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Sample records for system low-risk nulliparous

  1. Preferred place of birth: characteristics and motives of low-risk nulliparous women in the Netherlands.

    Science.gov (United States)

    van Haaren-Ten Haken, Tamar; Hendrix, Marijke; Nieuwenhuijze, Marianne; Budé, Luc; de Vries, Raymond; Nijhuis, Jan

    2012-10-01

    to explores preferences, characteristics and motives regarding place of birth of low-risk nulliparous women in the Netherlands. a prospective cohort study of low-risk nulliparous women and their partners starting their pregnancy in midwifery-led care or in obstetric-led care. Data were collected using a self-administered questionnaire, including questions on demographic, psychosocial and pregnancy factors and statements about motives with regard to place of birth. Depression, worry and self-esteem were explored using the Edinburgh Depression Scale (EDS), the Cambridge Worry Scale (CWS) and the Rosenberg Self Esteem Scale (RSE). participants were recruited in 100 independent midwifery practices and 14 hospitals from 2007 to 2011. 550 low-risk nulliparous women; 231 women preferred a home birth, 170 women a hospital birth in midwifery-led care and 149 women a birth in obstetric-led care. Significant differences in characteristics were found in the group who preferred a birth in obstetric-led care compared to the two groups who preferred midwifery-led care. Those women were older (F (2,551)=16.14, pbirth is driven by a desire for greater personal autonomy, whereas women's choice for a hospital birth is driven by a desire to feel safe and control risks. the characteristics of women who prefer a hospital birth are different than the characteristics of women who prefer a home birth. It appears that for women preferring a hospital birth, the assumed safety of the hospital is more important than type of care provider. This brings up the question whether women are fully aware of the possibilities of maternity care services. Women might need concrete information about the availability and the characteristics of the services within the maternity care system and the risks and benefits associated with either setting, in order to make an informed choice where to give birth. Copyright © 2012 Elsevier Ltd. All rights reserved.

  2. Emergency caesarean section in low risk nulliparous women

    DEFF Research Database (Denmark)

    Haerskjold, Ann; Hegaard, H K; Kjaergaard, H

    2012-01-01

    and identifies maternal and fetal risk factors associated with ECS. We included 2,748 low-risk women and 8.7% had ECS. Failure-to-progress (FTP) accounted for 68.3% of the ECS and 30.4% were performed due to suspected fetal distress (SFD). Multivariate logistic regression analyses were done to estimate.......26-3.20) were associated with increased risk of ECS due to FTP....

  3. Cost analysis of the Dutch obstetric system: low-risk nulliparous women preferring home or short-stay hospital birth--a prospective non-randomised controlled study.

    Science.gov (United States)

    Hendrix, Marijke Jc; Evers, Silvia Maa; Basten, Marloes Cm; Nijhuis, Jan G; Severens, Johan L

    2009-11-19

    In the Netherlands, pregnant women without medical complications can decide where they want to give birth, at home or in a short-stay hospital setting with a midwife. However, a decrease in the home birth rate during the last decennium may have raised the societal costs of giving birth. The objective of this study is to compare the societal costs of home births with those of births in a short-stay hospital setting. This study is a cost analysis based on the findings of a multicenter prospective non-randomised study comparing two groups of nulliparous women with different preferences for where to give birth, at home or in a short-stay hospital setting. Data were collected using cost diaries, questionnaires and birth registration forms. Analysis of the data is divided into a base case analysis and a sensitivity analysis. In the group of home births, the total societal costs associated with giving birth at home were euro3,695 (per birth), compared with euro3,950 per birth in the group for short-stay hospital births. Statistically significant differences between both groups were found regarding the following cost categories 'Cost of contacts with health care professionals during delivery' (euro138.38 vs. euro87.94, -50 (2.5-97.5 percentile range (PR)-76;-25), p home' (euro1,551.69 vs. euro1,240.69, -311 (PR -485; -150), p home birth are euro4,364 per birth, and euro4,541 per birth for short-stay hospital births. The total costs associated with pregnancy, delivery, and postpartum care are comparable for home birth and short-stay hospital birth. The most important differences in costs between the home birth group and the short-stay hospital birth group are associated with maternity care assistance, hospitalisation, and travelling costs.

  4. Cost Analysis of the Dutch Obstetric System: low-risk nulliparous women preferring home or short-stay hospital birth - a prospective non-randomised controlled study

    Directory of Open Access Journals (Sweden)

    Nijhuis Jan G

    2009-11-01

    Full Text Available Abstract Background In the Netherlands, pregnant women without medical complications can decide where they want to give birth, at home or in a short-stay hospital setting with a midwife. However, a decrease in the home birth rate during the last decennium may have raised the societal costs of giving birth. The objective of this study is to compare the societal costs of home births with those of births in a short-stay hospital setting. Methods This study is a cost analysis based on the findings of a multicenter prospective non-randomised study comparing two groups of nulliparous women with different preferences for where to give birth, at home or in a short-stay hospital setting. Data were collected using cost diaries, questionnaires and birth registration forms. Analysis of the data is divided into a base case analysis and a sensitivity analysis. Results In the group of home births, the total societal costs associated with giving birth at home were €3,695 (per birth, compared with €3,950 per birth in the group for short-stay hospital births. Statistically significant differences between both groups were found regarding the following cost categories 'Cost of contacts with health care professionals during delivery' (€138.38 vs. €87.94, -50 (2.5-97.5 percentile range (PR-76;-25, p Conclusion The total costs associated with pregnancy, delivery, and postpartum care are comparable for home birth and short-stay hospital birth. The most important differences in costs between the home birth group and the short-stay hospital birth group are associated with maternity care assistance, hospitalisation, and travelling costs.

  5. Fear of childbirth and emergency caesarean section in low-risk nulliparous women

    DEFF Research Database (Denmark)

    Jespersen, Cecilie; Hegaard, Hanne Kristine; Schroll, Anne-Mette

    2014-01-01

    OBJECTIVE: To assess the association between fear of childbirth (FOC) and emergency caesarean section. DESIGN: A prospective cohort study of low-risk nulliparous women at term. SETTING: Nine obstetric departments in Denmark, May 2004-July 2005. POPULATION: A total of 2598 nulliparous women...... in spontaneous labor with a single fetus in cephalic presentation at term. METHODS: Self-reported FOC was assessed at 37 weeks of gestation by the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) version A and at admission to the labor ward by the Delivery Fear Scale (DFS). Mode of delivery...... was recorded by the attending staff. Logistic regression analyses were used to estimate unadjusted and adjusted odds ratios (OR). MAIN OUTCOME MEASURES: Risk of emergency caesarean section in women who feared childbirth. RESULTS: FOC (W-DEQ sum score ≥ 85 and DFS sum score ≥ 70) was not associated...

  6. Physiologic partograph to improve birth safety and outcomes among low-risk, nulliparous women with spontaneous labor onset

    Science.gov (United States)

    Neal, Jeremy L.; Lowe, Nancy K.

    2011-01-01

    Oxytocin augmentation and cesarean rates among low-risk, term, nulliparous women with a spontaneous onset of labor in the United States approximate 50% and 26.5%, respectively. This indicates that the quality of obstetrical care is much less than optimal in this nation. Exorbitant oxytocin use, the intervention most commonly associated with preventable adverse perinatal outcomes, jeopardizes birth safety while the high cesarean rate in this high-volume group compromises population health and increases health care costs. Dystocia, characterized by the slow, abnormal progression of labor, is the most commonly reported indication for primary cesareans, accounting directly for approximately 50% of all nulliparous cesareans and indirectly for most repeat cesareans. Diagnoses of dystocia are most often based on ambiguously defined delays in cervical dilation beyond which labor augmentation is deemed justified. Dystocia is known to be over-diagnosed which undoubtedly contributes to contemporary oxytocin augmentation and primary cesarean rates. Labor attendants would benefit from an evidence-based framework for homogenous labor assessment. To this end, we present a physiologically-based partograph for `in-hospital' use in assessing the labors of low-risk, term, nulliparous women with spontaneous labor onset. This tool incorporates several evidence-based labor principles that combine to give needed clinical meaning to `dystocia' as a diagnosis. It is hypothesized that our partograph will safely limit diagnoses of dystocia to only the slowest 10% of low-risk, nulliparous women. This should, in turn, safe-guard against unnecessary, injudicious, and potentially harmful use of oxytocin when labor is already adequately progressing while also indicating when its use may be justified. We further hypothesize that cesareans performed for dystocia in this population will decrease by ≥ 50%. No significant influence on other labor process or labor outcome variables is expected with

  7. Oxytocin and dystocia as risk factors for adverse birth outcomes: a cohort of low-risk nulliparous women.

    Science.gov (United States)

    Bernitz, Stine; Øian, Pål; Rolland, Rune; Sandvik, Leiv; Blix, Ellen

    2014-03-01

    augmented and not augmented women without dystocia were compared to investigate associations between oxytocin and adverse birth outcomes. Augmented women with and without dystocia were compared, to investigate associations between dystocia and adverse birth outcomes. a cohort of low-risk nulliparous women originally included in a randomised controlled trial. the Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Norway. the study population consists of 747 well defined low-risk women. incidence of oxytocin augmentation, and associations between dystocia and augmentation, and mode of delivery, transfer of newborns to the intensive care unit, episiotomy and postpartum haemorrhage. of all participants 327 (43.8%) were augmented with oxytocin of which 139 (42.5%) did not fulfil the criteria for dystocia. Analyses adjusted for possible confounders found that women without dystocia had an increased risk of instrumental vaginal birth (OR 3.73, CI 1.93-7.21) and episiotomy (OR 2.47, CI 1.38-4.39) if augmented with oxytocin. Augmented women had longer active phase if vaginally delivered and longer labours if delivered by caesarean section if having dystocia. Among women without dystocia, those augmented had higher body mass index, gave birth to heavier babies, had longer labours if vaginally delivered and had epidural analgesia more often compared to women not augmented. in low-risk nulliparous without dystocia, we found an association between the use of oxytocin and an increased risk of instrumental vaginal birth and episiotomy. careful attention should be paid to criteria for labour progression and guidelines for oxytocin augmentation to avoid unnecessary use. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Effects of caesarean section on maternal health in low risk nulliparous women: a prospective matched cohort study in Shanghai, China

    Directory of Open Access Journals (Sweden)

    Gao Xiao-ling

    2010-12-01

    Full Text Available Abstract Background Rates of caesarean section are progressively increasing in many parts of the world. As a result of psychosocial factors there has been an increasing tendency for pregnant women without justifiable medical indications for caesarean section to ask for this procedure in China. A critical examination of this issue in relation to maternal outcomes is important. At present there are no clinical trials to help assess the risks and benefits of caesarean section in low risk women. To fill the gap left by trials, this indication-matched cohort study was carried out to examine prospectively the outcomes of caesarean section on women with no absolute obstetric indication compared with similar women who had vaginal delivery. Methods An indication-matched cohort study was undertaken to compare maternal outcomes following caesarean section with those undergoing vaginal delivery, in which the two groups were matched for non-absolute indications. 301 nulliparous women with caesarean section were matched successfully with 301 women who delivered vaginally in the Maternal and Children's Hospitals (MCHs in Shanghai, China. Logistic regression model or binomial regression model was used to estimate the relative risk (RR directly. Adjusted RRs were calculated adjusting for propensity score and medical indications. Results The incidence of total complications was 2.2 times higher in the caesarean section group during hospitalization post-partum, compared with the vaginal delivery group (RR = 2.2; 95% CI: 1.1-4.4. The risk of haemorrhage from the start of labour until 2 hours post-partum was significantly higher in the caesarean group (RR = 5.6; 95% CI: 1.2-26.9. The risk of chronic abdominal pain was significantly higher for the caesarean section group (RR = 3.6; 95% CI: 1.2-10.9 than for the vaginal delivery group within 12 months post-partum. The two groups had similar incidences of anaemia and complicating infections such as wound complications

  9. Risk indicators for dystocia in low-risk nulliparous women: a study on lifestyle and anthropometrical factors

    DEFF Research Database (Denmark)

    Kjaergaard, H; Dykes, A K; Ottesen, B

    2010-01-01

    We examined background information and course of labour from a cohort of 2,810 low-risk nulliparas to identify possible lifestyle and anthropometrical risk indicators for dystocia. Criteria for dystocia: cervical dilatation or =4 h per week appeared protective for dystocia (OR 0.63, CI 0.45-0.89)......We examined background information and course of labour from a cohort of 2,810 low-risk nulliparas to identify possible lifestyle and anthropometrical risk indicators for dystocia. Criteria for dystocia: cervical dilatation or =4 h per week appeared protective for dystocia (OR 0.63, CI 0...

  10. Decision Making about Hospital Arrival among Low-Risk Nulliparous Women after Spontaneous Labor Onset at Home.

    Science.gov (United States)

    Edmonds, Joyce K; Miley, Kathleen; Angelini, Kimberly J; Shah, Neel T

    2018-05-15

    Postponing hospital admission until the active phase of labor is a recommended strategy to safely reduce the incidence of primary cesarean births. Success of this strategy depends on women's decisions about when to transfer from home to the hospital, a process that is largely absent from research about childbirth. This study aimed to determine the decision-making criteria used by women about when to go to the hospital after the self-identification of labor onset at home. A qualitative study was conducted at an academic medical center with a sample of 21 nulliparous women who went into spontaneous labor at home and had term, singleton, and vertex-presentation births. The purposive sample consisted of women who decided to stay at home or go to the hospital in early labor. Birth narratives from in-depth interviews conducted in the postpartum period using a semistructured interview guide were subjected to content analysis. The verbatim transcriptions of the interviews were coded and categorized into a set of decision criteria. Criteria used by women in deciding to go to the hospital or stay at home in early labor included the degree of certainty with the self-identification of labor onset, ability to cope with labor pain, influence of social network members, health care provider advice, and concerns about travel to the hospital. Perception of childbirth risk and the need for reassurance about the normalcy of symptoms and fetal well-being also influenced women's decisions. Women use a common set of criteria in deciding when to arrive at the hospital during labor. Antenatal education and telephone triage interventions that incorporate the considerations of women deciding to seek or delay hospital admission in childbirth may facilitate health seeking in more advanced labor. Symptom recognition education about early labor onset and progression could reduce decisional uncertainty. © 2018 by the American College of Nurse-Midwives.

  11. Use of frameless intrauterine devices and systems in young nulliparous and adolescent women: results of a multicenter study

    Directory of Open Access Journals (Sweden)

    Wildemeersch D

    2014-08-01

    Full Text Available Dirk Wildemeersch,1 Sohela Jandi,2 Ansgar Pett,2 Kilian Nolte,3 Thomas Hasskamp,4 Marc Vrijens5 1Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium; 2Gynecological Outpatient Clinic, Berlin, 3Gynecological Outpatient Clinic, Uetze, 4GynMünster, Münster, Germany; 5Gynecological Outpatient Clinic, Ghent, Belgium Background: The purpose of this study was to provide additional data on the experience with frameless copper and levonorgestrel (LNG intrauterine devices (IUDs in nulliparous and adolescent women. Methods: Nulliparous and adolescent women, 25 years of age or younger, using the frameless copper IUD or the frameless LNG-releasing intrauterine system (IUS, were selected from previous studies and a current multicenter post-marketing study with the frameless copper IUD. The small copper-releasing GyneFix® 200 IUD consists of four copper cylinders, each 5 mm long and only 2.2 mm wide. The frameless FibroPlant® LNG-IUS consists of a fibrous delivery system releasing the hormone levonorgestrel (LNG-IUS. The main features of these intrauterine contraceptives are that they are frameless, flexible, and anchored to the fundus of the uterus. Results: One hundred and fifty-four nulliparous and adolescent women participated in the combined study. One pregnancy occurred with the GyneFix 200 IUD after unnoticed early expulsion of the device (cumulative pregnancy rate 1.1 at one year. Two further expulsions were reported, one with the GyneFix 200 IUD and the other with the FibroPlant LNG-IUS. The cumulative expulsion rate at one year was 1.1 with the copper IUD and 2.2 with the LNG-IUS. The total discontinuation rate at one year was low (3.3 and 4.3 with the copper IUD and LNG-IUS, respectively and resulted in a high rate of continuation of use at one year (96.7 with the copper IUD and 95.7 with the LNG-IUS, respectively. Continuation rates for both frameless copper IUD and frameless LNG-IUS remained high at 3 years (>90%. There

  12. Cost Analysis of the Dutch Obstetric System: low-risk nulliparous women preferring home or short-stay hospital birth - a prospective non-randomised controlled study

    OpenAIRE

    Hendrix, Marijke JC; Evers, Silvia MAA; Basten, Marloes CM; Nijhuis, Jan G; Severens, Johan L

    2009-01-01

    Abstract Background In the Netherlands, pregnant women without medical complications can decide where they want to give birth, at home or in a short-stay hospital setting with a midwife. However, a decrease in the home birth rate during the last decennium may have raised the societal costs of giving birth. The objective of this study is to compare the societal costs of home births with those of births in a short-stay hospital setting. Methods This study is a cost analysis based on the finding...

  13. Midpregnancy Cervical Length in Nulliparous Women and its Association with Postterm Delivery and Intrapartum Cesarean Delivery

    NARCIS (Netherlands)

    van der Ven, A. J.; van Os, M. A.; Kleinrouweler, C. E.; Verhoeven, C. J. M.; de Miranda, E.; Bossuyt, P. M.; de Groot, C. J. M.; Haak, M. C.; Pajkrt, E.; Mol, B. W. J.; Kazemier, B. M.

