, relapsed and refractory disease, and both autologous and allogeneic transplant. Finally, perspective is provided regarding new agents and promising directions in management of relapsed MM.

  19. The Relationship between Physical Activity during Pregnancy and Postpartum Mood in Primiparous Women

    Directory of Open Access Journals (Sweden)

    M Mirghafourvand

    2016-06-01

    Full Text Available BACKGROUND AND OBJECTIVE: Physical activity might reduce postpartum depressive symptoms and improve temperament. This study aimed to evaluate the relationship between physical activity during pregnancy and postpartum mood in primiparous women. METHODS: This cohort study was conducted in 165 primiparous women aged 18-35 years referring to the healthcare centers in Tehran, Iran, during 2013-2014. The participants were chosen through stratified random sampling and divided into two groups of low physical activity (n=68 and moderate or high physical activity (n=97. Both groups completed the International Physical Activity Questionnaire (IPAQ during weeks 28 and 34 and Depression Anxiety Stress Scale (DASS at the end of the sixth postpartum week. For each sub-scale, the minimum and maximum possible scores of this scale are 0 and 21, respectively. FINDINGS: Mean total scores of stress, anxiety, and depression of the low physical activity group were 9.85±5.74, 5.61±5.11, and 6.23±5.77, respectively, while for the moderate or high physical activity group they were 9.88±5.84, 5.72±5.03, and 6.51±5.70, respectively. In addition, no significant difference was observed between the two groups in terms of mean total score of stress (p=0.969, anxiety (p=0.585, and depression (p=0.396 at the end of the sixth postpartum week. Moreover, no statistically significant relationship was observed between the level of physical activity during pregnancy and postpartum mood. CONCLUSION: According to our results, physical activity during pregnancy is not associated with postpartum stress, anxiety, and depression.

  20. [Shenghua soup: a study of the relationships among related knowledge, expected effectiveness, and consumption behavior in postpartum women].

    Science.gov (United States)

    Liu, Shu-Hsun; Wang, Hsiao-Ling; Kuo, Shih-Hsien; Chou, Fan-Hao

    2013-02-01

    Women in Taiwan are concerned about postpartum personal healthcare, and over 90% consume Shenghua soup as part of their postpartum recovery regimen. However, knowledge regarding Shenghua soup is inadequate among this population. Therefore, the correlation between Shenghua soup knowledge and consumption behavior deserves further clarification. The study explores the relationships among Shenghua soup knowledge, expected effectiveness, and consumption behavior in postpartum women. A descriptive and correlational research design recruited a convenience sample of 515 soup consumption behavior. Those with bachelor and master school degrees earned a higher average score than those educated to the senior high school level; (2) Knowledge correlated significantly and positively with expected effectiveness (r = .14, p soup consumption behavior; (4) Principal sources of participant information on Shenghua soup were family members (30.84%), media (26.65%), and medical staff (16.44%); (5) Knowledge scores for over half of participants were in the "wrong" to "no idea" range; and (6) 66.6% of participants took Chinese and Western medicines to help uterine contraction, while 76% had consumed Shenghua soup. Findings indicate that postpartum women in Taiwan have insufficient and incorrect knowledge regarding Shenghua soup; hold positive expectations regarding Shenghua soup effectiveness; and have a high Shenghua soup consumption rate. This study may serve as a postpartum care reference for healthcare professionals to improve the postpartum health of women.

  1. Relapsing/remitting type 1 diabetes

    NARCIS (Netherlands)

    van Megen, Kayleigh M.; Spindler, Matthew P.; Keij, Fleur M.; Bosch, Ineke; Sprangers, Fleur; van Royen-Kerkhof, Annet; Nikolic, Tatjana; Roep, Bart O.

    2017-01-01

    Aims/hypothesis: Type 1 diabetes is believed to be an autoimmune disease associated with irreversible loss of insulin secretory function that follows a chronic progressive course. However, it has been speculated that relapsing/remitting disease progression may occur in type 1 diabetes. Methods: We

  2. Recurrence and Relapse in Bipolar Mood Disorder

    Directory of Open Access Journals (Sweden)

    S Gh Mousavi

    2004-06-01

    Full Text Available Background: Despite the effectiveness of pharmacotherapy in acute phase of bipolar mood disorder, patients often experience relapses or recurrent episodes. Hospitalization of patients need a great deal of financial and humanistic resources which can be saved through understanding more about the rate of relapse and factors affecting this rate. Methods: In a descriptive analytical study, 380 patients with bipolar disorder who were hospitalized in psychiatric emergency ward of Noor hospital, Isfahan, Iran, were followed. Each patient was considered for; the frequency of relapse and recurrence, kind of pharmachotherapy, presence of psychotherapeutic treatments, frequency of visits by psychiatrist and the rank of present episode. Results: The overall prevalence of recurrence was 42.2%. Recurrence was lower in patients using lithium carbonate or sodium valproate or combined therapy (about 40%, compared to those using carbamazepine (80%. Recurrence was higher in patients treated with only pharmacotherapy (44.5% compared to those treated with both pharmacotherapy and psychotherapy (22.2%. Patients who were visited monthy by psychiatrist had lower rate of recurrence compared to those who had irregular visits. Conclusion: The higher rate of recurrence observed in carbamazepine therapy may be due to its adverse reactions and consequently poor compliance to this drug. Lower rates of recurrence with psychotherapy and regular visits may be related to the preventive effects of these procedures and especially to the effective management of stress. Keywords: Bipolar Mood Disorder, Recurrence, Relapse.

  3. Resistance to Change and Relapse of Observing

    Science.gov (United States)

    Thrailkill, Eric A.; Shahan, Timothy A.

    2012-01-01

    Four experiments examined relapse of extinguished observing behavior of pigeons using a two-component multiple schedule of observing-response procedures. In both components, unsignaled periods of variable-interval (VI) food reinforcement alternated with extinction and observing responses produced stimuli associated with the availability of the VI…

  4. Investigating the use of social media to help women from going back to smoking post-partum.

    Science.gov (United States)

    Lowe, John B; Barnes, Margaret; Teo, Cynthia; Sutherns, Stephanie

    2012-02-01

    To investigate the social factors that would help women who had quit smoking due to pregnancy from returning to smoking after delivery of their baby. Women who attended their first antenatal check-up at a general public hospital were invited to participate in pre- and postpartum interviews. A total of 24 women were interviewed pre- and postpartum. They reported isolation as a factor that influenced how they dealt with stress. This stress was linked to relapse. The use of electronic media through the Internet was a way women could interact with the outside community without having to leave home. Women who had strong family relationships in geographic proximity were not as likely to use the computer to interact with relatives and friends. Women who did not have strong local and family ties that support their desire to not go back to smoking, reported using Facebook and other Internet activities to keep in touch while they stayed at home with their new infant. The use of electronic media may help facilitate interaction between new mothers, which could prevent isolation and relapse back to smoking after delivery. This mechanism might also be used to enhance skill-development and problem-solving by these women. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

  5. Postpartum consultation: Occurrence, requirements and expectations

    Directory of Open Access Journals (Sweden)

    Carlgren Ingrid

    2008-07-01

    Full Text Available Abstract Background As a matter of routine, midwives in Sweden have spoken with women about their experiences of labour in a so-called 'postpartum consultation'. However, the possibility of offering women this kind of consultation today is reduced due to shortage of both time and resources. The aim of this study was to explore the occurrence, women's requirements of, and experiences of a postpartum consultation, and to identify expectations from women who wanted but did not have a consultation with the midwife assisting during labour. Methods All Swedish speaking women who gave birth to a live born child at a University Hospital in western Sweden were consecutively included for a phone interview over a three-week period. An additional phone interview was conducted with the women who did not have a postpartum consultation, but who wanted to talk with the midwife assisting during labour. Data from the interviews were analysed using qualitative content analysis. Results Of the 150 interviewed women, 56% (n = 84 had a postpartum consultation of which 61.9% (n = 52 had this with the midwife assisting during labour. Twenty of the 28 women who did not have a consultation with anyone still desired to talk with the midwife assisting during labour. Of these, 19 were interviewed. The content the women wanted to talk about was summarized in four categories: to understand the course of events during labour; to put into words, feelings about undignified management; to describe own behaviour and feelings, and to describe own fear. Conclusion The survey shows that the frequency of postpartum consultation is decreasing, that the majority of women who give birth today still require it, but only about half of them receive it. It is crucial to develop a plan for these consultations that meets both the women's needs and the organization within current maternity care.

  6. Possible Rivaroxaban Failure during the Postpartum Period.

    Science.gov (United States)

    Rudd, Kelly M; Winans, Amanda R McFee; Panneerselvam, Narmadha

    2015-11-01

    Rivaroxaban, a factor Xa inhibitor, is a direct-acting oral anticoagulant (DOAC) indicated for the treatment of deep vein thrombosis (DVT) and pulmonary embolism (PE), and for reducing the risk of DVT and PE recurrence. To our knowledge, no data are presently available to guide DOAC dosing in the postpartum period when pharmacokinetic and pharmacodynamic changes induced by pregnancy have an impact on drug clearance and increase hypercoagulability for a period of 6-8 weeks after delivery. We describe the case of a 35-year-old postpartum woman who presented to the emergency department with a diagnosis of a new multiple segmental PE 5 days after starting rivaroxaban therapy for a diagnosis of DVT. No precipitating cause, including noncompliance, was identified as a source of thrombosis embolization or extension. The patient was admitted, a heparin infusion was started for the management of PE, and rivaroxaban was discontinued. She was transitioned to enoxaparin 1 mg/kg (90 mg) subcutaneously every 12 hours the next day, bridged to warfarin, and discharged home on the overlapping regimen with close follow-up by the pharmacist-managed outpatient Anticoagulation Management Service. To our knowledge, this is the first case report of potential failure associated with rivaroxaban therapy in the postpartum period, possibly due to pharmacokinetic alterations seen in the postpartum period contributing to decreased drug exposure, yielding reduced anticoagulant efficacy. Clinicians should carefully weigh the risks and benefits of DOAC therapy in postpartum patients or other special populations requiring anticoagulation therapy. This report also highlights the need for further research identifying the impact of pharmacokinetic changes induced by special populations and the need to develop monitoring assays for such clinical situations. © 2015 Pharmacotherapy Publications, Inc.

  7. Does Coordinated Postpartum Care Influence Costs?

    Directory of Open Access Journals (Sweden)

    Elisabeth Zemp

    2017-03-01

    Full Text Available Questions under study: To investigate changes to health insurance costs for post-discharge postpartum care after the introduction of a midwife-led coordinated care model. Methods: The study included mothers and their newborns insured by the Helsana health insurance group in Switzerland and who delivered between January 2012 and May 2013 in the canton of Basel Stadt (BS (intervention canton. We compared monthly post-discharge costs before the launch of a coordinated postpartum care model (control phase, n = 144 to those after its introduction (intervention phase, n = 92. Costs in the intervention canton were also compared to those in five control cantons without a coordinated postpartum care model (cross-sectional control group: n = 7, 767. Results: The average monthly post-discharge costs for mothers remained unchanged in the seven months following the introduction of a coordinated postpartum care model, despite a higher use of midwife services (increasing from 72% to 80%. Likewise, monthly costs did not differ between the intervention canton and five control cantons. In multivariate analyses, the ambulatory costs for mothers were not associated with the post-intervention phase. Cross-sectionally, however, they were positively associated with midwifery use. For children, costs in the post-intervention phase were lower in the first month after hospital discharge compared to the pre-intervention phase (difference of –114 CHF [95%CI –202 CHF to –27 CHF], yet no differences were seen in the cross-sectional comparison. Conclusions: The introduction of a coordinated postpartum care model was associated with decreased costs for neonates in the first month after hospital discharge. Despite increased midwifery use, costs for mothers remained unchanged.

  8. Prevention of postpartum haemorrhage with the oxytocin analogue carbetocin.

    Science.gov (United States)

    Rath, Werner

    2009-11-01

    Postpartum haemorrhage is the leading cause of maternal mortality worldwide: 67-80% of cases are caused by uterine atony. Preventive measures include prophylactic drug use to aid uterine contraction after delivery, thus avoiding severe blood loss and reducing maternal morbidity and mortality. Carbetocin is a synthetic analogue of oxytocin with a half-life approximately 4-10 times longer than that reported for oxytocin. It combines the safety and tolerability profile of oxytocin with the sustained uterotonic activity of injectable ergot alkaloids. Furthermore, carbetocin can be administered as a single dose injection either intravenously or intramuscularly rather than as an infusion over several hours as is the case with oxytocin. Carbetocin is currently indicated for prevention of uterine atony after delivery by caesarean section in spinal or epidural anaesthesia. Data from three randomised controlled trials in caesarean delivery and a meta-analysis indicate that carbetocin significantly reduces the need for additional uterotonic agents or uterine massage to prevent excessive bleeding compared with placebo or oxytocin. The risk of headache, tremor, hypotension, flushing, nausea, abdominal pain, pruritus and feeling of warmth was similar in women who received carbetocin or oxytocin. The findings from two more recent double-blind randomised trials and one retrospective study suggest that carbetocin may also represent a good alternative to conventional uterotonic agents for prevention of postpartum haemorrhage after vaginal deliveries. A reduced need for additional uterotonics was observed with carbetocin vs. oxytocin in high-risk women and carbetocin was at least as effective as syntometrine in low-risk women. In these studies of vaginal deliveries, carbetocin was associated with a low incidence of adverse effects and demonstrated a better tolerability profile than syntometrine. Carbetocin had a long duration of action compared with intravenous oxytocin alone and a

  9. Return to work, economic hardship, and women's postpartum health.

    Science.gov (United States)

    Tucker, Jenna N; Grzywacz, Joseph G; Leng, Iris; Clinch, C Randall; Arcury, Thomas A

    2010-10-01

    This study followed a sample of 217 new mothers in a North Carolina county as they returned to work full-time, measuring their mental and physical health-related quality of life through 16 months postpartum. In general, working mothers of infants had mental health scores that were comparable to the general population of U.S. women, and physical health that was slightly better than women in general. Using ANCOVA and controlling for important demographic characteristics, health-related quality of life was compared between mothers experiencing low and high levels of economic hardship. Across the study period, women with high economic hardship, who constituted 30.7% of the sample, had levels of mental and physical health below those of women with low economic hardship. Mothers with high economic hardship also had less stable health trajectories than mothers with low economic hardship. The findings highlight the importance of reconsidering the traditionally accepted postpartum recovery period of six weeks and extending benefits, such as paid maternity and sick leave, as well as stable yet flexible work schedules.

  10. Prognostic value of comorbidity for auto-SCT eligibility and outcome in relapsed or refractory aggressive non-Hodgkin's lymphoma.

    Science.gov (United States)

    Plattel, W J; Kluin-Nelemans, H C; de Bock, G H; van Imhoff, G W

    2011-06-01

    Salvage reinduction therapy followed by high-dose chemotherapy (HDCT) and auto-SCT is the treatment of choice for fit patients with refractory or relapsed aggressive non-Hodgkin's lymphoma (NHL). We assessed the prognostic value of comorbidity at the time of relapse to predict receipt of auto-SCT and outcome. We analyzed 156 consecutive NHL patients, referred to our center between 1999 and 2007 for salvage reinduction therapy, followed by HDCT and auto-SCT. Comorbidity according to the hematopoietic SCT comorbidity index was scored at relapse and directly before HDCT and auto-SCT. Primary end points were actual receipt of auto-SCT and survival. At relapse, comorbidity scores of 0, 1-2 and ≥3 were found among 64 (41%), 62 (40%) and 30 (19%) patients, respectively. Ultimately, 95 patients received auto-SCT. Higher comorbidity scores at relapse were associated with significantly less chance of receiving auto-SCT and with inferior OS, independently from secondary age-adjusted International Prognostic Index (sAAIPI) scores. For transplanted patients, OS rates at 5 years were 62, 30 and 17% for relapse comorbidity scores of 0, 1-2 and ≥3, respectively. In patients with relapsed NHL, comorbidity at relapse is associated with receipt of auto-SCT and subsequent survival independently from the sAAIPI.

  11. Influence of chest radiotherapy in frequency and patterns of chest relapse in disseminated small cell lung carcinoma

    International Nuclear Information System (INIS)

    Mira, J.G.; Livingston, R.B.; Moore, T.N.