    2016-01-01

    To evaluate the association between midpregnancy cervical length and postterm delivery and cesarean delivery during labor. In a multicenter cohort study, cervical length was measured in low-risk singleton pregnancies between 16 and 22 weeks of gestation. From this cohort, we identified nulliparous

  14. Low Risk Anomalies?

    DEFF Research Database (Denmark)

    Schneider, Paul; Wagner, Christian; Zechner, Josef

    . Empirically, we find that option-implied ex-ante skewness is strongly related to ex-post residual coskewness and alphas. Beta- and volatility-based low risk anomalies are largely driven by a single principal component, which is in turn largely explained by skewness. Controlling for skewness renders the alphas......This paper shows that stocks' CAPM alphas are negatively related to CAPM betas if investors demand compensation for negative skewness. Thus, high (low) beta stocks appear to underperform (outperform). This apparent anomaly merely reflects compensation for residual coskewness ignored by the CAPM...... of betting-against-beta and -volatility insignificant....

  15. Low Risk Anomalies?

    DEFF Research Database (Denmark)

    Schneider, Paul; Wagner, Christian; Zechner, Josef

    This paper shows theoretically and empirically that beta- and volatility-based low risk anomalies are driven by return skewness. The empirical patterns concisely match the predictions of our model that endogenizes the role of skewness for stock returns through default risk. With increasing downside...... risk, the standard capital asset pricing model (CAPM) increasingly overestimates expected equity returns relative to firms' true (skew-adjusted) market risk. Empirically, the profitability of betting against beta/volatility increases with firms' downside risk, and the risk-adjusted return differential...... of betting against beta/volatility among low skew firms compared to high skew firms is economically large. Our results suggest that the returns to betting against beta or volatility do not necessarily pose asset pricing puzzles but rather that such strategies collect premia that compensate for skew risk...

  16. Amygdala response to negative images in postpartum vs nulliparous women and intranasal oxytocin.

    Science.gov (United States)

    Rupp, Heather A; James, Thomas W; Ketterson, Ellen D; Sengelaub, Dale R; Ditzen, Beate; Heiman, Julia R

    2014-01-01

    The neuroendocrine state of new mothers may alter their neural processing of stressors in the environment through modulatory actions of oxytocin on the limbic system. We predicted that amygdala sensitivity to negatively arousing stimuli would be suppressed in postpartum compared to nulliparous women and that this suppression would be modulated by administration of oxytocin nasal spray. We measured brain activation (fMRI) and subjective arousal in response to negatively arousing pictures in 29 postpartum and 30 nulliparous women who received either oxytocin nasal spray or placebo before scanning. Pre- and post-exposure urinary cortisol levels were also measured. Postpartum women (placebo) demonstrated lower right amygdala activation in response to negative images, lower cortisol and lower negative photo arousal ratings to nulliparous women. Nulliparous women receiving oxytocin had lower right amygdala activation compared to placebo. Cortisol levels in the placebo group, and ratings of arousal across all women, were positively associated with right amygdala activation. Together, these findings demonstrate reductions in both amygdala activation and subjective negative arousal in untreated postpartum vs nulliparous women, supporting the hypothesis of an attenuated neural response to arousing stimuli in postpartum women. A causal role of oxytocin and the timing of potential effects require future investigation.

  17. Risk Factors of Dystocia in Nulliparous Women

    Science.gov (United States)

    Alijahan, Rahele; Kordi, Masoumeh

    2014-01-01

    Background: Detection of women at risk for dystocia will allow physicians to make preparations and treatment decisions that can minimize maternal and neonatal morbidity. We aimed to determine the risk factors for dystocia in nulliparous women. Methods: This case series enrolled 447 nulliparous women who presented with a single pregnancy in the vertex presentation and gestational age of 38-42 weeks. Maternal anthropometric measurements were obtained upon admission. We defined dystocia as a cesarean section or vacuum delivery for abnormal progression of labor as evidenced by the presence of effective uterine contractions, cervical dilation of less than 1 cm/h in the active phase for 2 h, duration of the second stage beyond 2 h, or fetal head descent less than 1 cm/h. Data were analyzed by SPSS software version 11.5. Kruskal-Wallis, logistic regression, chi-square, Student’s t test and the Mann-Whitney tests were used as appropriated. Results: The state anxiety score (OR=10.58, CI: 1.97-56.0), posterior head position (OR=9.53, CI: 4.68-19.36), fetal head swelling in the second stage of labor (OR=6.85, CI: 2.60-18.01), transverse diagonal of Michaelis sacral ≤9.6 cm (OR=6.19, CI: 2.49-15.40), and height to fundal ratio dystocia. Conclusion: Critical care during labor and delivery in women who have a height to fundal height ratio of dystocia. PMID:24850982

  18. Incidence and outcomes of dystocia in the active phase of labor in term nulliparous women with spontaneous labor onset

    DEFF Research Database (Denmark)

    Kjaergaard, Hanne; Olsen, Jørn; Ottesen, Bent

    2009-01-01

    OBJECTIVE: To estimate the incidence of dystocia among nulliparous women without apparent co-morbidity and to examine maternal and fetal short-term outcomes after dystocia. DESIGN: A multi-center cohort study with prospectively collected data. SETTING: Nine obstetric departments with annual birth...... rates between 850 and 5,400. POPULATION: Low-risk nulliparous women in term spontaneous labor with a singleton fetus in cephalic presentation. METHODS: Follow-up of 2,810 nulliparas using self-administered questionnaires supplemented with clinical records. CRITERIA FOR DYSTOCIA: Cervical dilatation...... OUTCOME MEASURES: Incidences of dystocia, maternal, and fetal outcomes. RESULTS: The cumulative incidence of dystocia was 37% and of the diagnoses 61% were given in the second stage of labor. Women with dystocia treated by augmentation had more cesarean and ventouse deliveries, more often non...

  19. Outcomes of Nulliparous Women with Spontaneous Labor Onset Admitted to Hospitals in Pre-active versus Active Labor

    Science.gov (United States)

    NEAL, Jeremy L.; LAMP, Jane M.; BUCK, Jacalyn S.; LOWE, Nancy K.; GILLESPIE, Shannon L.; RYAN, Sharon L.

    2014-01-01

    Introduction The timing of when a woman is admitted to the hospital for labor care following spontaneous contraction onset may be among the most important decisions that labor attendants make as it can influence care patterns and birth outcomes. The aims of this study were to estimate the percentage of low-risk, nulliparous women at term who are admitted to labor units prior to active labor and to evaluate the effects of the timing of admission (i.e., pre-active versus active labor) on labor interventions and mode of birth. Methods Obstetrics data from low-risk, nulliparous women with spontaneous labor onset at term gestation (N = 216) were merged from two prospective studies conducted at three large, Midwestern hospitals. Baseline characteristics, labor interventions, and outcomes were compared between groups using Fisher’s exact and Mann-Whitney U tests, as appropriate. Likelihoods for oxytocin augmentation, amniotomy, and cesarean delivery were assessed by logistic regression. Results Of the sample of 216 low-risk nulliparous women, 114 (52.8%) were admitted in pre-active labor and 102 (47.2%) were admitted in active labor. Women admitted in pre-active labor were more likely to undergo oxytocin augmentation (84.2% and 45.1%, respectively; odds ratio (OR) 6.5, 95% confidence interval (CI) 3.43–12.27) but not amniotomy (55.3% and 61.8%, respectively; OR 0.8, 95% CI 0.44–1.32) when compared to women admitted in active labor. The likelihood of cesarean delivery was higher for women admitted before active labor onset (15.8% and 6.9%, respectively; OR 2.6, 95% CI 1.02–6.37). Discussion Many low-risk nulliparous women with regular, spontaneous uterine contractions are admitted to labor units before active labor onset, which increases their likelihood of receiving oxytocin and being delivered via cesarean section. An evidence-based, standardized approach for labor admission decision-making is recommended to decrease inadvertent admissions of women in pre

  20. Knowledge of the pelvic floor in nulliparous women

    OpenAIRE

    Neels, Hedwig; Wyndaele, Jean-Jacques; Tjalma, Wiebren A. A.; De Wachter, Stefan; Wyndaele, Michel; Vermandel, Alexandra

    2016-01-01

    [Purpose] Proper pelvic floor function is important to avoid serious dysfunctions including incontinence, prolapse, and sexual problems. The current study evaluated the knowledge of young nulliparous women about their pelvic floor and identified what additional information they wanted. [Subjects and Methods] In this cross-sectional survey, a validated, 36 item questionnaire was distributed to 212 nulliparous women. The questionnaire addressed demography, pelvic floor muscles, pelvic floor dys...

  1. Amygdala response to negative images in postpartum vs nulliparous women and intranasal oxytocin

    OpenAIRE

    Rupp, Heather A.; James, Thomas W.; Ketterson, Ellen D.; Sengelaub, Dale R.; Ditzen, Beate; Heiman, Julia R.

    2012-01-01

    The neuroendocrine state of new mothers may alter their neural processing of stressors in the environment through modulatory actions of oxytocin on the limbic system. We predicted that amygdala sensitivity to negatively arousing stimuli would be suppressed in postpartum compared to nulliparous women and that this suppression would be modulated by administration of oxytocin nasal spray. We measured brain activation (fMRI) and subjective arousal in response to negatively arousing pictures in 29...

  2. Obstetric risk indicators for labour dystocia in nulliparous women

    DEFF Research Database (Denmark)

    Kjaergaard, Hanne; Olsen, Jørn; Ottesen, Bent

    2008-01-01

    In nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors for dystocia often...

  3. Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases.

    Science.gov (United States)

    de Jonge, A; Geerts, C C; van der Goes, B Y; Mol, B W; Buitendijk, S E; Nijhuis, J G

    2015-04-01

    To compare rates of adverse perinatal outcomes between planned home births versus planned hospital births. A nationwide cohort study. The Netherlands. Low-risk women in midwife-led care at the onset of labour. Analysis of national registration data. Intrapartum and neonatal death, Apgar scores, and admission to a neonatal intensive care unit (NICU) within 28 days of birth. Of the total of 814 979 women, 466 112 had a planned home birth and 276 958 had a planned hospital birth. For 71 909 women, their planned place of birth was unknown. The combined intrapartum and neonatal death rates up to 28 days after birth, including cases with discrepancies in the registration of the moment of death, were: for nulliparous women, 1.02‰ for planned home births versus 1.09‰ for planned hospital births, adjusted odds ratio (aOR) 0.99, 95% confidence interval (95% CI) 0.79-1.24; and for parous women, 0.59‰ versus 0.58‰, aOR 1.16, 95% CI 0.87-1.55. The rates of NICU admissions and low Apgar scores did not significantly differ among nulliparous women (NICU admissions up to 28 days, 3.41‰ versus 3.61‰, aOR 1.05, 95% CI 0.92-1.18). Among parous women the rates of Apgar scores below seven and NICU admissions were significantly lower among planned home births (NICU admissions up to 28 days, 1.36 versus 1.95‰, aOR 0.79, 95% CI 0.66-0.93). We found no increased risk of adverse perinatal outcomes for planned home births among low-risk women. Our results may only apply to regions where home births are well integrated into the maternity care system. © 2014 Royal College of Obstetricians and Gynaecologists.

  4. Change in primary midwife-led care in the Netherlands in 2000-2008: a descriptive study of caesarean sections and other interventions among 789,795 low risk births.

    Science.gov (United States)

    Offerhaus, Pien M; de Jonge, Ank; van der Pal-de Bruin, Karin M; Hukkelhoven, Chantal W P M; Scheepers, Peer L H; Lagro-Janssen, Antoine L M

    2014-05-01

    to study whether an increase in intrapartum referrals in primary midwife-led care births in the Netherlands is accompanied by an increase in caesarean sections. nationwide descriptive study. the Netherlands Perinatal Registry. 789,795 births of nine year cohorts of women with low risk pregnancies in primary midwife-led care at the onset of labour between 2000 and 2008. primary outcome is the caesarean section rate. Vaginal instrumental delivery, augmentation with oxytocin, and pharmacological pain relief are secondary outcomes. Trends in outcomes are described. We used logistic regression to explore whether changes in the planned place of birth and other maternal characteristics influenced the caesarean section rate. the caesarean section rate did not increase and was 5.5 per cent (range 4.9-6.3 per cent) for nulliparous women, and 1.0 per cent (range 0.8-1.1 per cent) for multiparous women. After controlling for the decline in planned home births and other maternal characteristics no increase in the caesarean section rate was found. The vaginal instrumental birth rate showed no increase, and was 18.1 per cent (range 17.9-18.5 per cent) for nulliparous women and 1.5 per cent (range 1.4-1.7 per cent) for multiparous women. Augmentation of labour and/or pharmacological pain relief increased from 24.0 to 38.8 per cent for nulliparous women, and from 5.4 to 10.0 per cent for multiparous women. the rise in intrapartum referrals was not accompanied by an increase in caesarean section rate over the period 2000-2008. Despite a considerable rise in the use of pain relief and augmentation, the rate of spontaneous vaginal birth remained high for low risk women who started labour in primary midwife-led care. the current strict role division between primary care midwives and the obstetrician-led team increasingly results in a change in care provider during labour. In a more integrated care system, more women can receive continuous support of labour from their own primary care

  5. Fear of childbirth in nulliparous and multiparous women

    DEFF Research Database (Denmark)

    Räisänen, S; Lehto, S M; Nielsen, H S

    2014-01-01

    OBJECTIVE: To identify risk factors for fear of childbirth (FOC) according to parity and socioeconomic status, and to evaluate associations between FOC and adverse perinatal outcomes. DESIGN: A cohort study. SETTING: The Finnish Medical Birth Register. POPULATION: All 788 317 singleton births...... during 1997-2010 in Finland. METHODS: Fear of childbirth was defined according to the International Classification of Diseases code O99.80, and its associations with several risk factors and perinatal outcomes were analysed by multivariable logistic regression. MAIN OUTCOME MEASURES: Prevalence of, risk...... factors for and outcomes of FOC. RESULTS: Fear of childbirth was experienced by 2.5% of nulliparous women and 4.5% of multiparous women. The strongest risk factors for FOC in nulliparous women were depression [adjusted odds ratio (aOR), 6.35; 95% confidence interval (CI), 5.25-7.68], advanced maternal age...

  6. Treatment of nulliparous women with severe fear of childbirth via the Internet: a feasibility study.

    Science.gov (United States)

    Nieminen, Katri; Andersson, Gerhard; Wijma, Barbro; Ryding, Elsa-Lena; Wijma, Klaas

    2016-01-01

    The aim of the present study was to test the feasibility of Internet interventions among nulliparous women suffering from severe fear of childbirth (FOC) by means of an Internet-delivered therapist-supported self-help program based on cognitive behavioral therapy (ICBT). Prospective, longitudinal cohort study. A feasibility study of an ICBT program for the treatment of severe FOC in pregnant women. Twenty-eight Swedish-speaking nulliparous women with severe FOC recruited via a project home page from January 2012 to December 2013. The main components of the ICBT program for the treatment of severe FOC comprised psycho-education, breathing retraining, cognitive restructuring, imaginary exposure, in vivo exposure and relapse prevention. The study participants were anonymously self-recruited over the Internet, interviewed by telephone and then enrolled. All participants were offered 8 weeks of treatment via the Internet. Participants reported their homework weekly, submitted measurements of their fear and received feedback from a therapist via a secure online contact management system. Level of FOC measured with the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ A) during screening at enrollment and weekly during the treatment (W-DEQ version A), and after the delivery (W-DEQ version B). A statistically significant (p pre to post-therapy, with a large effect size (Cohen's d = 0.95)]. The results of this feasibility study suggest that ICBT has potential in the treatment of severe FOC during pregnancy in motivated nulliparous women. The results need to be confirmed by randomized controlled studies.

  7. Inter-rater reliability of assessment of levator ani muscle strength and attachment to the pubic bone in nulliparous women.

    Science.gov (United States)

    van Delft, K; Schwertner-Tiepelmann, N; Thakar, R; Sultan, A H

    2013-09-01

    The modified Oxford scale (MOS) has been found previously to have poor inter-rater reliability, whereas digital assessment of levator ani muscle (LAM) attachment to the pubic bone has been shown to have acceptable reliability. Our aim was to evaluate inter-rater reliability of the validated MOS and to develop a reliable classification system for digital assessment of LAM attachment, correlating this to findings on transperineal ultrasound (TPUS) examination. Evaluation of the MOS by palpation was performed in nulliparous women by two investigators. LAM attachment was evaluated using digital palpation, for which a novel classification system was developed with four grades based on the position of the attachment and presence of discernible muscle. Findings were compared with those on TPUS examination. Inter-rater reliability was assessed using Cohen's kappa statistic. Twenty-five nulliparous women were examined. There was agreement in MOS scores between the investigators in 64% of women (n = 16), with a kappa of 0.66 (indicating substantial agreement). There was agreement in palpation of LAM attachment using the new grading system in 96% of women (n = 24), with a kappa of 0.90 (indicating almost perfect agreement). TPUS examination did not show LAM avulsion in any woman, with the exception of one with a partial avulsion. In this group of nulliparous patients, there was substantial agreement between the two investigators in evaluation of the MOS and there was good agreement between grades of LAM attachment using the new classification system, which correlated with findings on TPUS examination. It therefore appears that these results are reproducible in nulliparous women and the techniques can be readily learned and reliably incorporated into clinical practice and research after appropriate training. Further research is required to establish clinical utility of the grading system for LAM attachment in postpartum women and in women with symptomatic pelvic organ

  8. Effect of Guided Imagery on Maternal Fetal Attachment in Nulliparous Women with Unplanned Pregnancy

    OpenAIRE

    Masoumeh Kordi; Maryam Fasanghari; Negar Asgharipour; Habibollah Esmaily

    2016-01-01

    Introduction and Objectives: Nulliparous women with unplanned pregnancy experience high levels of anxiety, which may adversely affect maternal-fetal attachment. Therefore, in this study, we aimed to determine the effect of guided imagery on maternal-fetal attachment in nulliparous women with unplanned pregnancy. Materials and Methods: In this clinical trial, 67 nulliparous women with unplanned pregnancy were randomly divided into two groups of intervention (n=35) and control (n=32) in 2015. D...

  9. Mode of birth and medical interventions among women at low risk of complications: A cross-national comparison of birth settings in England and the Netherlands.

    Directory of Open Access Journals (Sweden)

    Ank de Jonge

    Full Text Available To compare mode of birth and medical interventions between broadly equivalent birth settings in England and the Netherlands.Data were combined from the Birthplace study in England (from April 2008 to April 2010 and the National Perinatal Register in the Netherlands (2009. Low risk women in England planning birth at home (16,470 or in freestanding midwifery units (11,133 were compared with Dutch women with planned home births (40,468. Low risk English women with births planned in alongside midwifery units (16,418 or obstetric units (19,096 were compared with Dutch women with planned midwife-led hospital births (37,887.CS rates varied across planned births settings from 6.5% to 15.5% among nulliparous and 0.6% to 5.1% among multiparous women. CS rates were higher among low risk nulliparous and multiparous English women planning obstetric unit births compared to Dutch women planning midwife-led hospital births (adjusted (adj OR 1.89 (95% CI 1.64 to 2.18 and 3.66 (2.90 to 4.63 respectively. Instrumental vaginal birth rates varied from 10.7% to 22.5% for nulliparous and from 0.9% to 5.7% for multiparous women. Rates were lower in the English comparison groups apart from planned births in obstetric units. Transfer, augmentation and episiotomy rates were much lower in England compared to the Netherlands for all midwife-led groups. In most comparisons, epidural rates were higher among English groups.When considering maternal outcomes, findings confirm advantages of giving birth in midwife-led settings for low risk women. Further research is needed into strategies to decrease rates of medical intervention in obstetric units in England and to reduce rates of avoidable transfer, episiotomy and augmentation of labour in the Netherlands.

  10. A prospective pilot study of Dilapan-S compared with Propess for induction of labour at 41+ weeks in nulliparous pregnancy.

    Science.gov (United States)

    Crosby, David A; O'Reilly, Claire; McHale, Helen; McAuliffe, Fionnuala M; Mahony, Rhona

    2017-12-21

    The incidence of labour induction has risen worldwide over the past decade, and this may contribute to the rising caesarean delivery rate. The mechanisms for induction of labour are generally divided into two categories: mechanical and pharmacological. The objective of this study was to determine if mechanical induction with Dilapan-S is an acceptable, safe method of induction of labour in post-dates uncomplicated nulliparous pregnancy. This was a single-centre prospective observational pilot study trial. Fifty-two low-risk nulliparous women with an unfavourable cervix, scheduled for induction of labour for post-dates ≥ 41 weeks gestation, were offered induction of labour with Dilapan-S or Propess from May 2016 until November 2016. The primary outcomes measured were compliance to study protocol and maternal (infection, hyperstimulation) and neonatal outcomes (Apgar score at birth). The secondary outcome measures included change in Bishop's score and caesarean delivery rate. Compliance to study protocol was 25/26 (96%); it was possible to insert Dilapan-S in all but one woman. There were no differences in maternal and neonatal primary outcomes between the groups. There were no cases in either arm of hyperstimulation with either induction method. No difference between the groups was noted in the caesarean delivery rate nor in the mean change in Bishop's score. Dilapan-S is an acceptable, safe form of induction of labour in post-dates uncomplicated nulliparous pregnancy. No cases of hyperstimulation were found, and therefore, Dilapan-S may be a suitable option for outpatient induction of labour in low-risk post-dates nulliparas.

  11. Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study.

    Science.gov (United States)

    de Jonge, Ank; Mesman, Jeanette A J M; Manniën, Judith; Zwart, Joost J; van Dillen, Jeroen; van Roosmalen, Jos

    2013-06-13

    To test the hypothesis that low risk women at the onset of labour with planned home birth have a higher rate of severe acute maternal morbidity than women with planned hospital birth, and to compare the rate of postpartum haemorrhage and manual removal of placenta. Cohort study using a linked dataset. Information on all cases of severe acute maternal morbidity in the Netherlands collected by the national study into ethnic determinants of maternal morbidity in the netherlands (LEMMoN study), 1 August 2004 to 1 August 2006, merged with data from the Netherlands perinatal register of all births occurring during the same period. 146 752 low risk women in primary care at the onset of labour. Severe acute maternal morbidity (admission to an intensive care unit, eclampsia, blood transfusion of four or more packed cells, and other serious events), postpartum haemorrhage, and manual removal of placenta. Overall, 92 333 (62.9%) women had a planned home birth and 54 419 (37.1%) a planned hospital birth. The rate of severe acute maternal morbidity among planned primary care births was 2.0 per 1000 births. For nulliparous women the rate for planned home versus planned hospital birth was 2.3 versus 3.1 per 1000 births (adjusted odds ratio 0.77, 95% confidence interval 0.56 to 1.06), relative risk reduction 25.7% (95% confidence interval -0.1% to 53.5%), the rate of postpartum haemorrhage was 43.1 versus 43.3 (0.92, 0.85 to 1.00 and 0.5%, -6.8% to 7.9%), and the rate of manual removal of placenta was 29.0 versus 29.8 (0.91, 0.83 to 1.00 and 2.8%, -6.1% to 11.8%). For parous women the rate of severe acute maternal morbidity for planned home versus planned hospital birth was 1.0 versus 2.3 per 1000 births (0.43, 0.29 to 0.63 and 58.3%, 33.2% to 87.5%), the rate of postpartum haemorrhage was 19.6 versus 37.6 (0.50, 0.46 to 0.55 and 47.9%, 41.2% to 54.7%), and the rate of manual removal of placenta was 8.5 versus 19.6 (0.41, 0.36 to 0.47 and 56.9%, 47.9% to 66.3%). Low risk

  12. Low-Risk Investing without Industry Bets

    DEFF Research Database (Denmark)

    Asness, Clifford S.; Frazzini, Andrea; Heje Pedersen, Lasse

    2014-01-01

    The strategy of buying safe low-beta stocks while shorting (or underweighting) riskier high-beta stocks (“betting against beta”) has been shown to deliver significant risk-adjusted returns. Some have suggested, however, that such “low-risk investing” delivers high returns primarily because...... of industry bets that favor a slowly changing set of stodgy, stable industries. The authors refute this notion by showing that a strategy of betting against beta has delivered positive returns both as an industry-neutral bet within each industry and as a pure bet across industries....

  13. Nulliparity is associated with subtle adverse metabolic outcomes in overweight/obese mothers and their offspring.

    Science.gov (United States)

    Seneviratne, Sumudu N; Derraik, José G B; Jiang, Yannan; McCowan, Lesley M E; Gusso, Silmara; Biggs, Janene B; Parry, Graham K; Chiavaroli, Valentina; Cutfield, Wayne S; Hofman, Paul L

    2017-11-01

    We aimed to evaluate metabolic outcomes in overweight/obese nulliparous and multiparous women and their offspring. Seventy-two overweight and obese women who participated in a randomized controlled trial of exercise in pregnancy were included in the study, comparing 18 nulliparous and 54 multiparous women and their singleton offspring. Women were assessed at 19 and 36 weeks of gestation. Fetal growth was measured using standard obstetric ultrasound techniques. Cord blood was collected at birth. Maternal and offspring body composition was assessed using DXA ~2 weeks after delivery. Nulliparous women had higher HbA1c in the third trimester of pregnancy than multiparous women (5.48% vs 5.29%; P=.002) and were more insulin-resistant based on the surrogate marker sex hormone-binding globulin (354 vs 408 nmol/L; P=.047). Nulliparous women also had higher levels of the inflammatory marker tumour necrosis factor-alpha (4.74 vs 3.62 pg/mL; P=.025). At birth, the offspring of nulliparous women were on average 340 g (P=.013) and 0.69 standard deviation scores (P=.026) lighter than those born of multiparous women. Cord blood data showed lower insulin-like growth factor-II (P=.026) and higher IGF binding protein-1 (P=.002) levels in the offspring of nulliparous women. In addition, a less favourable metabolic profile was observed in the offspring of nulliparous women, as indicated by higher triglyceride (P<.001) and interleukin-6 (P=.039) concentrations. Infants born of nulliparous overweight and obese women appear to be exposed to a less favourable metabolic environment in utero, with evidence of subtle adverse metabolic outcomes at birth compared to infants of overweight/obese multiparous women. © 2017 John Wiley & Sons Ltd.

  14. Intravenous fluid rate for reduction of cesarean delivery rate in nulliparous women: a systematic review and meta-analysis.

    Science.gov (United States)

    Ehsanipoor, Robert M; Saccone, Gabriele; Seligman, Neil S; Pierce-Williams, Rebecca A M; Ciardulli, Andrea; Berghella, Vincenzo

    2017-07-01

    0.60, 95% CI 0.38-0.97; five studies, 1093 participants; I 2 = 18%), a significantly shorter mean duration of labor of about one hour (mean difference -64.38 min, 95% CI -121.88 to -6.88; six studies, 1155 participants; I 2 = 83%) and a significantly shorter mean length of second stage of labor (mean difference -2.80 min, 95% CI -4.49 to -1.10; 899 participants; I 2 = 22%) compared with those who received intravenous fluid at 125 mL/h. No differences were found in the other secondary outcomes. There were no maternal or perinatal deaths and only one woman, in the 125 mL/h group, developed pulmonary edema. The findings persisted regardless of the type of intravenous fluid used. No significant reduction in the incidence of cesarean delivery was demonstrated in women with unrestricted oral intake; however, this was limited to only two studies evaluating 254 women. Our findings provide evidence that the duration of labor in low-risk nulliparous women may be shortened by a policy of intravenous fluids at a rate of 250 mL/h rather than 125 mL/h. A rate of 250 mL/h seems to be associated with a reduction in the incidence of cesarean delivery compared to 125 mL/h. The number needed to treat to prevent one cesarean delivery is 18 women. Our data support increased hydration among nulliparous women in labor when oral intake is restricted. Further study is needed regarding risks and benefits of increased hydration among women with unrestricted oral intake, those undergoing induction of labor, and those with medical comorbidities. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  15. A qualitative study of nulliparous women's decision making on mode of delivery under China's two-child policy.

    Science.gov (United States)

    Gu, Chunyi; Zhu, Xinli; Ding, Yan; Setterberg Simone; Wang, Xiaojiao; Tao, Hua; Zhang, Yu

    2018-07-01

    To explore nulliparous women's perceptions of decision making regarding mode of delivery under China's two-child policy. Qualitative descriptive design with in-depth semi-structured interviews. Postnatal wards at a tertiary specialized women's hospital in Shanghai, China. 21 nulliparous women 2-3 days postpartum were purposively sampled until data saturation. In-depth semi-structured interviews were conducted between October 8th, 2015 and January 31st, 2016. Two overarching descriptive categories were identified: (1) women's decision-making process: stability versus variability, and (2) factors affecting decision making: variety versus interactivity. Four key themes emerged from each category: (1) initial decision making with certainty: anticipated trial of labour, failed trial of labour, 'shy away' and compromise, anticipated caesarean delivery; (2) initial decision making with uncertainty: anticipated trial of labour, failed trial of labour, 'shy away' and compromise; (3) internal factors affecting decision making: knowledge and attitude, and childbirth self-efficacy; and (4) external factors affecting decision making: social support, and the situational environment. At the initial period of China's two-child policy, nulliparous women have perceived their decision-making process regarding mode of delivery as one with complexity and uncertainty, influenced by both internal and external factors. This may have implications for the obstetric setting to develop a well-designed decision support system for pregnant women during the entire pregnancy periods. And it is recommended that care providers should assess women's preferences for mode of delivery from early pregnancy and provide adequate perinatal support and continuity of care for them. Copyright © 2018 Elsevier Ltd. All rights reserved.

  16. The influence of preferred place of birth on the course of pregnancy and labor among healthy nulliparous women: a prospective cohort study.

    Science.gov (United States)

    van Haaren-ten Haken, Tamar M; Hendrix, Marijke; Smits, Luc J; Nieuwenhuijze, Marianne J; Severens, Johan L; de Vries, Raymond G; Nijhuis, Jan G

    2015-02-14

    Most studies on birth settings investigate the association between planned place of birth at the start of labor and birth outcomes and intervention rates. To optimize maternity care it also is important to pay attention to the entire process of pregnancy and childbirth. This study explores the association between the initial preferred place of birth and model of care, and the course of pregnancy and labor in low-risk nulliparous women in the Netherlands. As part of a Dutch prospective cohort study (2007-2011), we compared medical indications during pregnancy and birth outcomes of 576 women who initially preferred a home birth (n = 226), a midwife-led hospital birth (n = 168) or an obstetrician-led hospital birth (n = 182). Data were obtained by a questionnaire before 20 weeks of gestation and by medical records. Analyses were performed according to the initial preferred place of birth. Low-risk nulliparous women who preferred a home birth with midwife-led care were less likely to be diagnosed with a medical indication during pregnancy compared to women who preferred a birth with obstetrician-led care (OR 0.41 95% CI 0.25-0.66). Preferring a birth with midwife-led care - both at home and in hospital - was associated with lower odds of induced labor (OR 0.51 95% CI 0.28-0.95 respectively OR 0.42 95% CI 0.21-0.85) and epidural analgesia (OR 0.32 95% CI 0.18-0.56 respectively OR 0.34 95% CI 0.19-0.62) compared to preferring a birth with obstetrician-led care. In addition, women who preferred a home birth were less likely to experience augmentation of labor (OR 0.54 95% CI 0.32-0.93) and narcotic analgesia (OR 0.41 95% CI 0.21-0.79) compared to women who preferred a birth with obstetrician-led care. We observed no significant association between preferred place of birth and mode of birth. Nulliparous women who initially preferred a home birth were less likely to be diagnosed with a medical indication during pregnancy. Women who initially preferred a birth

  17. Comparison of post-cervical and cervical porcine artificial insemination in nulliparous and multiparous

    Directory of Open Access Journals (Sweden)

    Luchetti CG

    2016-12-01

    Full Text Available The post-cervical artificial insemination (PCAI in sows increases semen performance compared to cervical artificial insemination (CAI. In Argentina the use of the PCAI is restricted to multiparous while it is not applied to nulliparous. The aim of this study was to compare porcine CAI and PCAI in nulliparous and multiparous. Pregnancy rates and number of live pups with CAI and PCAI in nulliparous and multiparous, assessing advantages and disadvantages of each method were compared. This is a small-scale work (4 CAI and 7 PCAI in nulliparous, 3 CAI and 3 PCAI in multiparous in a small field productive site in the Province of Buenos Aires. Here the boar was omitted for heat detection and to stimulate the sow during AI. Pregnancy rates and the number of pups born alive per pregnant sow were similar with the two techniques and two categories. The PCAI is a good practice in nulliparous and multiparous because this technique increases semen performance compared to CAI and it is omitted the presence of the boar.

  18. Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women: a cohort study in the Netherlands.

    Science.gov (United States)

    Bolten, N; de Jonge, A; Zwagerman, E; Zwagerman, P; Klomp, T; Zwart, J J; Geerts, C C

    2016-10-28

    The use of interventions in childbirth has increased the past decades. There is concern that some women might receive more interventions than they really need. For low-risk women, midwife-led birth settings may be of importance as a counterbalance towards the increasing rate of interventions. The effect of planned place of birth on interventions in the Netherlands is not yet clear. This study aims to give insight into differences in obstetric interventions and maternal outcomes for planned home versus planned hospital birth among women in midwife-led care. Women from twenty practices across the Netherlands were included in 2009 and 2010. Of these, 3495 were low-risk and in midwife-led care at the onset of labour. Information about planned place of birth and outcomes, including instrumental birth (caesarean section, vacuum or forceps birth), labour augmentation, episiotomy, oxytocin in third stage, postpartum haemorrhage >1000 ml and perineal damage, came from the national midwife-led care perinatal database, and a postpartum questionnaire. Women who planned home birth more often had spontaneous birth (nulliparous women aOR 1.38, 95 % CI 1.08-1.76, parous women aOR 2.29, 95 % CI 1.21-4.36) and less often episiotomy (nulliparous women aOR 0.73, 0.58-0.91, parous women aOR 0.47, 0.33-0.68) and use of oxytocin in the third stage (nulliparous women aOR 0.58, 0.42-0.80, parous women aOR 0.47, 0.37-0.60) compared to women who planned hospital birth. Nulliparous women more often had anal sphincter damage (aOR 1.75, 1.01-3.03), but the difference was not statistically significant if women who had caesarean sections were excluded. Parous women less often had labour augmentation (aOR 0.55, 0.36-0.82) and more often an intact perineum (aOR 1.65, 1.34-2.03). There were no differences in rates of vacuum/forceps birth, unplanned caesarean section and postpartum haemorrhage >1000 ml. Women who planned home birth were more likely to give birth spontaneously and had fewer

  19. Obstetric risk indicators for labour dystocia in nulliparous women: a multi-centre cohort study

    DEFF Research Database (Denmark)

    Kjaergaard, H.; Olsen, J.; Ottesen, Bent Smedegaard

    2008-01-01

    nulliparous women in term spontaneous labour with a singleton infant in cephalic presentation. Data were collected by self-administered questionnaires and clinical data-records. Logistic regression analyses were used to estimate adjusted Odds Ratios (OR) and 95% confidence intervals (CI) are given. RESULTS......BACKGROUND: In nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors......: The following characteristics, present at admission to hospital, were associated with dystocia during labour (OR, 95% CI): dilatation of cervix

  20. Differences in nulliparous caesarean section rates across models of care: a decomposition analysis.

    LENUS (Irish Health Repository)

    Brick, Aoife

    2016-01-01

    To evaluate the extent of the difference in elective (ELCS) and emergency (EMCS) caesarean section (CS) rates between nulliparous women in public maternity hospitals in Ireland by model of care, and to quantify the contribution of maternal, clinical, and hospital characteristics in explaining the difference in the rates.