    1982-01-01

    The value of radiotherapy to the chest (RC) in disseminated small cell lung carcinoma (SCLC) has been questioned. Two protocols for disseminated SCLC from the Southwest Oncology Group (SWOG) have been compared. The first one included radiotherapy (RT), 3000 rad in two weeks, to the primary tumor, mediastinum and supraclavicular areas, while the second one deleted any RC. Multidrug chemotherapy (CT) and brain RT were used in both protocols. Nonresponders to CT were removed from the study. Our main findings are as follows: (1) Initial chest relapses (patients with no initial extrathoracic relapse) have increased from 24-55% when RC is not given (P = 0.0001). Overall chest relapse (adding those patients that relapsed simultaneously in the chest plus other sites) in the second protocol was 73%. (2) Amount of response to CT does not influence the chances for relapse. Even complete responders to CT have a high chance for chest relapse. (3) Sites of relapse without RC are mainly in the primary tumor, ipsilateral hilus and mediastinum. (4) With RC, relapses shift to the chest periphery, mostly to the lung outside the radiotherapy field and to the pleura. (5) The two very different CT regimens have produced similar percentages and duration of response. (6) CT schema with periodic reinductions prolongs duration of response and survival over schema with continuous maintenance. Hence, interruption of CT to allow RC does not seem to adversely influence CT efficacy

  12. The efficacy of natalizumab in patients with relapsing multiple sclerosis: subgroup analyses of AFFIRM and SENTINEL.

    LENUS (Irish Health Repository)

    Hutchinson, Michael

    2012-02-01

    The AFFIRM and SENTINEL studies showed that natalizumab was effective both as monotherapy and in combination with interferon beta (IFNbeta)-1a in patients with relapsing multiple sclerosis (MS). Further analyses of AFFIRM and SENTINEL data were conducted to determine the efficacy of natalizumab in prespecified patient subgroups according to baseline characteristics: relapse history 1 year before randomization (1, 2, > or = 3), Expanded Disability Status Scale score (< or = 3.5, > 3.5), number of T2 lesions (< 9, > or = 9), presence of gadolinium-enhancing (Gd+) lesions (0, > or = 1), age (< 40, > or = 40) and gender (male, female). A post hoc analysis was conducted to determine the efficacy of natalizumab in patients with highly active disease (i. e., > or = 2 relapses in the year before study entry and > or = 1 Gd+ lesion at study entry). In both AFFIRM and SENTINEL studies natalizumab reduced the annualized relapse rates across all subgroups (except the small subgroups with < 9 baseline T2 lesions) over 2 years. In AFFIRM, natalizumab significantly reduced the risk of sustained disability progression in most subgroups. In SENTINEL, natalizumab significantly reduced the risk of sustained disability progression in the following subgroups: > or = 9 T2 lesions at baseline, > or = 1 Gd+ lesions at baseline, female patients and patients < 40 years of age. Natalizumab reduced the risk of disability progression by 64 % and relapse rate by 81 % in treatment- naive patients with highly active disease and by 58 % and 76 %, respectively, in patients with highly active disease despite IFNbeta-1a treatment. These results indicate that natalizumab is effective in reducing disability progression and relapses in patients with relapsing MS, particularly in patients with highly active disease.

  13. Post-relapse survival in patients with Ewing sarcoma.

    Science.gov (United States)

    Ferrari, Stefano; Luksch, Roberto; Hall, Kirsten Sundby; Fagioli, Franca; Prete, Arcangelo; Tamburini, Angela; Tienghi, Amelia; DiGirolamo, Stefania; Paioli, Anna; Abate, Massimo Eraldo; Podda, Marta; Cammelli, Silvia; Eriksson, Mikael; Brach del Prever, Adalberto

    2015-06-01

    Post-relapse survival (PRS) was evaluated in patients with Ewing sarcoma (EWS) enrolled in chemotherapy protocols based on the use of high-dose chemotherapy with busulfan and melfalan (HDT) as a first-line consolidation treatment in high-risk patients. EWS patients enrolled in ISG/SSG III and IV trials who relapsed after complete remission were included in the analysis. At recurrence, chemotherapy based on high-dose ifosfamide was foreseen, and patients who responded but had not received HDT underwent consolidation therapy with HDT. Data from 107 EWS patients were included in the analysis. Median time to recurrence (RFI) was 18 months, and 45 (42%) patients had multiple sites of recurrence. Patients who had previously been treated with HDT had a significantly (P = 0.02) shorter RFI and were less likely to achieve a second complete remission (CR2). CR2 status was achieved by 42 (39%) patients. Fifty patients received high-dose IFO (20 went to consolidation HDT). The 5-year PRS was 19% (95% CI 11 to 27%). With CR2, the 5-year PRS was 48% (95% CI 31 to 64%). Without CR2, median time to death was six months (range 1-45 months). According to the multivariate analysis, patients younger than 15 years, recurrence to the lung only, and RFI longer than 24 months significantly influenced the probability of PRS. Age, pattern of recurrence, RFI, and response to second-line chemotherapy influence post-relapse survival in patients with recurrent Ewing sarcoma. No survival advantage was observed from chemotherapy consolidation with HDT. © 2015 Wiley Periodicals, Inc.

  14. A couple-focused intervention to prevent postnatal smoking relapse: PRISM study design.

    Science.gov (United States)

    Meghea, Cristian Ioan; Brînzaniuc, Alexandra; Mihu, Dan; Iuhas, Cristian Ioan; Stamatian, Florin; Caracostea, Gabriela; Sidor, Alexandra; Alexa, Paula Mădălina; Brînza, Cătălina; Pop, Oana Maria; Cherecheș, Răzvan Mircea

    2015-03-01

    Maternal smoking is one of the most modifiable factors with clear adverse effects for the fetus and the entire family. Addressing the dearth of pregnancy smoking interventions with partner support, PRISM (Prevent Relapse In SMoking) is a partnership between a research institution and the two largest state-owned obstetrics and gynecology clinics in Cluj-Napoca, Romania. The study will assess the efficacy of a couple-focused telephone-counseling program to prevent smoking relapse among mothers who quit smoking closely before or during pregnancy. The intervention is a program for couples based on motivational interviewing delivered over the phone after birth. The study is an ongoing randomized controlled trial of 250 Romanian women recruited soon after childbirth, who quit smoking in the six months before pregnancy or no later than the end of the first pregnancy trimester and remained abstinent (which was biochemically verified) until delivery. Participants were randomized to: (1) a control arm (usual care); and (2) an intervention arm consisting of up to 4 postnatal counseling calls for mothers and their partners using motivational interviewing to encourage the woman to remain smoke-free and the partner to support her decision. The primary outcome is maternal smoking abstinence at 6 months postpartum (biochemically verified). PRISM has the potential to identify strategies to reduce maternal postnatal relapse and increase partner quitting. If successful, the program may be an effective method to prevent and reduce smoking, which may lead to improved child, mother, and partner health both in the short and the long term. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Postpartum depression peer support: maternal perceptions from a randomized controlled trial.

    Science.gov (United States)

    Dennis, Cindy-Lee

    2010-05-01

    Peer support in the early postpartum period is effective in the prevention of postpartum depression among women identified as high-risk. To describe maternal perceptions of peer support received while participating in a trial. Cross-sectional survey of women participating in a randomized controlled trial to evaluate the effect of peer support in the prevention of postpartum depression. Seven health regions across Ontario Canada. 701 women were recruited between November 2004 and September 2006. Women eligible for the study were all mothers with an Edinburgh Postnatal Depression Scale score >9 who were within 2 weeks postpartum, at least 18 years of age, able to speak English, had a live birth, and had been discharged home from the hospital. Exclusion criteria included an infant not discharged home with the mother and current use of antidepressant or antipsychotic medication. Two hundred and twenty-one mothers completed the mailed questionnaire. Women were randomly allocated to receive usual postpartum care (control group) or usual postpartum care plus telephone-based peer support (intervention group). Maternal perceptions of peer support were evaluated at 12 weeks postpartum using the validated Peer Support Evaluation Inventory. Interactions provided by the peer volunteer included the provision of emotional (92.7%), informational (72.4%), and appraisal (72.0%) support. Mothers reported high levels of positive relationship qualities such as trust (83.6%) and perceived acceptance (79.1%). Most (80.5%) mothers indicated they were very satisfied with their peer support experience. Maternal satisfaction was associated with the number and duration of peer volunteer contacts. The majority of mothers perceived their peer volunteer experience positively lending further support to telephone-based peer support as a preventative strategy for postpartum depression. The following program modifications were suggested: (a) adapt training to enhance the provision of appraisal

  16. Productivity cost due to postpartum ill health: A cross-sectional study in Sri Lanka.

    Science.gov (United States)

    Wickramasinghe, Nuwan Darshana; Horton, Jennifer; Darshika, Ishani; Galgamuwa, Kaushila Dinithi; Ranasinghe, Wasantha Pradeep; Agampodi, Thilini Chanchala; Agampodi, Suneth Buddhika

    2017-01-01

    Even though postpartum morbidity continues to cause high disease burden in maternal morbidity and mortality across the globe, the literature pertaining to resultant productivity loss is scarce. Hence, the present study aimed at determining the productivity loss and associated cost of episodes of postpartum ill health. A cross sectional study was conducted in two Medical Officer of Heath areas in the Anuradhapura district, Sri Lanka in 2011, among 407 women residing in Anuradhapura district with an infant aged between 8 to 24 weeks. Validated interviewer administered questionnaires, including the IMMPACT productivity cost tool, were used to collect data on self-reported episodes of postpartum ill health. The productivity loss was calculated as the sum of days lost due to partial and total incapacitation. The adjusted productivity loss for coping strategies was calculated. Productivity cost, both total and adjusted, were calculated based on the mean daily per capita income of the study sample. Of the 407 participants, 161(39.6%) reported at least one episode of postpartum illness. Hospitalisations were reported by 27 (16.8%) of all symptomatic postpartum women. Common symptoms of postpartum ill health were pain/infection at either episiotomy or surgical site (n = 44, 27.3%), lower abdominal pain (n = 40, 24.8%) and backache (n = 27, 16.8%). The mean productivity loss per episode of ill health was 15 days (SD = 7.8 days) and the mean productivity loss per episode after adjusting for coping strategies was 7.9 days (SD = 4.4 days). The mean productivity cost per an episode was US$ 34.2(95%CI US$ 26.7-41.6) and the mean productivity cost per an episode after adjusting for coping strategies was US$ 18.0 (95%CI US$ 14.1-22.0). The prevalence of self-reported postpartum ill health, associated productivity loss and cost were high in the study sample and the main contributors were preventable conditions including pain and infection. Thus, effective pain management and proper

  17. Enantiomer-specific ketorolac pharmacokinetics in young women, including pregnancy and postpartum period

    Directory of Open Access Journals (Sweden)

    Aida Kulo

    2017-02-01

    Full Text Available Racemic ketorolac clearance (CL is significantly higher at delivery, but S-ketorolac disposition determines the analgesic effects. The aim of this study was to investigate the effect of pregnancy and postpartum period on enantiomer-specific (S and R intravenous (IV ketorolac pharmacokinetics (PKs. Data in women shortly following cesarean delivery (n=39 were pooled with data in a subgroup of these women that was reevaluated in the later postpartum period (postpartum group, n=8/39 and with eight healthy female volunteers. All women received single IV bolus of 30 mg ketorolac tromethamine. Five plasma samples were collected at 1, 2, 4, 6, and 8 hours and plasma concentrations were determined using high performance liquid chromatography. Enantiomer-specific PKs were calculated using PKSolver. Unpaired analysis showed that distribution volume at steady state (Vss, L/kg for S- and R-ketorolac was significantly higher in women shortly following cesarean delivery (n=31 compared to postpartum group (n=8 or to healthy female volunteers (n=8. CL, CL to body weight, and CL to body surface area (CL/BSA for S- and R-ketorolac were also significantly higher in women following delivery. In addition, S/R-ketorolac CL/BSA ratio was significantly higher at delivery. Paired PK analysis in eight women shortly following delivery and in postpartum group showed the same pattern. Finally, the simultaneous increase in CL and Vss resulted in similar estimates for elimination half-life in both unpaired and paired analysis. In conclusion, pregnancy affects S-, R-, and S/R-ketorolac disposition. This is of clinical relevance since S-ketorolac (analgesia CL is even more increased compared to R-ketorolac CL, and S/R-ketorolac CL ratio is higher following delivery compared to postpartum period or to healthy female volunteers.

  18. Accuracy of Brief Screening Tools for Identifying Postpartum Depression Among Adolescent Mothers

    Science.gov (United States)

    Venkatesh, Kartik K.; Zlotnick, Caron; Triche, Elizabeth W.; Ware, Crystal

    2014-01-01

    OBJECTIVE: To evaluate the accuracy of the Edinburgh Postnatal Depression Scale (EPDS) and 3 subscales for identifying postpartum depression among primiparous adolescent mothers. METHODS: Mothers enrolled in a randomized controlled trial to prevent postpartum depression completed a psychiatric diagnostic interview and the 10-item EPDS at 6 weeks, 3 months, and 6 months postpartum. Three subscales of the EPDS were assessed as brief screening tools: 3-item anxiety subscale (EPDS-3), 7-item depressive symptoms subscale (EPDS-7), and 2-item subscale (EPDS-2) that resemble the Patient Health Questionnaire-2. Receiver operating characteristic curves and the areas under the curves for each tool were compared to assess accuracy. The sensitivities and specificities of each screening tool were calculated in comparison with diagnostic criteria for a major depressive disorder. Repeated-measures longitudinal analytical techniques were used. RESULTS: A total of 106 women contributed 289 postpartum visits; 18% of the women met criteria for incident postpartum depression by psychiatric diagnostic interview. When used as continuous measures, the full EPDS, EPDS-7, and EPDS-2 performed equally well (area under the curve >0.9). Optimal cutoff scores for a positive depression screen for the EPDS and EPDS-7 were lower (≥9 and ≥7, respectively) than currently recommended cutoff scores (≥10). At optimal cutoff scores, the EPDS and EPDS-7 both had sensitivities of 90% and specificities of >85%. CONCLUSIONS: The EPDS, EPDS-7, and EPDS-2 are highly accurate at identifying postpartum depression among adolescent mothers. In primary care pediatric settings, the EPDS and its shorter subscales have potential for use as effective depression screening tools. PMID:24344102

  19. Sexual Behavior and Vaginal Practices During Pregnancy and Postpartum: Implications for HIV Prevention Strategies.

    Science.gov (United States)

    Kinuthia, John; Richardson, Barbra A; Drake, Alison L; Matemo, Daniel; Unger, Jennifer A; McClelland, Raymond S; John-Stewart, Grace

    2017-02-01

    Understanding sexual behaviors and vaginal practices of pregnant and breastfeeding women in sub-Saharan Africa is critical to inform HIV prevention strategies during these periods. HIV-uninfected women presenting for antenatal care in western Kenya were enrolled and followed through 36 weeks postpartum. Sexual behavior and vaginal practices were ascertained by structured questionnaires. Logistic regression was used to assess correlates of unprotected sex, vaginal washing, and vaginal drying. Among 1252 women enrolled, 78.4% were married (of whom 15.1% were in polygamous unions), 1.4% had a known HIV-infected partner, and 33.6% had a partner of unknown HIV status. At enrollment, 58.5% reported sex in the past month (94.3% unprotected) and 4.5% reported forced sex. Odds of unprotected sex at enrollment was >11-fold higher in married than in unmarried women (P < 0.001) and lower among women who reported partners of unknown HIV status or HIV-infected compared with HIV-uninfected partners. Median time to postpartum resumption of sex was 7 weeks (interquartile range 4-12). Prevalence of unprotected sex in the past week increased from 6.6% to 60.0% between 2 and 36 weeks postpartum (P < 0.001). Vaginal washing was reported by 60.1% of women at enrollment and prevalence remained stable postpartum; vaginal drying was reported by 17.9% at enrollment and decreased to 6.1% at 36 weeks postpartum (P < 0.001). Vaginal washing and drying were associated with forced sex. High rates of unknown partner HIV status, polygamy, and less frequent condom use among pregnant/postpartum women underscore the need for female-controlled HIV prevention interventions. Vaginal washing and drying may present challenges to microbicide use.

  20. Can Insomnia in Pregnancy Predict Postpartum Depression? A Longitudinal, Population-Based Study

    Science.gov (United States)

    Dørheim, Signe K.; Bjorvatn, Bjørn; Eberhard-Gran, Malin

    2014-01-01

    Background Insomnia and depression are strongly interrelated. This study aimed to describe changes in sleep across childbirth, and to evaluate whether insomnia in pregnancy is a predictor of postpartum depression. Methods A longitudinal, population-based study was conducted among perinatal women giving birth at Akershus University Hospital, Norway. Women received questionnaires in weeks 17 and 32 of pregnancy and eight weeks postpartum. This paper presents data from 2,088 of 4,662 women with complete data for insomnia and depression in week 32 of pregnancy and eight weeks postpartum. Sleep times, wake-up times and average sleep durations were self-reported. The Bergen Insomnia Scale (BIS) was used to measure insomnia. The Edinburgh Postnatal Depression Scale (EPDS) was used to measure depressive symptoms. Results After delivery, sleep duration was reduced by 49 minutes (to 6.5 hours), and mean sleep efficiency was reduced from 84% to 75%. However, self-reported insomnia scores (BIS) improved from 17.2 to 15.4, and the reported prevalence of insomnia decreased from 61.6% to 53.8%. High EPDS scores and anxiety in pregnancy, fear of delivery, previous depression, primiparity, and higher educational level were risk factors for both postpartum insomnia and depression. Insomnia did not predict postpartum depression in women with no prior history of depression, whereas women who recovered from depression had residual insomnia. Limitations Depression and insomnia were not verified by clinical interviews. Women with depressive symptoms were less likely to remain in the study. Conclusions Although women slept fewer hours at night after delivery compared to during late pregnancy, and reported more nights with nighttime awakenings, their self-reported insomnia scores improved, and the prevalence of insomnia according to the DSM-IV criteria decreased. Insomnia in pregnancy may be a marker for postpartum recurrence of depression among women with previous depression. PMID

  1. Postpartum Depression Prevention for Reservation-Based American Indians: Results from a Pilot Randomized Controlled Trial

    Science.gov (United States)

    Ginsburg, Golda S.; Barlow, Allison; Goklish, Novalene; Hastings, Ranelda; Baker, Elena Varipatis; Mullany, Britta; Tein, Jenn-Yun; Walkup, John

    2012-01-01

    Background: Postpartum depression is a devastating condition that affects a significant number of women and their offspring. Few preventive interventions have targeted high risk youth, such as American Indians (AIs). Objective: To evaluate the feasibility of a depression prevention program for AI adolescents and young adults. Methods: Expectant AI…

  2. Relationship between Postpartum Depression and Maternal Perceptions about Ethnotheories and Childrearing Practices

    Science.gov (United States)

    Defelipe, Renata P.; Bussab, Vera S. R.; Vieira, Mauro L.

    2016-01-01

    Postpartum depression (PPD) is a mood disorder which can adaptively alter maternal socialisation strategies. Our objective was to investigate differences in ethnotheories and childrearing practices of mothers with low (N = 46) and high (N = 45) intensity of PPD. The Brazilian version of Edinburgh Postnatal Depression Scale was applied at 3, 8 and…

  3. Effectiveness of a discharge education program in reducing the severity of postpartum depression: a randomized controlled evaluation study.

    Science.gov (United States)

    Ho, Shiao-Ming; Heh, Shu-Shya; Jevitt, Cecilia M; Huang, Lian-Hua; Fu, Yu-Ying; Wang, Li-Lin

    2009-10-01

    The effectiveness of a hospital discharge education program including information on postnatal depression was evaluated to reduce psychological morbidity after childbirth. A randomized controlled trial (RCT) was conducted in a regional hospital in Taipei. Two hundred first-time mothers agreed to take part and were randomly allocated to an intervention group (n=100) or control group (n=100). The intervention group received discharge education on postnatal depression provided by postpartum ward nurses. The control group received general postpartum education. The main outcome measure was the Edinburgh Postnatal Depression Scale (EPDS) administered by postal questionnaire at six weeks and three months after delivery. Women who received discharge education intervention on postnatal depression were less likely to have high depression scores when compared to the control group at three months postpartum. A discharge educational intervention including postnatal depression information given to women during the postpartum stay benefits psychological well-being. A postpartum discharge education program including information on postnatal depression should be integrated into postpartum discharge care in general practice. 2009 Elsevier Ireland Ltd.

  4. Maternal anxiety from pregnancy to 2 years postpartum: transactional patterns of maternal early adversity and child temperament.

    Science.gov (United States)

    Agrati, Daniella; Browne, Dillon; Jonas, Wibke; Meaney, Michael; Atkinson, Leslie; Steiner, Meir; Fleming, Alison S

    2015-10-01

    The aims of this study were to examine the anxiety trajectories of women from pregnancy to 2 years postpartum and to assess the influence of their early life experiences and the temperament of the child on these trajectories. We evaluated state anxiety (State-Trait Anxiety Inventory) at pregnancy and 3, 6, 12, 18, and 24 months postpartum and determined its course as a function of self-reported early adverse experiences (Childhood Trauma Questionnaire) and the temperament of the child at 18 months (Early Child Behavior Questionnaire). Based on growth curve modeling, we found that anxiety followed a general U-shape pattern from gestation to 2 years postpartum, which was modified by early life experience of women. Greater early adversity was associated with higher gestational anxiety, followed by a marked decrease once the baby was born, and subsequent increase during the later postpartum period. The temperament of the child also modulated anxiety trajectories. Thus, mothers of children high in negative affectivity and who also experienced greater early adversity had elevated and flat anxiety trajectories, while child extraversion was associated with increasing anxiety courses approaching 2 years postpartum. These results show that maternal anxiety dynamically changes through the postpartum period with a course that is affected by previous and current experiences.

  5. Targeting BTK with ibrutinib in relapsed chronic lymphocytic leukemia.

    Science.gov (United States)

    Byrd, John C; Furman, Richard R; Coutre, Steven E; Flinn, Ian W; Burger, Jan A; Blum, Kristie A; Grant, Barbara; Sharman, Jeff P; Coleman, Morton; Wierda, William G; Jones, Jeffrey A; Zhao, Weiqiang; Heerema, Nyla A; Johnson, Amy J; Sukbuntherng, Juthamas; Chang, Betty Y; Clow, Fong; Hedrick, Eric; Buggy, Joseph J; James, Danelle F; O'Brien, Susan

    2013-07-04

    The treatment of relapsed chronic lymphocytic leukemia (CLL) has resulted in few durable remissions. Bruton's tyrosine kinase (BTK), an essential component of B-cell-receptor signaling, mediates interactions with the tumor microenvironment and promotes the survival and proliferation of CLL cells. We conducted a phase 1b-2 multicenter study to assess the safety, efficacy, pharmacokinetics, and pharmacodynamics of ibrutinib (PCI-32765), a first-in-class, oral covalent inhibitor of BTK designed for treatment of B-cell cancers, in patients with relapsed or refractory CLL or small lymphocytic lymphoma. A total of 85 patients, the majority of whom were considered to have high-risk disease, received ibrutinib orally once daily; 51 received 420 mg, and 34 received 840 mg. Toxic effects were predominantly grade 1 or 2 and included transient diarrhea, fatigue, and upper respiratory tract infection; thus, patients could receive extended treatment with minimal hematologic toxic effects. The overall response rate was the same in the group that received 420 mg and the group that received 840 mg (71%), and an additional 20% and 15% of patients in the respective groups had a partial response with lymphocytosis. The response was independent of clinical and genomic risk factors present before treatment, including advanced-stage disease, the number of previous therapies, and the 17p13.1 deletion. At 26 months, the estimated progression-free survival rate was 75% and the rate of overall survival was 83%. Ibrutinib was associated with a high frequency of durable remissions in patients with relapsed or refractory CLL and small lymphocytic lymphoma, including patients with high-risk genetic lesions. (Funded by Pharmacyclics and others; ClinicalTrials.gov number, NCT01105247.).

  6. Preventing Relapse to Cigarette Smoking by Behavioral Skill Training.

    Science.gov (United States)

    Hall, Sharon M.; And Others

    1984-01-01

    Crossed two relapse prevention conditions (skills training-vs-discussion control) with two levels of aversive smoking in volunteer subjects (N=123). Results indicated that relapse-prevention skill training did prevent relapse among cigarette smokers. Lighter smokers were more favorably influenced. (LLL)

  7. A classification framework for drug relapse prediction | Salleh ...

    African Journals Online (AJOL)

    mining algorithms, Artificial Intelligence Neural Network (ANN) is one of the best algorithms to predict relapse among drug addicts. This may help the rehabilitation center to predict relapse individually and the prediction result is hoped to prevent drug addicts from relapse. Keywords: classification; artificial neural network; ...

  8. Risk factors for alcohol relapse following orthotopic liver transplantation: a systematic review.

    Science.gov (United States)

    Rustad, James K; Stern, Theodore A; Prabhakar, Maithri; Musselman, Dominique

    2015-01-01

    Each year, 5000-6000 individuals undergo orthotopic liver transplantation (OLT) in the United States, and of these, nearly 18% have alcoholic liver disease. Relapse to alcohol occurs in more than 40% of patients with OLT for alcoholic liver disease. We sought to identify factors that predict relapse to alcohol or medication nonadherence following OLT in patients with alcoholic liver disease and to review what randomized clinical interventions have addressed these factors following OLT. Our hypothesis was that there would be factors before and after OLT that predict relapse to alcohol following OLT, and that these, if targeted, might improve sobriety and associated outcomes of adherence with medications and appointments. We performed a review (focusing on articles published since 2004) with PubMed and MEDLINE searches using the following search terms: liver transplantation, recidivism, alcohol relapse, and predictors of alcohol relapse. We supplemented the online searches with manual reviews of article reference lists and selected relevant articles for further review by author consensus. In largely white populations, prospective studies document that shorter length of pretransplantation sobriety is a significant predictor of time to first drink and time to binge use. Presence of psychiatric comorbidity, high score on standardized High-risk Alcoholism Relapse Scale, and diagnosis of Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) alcohol dependence are predictive of posttransplantation alcohol relapse. Pretransplantation alcohol use history variables (e.g., family history of alcoholism) reliably discriminate between complete abstainers and those who drink, while medical and psychosocial characteristics at early post-liver transplantation period (e.g., more bodily pain) maximally discriminate patterns of alcohol use. Alcoholic individuals with early-onset, rapidly accelerating moderate use and early-onset, continuously increasing heavy use have

  9. Health after childbirth: patterns of reported postpartum morbidity from Lebanon.

    Science.gov (United States)

    Kabakian-Khasholian, Tamar; Shayboub, Rawan; Ataya, Alexandra

    2014-03-01

    The postpartum period is under-researched in low and middle income countries. The scarce literature reveals heavy burden of ill health experienced in that period and under utilisation of health services. Understanding the postpartum morbidity burden and identifying the care-seeking behaviours is essential to improve service delivery. This paper examines reported postpartum morbidity, care seeking behaviour and whether postpartum morbidity is associated with method of birth. A cross sectional study of women delivering in 18 private hospitals from two regions in Lebanon was undertaken. Women in their second or third trimester of pregnancy, visiting private obstetric clinics affiliated with participating hospitals were interviewed for baseline information. Reported postpartum morbidity was assessed in an interview conducted at women's homes from 40 days up to six months postpartum. Of the 269 women recruited, physical postpartum health problems were reported by 93.6% and psychological health problems by 84.4% of women, with more health problems being reported beyond two months postpartum. Women were less likely to seek professional care for psychological health problems. Reporting postpartum health problems was not associated with method of birth. A heavy burden of postpartum morbidity is experienced by women with gaps in utilisation of relevant health services. Efforts should be directed towards the organisation and delivery of comprehensive maternity care services. Copyright © 2013 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  10. Women's experiences with postpartum anxiety disorders: a narrative literature review.

    Science.gov (United States)

    Ali, Elena

    2018-01-01

    Postpartum anxiety disorders are common and may have significant consequences for mothers and their children. This review examines the literature on women's experiences with postpartum generalized anxiety disorder (GAD), postpartum panic disorder (PD), obsessive compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). MEDLINE (Ovid), CINAHL, PsycINFO, and reference lists were searched. Qualitative and quantitative studies assessing women's experiences with GAD, postpartum PD, OCD, and PTSD were included. Narrative approach to literature synthesis was used. Fourteen studies (among 44 articles) met the criteria for review to identify descriptions of women's cognitive, affective, and somatic experiences related to postpartum anxiety disorders. Loss, frustration, and guilt, accompanied by physical symptoms of tension, were some of the experiences identified across studies. Most women suffered from more than one anxiety disorder, in addition to postpartum depression. To date, research has focused on prevalence rates of postpartum anxiety disorders, and evidence about clinical and subclinical symptoms of postpartum anxiety disorders and outcomes on mother and child is lacking. Postpartum anxiety disorders may have negative effects on parenting and child development; however, the nature of the underlying mechanisms is unclear. More robust longitudinal studies are needed to examine the impact of postpartum GAD, PD, OCD, and PTSD symptoms on the mother and the mother-child relationship to develop targets for therapeutic preventative interventions.

  11. Preventing urinary incontinence during pregnancy and postpartum: a review.

    Science.gov (United States)

    Wesnes, Stian Langeland; Lose, Gunnar

    2013-06-01

    Urinary incontinence (UI) is a common condition in association with pregnancy. Incident UI in pregnancy or postpartum are significant risk factors for UI later in life. Epidemiological studies on UI during pregnancy and postpartum list numerous variables associated with UI. For women, the main focus is on pelvic floor muscle training to prevent UI. However, several other modifiable risk factors are likely to contribute to prevention of UI during pregnancy and postpartum. This review investigated modifiable risk factors for UI during pregnancy and postpartum and also reviewed randomized controlled trials on prevention of UI in association with pregnancy. Systematic searches for publications until September 2012 on prevention of UI during pregnancy and postpartum were performed. Based on available evidence, the following recommendations to prevent UI during pregnancy and postpartum were made: women should be advised not to smoke before or during pregnancy (grade B), aim at normal weight before pregnancy (grade B), and aim at regaining prepregnancy weight postpartum (grade B). Occasional low-intensity training should be advocated (grade B), and constipation should be avoided during pregnancy (grade B) and postpartum (grade C). Women should be advised to perform pelvic floor muscle training during pregnancy and postpartum (grade A) and to use perineal warm packs during delivery (grade B). Cesarean section to prevent UI cannot be recommended (grade D). If lifestyle recommendations are addressed in association with pregnancy, incidence of UI during pregnancy and postpartum is likely to decrease.

  12. Intensification of mercaptopurine/methotrexate maintenance chemotherapy may increase the risk of relapse for some children with acute lymphoblastic leukemia

    DEFF Research Database (Denmark)

    Schmiegelow, Kjeld; Björk, Olle; Glomstein, Anders

    2003-01-01

    by erythrocyte (E) levels of TGN and MTX (including polyglutamates) could improve outcome in childhood acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS: A total of 538 children with ALL were randomly assigned to have their oral MP/MTX maintenance therapy adjusted by white cell counts (WBC), E-TGN, and E......-MTX (pharmacology group), or by WBC only (control group). RESULTS: After a median follow-up of 7.8 years, 79 patients had relapsed. Cox regression analysis showed an increased risk of relapse for boys (P =.00003), high WBC at diagnosis (P =.03), pharmacology arm (6.6 times increased relapse hazard for girls), high...

  13. Stigma and Postpartum Depression Treatment Acceptability Among Black and White Women in the First Six-Months Postpartum.

    Science.gov (United States)

    Bodnar-Deren, Susan; Benn, E K T; Balbierz, Amy; Howell, E A

    2017-07-01

    Objective To measure stigma associated with four types of postpartum depression therapies and to estimate the association between stigma and the acceptance of these therapies for black and white postpartum mothers. Methods Using data from two postpartum depression randomized trials, this study included 481 black and white women who gave birth in a large urban hospital and answered a series of questions at 6-months postpartum. Survey items included socio demographic and clinical factors, attitudes about postpartum depression therapies and stigma. The associations between race, stigma, and treatment acceptability were examined using bivariate and multivariate analyses. Results Black postpartum mothers were less likely than whites to accept prescription medication (64 vs. 81%, p = 0.0001) and mental health counseling (87 vs. 93%, p = 0.001) and more likely to accept spiritual counseling (70 vs. 52%, p = 0.0002). Women who endorsed stigma about receipt of postpartum depression therapies versus those who did not were less likely to accept prescription medication, mental health and spiritual counseling for postpartum depression. Overall black mothers were less likely to report stigma associated with postpartum depression therapies. In adjusted models, black women versus white women remained less likely to accept prescription medication for postpartum depression (OR = 0.42, 95% CI 0.24-0.72) and stigma did not explain this difference. Conclusions Although treatment stigma is associated with lower postpartum depression treatment acceptance, stigma does not explain the lower levels of postpartum depression treatment acceptance among black women. More research is needed to understand treatment barriers for postpartum depression, especially among black women.

  14. Relapse rate of uveitis post-methotrexate treatment in juvenile idiopathic arthritis.

    Science.gov (United States)

    Kalinina Ayuso, Viera; van de Winkel, Evelyne Leonce; Rothova, Aniki; de Boer, Joke Helena

    2011-02-01

    decrease of hazard for new relapse of 93%. A high number of patients with inactive uveitis relapse quickly after the withdrawal of MTX. Our results suggest that a longer period of inactivity prior to withdrawal and a longer treatment period with MTX reduce the chance of relapse after withdrawal. Copyright © 2011 Elsevier Inc. All rights reserved.