  1. Long-Acting Reversible Contraception Counseling and Use for Older Adolescents and Nulliparous Women.

    Science.gov (United States)

    Gibbs, Susannah E; Rocca, Corinne H; Bednarek, Paula; Thompson, Kirsten M J; Darney, Philip D; Harper, Cynthia C

    2016-12-01

    The majority of pregnancies during adolescence are unintended, and few adolescents use long-acting reversible contraception (LARC) due in part to health care providers' misconceptions about nulliparous women's eligibility for the intrauterine device. We examined differences in LARC counseling, selection, and initiation by age and parity in a study with a provider's LARC training intervention. Sexually active women aged 18-25 years receiving contraceptive counseling (n = 1,500) were enrolled at 20 interventions and 20 control clinics and followed for 12 months. We assessed LARC counseling and selection, by age and parity, with generalized estimated equations with robust standard errors. We assessed LARC use over 1 year with Cox proportional hazards models with shared frailty for clustering. Women in the intervention had increased LARC counseling, selection, and initiation, with similar effects among older adolescent and nulliparous women, and among young adult and parous women. Across study arms, older adolescents were as likely as young adults to receive LARC counseling (adjusted odds ratio [aOR] = .85; 95% confidence interval [CI]: .63-1.15), select LARC (aOR = .86; 95% CI: .64-1.17), and use LARC methods (adjusted hazard ratio [aHR] = .94; 95% CI: .69-1.27). Nulliparous women were less likely to receive counseling (aOR = .57; 95% CI: .42-.79) and to select LARC (aOR = .53; 95% CI: .37-.75) than parous women, and they initiated LARC methods at lower rates (aHR = .65; 95% CI: .48-.90). Nulliparous women had similar rates of implant initiation but lower rates of intrauterine device initiation (aHR = .59; 95% CI: .41-.85). Continued efforts should be made to improve counseling and access to LARC methods for nulliparous women of all ages. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  2. Growth recovery lines are more common in infants at high vs. low risk for abuse

    International Nuclear Information System (INIS)

    Zapala, Matthew A.; Tsai, Andy; Kleinman, Paul K.

    2016-01-01

    Growth recovery lines, also known as growth arrest lines, are transverse radiodense metaphyseal bands that develop due to a temporary arrest of endochondral ossification caused by local or systemic insults. To determine if growth recovery lines are more common in infants at high risk versus low risk for abuse. Reports of American College of Radiology compliant skeletal surveys (1999-2013) were reviewed with clinical records. Infants at low risk for abuse had a skull fracture without significant intracranial injury, history of a fall and clinical determination of low risk (child protection team/social work assessment). Infants at high risk had significant intracranial injury, retinal hemorrhages, other skeletal injuries and clinical determination of high risk. There were 52 low-risk infants (mean: 4.7 months, range: 0.4-12 months) and 21 high-risk infants (mean: 4.2 months, range: 0.8-9.1 months). Two blinded radiologists independently evaluated the skeletal survey radiographs of the knees/lower legs for the presence of at least one growth recovery line. When growth recovery lines are scored as probably present or definitely present, their prevalence in the low-risk group was 38% (standard deviation [SD] = 8%; reader 1 = 17/52, reader 2 = 23/52) vs. 71% (SD = 7%; reader 1 = 16/21, reader 2 = 14/21) in the high-risk group (P < 0.001; odds ratio 4.0, 95% CI: 1.7-9.5). Growth recovery lines are encountered at a significantly higher rate in infants at high risk vs. low risk for abuse. This suggests that abused infants are prone to a temporary disturbance in endochondral ossification as a result of episodic physiological stresses. (orig.)

  3. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.

    Science.gov (United States)

    Brocklehurst, Peter; Hardy, Pollyanna; Hollowell, Jennifer; Linsell, Louise; Macfarlane, Alison; McCourt, Christine; Marlow, Neil; Miller, Alison; Newburn, Mary; Petrou, Stavros; Puddicombe, David; Redshaw, Maggie; Rowe, Rachel; Sandall, Jane; Silverton, Louise; Stewart, Mary

    2011-11-23

    To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. Prospective cohort study. England: all NHS trusts providing intrapartum care at home, all freestanding midwifery units, all alongside midwifery units (midwife led units on a hospital site with an obstetric unit), and a stratified random sample of obstetric units. 64,538 eligible women with a singleton, term (≥37 weeks gestation), and "booked" pregnancy who gave birth between April 2008 and April 2010. Planned caesarean sections and caesarean sections before the onset of labour and unplanned home births were excluded. A composite primary outcome of perinatal mortality and intrapartum related neonatal morbidities (stillbirth after start of care in labour, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus, or fractured clavicle) was used to compare outcomes by planned place of birth at the start of care in labour (at home, freestanding midwifery units, alongside midwifery units, and obstetric units). There were 250 primary outcome events and an overall weighted incidence of 4.3 per 1000 births (95% CI 3.3 to 5.5). Overall, there were no significant differences in the adjusted odds of the primary outcome for any of the non-obstetric unit settings compared with obstetric units. For nulliparous women, the odds of the primary outcome were higher for planned home births (adjusted odds ratio 1.75, 95% CI 1.07 to 2.86) but not for either midwifery unit setting. For multiparous women, there were no significant differences in the incidence of the primary outcome by planned place of birth. Interventions during labour were substantially lower in all non-obstetric unit settings. Transfers from non-obstetric unit settings were more frequent for nulliparous women (36% to 45%) than for multiparous women (9% to 13%). The results support a policy

  4. Misoprostol for cervical priming prior to hysteroscopy in postmenopausal and premenopausal nulliparous women; a multicentre randomised placebo controlled trial

    NARCIS (Netherlands)

    Tasma, M L; Louwerse, M D; Hehenkamp, W J; Geomini, P M; Bongers, M Y; Veersema, S; van Kesteren, P J; Tromp, E; Huirne, J A; Graziosi, G C

    OBJECTIVE: To evaluate the reduction of pain by misoprostol compared with placebo prior to hysteroscopy in postmenopausal and premenopausal nulliparous women. DESIGN: Randomised multicentre double-blind placebo controlled trial. SETTING: Two Dutch teaching hospitals and one Dutch university medical

  5. The Diagnostic Accuracy of Clinical and External Pelvimetry in Prediction of Dystocia in Nulliparous Women

    Directory of Open Access Journals (Sweden)

    R Alijahan

    2011-08-01

    Full Text Available Introduction: Clinical pelvimetry is very uncomfortable for the patient and is associated with subjective error, while external pelvimetry is a simple and acceptable method for patients. The objective of this study was to compare the diagnostic accuracy of clinical and external pelvimetry in prediction of dystocia in nulliparous women. Methods: In this study between December 2008 and January 2009, 447 nulliparous women with a single pregnancy in vertex presentation and gestational age 38-42 weeks referring to the Ommolbanin hospital of Mashhad were included. External pelvic dimensions were assessed at the time of admission and clinical pelvimetry was performed by another examiner. These measurements were not available to the clinician in charge of the delivery. Dystocia was defined as caesarean section and vacuum or forceps delivery for abnormal progress of labor ( active uterine contractions, arrest of cervical dilatation or cervical dilatation less than 1 cm /h in the active phase for 2 hours, prolongation of second stage beyond 2 hours or fetal head descent less than 1cm/h. Statistical tests included Fisher exact test and Chi- square test. Results: The highest sensitivity obtained from clinical pelvimetry was 33.3% and related to diagonal conjugate less than 11.5 cm. The sensitivity of external pelvic dimensions was higher than clinical pelvimetry that was highest for the Michaelis transverse diameter(60.72%. Conclusion: External pelvimetry in comparison to clinical pelvimetry is a better method for identifying dystocia in nulliparous women and can replace clinical pelvimetry in antenatal care programs.

  6. Correlations of third-trimester hiatal biometry obtained using our-dimensional translabial ultrasonography with the delivery route in nulliparous pregnant women

    Energy Technology Data Exchange (ETDEWEB)

    Temtanakitpaisan, Teerayut [Dept. of Obstetrics and Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen (Thailand); Chantarason, Varisara [Dept. of Obstetrics and Gynaecology, Bumrungrad Hospital, Bangkok (Thailand); Bunyavejchevin, Suvit [Dept. of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok (Thailand)

    2016-01-15

    The goal of this study was to evaluate normal hiatal dimensions in the third trimester in nulliparous Thai pregnant women and to establish which biometric factors were associated with various pregnancy outcomes. Fifty-seven consecutive nulliparous pregnant Thai women in their third trimester were recruited on a voluntary basis from April to October 2014. All subjects underwent four-dimensional (4D) translabial ultrasonography. Hiatal biometric parameters were measured at rest, while performing a Valsalva maneuver, and during contraction. Information about the patients’ eventual deliveries was obtained from their medical records. The mean values of the patients’ age, body mass index, and gestational age at the time of examination were 27.4±5.47 years, 26.7±3.48 kg/m{sup 2}, and 36.6±1.49 weeks, respectively. No subjects had vaginal lumps or experienced prolapse greater than stage 1 of the Pelvic Organ Prolapse Quantification system. Ultrasonography showed that the mean values of the hiatal area at rest, while performing a Valsalva maneuver, and during contraction were 13.10±2.92 cm{sup 2}, 17.50±4.81 cm{sup 2}, and 9.69±2.09 cm{sup 2}, respectively. The hiatal area at rest, the axial measurement at rest, and the axial measurement while performing a Valsalva maneuver were significantly associated with the route of delivery (P=0.02, P=0.04, and P=0.03, respectively). The route of delivery was associated with hiatal biometric values measured using 4D translabial ultrasonography, based on the results of nulliparous Thai women in the third trimester.

  7. Correlations of third-trimester hiatal biometry obtained using our-dimensional translabial ultrasonography with the delivery route in nulliparous pregnant women

    International Nuclear Information System (INIS)

    Temtanakitpaisan, Teerayut; Chantarason, Varisara; Bunyavejchevin, Suvit

    2016-01-01

    The goal of this study was to evaluate normal hiatal dimensions in the third trimester in nulliparous Thai pregnant women and to establish which biometric factors were associated with various pregnancy outcomes. Fifty-seven consecutive nulliparous pregnant Thai women in their third trimester were recruited on a voluntary basis from April to October 2014. All subjects underwent four-dimensional (4D) translabial ultrasonography. Hiatal biometric parameters were measured at rest, while performing a Valsalva maneuver, and during contraction. Information about the patients’ eventual deliveries was obtained from their medical records. The mean values of the patients’ age, body mass index, and gestational age at the time of examination were 27.4±5.47 years, 26.7±3.48 kg/m 2 , and 36.6±1.49 weeks, respectively. No subjects had vaginal lumps or experienced prolapse greater than stage 1 of the Pelvic Organ Prolapse Quantification system. Ultrasonography showed that the mean values of the hiatal area at rest, while performing a Valsalva maneuver, and during contraction were 13.10±2.92 cm 2 , 17.50±4.81 cm 2 , and 9.69±2.09 cm 2 , respectively. The hiatal area at rest, the axial measurement at rest, and the axial measurement while performing a Valsalva maneuver were significantly associated with the route of delivery (P=0.02, P=0.04, and P=0.03, respectively). The route of delivery was associated with hiatal biometric values measured using 4D translabial ultrasonography, based on the results of nulliparous Thai women in the third trimester.

  8. Correlations of third-trimester hiatal biometry obtained using four-dimensional translabial ultrasonography with the delivery route in nulliparous pregnant women

    Directory of Open Access Journals (Sweden)

    Teerayut Temtanakitpaisan

    2016-01-01

    Full Text Available Purpose: The goal of this study was to evaluate normal hiatal dimensions in the third trimester in nulliparous Thai pregnant women and to establish which biometric factors were associated with various pregnancy outcomes. Methods: Fifty-seven consecutive nulliparous pregnant Thai women in their third trimester were recruited on a voluntary basis from April to October 2014. All subjects underwent four-dimensional (4D translabial ultrasonography. Hiatal biometric parameters were measured at rest, while performing a Valsalva maneuver, and during contraction. Information about the patients’ eventual deliveries was obtained from their medical records. Results: The mean values of the patients’ age, body mass index, and gestational age at the time of examination were 27.4±5.47 years, 26.7±3.48 kg/m2, and 36.6±1.49 weeks, respectively. No subjects had vaginal lumps or experienced prolapse greater than stage 1 of the Pelvic Organ Prolapse Quantification system. Ultrasonography showed that the mean values of the hiatal area at rest, while performing a Valsalva maneuver, and during contraction were 13.10±2.92 cm2, 17.50±4.81 cm2, and 9.69±2.09 cm2, respectively. The hiatal area at rest, the axial measurement at rest, and the axial measurement while performing a Valsalva maneuver were significantly associated with the route of delivery (P=0.02, P=0.04, and P=0.03, respectively. Conclusion: The route of delivery was associated with hiatal biometric values measured using 4D translabial ultrasonography, based on the results of nulliparous Thai women in the third trimester.

  9. 40 CFR 266.109 - Low risk waste exemption.

    Science.gov (United States)

    2010-07-01

    ... MANAGEMENT FACILITIES Hazardous Waste Burned in Boilers and Industrial Furnaces § 266.109 Low risk waste exemption. (a) Waiver of DRE standard. The DRE standard of § 266.104(a) does not apply if the boiler or... 99.9 percent destruction and removal efficiency. That is, assume that 0.1 percent of the mass weight...

  10. Contemporary management of low-risk bladder cancer

    NARCIS (Netherlands)

    Falke, J.; Witjes, J.A.

    2011-01-01

    Bladder cancer comprises a heterogeneous group of tumors, the majority of which are non-muscle-invasive bladder cancer (NMIBC) at initial presentation. Low-risk bladder cancer--defined as pTa low-grade papillary tumors--is the type of NMIBC with the most favorable oncologic outcome. Although the

  11. Adult Attachment Styles Associated with Brain Activity in Response to Infant Faces in Nulliparous Women: An Event-Related Potentials Study.

    Science.gov (United States)

    Ma, Yuanxiao; Ran, Guangming; Chen, Xu; Ma, Haijing; Hu, Na

    2017-01-01

    Adult attachment style is a key for understanding emotion regulation and feelings of security in human interactions as well as for the construction of the caregiving system. The caregiving system is a group of representations about affiliative behaviors, which is guided by the caregiver's sensitivity and empathy, and is mature in young adulthood. Appropriate perception and interpretation of infant emotions is a crucial component of the formation of a secure attachment relationship between infant and caregiver. As attachment styles influence the ways in which people perceive emotional information, we examined how different attachment styles associated with brain response to the perception of infant facial expressions in nulliparous females with secure, anxious, and avoidant attachment styles. The event-related potentials of 65 nulliparous females were assessed during a facial recognition task with joy, neutral, and crying infant faces. The results showed that anxiously attached females exhibited larger N170 amplitudes than those with avoidant attachment in response to all infant faces. Regarding the P300 component, securely attached females showed larger amplitudes to all infant faces in comparison with avoidantly attached females. Moreover, anxiously attached females exhibited greater amplitudes than avoidantly attached females to only crying infant faces. In conclusion, the current results provide evidence that attachment style differences are associated with brain responses to the perception of infant faces. Furthermore, these findings further separate the psychological mechanisms underlying the caregiving behavior of those with anxious and avoidant attachment from secure attachment.

  12. Adult Attachment Styles Associated with Brain Activity in Response to Infant Faces in Nulliparous Women: An Event-Related Potentials Study

    Directory of Open Access Journals (Sweden)

    Xu Chen

    2017-04-01

    Full Text Available Adult attachment style is a key for understanding emotion regulation and feelings of security in human interactions as well as for the construction of the caregiving system. The caregiving system is a group of representations about affiliative behaviors, which is guided by the caregiver’s sensitivity and empathy, and is mature in young adulthood. Appropriate perception and interpretation of infant emotions is a crucial component of the formation of a secure attachment relationship between infant and caregiver. As attachment styles influence the ways in which people perceive emotional information, we examined how different attachment styles associated with brain response to the perception of infant facial expressions in nulliparous females with secure, anxious, and avoidant attachment styles. The event-related potentials of 65 nulliparous females were assessed during a facial recognition task with joy, neutral, and crying infant faces. The results showed that anxiously attached females exhibited larger N170 amplitudes than those with avoidant attachment in response to all infant faces. Regarding the P300 component, securely attached females showed larger amplitudes to all infant faces in comparison with avoidantly attached females. Moreover, anxiously attached females exhibited greater amplitudes than avoidantly attached females to only crying infant faces. In conclusion, the current results provide evidence that attachment style differences are associated with brain responses to the perception of infant faces. Furthermore, these findings further separate the psychological mechanisms underlying the caregiving behavior of those with anxious and avoidant attachment from secure attachment.