  15. Received View of Addiction, Relapse and Treatment.

    Science.gov (United States)

    Ndasauka, Yamikani; Wei, Zhengde; Zhang, Xiaochu

    2017-01-01

    It is important to highlight that attempts at understanding and explaining addiction have been made for centuries. It is, however, just five decades ago, with the growth of science and technology that more interest has been observed in this field. This chapter examines different views and theories that have been posited to understand and explain addiction. More attention will be given to prominent views that seem to draw consensus among researchers and medical practitioners. The first section of the chapter introduces the addiction debate, the different theories that have been provided to explain it from different perspectives and disciplines such as neurosciences, philosophy and psychology. Then, the chapter discusses different views on the role of relapse and what it entails in understanding addiction. The second section discusses different proposed and used forms of treating addiction. Thus, the chapter discusses the received view of addiction, the understanding of relapse as a critical element in addiction and treatments.

  16. Pregnancy and postpartum control in HIV infected women

    Directory of Open Access Journals (Sweden)

    Eduardo M. Warley

    2017-04-01

    Full Text Available Pregnancy and postpartum control in HIV infected women. We present data from a retrospective observational descriptive study with the objective of evaluating characteristics of HIV-infected pregnant women, analyze the level of control of pregnancy and assess adherence to treatment and loss of follow up after delivery. We analyzed reported data of 104 pregnancies, 32.7% of them under 25 years old. The diagnosis was performed as part of pregnancy control in 36.5% of women. TARV started before 24 weeks of pregnancy in 70% of them and a regimen with 2 nucleos(tides and 1 ritonavir potenciated protease inhibitor (PIr was prescribed in 84.5%. Elective c-section was the most frequent mode of delivery. The viral load after 32 weeks of pregnancy was available in 82.7%, being less than 1000 cop/ml in 78 (75%, less than 200 cop/ml in 70 (67.3% and not available in 18 (17.3% of cases. We observed a considered high rate of adherence failure and loss of follow up after delivery. Reported data should alert programs on the need to implement strategies to promote early pregnancy control and increase adherence and retention in care, especially in the postpartum period

  17. [Pregnancy and postpartum control in HIV infected women].

    Science.gov (United States)

    Warley, Eduardo M; Tavella, Silvina; Rosas, Alejandra

    2017-01-01

    Pregnancy and postpartum control in HIV infected women. We present data from a retrospective observational descriptive study with the objective of evaluating characteristics of HIV-infected pregnant women, analyze the level of control of pregnancy and assess adherence to treatment and loss of follow up after delivery. We analyzed reported data of 104 pregnancies, 32.7% of them under 25 years old. The diagnosis was performed as part of pregnancy control in 36.5% of women. TARV started before 24 weeks of pregnancy in 70% of them and a regimen with 2 nucleos(t)ides and 1 ritonavir potenciated protease inhibitor (PIr) was prescribed in 84.5%. Elective c-section was the most frequent mode of delivery. The viral load after 32 weeks of pregnancy was available in 82.7%, being less than 1000 cop/ml in 78 (75%), less than 200 cop/ml in 70 (67.3%) and not available in 18 (17.3%) of cases. We observed a considered high rate of adherence failure and loss of follow up after delivery. Reported data should alert programs on the need to implement strategies to promote early pregnancy control and increase adherence and retention in care, especially in the postpartum period.

  18. Ultrasonography and radiography of the canine postpartum uterus

    International Nuclear Information System (INIS)

    Pharr, J.W.; Post, K.

    1992-01-01

    A vulvovaginal discharge following parturition in a bitch is often a cause of concern to owners and clinicians, especially if whelping was complicated in any way. Ultrasonography could potentially distinguish between normal and abnormal postpartum uterine states because the uterine wall and luminal contents can be imaged in detail. Five normal bitches were examined to determine the normal ultrasonographic appearance of the postpartum uterus and the sensitivity of ultrasonography in detecting the involuting uterus, comparing this sensitivity with that of radiography. Ultrasonography was done at 1, 4, 8, 12, 18 and 24 days postpartum, radiography at 1, 4, 8, 12 and 18 days postpartum. By 12 days postpartum, the uterus could not be seen on radiographs, while at 24 days postpartum the uterus was still sonographically identifiable. The ultrasonographic characteristics of the involuting uterus are described

  19. Risk factors for postpartum urinary incontinence

    Directory of Open Access Journals (Sweden)

    Lígia da Silva Leroy

    2016-04-01

    Full Text Available Abstract OBJECTIVE: To investigate the risk factors for postpartum urinary incontinence (UI and its characteristics. METHOD: This was a case-control study with 344 puerperal women (77 cases and 267 controls with up to 90 days postpartum. In a single session, participants were given a questionnaire with sociodemographic and clinical data and two others that assessed urine leakage, leakage situations, and type of UI. RESULTS: Stress UI was present in 45.5% of the women, incidents of urine leakage several times a day in 44.2%, of which 71.4% were in small amounts and 57.1% when coughing or sneezing. In 70.1% of cases, UI began during pregnancy and remained through the postpartum period. After running a binary logistic regression model, the following factors remained in the final model: UI during pregnancy (OR 12.82, CI 95% 6.94 - 23.81, p<0.0001, multiparity (OR 2.26, CI 95% 1.22 - 4.19, p=0.009, gestational age at birth greater or equal to 37 weeks (OR 2.52, CI 95% 1.16 - 5.46, p=0.02 and constipation (OR 1.94, CI 95% 1.05 - 5.46, p=0.035. CONCLUSION: Most often, UI first appeared during pregnancy and remained through the postpartum period. Urinary incontinence during pregnancy, multiparity, gestational age at birth greater or equal to 37 weeks, and constipation were presented as risk factors. In the studied group, stress UI was more frequent.

  20. Nutrition and the psychoneuroimmunology of postpartum depression

    OpenAIRE

    Ellsworth-Bowers, E. R.; Corwin, E. J.

    2012-01-01

    Postpartum depression (PPD) is a relatively common and often severe mood disorder that develops in women after childbirth. The aetiology of PPD is unclear, although there is emerging evidence to suggest a psychoneuroimmune connection. Additionally, deficiencies in n-3 PUFA, B vitamins, vitamin D and trace minerals have been implicated. This paper reviews evidence for a link between micronutrient status and PPD, analysing the potential contribution of each micronutrient to psychoneuroimmunolog...

  1. Brain Abscess Presenting as Postpartum Diabetes Insipidus

    Directory of Open Access Journals (Sweden)

    Silvia So-Haei Liu

    2004-03-01

    Conclusion: The diagnosis of brain abscess in this patient was masked by postpartum diabetes insipidus, which is an unusual manifestation. Symptoms and signs of brain abscess are nonspecific in the early stage and missed diagnosis is not uncommon. In conclusion, we reaffirm the importance of remarking on any past relevant information, and one should always be aware of any unresolved symptoms even though they may be nonspecific.

  2. Birth order and postpartum psychiatric disorders.

    Science.gov (United States)

    Munk-Olsen, Trine; Jones, Ian; Laursen, Thomas Munk

    2014-05-01

    Primiparity is a well-established and significant risk factor for postpartum psychosis and especially bipolar affective disorders. However, no studies have, to our knowledge, quantified the risk of psychiatric disorders after the first, second, or subsequent births. The overall aim of the present study was to study the risk of first-time psychiatric episodes requiring inpatient treatment after the birth of the first, second, or third child. A cohort comprising 750,127 women was defined using information from Danish population registries. Women were followed individually from the date of birth of their first, second, or third child through the following 12 months over the period 1970-2011. The outcome of interest was defined as first-time admissions to a psychiatric hospital with any type of psychiatric disorder. Women who had a first psychiatric episode which required inpatient treatment after their first (n = 1,327), second (n = 735), or third (n = 238) delivery were included. The highest risk was found in primiparous mothers 10-19 days postpartum [relative risk (RR) = 8.65; 95% confidence interval (CI): 6.89-10.85]. After the second birth, the highest risk was at 60-89 days postpartum (RR = 2.01; 95% CI: 1.52-2.65), and there was no increased risk after the third birth. The effect of primiparity was strongest for bipolar disorders. Primiparity is a significant risk factor for experiencing a first-time episode with a psychiatric disorder, especially bipolar disorders. A second birth was associated with a smaller risk, and there was no increased risk after the third birth. The risk of postpartum episodes after the second delivery increased with increasing inter-pregnancy intervals, a result which warrants further investigation. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  3. Postpartum depression and the male partner

    Directory of Open Access Journals (Sweden)

    Anna de Magistris

    2013-04-01

    Full Text Available Background: Numerous studies have shown that postpartum depression is a phenomenon that develops in a family, social and economic context capable of influencing its course. A predominant role in the onset of the pathology is played by the relationship of the couple, but up to now few studies have been carried out on the role of the partner of the depressed mother and on the interactions between the two partners, that is, on how maternal depression influences the behaviour of the male partner and is in turn influenced, and how the depression of both parents, and not only that of the mother, influences the neuropsychic development of the child and the interactions between the child and the outside world. Objectives: The objectives are to examine the literature to arrive at an understanding of how the father figure develops during the pregnancy and how postpartum depression impacts on the couple’s relationship and the care of the children by both partners. Materials and methods: This article presents a review of recent literature on the subject through a search for articles in Pubmed and Sciencedirect (keywords: men, postpartum depression, fathers, couple, prediction, detection, and by referring to classic texts in the fields of psychiatry and psychotherapy on the development of the parental figures. Conclusions: Although up to now the literature on the consequences of postpartum depression on the couple is scanty, the data collected allow us to affirm that it is not a problem that concerns only the mother, but one that has an impact on the entire family, on the child and the partner, triggering a chain reaction of maladjustment and distress that may lead to separation and destruction of the family unit with important repercussions on society as a whole.

  4. Bipolar postpartum depression: An update and recommendations.

    Science.gov (United States)

    Sharma, Verinder; Doobay, Minakshi; Baczynski, Christine

    2017-09-01

    Over the past few years there has been a surge of interest in the study of bipolar postpartum depression (PPD); however, questions remain about its prevalence, screening, clinical features, and treatment. Three electronic databases, MEDLINE/PubMed (1966-2016), PsycINFO (1806-2016), and the Cochrane Database of Systematic Reviews, were searched using a combination of the keywords bipolar, depression, postpartum, peripartum, prevalence, screening, diagnosis, treatment, drugs, and psychotherapy. The reference lists of articles identified were also searched. All relevant articles published in English were included. Depending on the population studied, 21.4-54% of women with PPD have a diagnosis of bipolar disorder (BD). Characteristic clinical features include younger age at illness onset, first onset of depression after childbirth, onset immediately after delivery, atypical depressive symptoms, psychotic features, mixed features, and history of BD in first-degree family members. Treatment should be guided by symptom acuity, safety concerns, the patient's response to past treatments, drug tolerability, and breastfeeding preference. In the absence of controlled treatment data, preference should be given to drugs normally indicated for bipolar depression including lithium, quetiapine and lamotrigine. Although antidepressants have been studied in combination with mood stabilizers in bipolar depression, these drugs should be avoided due to likelihood of elevated risk of induction of manic symptoms in the postpartum period. In the postpartum period, bipolar PPD is common, can be differentiated from unipolar PPD, and needs to be identified promptly in order to expedite appropriate treatment. Future studies on pharmacotherapy and psychotherapy should focus on the acute and preventative treatment of bipolar PPD. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Conservative management of primary postpartum haemorrhage

    International Nuclear Information System (INIS)

    Naqvi, S.; Makhdoom, T.

    2004-01-01

    Severe postpartum haemorrhage (PPH) is a serious obstetrical emergency. Two cases of severe PPH due to uterine atony are described which were managed by uterine packing with sterile ribbon gauze by vaginal route under general anesthesia. Along with supportive measures, it resulted in marked improvement in controlling haemorrhage and infectious morbidity. This is an effective treatment for severe PPH and should be practiced at tertiary care level in woman who wishes to preserve fertility. (author)

  6. TBI parameters and relapse of acute leukemia

    International Nuclear Information System (INIS)

    Sugawara, Tadashi; Inoue, Toshihiko; Mori, Tomoyuki.

    1994-01-01

    The purpose of this study, which involved 240 acute leukemia patients (ALL: 115, ANL: 125) who received an allogeneic bone marrow transplantation (BMT) with preconditioning by total body irradiation (TBI) and chemotherapy, was to examine retrospectively the TBI factors that may have influenced a leukemic relapse. The patients were divided into two groups: 124 patients who had received their BMT within a diagnosis-transplantation period of 9 months or less (DTP9 group), and 116 patients who had received their BMT within a diagnosis-transplantation period of 10 months or more (DTP10 group). It was concluded that: (1) the higher the TBI dose, the fewer the relapse rates in DTP9 group; (2) the longer the TBI period, the greater the increase in the relapse rate in DTP10 group. It was thus speculated that an effective TBI regimen for acute leukemia patients may vary depending on the length of time that has elapsed from the diagnosis of leukemia to the BMT. (author)

  7. Autoimmune Abnormalities of Postpartum Thyroid Diseases

    Directory of Open Access Journals (Sweden)

    Flavia Di Bari

    2017-07-01

    Full Text Available The year following parturition is a critical time for the de novo appearance or exacerbation of autoimmune diseases, including autoimmune thyroid disease. The vast majority of postpartum thyroid disease consists of postpartum thyroiditis (PPT and the minority by Graves’ disease and non-autoimmune thyroiditis. PPT has a worldwide prevalence ranging from 1 to 22% and averaging 5% based on a review published in 2012. Several factors confer risk for the development of PPT. Typically, the clinical course of PPT is characterized by three phases: thyrotoxic, hypothyroid, and euthyroid phase. Approximately half of PPT women will have permanent hypothyroidism. The best humoral marker for predictivity, already during the first trimester of gestation, is considered positivity for thyroperoxidase autoantibodies (TPOAb, though only one-third to half of such TPOAb-positive pregnant women will develop PPT. Nutraceuticals (such as selenium or omega-3-fatty acid supplements seem to have a role in prevention of PPT. In a recent study on pregnant women with stable dietary habits, we found that the fish consumers had lower rates of positivity (and lower serum levels of both TPOAb and thyroglobulin Ab compared to meat eaters. Finally, we remind the reader of other diseases that can be observed in the postpartum period, either autoimmune or non-autoimmune, thyroid or non-thyroid.

  8. Postpartum bleeding: efficacy of endovascular management

    International Nuclear Information System (INIS)

    Lee, Sun Young; Ko, Gi Young; Song, Ho Young; Gwon, Dong Il; Sung, Kyu Bo; Yoon, Hyun Ki

    2003-01-01

    To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding. Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented. Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due ro rebleeding on the 12 th and 13 th day, respectively, after embolization. Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding

  9. Postpartum bleeding: efficacy of endovascular management

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sun Young; Ko, Gi Young; Song, Ho Young; Gwon, Dong Il; Sung, Kyu Bo; Yoon, Hyun Ki [Asan Medical Center, Seoul (Korea, Republic of)

    2003-06-01

    To assess the effectiveness and safety of transcatheter arterial embolization for the treatment of massive postpartum bleeding. Transcatheter arterial embolization was attempted in 25 patients with massive postpartum bleeding. After identification at bilateral internal iliac arteriography, the bleeding artery was embolized using gelfoam, polyvinyl alcohol particles or microcoils, and to prevent rebleeding through collateral pathways, the contralateral uterine artery or anterior division of the internal iliac artery was also embolized. Clinical success and complications were retrospectively assessed and documented. Active bleeding foci were detected in 13 patients (52%), and involved the unilateral (n=10) or bilateral (n=2) uterine artery and unilateral vaginal artery (n=1). Twelve (92%) of the 13 patients recovered completely following embolization, but one underwent hysterectomy due to persistent bleeding. The focus of bleeding was not detected in 12 patients (48%), but 11 (92%) of these also recovered following embolization of the bilateral uterine or internal iliac arteries. One patient, however, died due to sepsis. Two of the 12 patients underwent hysterectomy due ro rebleeding on the 12{sup th} and 13{sup th} day, respectively, after embolization. Transcatheter arterial embolization is relatively safe and effective for the treatment massive postpartum bleeding.

  10. Women's challenges with postpartum weight loss.

    Science.gov (United States)

    Montgomery, Kristen S; Bushee, Tracy D; Phillips, Jennifer D; Kirkpatrick, Terrie; Catledge, Courtney; Braveboy, Kristin; O'Rourke, Carol; Patel, Neema; Prophet, Malshundria; Cooper, Anita; Mosley, Lori; Parker, Christie; Douglas, Gaye M

    2011-11-01

    This study was designed to examine women's experiences of weight loss during the postpartum period. Understanding women's positive and negative experiences can assist health care providers to successfully intervene in helping women lose weight following pregnancy and avoid long-term weight gain and obesity development. Phenomenology, according to Husserl's perspective. Private location of the women's choosing. Twenty-six women, who ranged in age from 25 to 35 years, and had given birth within the last 5 years, were interviewed regarding their experiences with postpartum weight loss. The majority of the sample was Caucasian. Interviews were transcribed and themes were identified from each of the interviews. Comparisons were made between interviews to identify common experiences between women. Data were analyzed according to the Giorgi method. The women in the study had a wide range of experiences. Themes that emerged from the interviews related to women's challenges with return to prepregnancy weight. These included: time and motivation issues, the need for support, and weight and other struggles. This study provides a look inside the lives of women faced with the reality of losing weight after childbirth. Losing weight after delivery is multi-faceted and influenced by many factors. Interventions to assist women with weight loss should target the challenges described in this paper. When effective strategies are developed, education can be done during pregnancy to prepare for the postpartum period. Ultimately, future research efforts can help us to eliminate pregnancy as a risk factor for obesity in women.