  13. Determinants of low risk of asthma exacerbation during pregnancy

    DEFF Research Database (Denmark)

    Ali, Z; Nilas, L; Ulrik, C S

    2018-01-01

    of Asthma during Pregnancy (MAP) programme at Hvidovre Hospital since 2007. Assessment of asthma control, adjustment of treatment, spirometry and measurement of exhaled nitric oxide (FENO) were performed, and baseline characteristics and exacerbation history were collected at enrolment. Determinants of low......: Clinically stable asthma at enrolment, together with no history of previous exacerbations and no prescribed controller medication, is a determinant of low risk of an asthma exacerbation during pregnancy, which may guide clinicians in individualizing surveillance of asthma during pregnancy.......BACKGROUND: Assessment of asthma control every 4-6 weeks during pregnancy is recommended to reduce risk of exacerbation, and by that improve outcome. OBJECTIVE: To identify determinants of pregnancies with low risk of asthma exacerbation. METHODS: All pregnant women enrolled into the Management...

  14. Remifentanil analgesia during external cephalic version for breech presentation in nulliparous women at term

    Science.gov (United States)

    Wang, Zhi-Hong; Yang, Yi; Xu, Gui-Ping

    2017-01-01

    Abstract Background: The aim of the study was to assess the efficacy and safety of remifentanil for pain relief during external cephalic version (ECV) for breech presentation in nulliparous women at term. Methods: A total of 144 nulliparous women with singleton breech presentation were randomly divided into the intervention group and the placebo group, with 72 subjects in each group. The subjects in the intervention group received remifentanil (infused at 0.1 μg kg–1 min–1 with demand boluses of 0.1 μg/kg), whereas those in the placebo group were given saline placebo. This study was conducted from May 2013 to April 2016. The outcomes measures include pain (measured with the visual analog scale, VAS), success rate of ECV, maternal satisfaction for ECV, and adverse events. Results: A total of 137 participants completed the study. The intervention with remifentanil showed greater efficacy than did placebo in decreasing the VAS score immediately after ECV (intervention group 4.3 ± 2.2 vs placebo group 6.4 ± 2.5, P < 0.01). A significant difference in the ECV success rate was also found between the 2 groups (intervention group 56.9% vs placebo group 38.9%, P = 0.03). In addition, a significant difference in the satisfaction score was also detected (intervention group 9.3 ± 0.9 vs placebo group 6.7 ± 1.2, P < 0.01). The observed adverse events were similar between the 2 groups. Conclusion: This study shows that remifentanil could decrease pain, improve the ECV success rate, and improve satisfaction in nulliparous women at term during the period of ECV. Furthermore, it is also well tolerated with few adverse events. PMID:28296735

  15. Caesarean section on maternal request: risks and benefits in healthy nulliparous women and their infants.

    Science.gov (United States)

    Dahlgren, Leanne S; von Dadelszen, Peter; Christilaw, Jan; Janssen, Patricia A; Lisonkova, Sarka; Marquette, Gerald P; Liston, Robert M

    2009-09-01

    To determine the risks and benefits of an elective Caesarean section (CS) at term in healthy nulliparous women. We conducted a population-based cohort study of deliveries between 1994 and 2002. Using bivariate and multivariable techniques, we compared maternal and neonatal outcomes in healthy nulliparous women who had undergone elective pre-labour CS (using breech presentation as a surrogate) with those in women who had undergone spontaneous labour with anticipated vaginal delivery (SL) at full term. There were 1046 deliveries in the pre-labour CS group and 38 021 in the SL group. Life-threatening maternal morbidity was similar in each group. Life-threatening neonatal morbidity was decreased in the CS group (RR 0.34; 99% CI 0.12 to 0.97). Subgroup analysis of the SL group by mode of delivery demonstrated the increased neonatal risk was associated with operative vaginal delivery and intrapartum CS but not spontaneous vaginal delivery. An elective pre-labour Caesarean section in a nulliparous woman at full term decreased the risk of life-threatening neonatal morbidity compared with spontaneous labour with anticipated vaginal delivery. However, the 63% of women with spontaneous labour who achieved a spontaneous vaginal delivery would not have benefited from delivery by Caesarean section. Further research is needed to better identify women with an increased likelihood of an operative vaginal or intrapartum Caesarean section, as this may assist maternity caregivers in decision-making about childbirth. Further research is also needed to determine if these findings can be confirmed in a prospective study.

  16. Effect of Guided Imagery on Maternal Fetal Attachment in Nulliparous Women with Unplanned Pregnancy

    Directory of Open Access Journals (Sweden)

    Masoumeh Kordi

    2016-10-01

    Full Text Available Introduction and Objectives: Nulliparous women with unplanned pregnancy experience high levels of anxiety, which may adversely affect maternal-fetal attachment. Therefore, in this study, we aimed to determine the effect of guided imagery on maternal-fetal attachment in nulliparous women with unplanned pregnancy. Materials and Methods: In this clinical trial, 67 nulliparous women with unplanned pregnancy were randomly divided into two groups of intervention (n=35 and control (n=32 in 2015. Data collection tools included a demographic form and London, DASS 21, and Cranley's maternal-fetal attachment questionnaires. In the intervention group, one session of guided imagery on maternal role was performed in 34th week of pregnancy in groups of four to seven. Afterwards, guided imagery CDs were given to mothers to be performed at home twice a week for two weeks; the control group only received the routine care. Maternal-fetal attachment was assessed before and two weeks after the intervention. To analyze the data, independent t-test, paired t-test, Chi-squared, Fisher’s exact test, and Mann-Whitney U tests were run using SPSS version 21. Results: Maternal mean age was 24.1±4.3 years, and most mothers (49.3% had high school education. Mean score of maternal-fetal attachment was significantly different between the intervention (94.26±6.7 and control (90.22 ± 9.5 groups after the intervention (P=0.04. Also, there was a significant difference between mean score of maternal-fetal attachment at the beginning and end of the intervention in the intervention and control groups (5.86±7.2 vs. 1.72±3.2; P=0.004. Conclusion: Guided imagery promoted maternal-fetal attachment in women with unplanned pregnancy; thus, it is recommended to use this method in prenatal care for these women.

  17. Risk factors for preterm birth in an international prospective cohort of nulliparous women.

    Directory of Open Access Journals (Sweden)

    Gustaaf Albert Dekker

    Full Text Available OBJECTIVES: To identify risk factors for spontaneous preterm birth (birth <37 weeks gestation with intact membranes (SPTB-IM and SPTB after prelabour rupture of the membranes (SPTB-PPROM for nulliparous pregnant women. DESIGN: Prospective international multicentre cohort. PARTICIPANTS: 3234 healthy nulliparous women with a singleton pregnancy, follow up was complete in 3184 of participants (98.5%. RESULTS: Of the 3184 women, 156 (4.9% had their pregnancy complicated by SPTB; 96 (3.0% and 60 (1.9% in the SPTB-IM and SPTB-PPROM categories, respectively. Independent risk factors for SPTB-IM were shorter cervical length, abnormal uterine Doppler flow, use of marijuana pre-pregnancy, lack of overall feeling of well being, being of Caucasian ethnicity, having a mother with diabetes and/or a history of preeclampsia, and a family history of low birth weight babies. Independent risk factors for SPTB-PPROM were shorter cervical length, short stature, participant's not being the first born in the family, longer time to conceive, not waking up at night, hormonal fertility treatment (excluding clomiphene, mild hypertension, family history of recurrent gestational diabetes, and maternal family history of any miscarriage (risk reduction. Low BMI (<20 nearly doubled the risk for SPTB-PPROM (odds ratio 2.64; 95% CI 1.07-6.51. The area under the receiver operating characteristics curve (AUC, after internal validation, was 0.69 for SPTB-IM and 0.79 for SPTB-PPROM. CONCLUSION: The ability to predict PTB in healthy nulliparous women using clinical characteristics is modest. The dissimilarity of risk factors for SPTB-IM compared with SPTB-PPROM indicates different pathophysiological pathways underlie these distinct phenotypes. TRIAL REGISTRATION: ACTR.org.au ACTRN12607000551493.

  18. Home cervical ripening with dinoprostone gel in nulliparous women with singleton pregnancies.

    Science.gov (United States)

    Stock, Sarah J; Taylor, Rebecca; Mairs, Rebecca; Azaghdani, Abdulhamid; Hor, Kahyee; Smith, Imogen; Dundas, Kirsty; Kissack, Chris; Norman, Jane E; Denison, Fiona

    2014-08-01

    To evaluate whether home cervical ripening is safe and results in shorter hospital stay. This was a retrospective cohort study of women with singleton pregnancies having induction of labor for postmaturity at a single center between January 2007 and June 2010. Women were offered home cervical ripening with 1 mg dinoprostone gel if they were nulliparous, had uncomplicated singleton pregnancies, and the indication for induction was postmaturity. Nine hundred seven of 1,536 (59.1%) nulliparous women having induction of labor for postmaturity were eligible for home cervical ripening. The median number of hours at home was 11.76 hours (range 0-24.82 hours). There were no cases of birth outside of the hospital, uterine rupture, or significant neonatal morbidity or neonatal death related to home cervical ripening. Eighty-five (5.5%) women who underwent hospital cervical ripening because of maternal preference or social issues formed a hospital cervical ripening comparison group. There was no significant difference in the total number of hours before delivery spent in the hospital between the two groups (26.25; 95% confidence interval [CI] 25.27-27.23 in home cervical ripening group compared with 24.28; 95% CI 22.5-26.0 in the hospital group; P=.26). Clinical outcomes are comparable in nulliparous women who receive a single dose of dinoprostone gel for home cervical ripening compared with those who undergo hospital cervical ripening. However, preadmission home cervical ripening with 1 mg dinoprostone does not decrease the number of hours women spend in the hospital. II.

  19. Characteristics of high- and low-risk individuals in the PRIORITY study

    DEFF Research Database (Denmark)

    Tofte, N; Lindhardt, M; Adamova, K

    2018-01-01

    variable. In a logistic regression model including clinical variables known to be associated with diabetic kidney disease, estimated GFR, gender, log urinary albumin:creatinine ratio and use of renin-angiotensin system-blocking agents remained significant determinants of the CKD273 high-risk group: area......AIM: To compare clinical baseline data in individuals with Type 2 diabetes and normoalbuminuria, who are at high or low risk of diabetic kidney disease based on the urinary proteomics classifier CKD273. METHODS: We conducted a prospective, randomized, double-blind, placebo-controlled international...... multicentre clinical trial and observational study in participants with Type 2 diabetes and normoalbuminuria, stratified into high- or low-risk groups based on CKD273 score. Clinical baseline data for the whole cohort and stratified by risk groups are reported. The associations between CKD273 and traditional...

  20. Determinants for hospitalization in " low-risk" community acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Aliyu Muktar H

    2003-06-01

    Full Text Available Abstract Background A variable decision in managing community acquired pneumonia (CAP is the initial site of care; in-patient versus outpatient. These variations persist despite comprehensive practice guidelines. Patients with a Pneumonia Severity Index (PSI score lower than seventy have low risk for complications and outpatient antibiotic management is recommended in this group. These patients are generally below the age of fifty years, non-nursing home residents, HIV negative and have no major cardiac, hepatic, renal or malignant diseases. Methods A retrospective analysis of 296 low-risk CAP patients evaluated within a year one period at St. Agnes Hospital, Baltimore, Maryland was undertaken. All patients were assigned a PSI score. 208 (70% were evaluated and discharged from the emergency department (E.D. to complete outpatient antibiotic therapy, while 88 (30% were hospitalized. Patients were sub-stratified into classes I-V according to PSI. A comparison of demographic, clinical, social and financial parameters was made between the E.D. discharged and hospitalized groups. Results Statistically significant differences in favor of the hospitalized group were noted for female gender (CI: 1.46-5.89, p= 0.0018, African Americans (CI: 0.31-0.73, p= 0.004, insurance coverage (CI: 0.19-0.63, p= 0.0034, temperature (CI: 0.04-0.09, p= 0.0001 and pulse rate (CI: 0.03-0.14, p= 0.0001. No statistically significant differences were observed between the two groups for altered mental status, hypotension, tachypnea, laboratory/radiological parameters and social indicators (p>0.05. The average length of stay for in-patients was 3.5 days at about eight time's higher cost than outpatient management. There was no difference in mortality or treatment failures between the two groups. The documentation rate and justifications for hospitalizing low risk CAP patients by admitting physicians was less than optimal. Conclusions High fever, tachycardia, female gender

  1. [Clinical guideline for management of patients with low risk differentiated thyroid carcinoma].

    Science.gov (United States)

    Díez, Juan José; Oleaga, Amelia; Álvarez-Escolá, Cristina; Martín, Tomás; Galofré, Juan Carlos

    2015-01-01

    Incidence of thyroid cancer is increasing in Spain and worldwide. Overall thyroid cancer survival is very high, and stratification systems to reliably identify patients with worse prognosis have been developed. However, marked differences exist between the different specialists in clinical management of low-risk patients with thyroid carcinoma. Almost half of all papillary thyroid carcinomas are microcarcinomas, and 90% are tumors < 2 cm that have a particularly good prognosis. However, they are usually treated more aggressively than needed, despite the lack of adequate scientific support. Surgery remains the gold standard treatment for these tumors. However, lobectomy may be adequate in most patients, without the need for total thyroidectomy. Similarly, prophylactic lymph node dissection of the central compartment is not required in most cases. This more conservative approach prevents postoperative complications such as hypoparathyroidism or recurrent laryngeal nerve injury. Postoperative radioiodine remnant ablation and strict suppression of serum thyrotropin, although effective for the more aggressive forms of thyroid cancer, have not been shown to be beneficial for the treatment of low risk patients, and may impair their quality of life. This guideline provides recommendations from the task force on thyroid cancer of the Spanish Society of Endocrinology and Nutrition for adequate management of patients with low-risk thyroid cancer. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

  2. Carbetocin versus oxytocin for prevention of postpartum hemorrhage in obese nulliparous women undergoing emergency cesarean delivery.

    Science.gov (United States)

    El Behery, Manal M; El Sayed, Gamal Abbas; El Hameed, Azza A Abd; Soliman, Badeea S; Abdelsalam, Walid A; Bahaa, Abeer

    2016-01-01

    To assess and compare the effectiveness and safety of single IV polus dose of carbetocin, versus IV oxytocin infusion in the prevention of PPH in obese nulliparous women undergoing emergency Cesarean Delivery. A double-blinded randomized-controlled trial was conducted on 180 pregnant women with BMI >30. Women were randomized to receive either oxytocin or carbetocin during C.S. The primary outcome measure was major primary PPH >1000 ml within 24 h of delivery as per the definition of PPH by the World Health Organization Secondary outcome measures were hemoglobin and hematocrit changes pre- and post-delivery, use of further ecobolics, uterine tone 2 and 12-h postpartum and adverse effects. A significant difference in the amount of estimated blood loss or the incidence of primary postpartum haemorrhage (>1000 ml) in both groups. Haemoglobin levels before and 24-h postpartum was similar. None from the carbetocin group versus 71.5% in oxytocin group needed additional utrotonics (p postpartum (p oxytocin infusion for maintaining adequate uterine tone and preventing postpartum bleeding in obese nulliparous women undergoing emergency cesarean delivery, both has similar safety profile and minor hemodynamic effect.

  3. Maternal obesity and its effect on labour duration in nulliparous women

    DEFF Research Database (Denmark)

    Ellekjaer, Karen Louise; Bergholt, Thomas; Løkkegaard, Ellen

    2017-01-01

    BACKGROUND: Obesity is increasing among primipara women. We aimed to describe the association between body mass index (BMI) during early-pregnancy and duration of labour in nulliparous women. METHODS: Retrospective observational cohort study of 1885 nulliparous women with a single cephalic......), overweight (BMI 25-29.9 kg/m2), and obese (BMI ≥30 kg/m2) women. Proportional hazards and multiple logistic regression models were applied. RESULTS: Early pregnancy BMI classified 1246 (66.1%) women as normal weight, 350 (18.6%) as overweight and 203 (10.8%) as obese. No difference in the duration of total...... or first stage of active labour was found for overweight (adjusted HR = 1.01, 95% CI 0.88-1.16) or obese (adjusted HR = 1.07, 95% CI 0.90-1.28) compared to normal weight women. Median active labour duration was 5.83 h for normal weight, 6.08 h for overweight and 5.90 h for obese women. The risk...

  4. The Relationship between Happiness and Fear of Childbirth in Nulliparous Women

    Directory of Open Access Journals (Sweden)

    Farnaz Sadat Seyed Ahmadi Nejad

    2017-10-01

    Full Text Available Background & aim: Happiness is a mental or emotional state of well-being. Happy individuals tend to interpret and process feeling in a positive way. Accordingly, the response to the pain may alter due to the effects of subjective elements on the pain perception. This study aimed to evaluate the relationship between the level of contentment and fear of childbirth (FOC in nulliparous women referring to the healthcare centers of Mashhad, Iran. Methods: This cross-sectional study was conducted on 370 nulliparous women who were selected through multistage sampling method from urban healthcare centers in Mashhad, Iran, 2014. Data collected using demographic and obstetric questionnaire, Oxford Happiness Questionnaire, and Childbirth Attitude Questionnaire (CAQ (an instrument for measuring the FOC. Data analyzed using Kolmogorov-Smirnov, one-way analysis of variance (ANOVA, independent samples t-test, regression, Kruskal-Wallis, Chi-square, Tukey honest significant difference (HSD, Mann-Whitney U, and Spearman and Pearson correlation coefficient tests with SPSS software version 11.5. Results: The mean levels of happiness and FOC were 123.97±18.82 and 45.80±7.57, respectively. There was a significant correlation between happiness and FOC (P

  5. Obstetric risk indicators for labour dystocia in nulliparous women: A multi-centre cohort study

    Science.gov (United States)

    Kjærgaard, Hanne; Olsen, Jørn; Ottesen, Bent; Nyberg, Per; Dykes, Anna-Karin

    2008-01-01

    Background In nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors for dystocia often do not provide diagnostic criteria for the diagnosis. The aim of the present study was to identify obstetric and clinical risk indicators of dystocia defined by strict and explicit criteria. Methods A multi-centre population based cohort study with prospectively collected data from 2810 nulliparous women in term spontaneous labour with a singleton infant in cephalic presentation. Data were collected by self-administered questionnaires and clinical data-records. Logistic regression analyses were used to estimate adjusted Odds Ratios (OR) and 95% confidence intervals (CI) are given. Results The following characteristics, present at admission to hospital, were associated with dystocia during labour (OR, 95% CI): dilatation of cervix dystocia. Conclusion Vaginal examinations at admission provide useful information on risk indicators for dystocia. The strongest risk indicator was use of epidural analgesia and if part of that is causal, it is of concern. PMID:18837972

  6. Obstetric risk indicators for labour dystocia in nulliparous women: A multi-centre cohort study

    Directory of Open Access Journals (Sweden)

    Ottesen Bent

    2008-10-01

    Full Text Available Abstract Background In nulliparous women dystocia is the most common obstetric problem and its etiology is largely unknown. The frequency of augmentation and cesarean delivery related to dystocia is high although it is not clear if a slow progress justifies the interventions. Studies of risk factors for dystocia often do not provide diagnostic criteria for the diagnosis. The aim of the present study was to identify obstetric and clinical risk indicators of dystocia defined by strict and explicit criteria. Methods A multi-centre population based cohort study with prospectively collected data from 2810 nulliparous women in term spontaneous labour with a singleton infant in cephalic presentation. Data were collected by self-administered questionnaires and clinical data-records. Logistic regression analyses were used to estimate adjusted Odds Ratios (OR and 95% confidence intervals (CI are given. Results The following characteristics, present at admission to hospital, were associated with dystocia during labour (OR, 95% CI: dilatation of cervix Conclusion Vaginal examinations at admission provide useful information on risk indicators for dystocia. The strongest risk indicator was use of epidural analgesia and if part of that is causal, it is of concern.

  7. The Effectiveness of Counseling in Reducing Anxiety Among Nulliparous Pregnant Women

    Directory of Open Access Journals (Sweden)

    Parisa Parsa

    2017-03-01

    Full Text Available Objective: To determine the effectiveness of counseling in reducing anxiety of nulliparous pregnant women.Materials and methods: In this quasi-experimental study, 110 nulliparous pregnant women were selected out of all pregnant women referring to Fatemieh Hospital in Hamadan, Iran. Then, the subjects were divided into two groups in experimental and control (55 women in each. The data were collected through a questionnaire covering demographic and obstetric characteristics and Spielberger’s State-Trait Anxiety Inventory. The experimental group participated in four weekly sessions of group counseling about mother-infant attachment behaviors. Whereas, the control group only receive routine cares. Two groups were compared in terms of anxiety before and after the study.Results: Before the intervention, no significant difference in anxiety level was observed between the two groups; however, state and trait anxiety levels of pregnant women in the experimental group significantly decreased after the intervention (p < 0.001. There was also significant difference in the mean score of state and trait anxiety levels between the two groups after the intervention (p < 0.001.Conclusion: The results showed the effectiveness of prenatal counseling in reducing state and trait anxiety levels of pregnant women. 

  8. Comparison between visual and computerized cardiotocography in low risk pregnancy

    International Nuclear Information System (INIS)

    Mirghani, Hisham M.; Khair, Howaida

    2005-01-01

    To compare between visual and computerized cardiotocography (cCTG) in low-risk pregnant women in predicting pregnancy outcome. One hundred and fifty-three consecutive computerized fetal heart tracings were recorded from non-laboring pregnant women at >/- 30 weeks gestation. All traces were reviewed by 2 experienced obstetricians. The study was carried out at Al-Ain Medical District, United Arab Emirates, between August 2004 and December 2004. Of the 153 pregnant women, 11 (7.2%) were delivered by cesarean section. The interobserver agreement was 0.60. The observers cCTG agreement were 0.48 and 0.45. The difference in cesarean section rate was not statistically significant. Observers interpretation and cCTG did not correlate well with Apgar score at 5 minutes and admission to special care baby unit. Computerized CTG has little advantage over conventional CTG in the prediction of Apgar score and need for neonatal intensive care unit admission in a low-risk population. (author)

  9. The Use of Episiotomy in a Low-Risk Population in The Netherlands : A Secondary Analysis

    NARCIS (Netherlands)

    Seijmonsbergen-Schermers, A. E.; Geerts, C. C.; Prins, M.; van Diem, M. T.; Klomp, T.; Lagro-Janssen, A. L. M.

    2013-01-01

    Background: To examine the episiotomy incidence and determinants and outcomes associated with its use in primary care midwifery practices. Methods: Secondary analysis of two prospective cohort studies (n=3,404). Results: The episiotomy incidence was 10.8 percent (20.9% for nulliparous and 6.3% for

  10. ROLE OF MESH REPAIR IN PELVIC ORGAN PROLAPSE, WITH PARTICULAR REFERENCE TO VAULT PROLAPSE & NULLIPAROUS PROLAPSE

    Directory of Open Access Journals (Sweden)

    Geeta Vandana Reddi

    2017-12-01

    Full Text Available BACKGROUND Pelvic organ prolapse is a common complaint in gynaecological practice. Nulliparous prolapse is seen in 2% of female population and vault prolapse in 0.5% following hysterectomy. Various surgical procedures have been described for the repair of vault prolapse e.g. transvaginal sacrospinous colpopexy, transabdominal sacral colpopexy, Le Forte's operation, colpoclesis, posterior intravaginal sling plasty etc. The introduction of synthetic mesh like Prolene, Mersilene for the repair of vault prolapse have the advantage of tensile strength. In nulliparous prolapse and uterovaginal prolapse also, the supports of uterus are weakened, so there seems to be a definite advantage of mesh repair over sling surgeries. MATERIALS AND METHODS A prospective study done in 50 patients with vault prolapse, Nulliparous prolapse and patients with UV prolapse who want to retain their menstrual and reproductive function were identified and repair of defects were done. 2 cases who underwent both hysterectomy and sacral colpopexy in two sittings were included in the study. They were followed up for a period of 6 weeks - 29 months. RESULTS In the present study, the mean age for vault prolapse was 52.14 years, mean parity was 3.36. Vault prolapses were found to be more common after abdominal hysterectomy 60.97% compared to vaginal 39.02%. Common indication for hysterectomy is pelvic organ prolapse followed by DUB in this study. The mean time between the hysterectomy and vault prolapse in this study was 5.46 years. Importance should be given to proper enterocoele repair and vault suspense time of primary surgery. In this study incidence of smoking in vault prolapse cases was 34.14% significant. In cases of sacral colpopexy for vault prolapse in this study there were no major mesh related complications and the cure rate was 97.5%. So, sacral colpopexy with prolene mesh i.e. abdominal mesh repair can be employed as the primary surgery for vault prolapse. The safety

  11. Selection of low-risk design guidelines for energetic events

    International Nuclear Information System (INIS)

    Ferguson, D.; Marchaterre, J.; Graham, J.

    1982-01-01

    This paper recommends the establishment of specific design guidelines for protection against potential, but low-probability, energetic events. These guidelines recognize the plant protective features incorporated to prevent such events, as well as the inherent capability of the plant to accommodate a certain level of energy release. Further, their application is recommended within the context of necessary standardized and agreed-upon acceptance criteria which are less restrictive than ASME code requirements. The paper provides the background upon which the selection of the design is made, including the characterization of energetic events dependent on various core-design parameters, and including the necessity of a low-risk design balanced between prevention of accidents and the mitigation of consequences

  12. Low-risk diet for colorectal cancer in Italy.

    Science.gov (United States)

    Calza, S; Ferraroni, M; La Vecchia, C; Franceschi, S; Decarli, A

    2001-12-01

    An innovative approach was used to define a low-risk diet for colorectal cancer from a multicentric case-control study of 1953 incident cases and 4154 hospital controls from Italy. A logistic regression model was fitted on the reported intake of five macronutrients, and the estimated coefficients were used to compute a diet-related logistic risk score (LRS). The mean of LRS within risk decile ranged from 0.89 to 1.86. Total energy intake and absolute consumption of each macronutrient increased with increasing LRS. In relative terms, however, starch intake showed an almost threefold increase across subsequent score levels, while a decline was observed for unsaturated fat, sugar and protein. Saturated fat consumption remained fairly stable in relative terms. When food groups were considered, bread and cereals dishes, cakes and desserts and refined sugar were positively associated, while the consumption of vegetables, fruit, fish, poultry and olive oils was inversely associated with LRS.

  13. 38 CFR 41.530 - Criteria for a low-risk auditee.

    Science.gov (United States)

    2010-07-01

    ... low-risk auditee and be eligible for reduced audit coverage in accordance with § 41.520: (a) Single... entity that has biennial audits does not qualify as a low-risk auditee, unless agreed to in advance by... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Criteria for a low-risk...

  14. Sports and leisure time physical activity during pregnancy in nulliparous women

    DEFF Research Database (Denmark)

    Hegaard, Hanne Kristine; Damm, Peter; Hedegaard, Morten

    2011-01-01

    included in the study at gestational week 33 from May 2004 to July 2005. Information was provided by self-administered questionnaires. Leisure time physical activity was categorised into four categories: competitive sport, moderate-to-heavy, light or sedentary. In this population of nulliparous women, 4......% participated in competitive sport, 25% in moderate-to-heavy activities, 66% in light activities, and 5% in sedentary activities in the year prior to pregnancy. Physical activity before pregnancy was statistically significantly associated with age, pre-pregnancy BMI, chronic diseases, number of years at school......, and smoking habits. The proportion of women who took part in competitive sports, and moderate-to-heavy activities decreased over the three trimesters of pregnancy. The proportion of women with light physical activity was stable during pregnancy while the proportion of women with sedentary activity increased...

  15. Early menarche, nulliparity and the risk for premature and early natural menopause.

    Science.gov (United States)

    Mishra, Gita D; Pandeya, Nirmala; Dobson, Annette J; Chung, Hsin-Fang; Anderson, Debra; Kuh, Diana; Sandin, Sven; Giles, Graham G; Bruinsma, Fiona; Hayashi, Kunihiko; Lee, Jung Su; Mizunuma, Hideki; Cade, Janet E; Burley, Victoria; Greenwood, Darren C; Goodman, Alissa; Simonsen, Mette Kildevæld; Adami, Hans-Olov; Demakakos, Panayotes; Weiderpass, Elisabete

    2017-03-01

    Are parity and the timing of menarche associated with premature and early natural menopause? Early menarche (≤11 years) is a risk factor for both premature menopause (final menstrual period, FMP menopause (FMP 40-44 years), a risk that is amplified for nulliparous women. Women with either premature or early menopause face an increased risk of chronic conditions in later life and of early death. Findings from some studies suggest that early menarche and nulliparity are associated with early menopause, however overall the evidence is mixed. Much of the evidence for a direct relationship is hampered by a lack of comparability across studies, failure to adjust for confounding factors and inadequate statistical power. This pooled study comprises 51 450 postmenopausal women from nine observational studies in the UK, Scandinavia, Australia and Japan that contribute to the International collaboration for a Life course Approach to reproductive health and Chronic disease Events (InterLACE). Age at menarche (categorized as ≤11, 12, 13, 14 and 15 or more years) and parity (categorized as no children, one child and two or more children) were exposures of interest. Age at FMP was confirmed by at least 12 months of cessation of menses where this was not the result of an intervention (such as surgical menopause due to bilateral oophorectomy or hysterectomy) and categorized as premature menopause (FMP before age 40), early menopause (FMP 40-44 years), 45-49 years, 50-51 years, 52-53 years and 54 or more years. We used multivariate multinomial logistic regression models to estimate relative risk ratio (RRR) and 95% CI for associations between menarche, parity and age at FMP adjusting for within-study correlation. The median age at FMP was 50 years (interquartile range 48-53 years), with 2% of the women experiencing premature menopause and 7.6% early menopause. Women with early menarche (≤11 years, compared with 12-13 years) were at higher risk of premature menopause (RRR 1

  16. Maternal obesity and its effect on labour duration in nulliparous women: a retrospective observational cohort study.

    Science.gov (United States)

    Ellekjaer, Karen Louise; Bergholt, Thomas; Løkkegaard, Ellen

    2017-07-12

    Obesity is increasing among primipara women. We aimed to describe the association between body mass index (BMI) during early-pregnancy and duration of labour in nulliparous women. Retrospective observational cohort study of 1885 nulliparous women with a single cephalic presentation from 37 0/7 to 42 6/7 weeks of completed gestation and spontaneous or induced labour at Nordsjællands Hospital, University of Copenhagen, Denmark, in 2011 and 2012. Total duration of labour and the first and second stages of labour were compared between early-pregnancy normal-weight (BMI women. Proportional hazards and multiple logistic regression models were applied. Early pregnancy BMI classified 1246 (66.1%) women as normal weight, 350 (18.6%) as overweight and 203 (10.8%) as obese. No difference in the duration of total or first stage of active labour was found for overweight (adjusted HR = 1.01, 95% CI 0.88-1.16) or obese (adjusted HR = 1.07, 95% CI 0.90-1.28) compared to normal weight women. Median active labour duration was 5.83 h for normal weight, 6.08 h for overweight and 5.90 h for obese women. The risk of caesarean delivery increased significantly for overweight and obese compared to normal weight women (odds ratios (OR) 1.62; 95%CI 1.18-2.22 and 1.76; 95%CI 1.20-2.58, respectively). Caesarean deliveries were performed earlier in labour in obese than normal-weight women (HR = 1.80, 95%CI 1.28-2.54). BMI had no significant effect on total duration of active labour. Risk of caesarean delivery increased with increasing BMI. Caesarean deliveries are undertaken earlier in obese women compared to normal weight women following the onset of active labour, shortening the total duration of active labour.

  17. Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, type, and risk factors.

    Science.gov (United States)

    Daly, Deirdre; Clarke, Mike; Begley, Cecily

    2018-03-01

    While many women report urinary incontinence (UI) during pregnancy, associations with pre-pregnancy urinary leakage remain under-explained. We performed a multi-strand prospective cohort study with 860 nulliparous women recruited during pregnancy. Prevalence of any urinary leakage was 34.8% before and 38.7% during pregnancy. Prevalence of UI, leaking urine at least once per month, was 7.2% and 17.7% respectively. Mixed urinary incontinence (MUI) was reported by 59.7% of women before and 58.8% during pregnancy, stress urinary incontinence (SUI) by 22.6% and 37.2%, and urge urinary incontinence (UUI) by 17.7% and 4.0%, respectively. SUI accounted for half (50.0%), MUI for less than half (44.2%), and UUI for 5.8% of new-onset UI in pregnancy. Pre-pregnancy UI was significantly associated with childhood enuresis [adjusted odds ratio (AOR) 2.9, 95% confidence interval (CI) 1.5-5.6, p = 0.001) and a body mass index (BMI) ≥30 kg/m 2 (AOR 4.2, 95% CI 1.9-9.4, p pregnancy BMI was 25-29.99 kg/m 2 (AOR 2.0, 95% CI 1.2-3.5, p = 0.01), and women who leaked urine less than once per month (AOR 2.6, 95% CI 1.6-4.1, p  pregnancy. Considerable proportions of nulliparous women leak urine before and during pregnancy, and most ignore symptoms. Healthcare professionals have several opportunities for promoting continence in all pregnant women, particularly in women with identifiable risk factors. If enquiry about UI, and offering advice on effective preventative and curative treatments, became routine in clinical practice, it is likely that some of these women could become or stay continent.