  11. Recurrent post-partum coronary artery dissection

    Directory of Open Access Journals (Sweden)

    Resnic Frederic S

    2010-10-01

    Full Text Available Abstract Coronary artery dissection is a rare but well-described cause for myocardial infarction during the post-partum period. Dissection of multiple coronary arteries is even less frequent. Here we present a case of recurrent post-partum coronary artery dissections. This unusual presentation poses unique problems for management. A 35 year-old female, gravida 3 para 2, presented with myocardial infarction 9 weeks and 3 days post-partum. Cardiac catheterization demonstrated left anterior descending (LAD dissection but an otherwise normal coronary anatomy. The lesion was treated with four everolimus eluting stents. Initially the patient made an unremarkable recovery until ventricular fibrillation arrest occurred on the following day. Unsynchronized cardioversion restored a normal sinus rhythm and repeat catheterization revealed new right coronary artery (RCA dissection. A wire was passed distally, but it was unclear whether this was through the true or false lumen and no stents could be placed. However, improvement of distal RCA perfusion was noted on angiogram. Despite failure of interventional therapy the patient was therefore treated conservatively. Early operation after myocardial infarction has a significantly elevated risk of mortality and the initial dissection had occurred within 24 hours. This strategy proved successful as follow-up transthoracic echocardiography after four months demonstrated a preserved left ventricular ejection fraction of 55-60% without regional wall motion abnormalities. The patient remained asymptomatic from a cardiac point of view.

  12. Women's postpartum maternity benefits and work experience.

    Science.gov (United States)

    Gjerdingen, D K; McGovern, P M; Chaloner, K M; Street, H B

    1995-10-01

    This study was conducted to describe women's perceptions of their maternity leave policy and its implementation, maternity leave benefits, postpartum work experience, and factors that relate to returning to work. Surveys were mailed to 436 married, recently employed, first-time mothers at 1, 3, 6, 9 and 12 months postpartum. Most respondents said they had written maternity leave policies they could understand, but they were not completely satisfied with their policies. The average 11.1-week maternity leave was considerably shorter than their 8-month ideal, and only 25.5% had the option of working part-time. A minority (35.8%) were allowed to use personal days to care for a sick infant. Most women were distressed about making child care arrangements. Compared with women who remained at home, those who returned to work complained of more respiratory, gynecologic, and breast symptoms. Relatively little is known about women's postpartum work experience. In this study, return to work after delivery was related to several demographic, occupational, and social factors and was associated with health problems and concerns about child care. With a majority of new mothers now returning to work, attention has recently been directed to factors that facilitate the merger of work and parenting roles. One such important factor is women's parental or maternity leave benefits, the focus of this study.

  13. The depression in women in pregnancy and postpartum period: A follow-up study.

    Science.gov (United States)

    Kirkan, Tulay Sati; Aydin, Nazan; Yazici, Esra; Aslan, Puren Akcali; Acemoglu, Hamit; Daloglu, Ali Gokhan

    2015-06-01

    This was a follow-up study to determine postpartum depression (PPD) and its causes in a population previously evaluated in the first trimester of pregnancy. The study sample consisted of pregnant women who were evaluated in the first trimester and 360 women who were re-evaluated in the postpartum period. Detailed sociodemographic data were obtained from the women, and depression was assessed with the Edinburgh Postpartum Depression scale (EPDS) and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I Disorders (SCID-I). In this follow-up study, the prevalence of PPD was 35% (n = 126). A depressive disorder in the first trimester of pregnancy, previous mental disorder, somatic disorder, exposure to domestic violence during pregnancy, baby's staying in the incubator and not breastfeeding were predictors of PPD. Exposure to violence and a history of previous depression predicted depression both in pregnancy and in the postpartum period. Depression rates are high in Eastern Turkey. Exposure to violence during pregnancy and the existence of a previous mental disorder were risk factors for perinatal depression in this study. Performing screening tests can identify women at risk of pregnancy-related depression. Prevention programs should be established in areas where the prevalence of depression is high. © The Author(s) 2014.

  14. Sociodemographic, pregnancy, obstetric, and postnatal predictors of postpartum stress, anxiety and depression in new mothers.

    Science.gov (United States)

    Clout, Danielle; Brown, Rhonda

    2015-12-01

    The purpose of this paper was to evaluate relationships between sociodemographic, pregnancy, obstetric, and postnatal variables and postpartum depression, anxiety and stress levels in new mothers. One-hundred-thirty-nine women completed the baseline questionnaire and 105 completed the follow-up questionnaire at 4-6 months postpartum. Sociodemographic and pregnancy factors were assessed at baseline, birth and postnatal factors were assessed at time 2, and depression, anxiety, and stress were assessed at both time points. Caesarean delivery was associated with high postpartum depression, anxiety, and stress levels. Child sleep problems was related to depression, child health problems were related to anxiety, more SLE related to high stress, and maternal sleep problems were related to PPD. However, the results became non-significant after controlling for antenatal distress levels. Finally, women who underwent caesarean delivery had higher antenatal stress, anxiety, and depression levels, relative to women who did not undergo the procedure. Psychological stress and distress tended to persist in the women from the third-trimester of pregnancy to 4-6 months postpartum. It tended to occur in the context of caesarean delivery, maternal sleep problems, child's health and sleep problems, and stressful life-events. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Late Ebola virus relapse causing meningoencephalitis: a case report.

    Science.gov (United States)

    Jacobs, Michael; Rodger, Alison; Bell, David J; Bhagani, Sanjay; Cropley, Ian; Filipe, Ana; Gifford, Robert J; Hopkins, Susan; Hughes, Joseph; Jabeen, Farrah; Johannessen, Ingolfur; Karageorgopoulos, Drosos; Lackenby, Angie; Lester, Rebecca; Liu, Rebecca S N; MacConnachie, Alisdair; Mahungu, Tabitha; Martin, Daniel; Marshall, Neal; Mepham, Stephen; Orton, Richard; Palmarini, Massimo; Patel, Monika; Perry, Colin; Peters, S Erica; Porter, Duncan; Ritchie, David; Ritchie, Neil D; Seaton, R Andrew; Sreenu, Vattipally B; Templeton, Kate; Warren, Simon; Wilkie, Gavin S; Zambon, Maria; Gopal, Robin; Thomson, Emma C

    2016-07-30

    There are thousands of survivors of the 2014 Ebola outbreak in west Africa. Ebola virus can persist in survivors for months in immune-privileged sites; however, viral relapse causing life-threatening and potentially transmissible disease has not been described. We report a case of late relapse in a patient who had been treated for severe Ebola virus disease with high viral load (peak cycle threshold value 13.2). A 39-year-old female nurse from Scotland, who had assisted the humanitarian effort in Sierra Leone, had received intensive supportive treatment and experimental antiviral therapies, and had been discharged with undetectable Ebola virus RNA in peripheral blood. The patient was readmitted to hospital 9 months after discharge with symptoms of acute meningitis, and was found to have Ebola virus in cerebrospinal fluid (CSF). She was treated with supportive therapy and experimental antiviral drug GS-5734 (Gilead Sciences, San Francisco, Foster City, CA, USA). We monitored Ebola virus RNA in CSF and plasma, and sequenced the viral genome using an unbiased metagenomic approach. On admission, reverse transcriptase PCR identified Ebola virus RNA at a higher level in CSF (cycle threshold value 23.7) than plasma (31.3); infectious virus was only recovered from CSF. The patient developed progressive meningoencephalitis with cranial neuropathies and radiculopathy. Clinical recovery was associated with addition of high-dose corticosteroids during GS-5734 treatment. CSF Ebola virus RNA slowly declined and was undetectable following 14 days of treatment with GS-5734. Sequencing of plasma and CSF viral genome revealed only two non-coding changes compared with the original infecting virus. Our report shows that previously unanticipated, late, severe relapses of Ebola virus can occur, in this case in the CNS. This finding fundamentally redefines what is known about the natural history of Ebola virus infection. Vigilance should be maintained in the thousands of Ebola survivors

  16. Recurrent Silent Thyroiditis as a Sequela of Postpartum Thyroiditis

    OpenAIRE

    Hanseree, Preaw; Salvador, Vincent Bryan; Sachmechi, Issac; Kim, Paul

    2014-01-01

    Thyroiditis encompasses a group of disorders characterized by thyroid inflammation. Though clinically indistinguishable from silent thyroiditis, postpartum thyroiditis occurs in women within 12 months after delivery. Recurrent postpartum thyroiditis in subsequent pregnancies is common, but recurrent silent thyroiditis is rare. We reported a case of patient with recurrent episodes of thyroiditis, unrelated to pregnancy, after an episode of postpartum thyroiditis. It is of interest that postpar...

  17. Socio-economic correlates of relapsed patients admitted in a Nigerian mental health institution.

    Science.gov (United States)

    Gbiri, Caleb A; Badru, Fatai A; Ladapo, Harry T O; Gbiri, Adefolakemi A

    2011-03-01

    Relapse in psychiatric disorders is highly distressing, costly and engenders burn-out syndrome among mental-health workers. To study the socio-economic factors associated with relapse in individual admitted with psychiatric disorders and the pattern of socio-economic impact of relapse in those groups. A cross-sectional survey of all relapsed patients without cognitive deficit admitted into the federal Neuro-Psychiatric Hospital, Lagos, Nigeria between June and October 2007 was conducted using a self-validated Structured Interview Schedule (Relapse Socio-economic Impact Interview Schedule) and Key Informant Interview Guide. Secondary data were elicited from the patient folders, case notes, ward admission registers and nominal rolls. Data were summarised using mean, standard deviation, frequency and percentiles. Pearson's moment correlation coefficient was used to test the association among variables. The Mann-Whitney U-test was used to compare the pre-morbid and the post-morbid states. This study involved 102 respondents. Their mean age was 36.5 ± 9.8 years, mainly of male gender (72.5%) suffering from schizophrenic disorder (37.8%). Relapse and re-admission ranged between 2 and 12. Unemployment rate, marital separation and divorce increased more than 5-fold from pre-morbid to morbid states. Few (4.9%) could still settle their hospital/drug bills on their own, while most (95.1%) depended on family, philanthropist and government/waivers to pay for their bills. Their social relationships were negatively influenced with most of them expressing social isolation and low quality of life. There were significant relationships (Peconomic status, employment status and marital status of the respondents between the pre-morbid and post-morbid periods. The illness significantly affected the emotional status of the participants. Relapse and readmission in psychiatric patients have a negative impact on socio-economic well-being of patients, family and the society. Efforts should

  18. Preventing postpartum depression: A meta-analytic review

    Science.gov (United States)

    Sockol, Laura E.; Epperson, C. Neill; Barber, Jacques P.

    2014-01-01

    This meta-analysis assessed the efficacy of a wide range of preventive interventions designed to reduce the severity of postpartum depressive symptoms or decrease the prevalence of postpartum depressive episodes. A systematic review identified 37 randomized or quasi-randomized controlled trials in which an intervention was compared to a control condition. Differences between treatment and control conditions in the level of depressive symptoms and prevalence of depressive episodes by 6 months postpartum were assessed in separate analyses. Depressive symptoms were significantly lower at post-treatment in intervention conditions, with an overall effect size in the small range after exclusion of outliers (Hedges' g = 0.18). There was a 27% reduction in the prevalence of depressive episodes in intervention conditions by 6 months postpartum after removal of outliers and correction for publication bias. Later timing of the postpartum assessment was associated with smaller differences between intervention and control conditions in both analyses. Among studies that assessed depressive symptoms using the EPDS, higher levels of depressive symptoms at pre-treatment were associated with smaller differences in depressive symptoms by 6 months postpartum. These findings suggest that interventions designed to prevent postpartum depression effectively reduce levels of postpartum depressive symptoms and decrease risk for postpartum depressive episodes. PMID:24211712

  19. Systematic review of the literature on postpartum care: effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health.

    Science.gov (United States)

    Shaw, Elizabeth; Levitt, Cheryl; Wong, Sharon; Kaczorowski, Janusz

    2006-09-01

    Postpartum support is recommended to prevent infant and maternal morbidity. This review examined the published evidence of the effectiveness of postpartum support programs to improve maternal knowledge, attitudes, and skills related to parenting, maternal mental health, maternal quality of life, and maternal physical health. MEDLINE, Cinahl, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postnatal women. The initial literature search was done in 1999 and was enhanced in 2003 and 2005. Studies were categorized based on the the above outcomes. Data were extracted in a systematic manner, and the quality of each study was reviewed. In the 1999 search, 9 studies met the inclusion criteria. The 2003 and 2005 searches identified 13 additional trials for a total of 22 trials. Universal postpartum support to unselected women at low risk did not result in statistically significant improvements for any outcomes examined. Educational visits to a pediatrician showed statistically significant improvements in maternal-infant parenting skills in low-income primiparous women. In women at high risk for family dysfunction and child abuse, nurse home visits combined with case conferencing produced a statistically significant improvement in home environment quality using the HOME (Home Observation for Measurement of the Environment) program. Similarly, in women at high risk for either family dysfunction or postpartum depression, home visitation or peer support, respectively, produced a statistically significant reduction in Edinburgh Postnatal Depression Scale scores (difference - 2.23, 95% CI -3.72 to -0.74, p= 0.004; and 15.0% vs 52.4%, OR 6.23, 95% CI 1.40 to 27.84, p= 0.01, respectively). Educational programs reduced repeat unplanned pregnancies (12.0% vs 28.3%, p= 0.003) and increased effective contraceptive use (RR 1.35, 95% CI 1.09 to 1.68, p= 0.007). Maternal satisfaction was

  20. Comparison of enrofloxacin and ceftiofur sodium for the treatment of relapse of undifferentiated fever/bovine respiratory disease in feedlot cattle

    Science.gov (United States)

    Abutarbush, Sameeh M.; Schunicht, Oliver C.; Wildman, Brian K.; Hannon, Sherry J.; Jim, G. Kee; Ward, Tracy I.; Booker, Calvin W.

    2012-01-01

    This commercial field trial compared the efficacy of enrofloxacin and ceftiofur sodium in beef cattle at high risk of developing undifferentiated fever (UF), also known as bovine respiratory disease (BRD) that received tilmicosin at feedlot arrival, were diagnosed and initially treated for UF with tilmicosin, and subsequently required a second UF treatment (first relapse). Feedlot cattle (n = 463) were randomly assigned to 2 experimental groups: ENRO or CEF. Second UF relapse, 3rd UF relapse, overall case fatality and BRD case fatality rates were lower in the ENRO group than in the CEF group (P enrofloxacin than ceftiofur sodium for treatment of UF relapse. PMID:22753964

  1. Very Late Local Relapse of Ewing's Sarcoma of the Head and Neck treated with Aggressive Multimodal Therapy

    Directory of Open Access Journals (Sweden)

    J. Thariat

    2008-01-01

    Full Text Available Ewing's sarcoma's relapse rarely occurs more than two years after the initial diagnosis. We report the case of a 26-year-old man with a history of Ewing's sarcoma of the left maxillary sinus at the age of 10 who presented with a very late local relapse, 16 years after the first occurrence of disease. Ultimate control was achieved after multimodal therapy including surgery, high-dose chemotherapy, and radiotherapy. This report indicates that local relapses of Ewing's sarcoma can be treated with curative intent in selected cases.

  2. Daclizumab for the treatment of relapsing-remitting multiple sclerosis.

    Science.gov (United States)

    Herwerth, Marina; Hemmer, Bernhard

    2017-06-01

    Multiple sclerosis (MS) is a common inflammatory disease of the central nervous system. Over the last two decades, the number of therapeutic options for the treatment of relapsing remitting MS (RRMS) has been constantly growing, providing new treatment options to patients. Areas covered: Herein, the authors review the recently approved monoclonal antibody daclizumab for the treatment of RRMS. Based on original articles, they discuss its mode of action and evaluate its efficacy and safety profile compared to other available agents. Expert opinion: The IL-2 receptor modulator daclizumab is a new highly effective agent for the treatment of RRMS with novel immunomodulatory properties. Compared to interferon-beta i.m., daclizumab is more effective in reducing relapse rates and MRI activity. However, its use is limited by the risk of autoimmune disorders and hepatotoxicity. Similar to other monoclonal antibodies for RRMS, therapy with daclizumab needs a strict preselection and monitoring of patients based on individual risk benefit assessment. Given its substantial effectiveness, daclizumab can be an attractive option for patients with highly active MS.

  3. Incident HIV during pregnancy and postpartum and risk of mother-to-child HIV transmission: a systematic review and meta-analysis.

    Directory of Open Access Journals (Sweden)

    Alison L Drake

    2014-02-01

    .Pregnancy and the postpartum period are times of persistent HIV risk, at rates similar to "high risk" cohorts. MTCT risk was elevated among women with incident infections. Detection and prevention of incident HIV in pregnancy/postpartum should be prioritized, and is critical to decrease MTCT.

  4. Incident HIV during Pregnancy and Postpartum and Risk of Mother-to-Child HIV Transmission: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Drake, Alison L.; Wagner, Anjuli; Richardson, Barbra; John-Stewart, Grace

    2014-01-01

    heterogeneity. Conclusions Pregnancy and the postpartum period are times of persistent HIV risk, at rates similar to “high risk” cohorts. MTCT risk was elevated among women with incident infections. Detection and prevention of incident HIV in pregnancy/postpartum should be prioritized, and is critical to decrease MTCT. Please see later in the article for the Editors' Summary PMID:24586123

  5. A Comparison of Postpartum Depression among Low-risk-pregnant Women with Emotion- and Problem-focused Coping Strategies

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    Habibeh Salehi

    2013-03-01

    Full Text Available Background and Objectives: Postpartum depression is one of most important health problems in women. This study was performed with the purpose of comparing the frequency of postpartum depression in pregnant women with emotion and problem-focused coping strategies. Methods: This study was conducted as a prospective cohort study on 200 pregnant women with stress (low and high levels. The samples were pregnant women referred to all health-treatment, centers of Ardabil, which were selected using a multi-stage sampling method; and according to coping strategy, they were divided into two groups: emotion-focused and problem-focused. Low-risk pregnant women completed questionnaires about demographic characteristics, perceived stress, and Billings and Moos coping strategies in the 38th to 42th week of their pregnancy, and completed the Edinburgh depression scale in the 3th to 4th weeks after childbirth. Data were analyzed using chi 2 and t tests. p<0.05 considered significant.Results: In this study, 170 participant women (85% used emotion-focused strategy and 30 women (15% used problem-focused strategy. Frequency of postpartum depression was 6.7% in the problem-focused group and 8.2% in the emotion-focused group. There was no significant difference in the frequency of postpartum depression between women with the problem- and emotion-focused strategies. Relative risk for postpartum depression was 1.2 times more among the women used emotion-focused strategy than women used problem-focused strategy (p<0.05.Conclusion: According to the results of this study, there was no significant relationship between postpartum depression and the two emotion-focused and problem-focused coping strategies. This can be due to high influence of postpartum specific endocrine factors in the etiology of this type of depression compared to other depressions.

  6. Usefulness of a rapid faecal calprotectin test to predict relapse in Crohn's disease patients on maintenance treatment with adalimumab.

    Science.gov (United States)

    Ferreiro-Iglesias, Rocio; Barreiro-de Acosta, Manuel; Lorenzo-Gonzalez, Aurelio; Dominguez-Muñoz, Juan Enrique

    2016-01-01

    Predicting relapse in Crohn's disease (CD) patients by measuring non-invasive biomarkers could allow for early changes of treatment. Data are scarce regarding the utility of monitoring calprotectin to predict relapse. The aim of the study was to evaluate the predictive value of a rapid test of faecal calprotectin (FC) to predict for flares in CD patients on maintenance treatment with adalimumab (ADA). A prospective, observational cohort study was designed. Inclusion criteria were CD patients in clinical remission on a standard dose of ADA therapy. Fresh FC was measured using a rapid test. Thirty patients were included (median age 38 years, 56.7% female). After the 4 months follow-up, 70.0% patients remained in clinical remission and 30.0% had a relapse. FC concentration at inclusion was significantly higher in those patients who relapsed during the follow-up (625 μg/g) compared to those who stayed in remission (45 μg/g). The optimal cut-off for FC to predict relapse was 204 μg/g. The area under the receiver-operating characteristic curve was 0.968. Sensitivity, specificity, positive, and negative predictive value of FC to predict relapse were 100%, 85.7%, 74.1%, and 100%, respectively. In CD patients on ADA maintenance therapy, FC levels measured with a rapid test allow relapse over the following months to be predicted with high accuracy. Low FC levels exclude relapse within at least 4 months after testing, whereas high levels are associated with relapse in three out of every four patients.

  7. Outcome of relapse after allogeneic HSCT in children with ALL enrolled in the ALL-SCT 2003/2007 trial.

    Science.gov (United States)

    Kuhlen, Michaela; Willasch, Andre M; Dalle, Jean-Hugues; Wachowiak, Jacek; Yaniv, Isaac; Ifversen, Marianne; Sedlacek, Petr; Guengoer, Tayfun; Lang, Peter; Bader, Peter; Sufliarska, Sabina; Balduzzi, Adriana; Strahm, Brigitte; von Luettichau, Irene; Hoell, Jessica I; Borkhardt, Arndt; Klingebiel, Thomas; Schrappe, Martin; von Stackelberg, Arend; Glogova, Evgenia; Poetschger, Ulrike; Meisel, Roland; Peters, Christina

    2018-01-01

    Relapse remains the major cause of treatment failure in children with high-risk acute lymphoblastic leukaemia (ALL) undergoing allogeneic haematopoietic stem-cell transplantation (allo-SCT). Prognosis is considered dismal but data on risk factors and outcome are lacking from prospective studies. We analysed 242 children with recurrence of ALL after first allo-SCT enrolled in the Berlin-Frankfurt-Munster (BFM) ALL-SCT-BFM 2003 and ALL-SCT-BFM international 2007 studies. Median time from allo-SCT to relapse was 7·7 months; median follow-up from relapse after allo-SCT until last follow-up was 3·4 years. The 3-year event-free survival (EFS) was 15% and overall survival (OS) was 20%. The main cause of death was disease progression or relapse (86·5%). The majority of children (48%) received salvage therapy without second allo-SCT, 26% of the children underwent a second allo-SCT and 25% received palliative treatment only. In multivariate analyses, age, site of relapse, time to relapse and type of salvage therapy were identified as significant prognostic factors for OS and EFS, whereas factors associated with first SCT were not statistically significant. Combined approaches incorporating novel immunotherapeutic treatment options and second allo-SCT hold promise to improve outcome in children with post allo-SCT relapse. © 2017 John Wiley & Sons Ltd.

  8. Psychotic relapse and associated factors among patients attending health services in Southwest Ethiopia: a cross-sectional study.

    Science.gov (United States)

    Fikreyesus, Mahlet; Soboka, Matiwos; Feyissa, Garumma Tolu

    2016-10-20

    Psychotic relapse leads to repeated hospitalization and negatively affects the clinical prognosis of the patients. Information on prevalence of relapse among patients with psychotic disorders in Ethiopian setting is scarce. This study aimed to assess the prevalence of relapse among patients with psychotic disorders attending services in Jimma University Specialized Hospital (JUSH). Data were collected using interviewer administered questionnaire. We used medication adherence rating scale (MARS) to assess compliance to medication and abnormal involuntary movement scale (AIMS) to detect medication side effects. Logistic regression analysis was used to identify independent predictors of psychotic relapse. All variables with P-value value higher when compared to those who have never experienced medication side effects (aOR = 1.83, 95 % CI = 1.01, 3.31). The high prevalence of relapse among patients with psychotic disorder needs special attention. Clinicians need to pay attention to medication side effects the patient faces. Intervening noncompliance to medication and appropriately managing medication side effects may help in preventing psychotic relapse that may result because of non-compliance. The provision of counseling, psycho education, psycho social support may help patients in improving compliance to medication and reducing psychotic relapse. Developing and strengthening community based rehabilitation services should be emphasized as part of mental healthcare services.

  9. Potential risk factors associated with risk for drop-out and relapse during and following withdrawal of opioid prescription medication.

    Science.gov (United States)

    Heiwe, Susanne; Lönnquist, Ingeborg; Källmén, Håkan

    2011-10-01

    Withdrawal of opioid medication in patients with chronic pain has a drop-out and relapse problem. To evaluate if depressive symptoms, anxiety and pain intensity are potential risk factors for drop-out or relapse during the withdrawal process. Further, to assess internal consistency of scales for assessment of these potential risk factors. Twenty-nine patients were included. After 2 years 28 of these were followed-up. Those with depressive symptoms at baseline had a significant risk for drop-out from the withdrawal program (odds ratio 1.37) and relapse into use of opioids at follow-up (odds ratio 1.44). Drop-outs rated depressive symptoms significantly higher before detoxification. Those who relapsed rated significantly higher for pain intensity, depressive symptoms and abstinence prior to withdrawal. All scales had high reliability. To avoid drop-out and relapse clinical practice need to screen for depressive symptoms, pain intensity, and abstinence. This article presents significant reliability of scales useful within dependency centers. They can be used to identify these risk factors for drop-out and relapse, respectively, when initiating the withdrawal process. Taking these risk factors into consideration could improve the outcome of the withdrawal process by preventing drop-out and relapse. Copyright © 2011 European Federation of International Association for the Study of Pain Chapters. Published by Elsevier Ltd. All rights reserved.

  10. Emergent management of postpartum hemorrhage for the general and acute care surgeon

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    Blankenship Charles L

    2009-11-01

    Full Text Available Abstract Background Postpartum hemorrhage is one of the rare occasions when a general or acute care surgeon may be emergently called to labor and delivery, a situation in which time is limited and the stakes high. Unfortunately, there is generally a paucity of exposure and information available to surgeons regarding this topic: obstetric training is rarely found in contemporary surgical residency curricula and is omitted nearly completely from general and acute care surgery literature and continuing medical education. Methods The purpose of this manuscript is to serve as a topic specific review for surgeons and to present a surgeon oriented management algorithm. Medline and Ovid databases were utilized in a comprehensive literature review regarding the management of postpartum hemorrhage and a management algorithm for surgeons developed based upon a collaborative panel of general, acute care, trauma and obstetrical surgeons' review of the literature and expert opinion. Results A stepwise approach for surgeons of the medical and surgical interventions utilized to manage and treat postpartum hemorrhage is presented and organized into a basic algorithm. Conclusion The manuscript should promote and facilitate a more educated, systematic and effective surgeon response and participation in the management of postpartum hemorrhage.

  11. Antenatal Cognitive-behavioral Therapy for Prevention of Postpartum Depression: A Pilot Study

    Science.gov (United States)

    Kwon, Jung Hye; Lee, Jeong Jae

    2008-01-01

    Purpose To examine the efficacy of cognitive-behavioral therapy (CBT) for the prevention of postpartum depression (PPD) in "at risk" women. Materials and Methods We recruited 927 pregnant women in 6 obstetric and gynecology clinics and screened them using Beck Depression Inventory (BDI). Ninety-nine of the screened women who had significantly high scores in BDI (a score above 16) were selected for the study. They were contacted through by telephone, and 27 who had consented to participate in the study were interviewed via SCID-IV-I. Twenty-seven eligible women were randomly assigned to the CBT intervention (n = 15) and control condition (n = 12). All participants were required to complete written questionnaires, assessing demographic characteristics, depressive symptoms, negative thoughts, dyadic communication satisfaction, and global marital satisfaction prior to treatment and approximately 1 month postpartum. The 15 women in the CBT condition received 9 bi-weekly 1-hour individual CBT sessions, targeting and modifying negative patterns of thinking and behaviors occurring in the context of the dyadic relationship. Results The analysis of covariance (ANCOVA) showed that there were significant differences in all postpartum measures between the 2 groups, indicating that our antenatal intervention with CBT was effective in reducing depressive symptoms and improving marital satisfaction, which lasted until the postpartum period. Conclusion Our pilot study has provided preliminary empirical evidence that antenatal CBT intervention can be an effective preventive treatment for PPD. Further study in this direction was suggested. PMID:18729297

  12. Positive predictors of quality of life for postpartum mothers with a history of childhood maltreatment.

    Science.gov (United States)

    Irwin, Jessica L; Beeghly, Marjorie; Rosenblum, Katherine L; Muzik, Maria

    2016-12-01

    The postpartum period brings a host of biopsychosocial, familial, and economic changes, which may be challenging for new mothers, especially those with trauma histories. Trauma-exposed women are at heightened risk for psychiatric symptomatology and reduced quality of life. The current study sought to evaluate whether a set of hypothesized promotive factors assessed during the first 18 months postpartum (positive parenting, family cohesion, and maternal resilience) are associated with life satisfaction in this population, after controlling for income and postpartum psychiatric symptoms. Analyses were based on data collected for 266 mother-infant dyads from a longitudinal cohort study, Maternal Anxiety during the Childbearing Years (MACY), of women oversampled for childhood maltreatment history. Hierarchical linear regression was used to evaluate the study hypotheses. Consistent with prior work, greater postpartum psychiatric symptoms and less income predicted poor perceptions of life quality. In hierarchical regressions controlling for income and psychiatric symptoms, positive parenting and family cohesion predicted unique variance in mothers' positive perceptions of life quality, and resilience was predictive beyond all other factors. Factors from multiple levels of analysis (maternal, dyadic, and familial) may serve as promotive factors predicting positive perceptions of life quality among women with childhood trauma histories, even those struggling with high levels of psychiatric or economic distress.

  13. Precarious beginnings: Gendered risk discourses in psychiatric research literature about postpartum depression.

    Science.gov (United States)

    Godderis, Rebecca

    2010-09-01

    The transition to motherhood in western society is particularly informed by risk-based scientific and medical discourses and, as a result, women are especially subject to rationalities and practices that are employed in the name of risk. The aim of this article is to examine the gendered risk discourses that are embedded in one aspect of medicalized mothering - the postpartum period. This article interrogates three key elements of the discursive construction of postpartum depression (PPD) in contemporary psychiatric research literature (approximately 1980-2007). Specifically, I examine how risk-based reasoning is incorporated into the concepts of the postpartum triad and the high-risk mother, and how arguments about why PPD is a 'significant social problem' create a tension between the rights of the mother and those of the child. By placing women in a position to manage certain types of risks related to the postpartum period, these discourses serve to responsibilize women and structure their subjectivities in gendered ways.This analysis contributes to a growing literature that investigates how assumptions about gender, race, class and sexuality are produced and re-produced through the notion of risk.

  14. Paternal and maternal transition to parenthood: the risk of postpartum depression and parenting stress

    Directory of Open Access Journals (Sweden)

    Maria Stella Epifanio

    2015-06-01

    Full Text Available Transition to parenthood represents an important life event increasing vulnerability to psychological disorders. Postpartum depression and parenting distress are the most common psychological disturbances and a growing scientific evidence suggests that both mothers and fathers are involved in this developmental crisis. This paper aims to explore maternal and paternal experience of transition to parenthood in terms of parenting distress and risk of postpartum depression. Seventy-five couples of first-time parents were invited to compile the Edinburgh Postnatal Depression Scale and the Parenting Stress Index-Short Form in the first month of children life. Study sample reported very high levels of parenting distress and a risk of postpartum depression in 20.8% of mothers and 5.7% of fathers. No significant correlation between parenting distress and the risk of postpartum depression emerged, both in mothers than in fathers group while maternal distress levels are related to paternal one. The first month after partum represents a critical phase of parents life and it could be considered a developmental crisis characterized by anxiety, stress and mood alterations that could have important repercussions on the child psycho-physical development.

  15. Progression of major depression during pregnancy and postpartum: a preliminary study.

    Science.gov (United States)

    Shivakumar, Geetha; Johnson, Neysa L; McIntire, Donald D; Leveno, Kenneth

    2014-04-01

    The purpose of this pilot study was to investigate major depressive symptoms among a high-risk group of pregnant women managed at a tertiary care setting. The study prospectively evaluated pregnant women who met DSM-IV criteria for a major depressive episode (MDE). Psychiatric measures for depression, anxiety and social impairment were administered at monthly intervals during pregnancy and immediate postpartum period. Twenty-four women provided longitudinal data from mid pregnancy to 2 months of postpartum period. 86% of women were clinically symptomatic at the beginning of study during pregnancy and only 32% remained clinically symptomatic at 2 months following delivery reaching. This difference reached a statistical significance level p depression, comorbid anxiety disorder, histories of domestic violence, and those with uninvolved spouse or partners were more at-risk to be clinically symptomatic in the immediate postpartum period. In a group consisting of largely Latina women at a tertiary care setting, progression of major depression when treated with antidepressant medication(s) is that of an improvement from pregnancy to immediate postpartum period. Further longitudinal studies are needed to assess impact of clinical characteristics and treatment on major depression in larger diverse obstetric group.