  18. Diagnostic accuracy of maternal anthropometric measurements as predictors for dystocia in nulliparous women

    Science.gov (United States)

    Alijahan, Rahele; Kordi, Masoumeh; Poorjavad, Munira; Ebrahimzadeh, Saeed

    2014-01-01

    Background: Dystocia is one of the important causes of maternal morbidity and mortality in low-income countries. This study was aimed to determine the diagnostic accuracy of maternal anthropometric measurements as predictors for dystocia in nulliparous women. Materials and Methods: This prospective cohort study was conducted on 447 nulliparous women who referred to Omolbanin hospital. Several maternal anthropometric measurements such as height, transverse and vertical diameters of Michaelis sacral rhomboid area, foot length, head circumference, vertebral and lower limb length, symphysio-fundal height, and abdominal girth were taken in cervical dilatation ≤ 5 cm. Labor progression was controlled by a researcher blind to these measurements. After delivery, the accuracy of individual and combined measurements in prediction of dystocia was analyzed. Dystocia was defined as cesarean section and vacuum or forceps delivery for abnormal progress of labor (cervical dilatation less than 1 cm/h in the active phase for 2 h, and during the second stage, beyond 2 h or fetal head descend less than 1 cm/h). Results: Among the different anthropometric measurements, transverse diameter of the Michaelis sacral rhomboid area ≤9.6 cm, maternal height ≤ 155 cm, height to symphysio-fundal height ratio ≤4.7, lower limb length ≤78 cm, and head circumference to height ratio ≥ 35.05 with accuracy of 81.2%, 68.2%, 65.5%, 63.3%, and 61.5%, respectively, were better predictors. The best predictor was obtained by combination of maternal height ≤155 cm or the transverse diameter of the Michaelis sacral rhomboid area ≤9.6 cm and Johnson's formula estimated fetal weight ≥3255 g, with an accuracy of 90.5%, sensitivity of 70%, and specificity of 93.7%. Conclusions: Combination of other anthropometric measurements and estimated fetal weight with maternal height in comparison to maternal height alone leads to a better predictor for dystocia. PMID:24554954

  19. The Relationship between Mode of Delivery and Sexual Function in Nulliparous Women

    Directory of Open Access Journals (Sweden)

    Aytay Alesheikh

    2016-07-01

    Full Text Available Background & aim: Sexual activity is one of the most important aspects of a marital life. Childbirth is also a major event in the life of women, and the period of postpartum is a time of emotional upheaval. Since women believe that vaginal delivery could negatively affect their sexual function after childbirth, they tend to give birth through caesarean section. Therefore, this study aimed to evaluate the relationship between mode of delivery and sexual function in nulliparous women referred to healthcare centers in Mashhad, Iran. Methods: This correlational study was conducted on 450 nulliparous women, divided into two groups of vaginal delivery and cesarean section in 2014. Suubjects were selected via multistage sampling. Data collection tools included Female Sexual Function Index (FSFI, Depression, Anxiety and Stress scale (DASS-21, and Cassidy social support scale. Data was analyzed in SPSS version 16 using Spearman correlation coefficient and Mann-Whitney test, T-test, ANOVA, and Kruskal-Wallis. Moreover, general linear model was used to control confounding variables, and P-value of less than 0.05 was considered statistically significant. Results: Independent t-test results indicated that mean scores of sexual function in two groups of the study were 26.11±4.36 and 26.38±4.41, respectively, which revealed no statistically significant difference between the groups (P=0.509. Conclusion: No significant difference was observed between the vaginal delivery and caesarean section groups regarding sexual function. Therefore, it seems that cesarean section does not necessarily lead to pleasing sexual relationships in postpartum period compared to vaginal delivery.

  20. Delivery outcomes for nulliparous women at the extremes of maternal age - a cohort study.

    LENUS (Irish Health Repository)

    Vaughan, DA

    2013-06-12

    OBJECTIVE: To examine the associations between extremes of maternal age (≤17 years or ≥40 years) and delivery outcomes. DESIGN: Retrospective cohort study. SETTING: Urban maternity hospital in Ireland. POPULATION: A total of 36 916 nulliparous women with singleton pregnancies who delivered between 2000 and 2011. METHODS: The study population was subdivided into five maternal age groups based on age at first booking visit: ≤17 years, 18-19 years, 20-34 years, 35-39 years and women aged ≥40 years. Logistic regression analyses were performed to examine the associations between extremes of maternal age and delivery outcomes, adjusting for potential confounding factors. MAIN OUTCOME MEASURES: Preterm birth, admission to the neonatal unit, congenital anomaly, caesarean section. RESULTS: Compared with maternal age 20-34 years, age ≤17 years was a risk factor for preterm birth (adjusted odds ratio [adjOR] 1.83, 95% confidence interval [95% CI] 1.33-2.52). Babies born to mothers ≥40 years were more likely to require admission to the neonatal unit (adjOR 1.35, 95% CI 1.06-1.72) and to have a congenital anomaly (adjOR 1.71, 95% CI 1.07-2.76). The overall caesarean section rate in nulliparous women was 23.9% with marked differences at the extremes of maternal age; 10.7% at age ≤17 years (adjOR 0.46, 95% CI 0.34-0.62) and 54.4% at age ≥40 years (adjOR 3.24, 95% CI 2.67-3.94). CONCLUSIONS: Extremes of maternal age need to be recognised as risk factors for adverse delivery outcomes. Low caesarean section rates in younger women suggest that a reduction in overall caesarean section rates may be possible.

  1. Sports and leisure time physical activity during pregnancy in nulliparous women.

    Science.gov (United States)

    Hegaard, Hanne Kristine; Damm, Peter; Hedegaard, Morten; Henriksen, Tine Brink; Ottesen, Bent; Dykes, Anna-Karin; Kjaergaard, Hanne

    2011-08-01

    To describe patterns of leisure time physical activity during pregnancy in relation to pre-pregnancy leisure time physical activity, socio-demographic characteristics, fertility history, and lifestyle factors. 4,718 nulliparous with singleton pregnancy and intended spontaneous vaginal delivery were included in the study at gestational week 33 from May 2004 to July 2005. Information was provided by self-administered questionnaires. Leisure time physical activity was categorised into four categories: competitive sport, moderate-to-heavy, light or sedentary. In this population of nulliparous women, 4% participated in competitive sport, 25% in moderate-to-heavy activities, 66% in light activities, and 5% in sedentary activities in the year prior to pregnancy. Physical activity before pregnancy was statistically significantly associated with age, pre-pregnancy BMI, chronic diseases, number of years at school, and smoking habits. The proportion of women who took part in competitive sports, and moderate-to-heavy activities decreased over the three trimesters of pregnancy. The proportion of women with light physical activity was stable during pregnancy while the proportion of women with sedentary activity increased from 6% to 29%. During the third trimester women performing competitive sports or moderate-to-heavy activities before pregnancy continued to have a higher level of physical activity than women with light activities or sedentary activities before pregnancy. In general the intensity and time spent on exercise decreased during pregnancy. Women with the highest level of exercise prior to pregnancy continued to be the most active during pregnancy. Among women with sedentary activities before pregnancy one-fourth changed to light activity during pregnancy.

  2. Comparing variation in hospital rates of cesarean delivery among low-risk women using 3 different measures.

    Science.gov (United States)

    Armstrong, Joanne C; Kozhimannil, Katy B; McDermott, Patricia; Saade, George R; Srinivas, Sindhu K

    2016-02-01

    This report describes the development of a measure of low-risk cesarean delivery by the Society for Maternal-Fetal Medicine (SMFM). Safely lowering the cesarean delivery rate is a priority for maternity care clinicians and health care delivery systems. Therefore, hospital quality assurance programs are increasingly tracking cesarean delivery rates among low-risk pregnancies. Two commonly used definitions of "low risk" are available, the Joint Commission (JC) and the Agency for Healthcare Research and Quality (AHRQ) measures, but these measures are not clinically comprehensive. We sought to refine the definition of the low-risk cesarean delivery rate to enhance the validity of the metric for quality measurement. We created this refined definition-called the SMFM definition-and compared it to the JC and AHRQ measures using claims-based data from the 2011 Nationwide Inpatient Sample of >863,000 births in 612 hospitals. Using these definitions, we calculated means and interquartile ranges (25th-75th percentile range) for hospital low-risk cesarean delivery rates, stratified by hospital size, teaching status, urban/rural location, and payer mix. Across all hospitals, the mean low-risk cesarean delivery rate was lowest for the SMFM definition (12.65%), but not substantially different from the JC and AHRQ measures (13.12% and 13.29%, respectively). We empirically examined the SMFM definition to ensure its validity and utility. This refined definition performs similarly to existing measures and has the added advantage of clinical perspective, enhanced face validity, and ease of use. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Timing of administration of epidural analgesia and risk of operative delivery in nulliparous women: A case–control randomised study

    Directory of Open Access Journals (Sweden)

    Ipsita Chattopadhyay

    2018-01-01

    Full Text Available >Background and Aim: Epidural analgesia (EA offers an effective form of labour analgesia. The time of administration of EA and its relationship with the mode of delivery is controversial. Our study tried to assess whether early initiation of epidural analgesia influences the obstetric outcome in nulliparous women.Materials and Methods: This was a case control, randomised study which included 60 parturients in spontaneous labour divided into two equal groups, the cases and controls. Cases received EA with 10 mL of 0.125% injection bupivacaine, whereas the control group received a systemic opioid (injection pethidine 100 mg intramuscularly for pain relief. Cases were further divided into parturients receiving EA at a cervical dilatation of 3 cm or less classified as the early epidural group and those receiving EA at 4 cm or more classified as the late epidural group. The modes of delivery for the study population were recorded. Data analysis was done using Wilcoxon two-sample test. P < 0.05 was considered statistically significant.Results: The rate of instrumental vaginal delivery between the early epidural group [95% confidence interval (CI 0.358–10.821; P = 0.43] and late epidural group (95% CI 0.150–6.055; P = 0.96 was not significantly different. The cesarean-delivery rate was also not significantly different between those receiving early EA (P = 0.95 and late EA (P = 0.58 when compared with control group.Conclusion: This study showed no significant difference in the incidence of caesarean or instrumental delivery for women receiving early epidural analgesia when compared with late epidurals or no EA.

  4. Low-risk diet for breast cancer in Italy.

    Science.gov (United States)

    Franceschi, S; La Vecchia, C; Russo, A; Negri, E; Favero, A; Decarli, A

    1997-11-01

    To define a low-risk diet for breast cancer in Italy, a multicentric case-control study of 2569 incident cases of breast cancer and 2588 controls from Italy was analyzed. A logistic regression model was applied to the estimated intake of five macronutrients and used to compute a diet-related risk score (RS). The pattern of macronutrient and food group intake across RS deciles was defined. The mean of diet-related RSs across subsequent risk deciles ranged from 0.83 to 1.44. Total energy intake first decreased slightly, from the first to the second decile, and then increased, mostly in the last three risk deciles. Intake of starch increased in absolute and relative terms, whereas saturated fat intake rose in absolute terms but remained stable as a proportion. A relative decline was observed for unsaturated fat and sugars, with a hint, however, of U-shape effect. From a food group viewpoint, there was a marked increase in the intake of bread and cereal dishes, cakes and desserts, and refined sugar across subsequent deciles, whereas the consumption of vegetables, olive and seed oils, and fruit decreased.

  5. Lack of international consensus in low-risk drinking guidelines.

    Science.gov (United States)

    Furtwaengler, Nina A F F; de Visser, Richard O

    2013-01-01

    To encourage moderate alcohol consumption, many governments have developed guidelines for alcohol intake, guidelines for alcohol consumption during pregnancy and legislation relating to blood alcohol limits when driving. The aim of this study was to determine the degree of international consensus within such guidelines. Official definitions of standard drinks and consumption guidelines were searched for on government websites, including all 27 European Union Member States and countries from all global geographic regions. There was a remarkable lack of agreement about what constitutes harmful or excessive alcohol consumption on a daily basis, a weekly basis and when driving, with no consensus about the ratios of consumption guidelines for men and women. International consensus in low-risk drinking guidelines is an important--and achievable--goal. Such agreement would facilitate consistent labelling of packaged products and could help to promote moderate alcohol consumption. However, there are some paradoxes related to alcohol content labelling and people's use of such information: although clearer information could increase people's capacity to monitor and regulate their alcohol consumption, not all drinkers are motivated to drink moderately or sensibly, and drinkers who intend to get drunk may use alcohol content labelling to select more alcoholic products. © 2012 Australasian Professional Society on Alcohol and other Drugs.

  6. Maternal and Neonatal Outcomes With Early Compared With Delayed Pushing Among Nulliparous Women.

    Science.gov (United States)

    Yee, Lynn M; Sandoval, Grecio; Bailit, Jennifer; Reddy, Uma M; Wapner, Ronald J; Varner, Michael W; Caritis, Steve N; Prasad, Mona; Tita, Alan T N; Saade, George; Sorokin, Yoram; Rouse, Dwight J; Blackwell, Sean C; Tolosa, Jorge E

    2016-11-01

    To describe factors associated with delayed pushing and evaluate the relationship between delayed pushing and perinatal outcomes in nulliparous women with singleton term gestations. This was a secondary analysis of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Assessment of Perinatal Excellence cohort of 115,502 women and their neonates born in 25 U.S. hospitals from 2008 to 2011. Nulliparous women with singleton, cephalic, nonanomalous term births who achieved 10-cm cervical dilation were included. Women in whom pushing was delayed by 60 minutes or greater (delayed group) were compared with those who initiated pushing within 30 minutes (early group). Multivariable regression analyses were used to assess the independent association of delayed pushing with mode of delivery, length of the second stage, and other maternal and perinatal outcomes (significance defined as Ppushing was delayed in 18.4% (n=3,870). Women who were older, privately insured, or non-Hispanic white as well as those who had induction or augmentation of labor, diabetes, or epidural analgesia were more likely to have delayed pushing. Delayed pushing was more common when the second stage began during daytime hours or in hospitals with dedicated 24-hour obstetric anesthesia, although differences were small. After adjusting for differences in baseline and labor characteristics including center, women in the delayed group had longer mean durations of the second stage (191 compared with 84 minutes, Ppushing (86 compared with 76 minutes, Ppushing was associated with greater rates of cesarean delivery (11.2% compared with 5.1%; adjusted odds ratio [OR] 1.86, 95% confidence interval [CI] 1.63-2.12), operative vaginal delivery (adjusted OR 1.26, 95% CI 1.14-1.40), postpartum hemorrhage (adjusted OR 1.43, 95% CI 1.05-1.95), and blood transfusion (adjusted OR 1.51, 95% CI 1.04-2.17). Delayed pushing was not associated with increased odds of adverse neonatal outcomes

  7. Pelvimetry in nulliparous and primiparous women using 3 Tesla magnetic resonance imaging.

    Science.gov (United States)

    Hampel, Franziska; Hallscheidt, Peter; Sohn, Christof; Schlehe, Bettina; Brocker, Kerstin A

    2018-02-21

    To perform pelvimetry in nulliparous and primiparous women using 3 Tesla magnetic resonance imaging (3T MRI). Twenty-five nulliparous volunteers and 25 primiparous women underwent pelvic 3T MRI within one week after vaginal childbirth in a prospective clinical single-center trial. The pelvimetric parameters interspinous distance (ISD), intertuberous distance (ITD), sagittal outlet (SO), obstetric conjugate (OC), and coccygeal curved length (CCL) were adapted from anthropometric measurements as well as from sonographic and computed tomography-based pelvimetry performed on high-resolution T2-weighted images. We compared the results of the two study groups to one another, recent literature and postpartum-diagnosed levator ani muscle (LAM) injuries. The mean values for primipara/nullipara were ISD 107 ± 8.3/105 ± 8.4 mm, ITD 119.8 ± 10.2/118.4 ± 13.1 mm, OC 129.4 ± 10/130.8 ± 6.9 mm, SO 114.3 ± 7.8/112.5 ± 8.9 mm, and CCL 37.3 ± 7.4/39 ± 8 mm. Significant differences (P < 0.05) were found between the results for OC, SO, and CCL (primipara) and ISD, ITD and OC (nullipara) and the values in the literature. No significant difference in pelvimetric values was found between the groups. A significant correlation was found between the pelvimetric parameters and five types of LAM injuries. Two-dimensional 3T MRI combines high-resolution images with objective pelvimetric measurements applicable in a postpartum setting. Our results provide a good foundation for further MRI-based studies evaluating the bony pelvis and its relation to LAM injuries during vaginal childbirth. © 2018 Wiley Periodicals, Inc.

  8. Maternal obesity and postpartum haemorrhage after vaginal and caesarean delivery among nulliparous women at term: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Fyfe Elaine M

    2012-10-01

    Full Text Available Abstract Background Increasing rates of postpartum haemorrhage in developed countries over the past two decades are not explained by corresponding changes in risk factors and conjecture has been raised that maternal obesity may be responsible. Few studies investigating risk factors for PPH have included BMI or investigated PPH risk among nulliparous women. The aim of this study was to determine in a cohort of nulliparous women delivering at term whether overweight and obesity are independent risk factors for major postpartum haemorrhage (PPH ≥1000ml after vaginal and caesarean section delivery. Methods The study population was nulliparous singleton pregnancies delivered at term at National Women’s Hospital, Auckland, New Zealand from 2006 to 2009 (N=11,363. Multivariable logistic regression was adjusted for risk factors for major PPH. Results There were 7238 (63.7% women of normal BMI, 2631 (23.2% overweight and 1494 (13.1% obese. Overall, PPH rates were increased in overweight and obese compared with normal-weight women (n=255 [9.7%], n=233 [15.6%], n=524 [7.2%], p Conclusion Nulliparous obese women have a twofold increase in risk of major PPH compared to women with normal BMI regardless of mode of delivery. Higher rates of PPH among obese women are not attributable to their higher rates of caesarean delivery. Obesity is an important high risk factor for PPH, and the risk following vaginal delivery is emphasised. We recommend in addition to standard practice of active management of third stage of labour, there should be increased vigilance and preparation for PPH management in obese women.

  9. The Effect of Ethnic Variation on the Success of Induced Labour in Nulliparous Women with Postdates Pregnancies

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    Dimitrios Papoutsis

    2016-01-01

    Full Text Available Objective. To identify the potential effect of ethnic variation on the success of induction of labour in nulliparous women with postdates pregnancies. Study Design. This was an observational cohort study of women being induced for postdates pregnancies (≥41 weeks between 2007 and 2013. Women induced for stillbirths and with multiple pregnancies were excluded. The primary objective was to identify the effect of ethnicity on the caesarean section (CS delivery rates in this cohort of women. Results. 1,636 nulliparous women were identified with a mean age of 27.2 years. 95.8% of the women were of White ethnic origin, 2.6% were Asian, and 1.6% were of Black ethnic origin. The CS delivery rate was 24.4% in the total sample. Women of Black ethnic origin had a 3.26 times greater likelihood for CS in comparison to White women, after adjusting for maternal age, BMI, smoking, presence of meconium, use of epidural analgesia, fetal gender, birth weight, and head circumference (adjusted OR = 3.26; 95% CI: 1.31–8.08, p = 0.011. Conclusion. We have found that nulliparous women of Black ethnicity demonstrate an almost threefold increased risk of caesarean section delivery when induced for postdates pregnancy.