  16. The effect of interpersonal psychotherapy on marriage adaptive and postpartum depression in isfahan.

    Science.gov (United States)

    Hajiheidari, Mahnaz; Sharifi, Marzieh; Khorvash, Fariborz

    2013-05-01

    Regarding high prevalence and injurious consequences of postpartum depression, the aim of the present work is the study of the effect rate of interpersonal psychotherapy on marriage adaptive and postpartum in women. The present study is semi-empiric, and included control group and pre- and post-test groups. Thirty-two women suffering from postpartum depression were selected from among female referents to counseling centers and clinics in Esfahan city by purposive sampling and were placed in two groups (control and test) randomly case group participated in a 10-weeks marriage interpersonal psychotherapy meetings. Beck II depression questionnaire and marriage adaptive scale were completed by two groups at pre-test and post-test steps. Collected data were analyzed using SPSS software and multivariable covariance analysis. The scores of average of depression and marriage adaptive post-test in test group was significantly less than that in the control group (P marriage interpersonal psychotherapy on the depression recovery and the increasing marriage satisfaction of women suffering from postpartum depression.

  17. Spontaneous pushing to prevent postpartum urinary incontinence: a randomized, controlled trial.

    Science.gov (United States)

    Low, Lisa Kane; Miller, Janis M; Guo, Ying; Ashton-Miller, James A; DeLancey, John O L; Sampselle, Carolyn M

    2013-03-01

    The risk for urinary incontinence can be 2.6-fold greater in women after pregnancy and childbirth compared with their never-pregnant counterparts, with the incidence increasing with parity. We tested the hypothesis that the incidence of de novo postpartum urinary incontinence in primiparous women is reduced with the use of spontaneous pushing alone or in combination with perineal massage compared with women who experienced traditional directed pushing for second-stage management. This was a prospective clinical trial enrolling and randomizing 249 women into a four-group design: (1) routine care with coached or directed pushing, (2) spontaneous self-directed pushing, (3) prenatal perineal massage initiated in the third trimester, and (4) the combination of spontaneous pushing plus perineal massage. Self-report of incontinence was assessed using analysis of variance (ANOVA) and covariance (ANCOVA) models in 145 remaining women at 12 months postpartum using the Leakage Index, which is sensitive to minor leakage. No statistical difference in the incidence of de novo postpartum incontinence was found based on method of pushing (spontaneous/directed) (P value = 0.57) or in combination with prenatal perineal massage (P value = 0.57). Fidelity to pushing treatment of type was assessed and between-groups crossover detected. Spontaneous pushing did not reduce the incidence of postpartum incontinence experienced by women 1 year after their first birth due to high cross-over between randomization groups.

  18. Meta-analysis of the predictive factors of postpartum fatigue.

    Science.gov (United States)

    Badr, Hanan A; Zauszniewski, Jaclene A

    2017-08-01

    Nearly 64% of new mothers are affected by fatigue during the postpartum period, making it the most common problem that a woman faces as she adapts to motherhood. Postpartum fatigue can lead to serious negative effects on the mother's health and the newborn's development and interfere with mother-infant interaction. The aim of this meta-analysis was to identify predictive factors of postpartum fatigue and to document the magnitude of their effects using effect sizes. We used two search engines, PubMed and Google Scholar, to identify studies that met three inclusion criteria: (a) the article was written in English, (b) the article studied the predictive factors of postpartum fatigue, and (c) the article included information about the validity and reliability of the instruments used in the research. Nine articles met these inclusion criteria. The direction and strength of correlation coefficients between predictive factors and postpartum fatigue were examined across the studies to determine their effect sizes. Measurement of predictor variables occurred from 3days to 6months postpartum. Correlations reported between predictive factors and postpartum fatigue were as follows: small effect size (r range =0.10 to 0.29) for education level, age, postpartum hemorrhage, infection, and child care difficulties; medium effect size (r range =0.30 to 0.49) for physiological illness, low ferritin level, low hemoglobin level, sleeping problems, stress and anxiety, and breastfeeding problems; and large effect size (r range =0.50+) for depression. Postpartum fatigue is a common condition that can lead to serious health problems for a new mother and her newborn. Therefore, increased knowledge concerning factors that influence the onset of postpartum fatigue is needed for early identification of new mothers who may be at risk. Appropriate treatments, interventions, information, and support can then be initiated to prevent or minimize the postpartum fatigue. Copyright © 2017 Elsevier

  19. Glucose tolerance status of Asian Indian women with gestational diabetes at 6weeks to 1year postpartum (WINGS-7).

    Science.gov (United States)

    Bhavadharini, Balaji; Anjana, Ranjit Mohan; Mahalakshmi, Manni Mohanraj; Maheswari, Kumar; Kayal, Arivudainambi; Unnikrishnan, Ranjit; Ranjani, Harish; Ninov, Lyudmil; Pastakia, Sonak D; Usha, Sriram; Malanda, Belma; Belton, Anne; Uma, Ram; Mohan, Viswanathan

    2016-07-01

    To determine postpartum glucose tolerance status among women with gestational diabetes mellitus (GDM) recruited under the Women In India with GDM Strategy (WINGS) Model of Care (MOC). Through the WINGS MOC programme, 212 women with GDM were followed till delivery between November 2013 and August 2015. All women were advised to return for a postpartum oral glucose tolerance test (OGTT) 6-12weeks after delivery. A multivariate logistic regression (MLR) model was developed to identify the risk factors for postpartum dysglycemia which was defined as presence of diabetes (DM) or prediabetes. 203/212(95.8%) women completed their postpartum OGTT. Of the 161 women (79.3%) who came back for the test between 6 and 12weeks, 2(1.2%) developed DM, 5(3.1%), isolated IFG, 13(8.1%), isolated IGT and 5(3.1%) combined IFG/IGT [dysglycemia 25(15.5%)]. 136 women (84.5%) reverted to normal glucose tolerance (NGT). Of the 42 women who came back between 12weeks and a year, 5(11.9%) developed DM, 10(23.8%), isolated IFG and 1(2.4%) combined IFG/IGT [dysglycemia 16(38.1%)]. 26/42 women (61.9%) reverted to NGT. Thus overall dysglycemia occurred in 41/203 women (20.2%). MLR showed that BMI ⩾25kg/m(2) was significantly associated with postpartum dysglycemia (odds ratio: 4.47; 95% confidence interval: 1.8-11.2, p=0.001). Among Asian Indian women with GDM, over 20% develop dysglycemia within one year postpartum, and BMI ⩾25kg/m(2) increased this risk four-fold. Early postpartum screening can identify high risk women and help plan strategies for prevention of type 2 diabetes in the future. Copyright © 2016 The Author(s). Published by Elsevier Ireland Ltd.. All rights reserved.

  20. Timing of pregnancy, postpartum risk of virologic failure and loss to follow-up among HIV-positive women.

    Science.gov (United States)

    Onoya, Dorina; Sineke, Tembeka; Brennan, Alana T; Long, Lawrence; Fox, Matthew P

    2017-07-17

    We assessed the association between the timing of pregnancy with the risk of postpartum virologic failure and loss from HIV care in South Africa. This is a retrospective cohort study of 6306 HIV-positive women aged 15-49 at antiretroviral therapy (ART) initiation, initiated on ART between January 2004 and December 2013 in Johannesburg, South Africa. The incidence of virologic failure (two consecutive viral load measurements of >1000 copies/ml) and loss to follow-up (>3 months late for a visit) during 24 months postpartum were assessed using Cox proportional hazards modelling. The rate of postpartum virologic failure was higher following an incident pregnancy on ART [adjusted hazard ratio 1.8, 95% confidence interval (CI): 1.1-2.7] than among women who initiated ART during pregnancy. This difference was sustained among women with CD4 cell count less than 350 cells/μl at delivery (adjusted hazard ratio 1.8, 95% CI: 1.1-3.0). Predictors of postpartum virologic failure were being viremic, longer time on ART, being 25 or less years old and low CD4 cell count and anaemia at delivery, as well as initiating ART on stavudine-containing or abacavir-containing regimen. There was no difference postpartum loss to follow-up rates between the incident pregnancies group (hazard ratio 0.9, 95% CI: 0.7-1.1) and those who initiated ART in pregnancy. The risk of virologic failure remains high among postpartum women, particularly those who conceive on ART. The results highlight the need to provide adequate support for HIV-positive women with fertility intention after ART initiation and to strengthen monitoring and retention efforts for postpartum women to sustain the benefits of ART.

  1. [A postpartum woman with toxic shock syndrome: group A streptococcal infection, a much feared postpartum complication.

    NARCIS (Netherlands)

    Abbink, K.; Kortekaas, J.C.; Buise, M.P.; Dokter, J.; Kuppens, S.M.; Hasaart, T.H.M.

    2016-01-01

    BACKGROUND: The development of toxic shock syndrome (TSS) after an invasive group A streptococcal (GAS) infection in the postpartum period is a much feared complication. The mortality rate of TSS with necrotizing fasciitis is 30 to 50%. CASE DESCRIPTION: We present the case of a woman with atypical

  2. Perceived Relapse Risk and Desire for Medication Assisted Treatment among Persons Seeking Inpatient Opiate Detoxification

    Science.gov (United States)

    Bailey, Genie L; Herman, Debra S.; Stein, Michael D.

    2016-01-01

    Most patients with opioid addiction do not receive medication at the time of discharge from brief inpatient detoxification programs despite the high risk of relapse and the availability of three FDA-approved medications. We surveyed 164 inpatient opioid detoxification patients to assess desire for pharmacotherapy following detoxification program discharge. Participants were predominantly male (71.3%) and 80% had detoxed in the past. Reporting on their most recent previous inpatient detoxification, 27% had relapsed the day they were discharged, 65% within a month of discharge, and 90% within a year of discharge. 63% reported they wanted medication-assisted treatment (MAT) after discharge from the current admission. The odds of desiring a treatment medication increased by a factor of 1.02 for every 1% increase in perceived relapse risk (p detox abstinence. PMID:23786852

  3. Treatment of refractory/relapsed adult acute lymphoblastic leukemia with bortezomib- based chemotherapy

    Directory of Open Access Journals (Sweden)

    Zhao J

    2015-06-01

    Full Text Available Junmei Zhao,* Chao Wang,* Yongping Song, Yuzhang Liu, Baijun FangHenan Key Lab of Experimental Haematology, Henan Institute of Haematology, Henan Tumor Hospital, Zhengzhou University, Zhengzhou, People’s Republic of China  *These authors contributed equally to this work Abstract: Nine pretreated patients aged >19 years with relapsed/refractory acute lymphoblastic leukemia (ALL were treated with a combination of bortezomib plus chemotherapy before allogeneic hematopoietic stem cell transplantation (allo-HSCT. Eight (88.9% patients, including two Philadelphia chromosome-positive ALL patients, achieved a complete remission. Furthermore, the evaluable patients have benefited from allo-HSCT after response to this reinduction treatment. We conclude that bortezomib-based chemotherapy was highly effective for adults with refractory/relapsed ALL before allo-HSCT. Therefore, this regimen deserves a larger series within prospective trials to confirm these results. Keywords: acute lymphoblastic leukemia, refractory, relapsed, bortezomib

  4. Meta-Analysis of Comparing Personal and Environmental Factors Effective in Addiction Relapse (Iran, 2004 -2012

    Directory of Open Access Journals (Sweden)

    s Safari

    2014-12-01

    Full Text Available Objective: This As a meta-analysis, this study aimed to integrate different studies and investigate the impact of individual and environmental factors on the reappearance of addiction in quitted people. Method: This study is a meta-analysis which uses Hunter and Schmidt approach. For this purpose, 28 out of 42 studies enjoying acceptable methodologies were selected, upon which the meta-analysis was conducted. A meta-analysis checklist was the research instrument. Using summary of the study results, the researcher manually calculated effect size and interpreted it based on the meta-analysis approach and Cohen’s table. Findings: Results revealed that the effect size of environmental factors on addiction relapse was 0.64 while it was obtained 0.41 for individual factors on addiction relapse. Conclusion: According to Cohen’s table, the effect sizes are evaluated as moderate and high for individual factors and environmental factors on addiction relapse, respectively.

  5. Prolonged Survival of Acute Lymphoblastic Leukemia with Intrathecal Treatments for Isolated Central Nervous System Relapse

    Directory of Open Access Journals (Sweden)

    Elan Gorshein

    2018-01-01

    Full Text Available Acute lymphoblastic leukemia is commonly cured when diagnosed in the pediatric population. It portends a poorer prognosis if present in adult patients. Although adults frequently achieve complete remission, relapse rates are substantial, particularly among the elderly and high-risk populations. In the absence of prophylactic intrathecal chemotherapy, more than half of patients may develop CNS involvement or relapse, which is associated with significant risk for systemic illness. This report describes a patient with acute lymphoblastic leukemia with repeated isolated CNS relapses. This case should remind clinicians that isolated CNS disease in the absence of systemic recurrence could successfully respond to intrathecal therapy and offer patients a favorable quality of life.

  6. Bendamustine HCL for the treatment of relapsed indolent non-Hodgkin’s lymphoma

    Directory of Open Access Journals (Sweden)

    Rudolf Weide

    2008-09-01

    Full Text Available Rudolf WeidePraxisklinik für Hämatologie und Onkologie, Koblenz, GermanyAbstract: Bendamustine is an alkylating agent which also shows properties of a purine analog. Because of its unique mechanism of action it shows activity in relapsed indolent lymphomas which are resistant to alkylating agents, purine analogs, and rituximab. Bendamustine has a favorable toxicity profile causing no alopecia and only a moderate hematotoxicity and gastrointestinal toxicity. Combinations of bendamustine with mitoxantrone and rituximab and with rituximab alone have been shown to be highly active in relapsed/refractory indolent lymphomas and mantle cell lymphomas achieving long lasting complete remissions. Because of only moderate toxicity these combinations can be applied safely in elderly patients who can be treated in an outpatient setting.Keywords: bendamustine, relapsed-indolent, non-Hodgkin’s lymphoma

  7. Remitting - Relapsing Polyneuropathy In Juvenile Metachromatic Leukodystrophy

    Directory of Open Access Journals (Sweden)

    Taly AB

    2004-01-01

    Full Text Available A five-year-old girl manifested with acute relapsing polyradiculo-neuropathy. Elevated cerebrospinal fluid proteins, electro-physiological evidence of conduction block and remitting course suggested possible acquired demyelinating radiculoneuropathy. However, intellectual deterioration during follow up, evidence of extensive, symmetrical and periventricular demyelination on MRI of brain and metachromatic on sural nerve biopsy led to the diagnosis of metachromatic leukodystrophy (MLD. Inherited neuropathies such as MLD may occasionally present atypically in the early stages. Recognition of this variation has considerable therapeutic and prognostic significance.

  8. Breast cancer relapse stage I and II

    International Nuclear Information System (INIS)

    Perez Braojos, Ines; Diaz Gestoso, Yadira; Franco Odio, Sonia; Samuel Gonzalez, Victor

    2009-01-01

    Breast cancer has always been the most common malignancy in women and is the leading cause of death in women, study relapses Stages I and II therapeutic guidelines applied in the service Mastology the 1985 - 1989, was our first objective, the database used was Clinical history, which gave us all the material necessary, treatments were: In tumors up to 3 cm node-conserving surgery plus treatment N0 with ionizing radiation on the breast tangential C0G0 in tumors greater than 3 cm or less with N1 was modified radical mastectomy according to node status for the study of the part and the receiver adjuvant treatment conducted. (Author)

  9. Levels, trends and correlates of unmet need for family planning among postpartum women in Indonesia: 2007-2015.

    Science.gov (United States)

    Wilopo, Siswanto Agus; Setyawan, Althaf; Pinandari, Anggriyani Wahyu; Prihyugiarto, Titut; Juliaan, Flourisa; Magnani, Robert J

    2017-11-28

    Although Indonesia has relatively high contraceptive prevalence, postpartum family planning (PP-FP) has not been a particular point of emphasis. This article reports the results of analyses undertaken in order to (1) better understand levels and trends in unmet need for family planning among postpartum women, (2) assess the extent to which unmet need is concentrated among particular population sub-groups, and (3) assess the policy priority that PP-FP should have in relation to other interventions. The analyses were based on data from the 2007 and 2012 Indonesia Demographic and Health Surveys (IDHS) and the 2015 PMA2020 survey. Postpartum contraceptive use and unmet need were analyzed for fecund women who had given birth in the 3-5 years of preceding the respective surveys who were in the extended postpartum period at the time of the respective surveys. Factors associated with contraceptive use and unmet were assessed via multivariable logistic regressions using merged data from all three surveys. A wide range of biologic, demographic, socio-economic, geographic and programmatic factors were considered. Contraceptive use during the extended postpartum period is high in Indonesia, with more than 74% of post-partum women reporting currently using a family planning method in the 2015 PMA2020 survey. This is up from 68% in 2007 and 70% in 2012. Total unmet need was 28% in 2007, falling slightly to 23% in 2012 and 24% in 2015. However, the timing of contraceptive initiation is less than optimal. By six months postpartum, only 50% of mothers had begun contraceptive use. Unmet need was highest among older women, women with 4+ children, with limited knowledge of contraceptive methods, making fewer ANC visits, from poor families and residents of islands other than Java and Bali. Unmet need for family planning among postpartum women in Indonesia is low in comparison with other low- and middle-income countries. However, because of limited durations of exclusive breastfeeding

  10. Hematologic Response to Vorinostat Treatment in Relapsed Myeloid Leukemia of Down Syndrome.

    Science.gov (United States)

    Scheer, Carina; Kratz, Christian; Witt, Olaf; Creutzig, Ursula; Reinhardt, Dirk; Klusmann, Jan-Henning

    2016-09-01

    Children with Down syndrome are at high risk to develop myeloid leukemia (ML-DS). Despite their excellent prognosis, children with ML-DS particularly suffer from severe therapy-related toxicities and for relapsed ML-DS the cure rates are very poor. Here we report the clinical course of one child with ML-DS treated with the histone deacetylase (HDAC) inhibitor vorinostat (suberoylanilide hydroxamic acid) after second relapse. The child had previously received conventional chemotherapy and stem cell transplantation, yet showed a remarkable clinical and hematologic response. Thus, HDAC inhibitor may represent an effective class of drugs for the treatment of ML-DS. © 2016 Wiley Periodicals, Inc.

  11. The association between breastfeeding, the stress response, inflammation, and postpartum depression during the postpartum period: Prospective cohort study.

    Science.gov (United States)

    Ahn, Sukhee; Corwin, Elizabeth J

    2015-10-01

    Research suggests that exclusive breastfeeding may have a stress-protective role in postpartum depression; however, less is known about the underlying mechanisms by which this protection may occur or whether the protective relationship holds for women who mix breast and bottle feeding. To examine patterns of the stress response, inflammation, and depressive symptoms among women predominantly breastfeeding or bottle feeding their infants at 6 months postpartum. A part of a larger longitudinal study across 6 months postpartum investigating the psychoneuroimmunology (PNI) of postpartum depression. Prenatal clinics and community. One hundred nineteen postpartum women who met inclusion/exclusion criteria and followed up from the prenatal period to postpartum 6 months. Data were collected during seven home visits occurring during the 3rd trimester (weeks 32-36) and on postpartum days 7 and 14, months 1, 2, 3, and 6. Women completed stress and depression surveys and provided blood for pro- (IL-1β, IL-6, IL-8, TNF-a, IFN-γ) and anti-inflammatory (IL-10) cytokines, and collected saliva for diurnal cortisol. Self-report of predominant breastfeeding during 6 months postpartum ranged from 91.9% at day 7 to 70.6% at month 6 postpartum. There were no associations between the pattern of feeding and depressive symptoms. Biological differences, however, existed between the groups, with levels of salivary cortisol at 8 AM and 8:30 AM at month 6 higher and levels of IL-6 at month 6 lower in women who primarily breastfed compared to those who primarily bottle fed their infants after controlling for confounding variables. Breastfeeding was not related to postpartum depression however differences in stress and inflammatory markers are apparent at month 6 postpartum. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Traditional Practices of Mothers in the Postpartum Period: Evidence ...

    African Journals Online (AJOL)

    USER

    In various cultures, the postpartum period is a sensitive time and various ... femmes au cours des huit premières semaines du post-partum qui se sont ..... For instance, in cultures such as those in India,. China ..... Asia Pacific Journal of Clinical.

  13. Inside a Postpartum Nursing Center: Tradition and Change.

    Science.gov (United States)

    Yeh, Yueh-Chen; St John, Winsome; Venturato, Lorraine

    2016-06-01

    The purpose of this study was to explore how traditional ritual practices are incorporated into the context of contemporary healthcare. An ethnographic study was conducted, using observations and interviews with 27 first-time mothers and 3 nurses at a postpartum nursing center in Taipei, Taiwan. Nursing routines, policies and care provision at the center affected the way traditional ritual practices were conducted. New mothers in this study constructed their everyday activities at the center by incorporating and modifying the ritual practices inside and outside the postpartum nursing center setting. Social changes have an influence on traditional postpartum ritual practices so a postpartum nursing center becomes a choice for postpartum women. Thus, health care professionals should value their own functions and roles at the postpartum nursing center since the new mothers regard them as the primary support resource to help them recover from giving birth. Therefore, they need to re-examine their practices from the postpartum women's perspective to provide better support and sensitive care to postpartum women and their families. Copyright © 2016. Published by Elsevier B.V.

  14. Short term effect of breastfeeding on postpartum maternal ...

    African Journals Online (AJOL)

    Background: Pregnancy related weight gain and retention of gained weight during the postpartum period has remained a challenge to African women. Studies have revealed that breastfeeding has various benefits on both mother and child, however studies on the ability to cause reduction in postpartum maternal weight ...

  15. Sequential serotonin and noradrenalin associated processes involved in postpartum blues

    NARCIS (Netherlands)

    Doornbos, B.; Fekkes, D.; Tanke, M.A.; de Jonge, P.; Korf, J.

    2008-01-01

    Objective: We investigated whether postpartum blues was related to changes in parameters of noradrenergic and serotonergic functioning. Methods: From 26 healthy pregnant women blood was collected at the End of pregnancy and 5 days and 6 weeks postpartum. Serotonergic parameters were: platelet

  16. Factors Influencing Physical Activity among Postpartum Iranian Women

    Science.gov (United States)

    Roozbahani, Nasrin; Ghofranipour, Fazlollah; Eftekhar Ardabili, Hassan; Hajizadeh, Ebrahim

    2014-01-01

    Background: Postpartum women are a population at risk for sedentary living. Physical activity (PA) prior to pregnancy may be effective in predicting similar behaviour in the postpartum period. Objective: To test a composite version of the extended transtheoretical model (TTM) by adding "past behaviour" in order to predict PA behaviour…

  17. The epidemiology of postpartum malaria: a systematic review

    NARCIS (Netherlands)

    Boel, Machteld E.; Rijken, Marcus J.; Brabin, Bernard J.; Nosten, François; McGready, Rose

    2012-01-01

    Pregnant women are more susceptible to malaria than their non-pregnant counterparts. Less is known about the risk of malaria in the postpartum period. The epidemiology of postpartum malaria was systematically reviewed. Eleven articles fitted the inclusion criteria. Of the 10 studies that compared

  18. Prevalence of autoimmune thyroid dysfunction in postpartum psychosis

    NARCIS (Netherlands)

    Bergink, Veerle; Kushner, Steven A.; Pop, Victor; Kuijpens, Hans; Lambregtse-van den Berg, Mijke P.; Drexhage, Roos C.; Wiersinga, Wilmar; Nolen, Willem A.; Drexhage, Hemmo A.

    2011-01-01

    Postpartum psychosis is a life-threatening psychiatric emergency, which often occurs without significant premorbid symptoms. Although many studies have postulated an involvement of the immune and endocrine systems in the onset of postpartum psychosis, the specific aetiological factors have remained

  19. Women's Experiences with Postpartum Anxiety: Expectations, Relationships, and Sociocultural Influences

    Science.gov (United States)

    Wardrop, Andrea A.; Popadiuk, Natalee E.

    2013-01-01

    Evidence about anxiety in the postpartum is sparse and contradictory. Our research expands this knowledge by using a qualitative methodology, the Feminist Biographical Method, to explore first time mothers' experiences of postpartum anxiety. Data collection included 1.5 to 2.0 hour interviews with six women about their experiences of anxiety in…

  20. Challenges in Diagnosing and Treating Postpartum Blues, Depression and Psychosis

    Science.gov (United States)

    Lewis, Carol A.; Byers, Alison Daly; Malard, Sarah Deann; Dawson, Gregory A.

    2010-01-01

    With recent media attention and a growing awareness in popular culture, the appropriate treatment for postpartum depression has taken center stage as a prevalent women's health issue. There is little agreement on the definition, existence and treatment of postpartum depression. Contributing to this factor is the lack of research that exists to…

  1. Serum cholesterol decline and depression in the postpartum period

    NARCIS (Netherlands)

    Dam, van R.M.; Schuit, A.J.; Schouten, E.G.; Vader, H.L.; Pop, V.J.M.

    1999-01-01

    We examined the relation between total serum cholesterol decline and depression in the postpartum period in a prospective study of 266 Dutch women, who were followed until 34 weeks after delivery. The decline in serum cholesterol between week 32 of pregnancy and week 10 postpartum was similar for

  2. Serum cholesterol decline and depression in the postpartum period

    NARCIS (Netherlands)

    van Dam, R M; Schuit, A.J.; Schouten, E G; Vader, H L; Pop, V.J.

    We examined the relation between total serum cholesterol decline and depression in the postpartum period in a prospective study of 266 Dutch women, who were followed until 34 weeks after delivery. The decline in serum cholesterol between week 32 of pregnancy and week 10 postpartum was similar for

  3. Gestational Diabetes Mellitus: Post-partum Risk and Follow Up.

    Science.gov (United States)

    Poola-Kella, Silpa; Steinman, Rachel A; Mesmar, Bayan; Malek, Rana

    2018-01-31

    Women with gestational diabetes mellitus (GDM) are at an increased risk for developing metabolic syndrome, type 2 diabetes mellitus (T2DM), and cardiovascular disease. In this review, we will discuss postpartum cardiovascular and diabetes risk in women with a history of GDM and different ways to improve postpartum screening. This review involves a comprehensive literature review on gestational diabetes and postpartum risk for cardiovascular disease and diabetes mellitus as well as post-partum screening methods. Cardiovascular risk post-partum is potentiated by increased inflammatory markers leading to worsening atherosclerosis and cardiovascular events downstream. Decreased insulin sensitivity and β cell compensation, recurrent GDM, maternal factors such as pre and post-partum weight gain and lactation may contribute to T2DM risk. Postpartum glucose testing is essential in screening women as hyperglycemia in pregnancy has long term effects on both cardiovascular disease and diabetes risk on the mother. Long and short term improvement to post-partum glucose testing is essential to decreasing cardiometabolic and diabetes risk in women with gestational diabetes mellitus. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  4. Clinical and Biomarkers Difference in Prepartum and Postpartum Eclampsia.

    Science.gov (United States)

    Berhan, Yifru; Endeshaw, Gezahegn

    2015-07-01

    There is a large body of literature which assessed the incidence and risk factors of eclampsia, but little was done in assessing the association of clinical features and biological markers with prepartum and postpartum eclampsia. A total of 361 eclamptic women admitted to three teaching hospitals between 2008 and 2013 were included in this analysis. A comparative analysis was done for several clinical and biological variables to assess their association with prepartum and postpartum eclampsia. The overall incidence of eclampsia was 1.2% (prepartum 71% and postpartum 29%). The majority of women with prepartum eclampsia were young, primigravida, more hypertensive, symptomatic and proteinuric. Conversely, the majorities of the women with post-partum eclampsia were adult, multiparous, carrying pregnancy to term, anemic, thrombocytopenic, and with hepatic dysfunction. The commonest severity symptom (headache) was less common in postpartum eclamptic women. The incidence of eclampsia was among the highest in the world. And, the analysis has shown that the clinical and biochemical spectrum of prepartum and postpartum eclampsia were apparently different. The majority of the women who developed postpartum eclampsia were multiparous and adult. Derangement of biomarkers was also more common in women with postpartum eclampsia.

  5. Primary postpartum haemorrhage at the university of Port Harcourt ...

    African Journals Online (AJOL)

    Background: Postpartum haemorrhage (PPH) is a leading global cause of severe maternal morbidity and mortality. Approximately 14 million women suffer postpartum haemorrhage annually and at least 128,000 of these women bleed to death. Most of these deaths, which occur within four hours of delivery and are as a ...

  6. Prevalence and correlates of postpartum depression in a teaching ...

    African Journals Online (AJOL)

    Background: Postpartum depression is a common and disabling disorder seen in new mothers having many deleterious effects on the new mother, the new infant, the father, the family and the society at large. This study determined the prevalence and socio-demographic correlates of postpartum depression among new ...

  7. Postpartum depression among mothers as seen in hospitals in ...

    African Journals Online (AJOL)

    Introduction: Postpartum depression is an uncommon and frequently undocumented issue that impacts negatively on maternal and child health. Methods: The study was carried out among mothers who attended postpartum clinics from two teaching hospitals and three private hospitals all in Enugu metropolis.

  8. Relationship of bipolar disorder with psychiatric comorbidity in the postpartum period-a scoping review.

    Science.gov (United States)

    Sharma, Verinder

    2018-04-01

    Childbirth can trigger a variety of psychiatric disorders; however, no disorder is as profoundly affected by childbirth as bipolar disorder. Rates of psychiatric comorbidity especially anxiety disorders, obsessive compulsive disorder, and substance use disorders are quite high in individuals with bipolar disorder. The purpose of this scoping review is to ascertain the effect of childbirth on the relationship between the onset of bipolar disorder and comorbid psychiatric disorders. On June 27, 2017, a search of the Medline, PsycINFO, CINHAL, EMBASE, SCOPUS, COCHRANE, and ISI-Web of Science (WOS) databases was performed using the terms mental disorders, mental disease, major depressive disorder, major depression, depression, panic disorder, bipolar disorder, comorbidity, anxiety disorders, obsessive compulsive disorder, post-traumatic stress disorder, schizophrenia, eating disorders, reactive attachment disorder, childbirth, parturition, puerperium, postpartum, postpartum period and postnatal period. Reference lists of identified papers were manually searched, and all relevant papers published in English were included. A total of eight relevant articles were identified and included in the review. There is some evidence to suggest that occurrence of certain psychiatric disorders in the postpartum period may predict later onset of bipolar disorder. It is unknown whether childbirth raises the risk of postpartum recurrence of comorbid disorders. Whether patients who have past histories of psychiatric disorders are at increased risk for onset of bipolar disorder in the postpartum period also remains unclear. Additional research is needed to increase our understanding of the impact of childbirth on bipolar disorder and comorbid psychiatric disorders. A better understanding of this issue could lead to more accurate and timely detection, improved treatment planning, and optimal delivery of care for these disorders.

  9. Predicting early post-partum depressive symptoms among older primiparous Japanese mothers.

    Science.gov (United States)

    Iwata, Hiroko; Mori, Emi; Tsuchiya, Miyako; Sakajo, Akiko; Maehara, Kunie; Ozawa, Harumi; Morita, Akiko; Maekawa, Tomoko; Aoki, Kyoko; Makaya, Miyuki; Tamakoshi, Koji

    2015-10-01

    The number of older primiparas is increasing in Japan. These women have been shown to be more vulnerable to post-partum depression. This study aimed to identify factors for predicting post-partum depressive symptoms during hospitalization after childbirth in Japanese primiparas aged 35 years and over. The present authors used the data of 479 primiparas aged 35 years and over from a prospective cohort study. Data were collected using self-report questionnaires on the day before hospital discharge. The questionnaire consisted of: demographics and background information; depressive symptoms; fatigue; maternal confidence and maternal satisfaction; child-care values; physical symptoms; perceptions of daily life during hospitalization; concerns about child care and daily life; and infant feeding. Additionally, vital records data were obtained from the hospitals. A stepwise logistic regression analysis was performed on the binary outcome variable of depressive symptoms, measured by the Japanese version of the Edinburgh Postnatal Depression Scale. Women who scored 9 or more were considered to be at high risk for post-partum depression. The authors obtained informed consent from all participants and institutional ethics approvals before initiating the study. The following six variables reliably predicted the risk of post-partum depression: emergency cesarean section, lower satisfaction with birth experience, higher physical burden in daily life, long-term complications with the newborn, more concerns about newborn caretaking after discharge, and more concerns about one's own life after discharge. Recognition of women with these factors will help nurses to identify those at risk for developing post-partum depression and to provide appropriate care during hospitalization after childbirth. © 2015 The Authors. Japan Journal of Nursing Science © 2015 Japan Academy of Nursing Science.

  10. Post-partum posterior reversible encephalopathy syndrome

    DEFF Research Database (Denmark)

    Aaen, Anne Albers; Jeppesen, Jørgen; Obaid, Hayder

    2015-01-01

    Posterior reversible encephalopathy syndrome (PRES) is a complex clinical condition with vasogenic subcortical oedema caused by hypertension. Oedema is often seen on magnetic resonance imaging. The wide clinical spectrum ranges from headaches to vision loss and even death. Early diagnosis...... and treatment is important for the reversibility of the condition. In this case report we emphasize the importance of blood pressure control in a post-partum woman, who had a rather complicated pregnancy. The symptoms of PRES were not recognized immediately because of failure to use and acknowledge a blood...