  10. The influence of different maternal pushing positions on birth outcomes at the second stage of labor in nulliparous women.

    Science.gov (United States)

    Moraloglu, Ozlem; Kansu-Celik, Hatice; Tasci, Yasemin; Karakaya, Burcu Kısa; Yilmaz, Yasar; Cakir, Ebru; Yakut, Halil Ibrahim

    2017-01-01

    To assess the effects on neonatal and maternal outcomes of different pushing positions during the second stage of labor in nulliparous women. This prospective study included 102 healthy, pregnant, nulliparous women who were randomly allocated to either of two positions: a squatting using bars (n = 51), or a supine position modified to 45 degree of semi-fowler (n = 51) during the second stage of labor. Duration of the second stage of labor, maternal pain, postpartum blood loss, abnormal fetal heart rate patterns that required intervention, and newborn outcomes were compared between the two groups. The trial showed that women who adopted the squatting position using bars experienced a significant reduction in the duration of the second stage of labor; they were less likely to be induced, and their Visual Analog Scale score was lower than those who were allocated the supine position modified to 45 degree of semi-fowler during second stage of labor (p < 0.05). There were no significant differences with regard to postpartum blood loss, neonatal birth weight, Apgar score at one and five minutes, or admission to the Neonatal Intensive Care Unit. In healthy nulliparous women, adopting a squatting position using bars was associated with a shorter second stage of labor, lower Visual Analog Scale score, more satisfaction, and a reduction in oxytocin requirements compared with adopting the supine position. For Turkish women, the squatting position is easy to adopt as it is more appropriate in terms of Turkish social habits and traditions.

  11. Identification of first-stage labor arrest by electromyography in term nulliparous women after induction of labor.

    Science.gov (United States)

    Vasak, Blanka; Graatsma, Elisabeth M; Hekman-Drost, Elske; Eijkemans, Marinus J; Schagen van Leeuwen, Jules H; Visser, Gerard H A; Jacod, Benoit C

    2017-07-01

    Worldwide induction and cesarean delivery rates have increased rapidly, with consequences for subsequent pregnancies. The majority of intrapartum cesarean deliveries are performed for failure to progress, typically in nulliparous women at term. Current uterine registration techniques fail to identify inefficient contractions leading to first-stage labor arrest. An alternative technique, uterine electromyography has been shown to identify inefficient contractions leading to first-stage arrest of labor in nulliparous women with spontaneous onset of labor at term. The objective of this study was to determine whether this finding can be reproduced in induction of labor. Uterine activity was measured in 141 nulliparous women with singleton term pregnancies and a fetus in cephalic position during induced labor. Electrical activity of the myometrium during contractions was characterized by its power density spectrum. No significant differences were found in contraction characteristics between women with induced labor delivering vaginally with or without oxytocin and women with arrested labor with subsequent cesarean delivery. Uterine electromyography shows no correlation with progression of labor in induced labor, which is in contrast to spontaneous labor. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  12. Risk Factors for Excessive Gestational Weight Gain in a Healthy, Nulliparous Cohort

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    Antonia Restall

    2014-01-01

    Full Text Available Objective. Excessive gestational weight gain (GWG is associated with adverse maternal and child outcomes and contributes to obesity in women. Our aim was to identify early pregnancy factors associated with excessive GWG, in a contemporary nulliparous cohort. Methods. Participants in the SCOPE study were classified into GWG categories (“not excessive” versus “excessive” based on pregravid body mass index (BMI using 2009 Institute of Medicine (IOM guidelines. Maternal characteristics and pregnancy risk factors at 14–16 weeks were compared between categories and multivariable analysis controlled for confounding factors. Results. Of 1950 women, 17% gained weight within the recommended range, 74% had excessive and 9% inadequate GWG. Women with excessive GWG were more likely to be overweight (adjOR 2.9 (95% CI 2.2–3.8 or obese (adjOR 2.5 (95% CI 1.8–3.5 before pregnancy compared to women with a normal BMI. Other factors independently associated with excessive GWG included recruitment in Ireland, younger maternal age, increasing maternal birthweight, cessation of smoking by 14–16 weeks, increased nightly sleep duration, high seafood diet, recent immigrant, limiting behaviour, and decreasing exercise by 14–16 weeks. Fertility treatment was protective. Conclusions. Identification of potentially modifiable risk factors for excessive GWG provides opportunities for intervention studies to improve pregnancy outcome and prevent maternal obesity.

  13. Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, and associated risk factors.

    Science.gov (United States)

    Brown, Stephanie J; Donath, Susan; MacArthur, Christine; McDonald, Ellie A; Krastev, Ann H

    2010-02-01

    Few studies have examined associations of prepregnancy urinary incontinence (UI). Multicentre prospective pregnancy cohort study (n = 1,507) using standardised measures to assess frequency and severity of UI. Prevalence of UI increased from 10.8% in the 12 months before the index pregnancy to 55.9% in the third trimester. Stress incontinence (36.9%) and mixed incontinence (13.1%) were more common during pregnancy than urge incontinence alone (5.9%). UI before pregnancy was associated with childhood enuresis (adjusted odds ratio (AdjOR) = 2.4, 95% confidence interval (CI) 1.6-3.4), higher maternal body mass index (AdjOR = 2.3, 95% CI 1.4-3.8), and previous miscarriages or terminations (AdjOR = 1.6, 95% CI 1.1-2.3). The strongest predictor of incident UI in pregnancy was occasional leakage (less than once a month) before pregnancy (AdjOR = 3.6, 95% CI 2.8-4.7). Further research is needed to elucidate the complex interplay of prepregnancy and pregnancy-related factors in the aetiology of UI in nulliparous women.

  14. Prevention of primary caesarean delivery: comprehensive management of dystocia in nulliparous patients at term.

    Science.gov (United States)

    Ragusa, Antonio; Gizzo, Salvatore; Noventa, Marco; Ferrazzi, Enrico; Deiana, Sara; Svelato, Alessandro

    2016-10-01

    Dystocia is the leading indication for primary caesarean sections. Our aim is to compare two approaches in the management of dystocia in labor in nulliparous women with a singleton fetus in cephalic presentation at term in spontaneous or induced labor. Prospective cohort study. Four hundred and nineteen consecutive patients were divided into two groups: the standard management group (SM), in acceleration of labor was commenced at the "action line" in the case of arrested or protracted labor, and the comprehensive management group (CM) in which arrested or protracted labor was considered as a warning sign promoting further diagnostic assessment prior to considering intervention. Caesarean sections rate was 22.2 % in the SM group (216 patients) and 10.3 % in the CM group (203 patients) (p = 0.001). The rate of oxytocin use decreased from 33.3 % in SM group to 13.8 % in the CM group (p dystocia enabled us to achieve a reduction in iatrogenic interventions in labor while maintaining good neonatal outcomes.

  15. High resolution magnetic resonance imaging of urethral anatomy in continent nulliparous pregnant women

    International Nuclear Information System (INIS)

    Preyer, Oliver; Brugger, Peter C.; Laml, Thomas; Hanzal, Engelbert; Prayer, Daniela; Umek, Wolfgang

    2011-01-01

    Introduction: To quantify the distribution of morphologic appearances of urethral anatomy and measure variables of urethral sphincter anatomy in continent, nulliparous, pregnant women by high resolution magnetic resonance imaging (MRI). Materials and methods: We studied fifteen women during their first pregnancy. We defined and quantified bladder neck and urethral morphology on axial and sagittal MR images from healthy, continent women. Results: The mean (±standard deviation) total transverse urethral diameter, anterior–posterior diameter, unilateral striated sphincter muscle thickness, and striated sphincter length were 15 ± 2 mm (range: 12–19 mm), 15 ± 2 mm (range: 11–20 mm), 2 ± 1 mm (range: 1–4 mm), and 13 ± 3 mm (range: 9–18 mm) respectively. The mean (±standard deviation) total urethral length on sagittal scans was 22 ± 3 mm (range: 17.6–26.4 mm). Discussion: Advances in MR technique combined with anatomical and histological findings will provide an insight to understand how changes in urethral anatomy might affect the continence mechanisms in pregnant and non-pregnant, continent or incontinent individuals.

  16. Home birth or short-stay hospital birth in a low risk population in The Netherlands.

    NARCIS (Netherlands)

    Wiegers, T.A.; Zee, J. van der; Kerssens, J.J.; Keirse, M.J.N.C.

    1998-01-01

    In the Netherlands women with low risk pregnancies can choose whether they want to give birth at home or in hospital, under the care of their own primary caregiver. The majority of these women prefer to give birth at home, but over the last few decades an increasing number of low risk women have

  17. Prediction of Small for Gestational Age Infants in Healthy Nulliparous Women Using Clinical and Ultrasound Risk Factors Combined with Early Pregnancy Biomarkers.

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    Lesley M E McCowan

    ultrasound data from a cohort of low-risk nulliparous women achieved modest performance. Incorporation of biomarkers into the models resulted in no improvement in performance of prediction of All-SGA and Normotensive-SGA but a small improvement in prediction of Hypertensive-SGA. Our models currently have insufficient reliability for application in clinical practice however, they have potential utility in two-staged screening tests which include third trimester biomarkers and or fetal biometry.

  18. Mental health help-seeking patterns and perceived barriers for care among nulliparous pregnant women.

    Science.gov (United States)

    Da Costa, Deborah; Zelkowitz, Phyllis; Nguyen, Tuong-Vi; Deville-Stoetzel, Jean-Benoit

    2018-05-30

    This study examined the patterns of consultation with health providers for emotional symptoms and barriers preventing mental health help-seeking among pregnant women. A total of 652 nulliparous women in their third trimester completed an online questionnaire assessing depressed mood, adjustment in their couple relationship, demographics, help-seeking behaviors for emotional problems and barriers to help-seeking in the past year. The prevalence of having consulted with at least one health provider over the past year for emotional symptoms was 20.1% for the entire sample and 32.7% for the subgroup of women reporting elevated depressive symptoms in the third trimester. Women in the 30-39 age range were more likely to discuss their emotional symptoms with a health provider in the past year compared to younger women (OR = 1.6, CI = 1.0, 2.6, p = 0.041). Among women depressed in the third trimester, being White was independently associated with a greater likelihood of having consulted with a health provider about their emotional symptoms (OR = 2.9, CI = 1.4, 6.1, p = 0.005). Barriers to mental help-seeking included not having gotten around to it (46.1%), being too busy (26.1%), deciding not to seek care (24.3%), cost (22.6%) and not knowing where to go (19.1%). Women with more depressive symptoms in the third trimester endorsed more barriers to mental health service use (β = 0.25, 95% CI = 0.02, 0.12, p = 0.015). Innovative, evidence-based approaches are needed to more effectively promote mental health during the perinatal period and help women overcome the practical barriers identified to help-seeking.

  19. Factors associated with the prevalence of periodontal disease in low-risk pregnant women

    Science.gov (United States)

    2012-01-01

    Objective To evaluate the prevalence of periodontal disease (PD) among Brazilian low-risk pregnant women and its association with sociodemographic factors, habits and oral hygiene. Method This cross-sectional study included 334 low-risk pregnant women divided in groups with or without PD. Indexes of plaque and gingival bleeding on probing, probing pocket depth, clinical attachment level and gingival recession were evaluated at one periodontal examination below 32 weeks of gestation. Independent variables were: age, race/color, schooling, marital status, parity, gestational age, smoking habit, alcohol and drugs consumption, use of medication, presence of any systemic diseases and BMI (body mass index). Statistical analyses provided prevalence ratios and their respective 95%CI and also a multivariate analysis. Results The prevalence of PD was 47% and significantly associated with higher gestational age (PR 1.40; 1.01 - 1.94 for 17-24 weeks and PR 1.52; 1.10 - 2.08 for 25-32 weeks), maternal age 25-29 years, obesity (PR 1.65; 1.02 - 2.68) and the presence of gingival bleeding on probing (ORadj 2.01, 95%CI 1.41 - 2.88). Poor oral hygiene was associated with PD by the mean values of plaque and bleeding on probing indexes significantly greater in PD group. Conclusions The prevalence of PD is high and associated with gingival bleeding on probing, more advanced gestational age and obesity. A program of oral health care should be included in prenatal care for early pregnancy, especially for low-income populations. PMID:22273008

  20. Factors associated with the prevalence of periodontal disease in low-risk pregnant women

    Directory of Open Access Journals (Sweden)

    Vogt Marianna

    2012-01-01

    Full Text Available Abstract Objective To evaluate the prevalence of periodontal disease (PD among Brazilian low-risk pregnant women and its association with sociodemographic factors, habits and oral hygiene. Method This cross-sectional study included 334 low-risk pregnant women divided in groups with or without PD. Indexes of plaque and gingival bleeding on probing, probing pocket depth, clinical attachment level and gingival recession were evaluated at one periodontal examination below 32 weeks of gestation. Independent variables were: age, race/color, schooling, marital status, parity, gestational age, smoking habit, alcohol and drugs consumption, use of medication, presence of any systemic diseases and BMI (body mass index. Statistical analyses provided prevalence ratios and their respective 95%CI and also a multivariate analysis. Results The prevalence of PD was 47% and significantly associated with higher gestational age (PR 1.40; 1.01 - 1.94 for 17-24 weeks and PR 1.52; 1.10 - 2.08 for 25-32 weeks, maternal age 25-29 years, obesity (PR 1.65; 1.02 - 2.68 and the presence of gingival bleeding on probing (ORadj 2.01, 95%CI 1.41 - 2.88. Poor oral hygiene was associated with PD by the mean values of plaque and bleeding on probing indexes significantly greater in PD group. Conclusions The prevalence of PD is high and associated with gingival bleeding on probing, more advanced gestational age and obesity. A program of oral health care should be included in prenatal care for early pregnancy, especially for low-income populations.

  1. Prediction of cesarean delivery in the term nulliparous woman: results from the prospective, multicenter Genesis study.

    Science.gov (United States)

    Burke, Naomi; Burke, Gerard; Breathnach, Fionnuala; McAuliffe, Fionnuala; Morrison, John J; Turner, Michael; Dornan, Samina; Higgins, John R; Cotter, Amanda; Geary, Michael; McParland, Peter; Daly, Sean; Cody, Fiona; Dicker, Pat; Tully, Elizabeth; Malone, Fergal D

    2017-06-01

    In contemporary practice many nulliparous women require intervention during childbirth such as operative vaginal delivery or cesarean delivery (CD). Despite the knowledge that the increasing rate of CD is associated with increasing maternal age, obesity and larger infant birthweight, we lack a reliable method to predict the requirement for such potentially hazardous obstetric procedures during labor and delivery. This issue is important, as there are greater rates of morbidity and mortality associated with unplanned CD performed in labor compared with scheduled CDs. A prediction algorithm to identify women at risk of an unplanned CD could help reduced labor associated morbidity. In this primary analysis of the Genesis study, our objective was to prospectively assess the use of prenatally determined, maternal and fetal, anthropomorphic, clinical, and ultrasound features to develop a predictive tool for unplanned CD in the term nulliparous woman, before the onset of labor. The Genesis study recruited 2336 nulliparous women with a vertex presentation between 39+0 and 40+6 weeks' gestation in a prospective multicenter national study to examine predictors of CD. At recruitment, a detailed clinical evaluation and ultrasound assessment were performed. To reduce bias from knowledge of these data potentially influencing mode of delivery, women, midwives, and obstetricians were blinded to the ultrasound data. All hypothetical prenatal risk factors for unplanned CD were assessed as a composite. Multiple logistic regression analysis and mathematical modeling was used to develop a risk evaluation tool for CD in nulliparous women. Continuous predictors were standardized using z scores. From a total enrolled cohort of 2336 nulliparous participants, 491 (21%) had an unplanned CD. Five parameters were determined to be the best combined predictors of CD. These were advancing maternal age (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.09 to 1.34), shorter maternal height (OR

  2. Remifentanil analgesia during external cephalic version for breech presentation in nulliparous women at term: A randomized controlled trial.

    Science.gov (United States)

    Wang, Zhi-Hong; Yang, Yi; Xu, Gui-Ping

    2017-03-01

    The aim of the study was to assess the efficacy and safety of remifentanil for pain relief during external cephalic version (ECV) for breech presentation in nulliparous women at term. A total of 144 nulliparous women with singleton breech presentation were randomly divided into the intervention group and the placebo group, with 72 subjects in each group. The subjects in the intervention group received remifentanil (infused at 0.1 μg kg min with demand boluses of 0.1 μg/kg), whereas those in the placebo group were given saline placebo. This study was conducted from May 2013 to April 2016. The outcomes measures include pain (measured with the visual analog scale, VAS), success rate of ECV, maternal satisfaction for ECV, and adverse events. A total of 137 participants completed the study. The intervention with remifentanil showed greater efficacy than did placebo in decreasing the VAS score immediately after ECV (intervention group 4.3 ± 2.2 vs placebo group 6.4 ± 2.5, P < 0.01). A significant difference in the ECV success rate was also found between the 2 groups (intervention group 56.9% vs placebo group 38.9%, P = 0.03). In addition, a significant difference in the satisfaction score was also detected (intervention group 9.3 ± 0.9 vs placebo group 6.7 ± 1.2, P < 0.01). The observed adverse events were similar between the 2 groups. This study shows that remifentanil could decrease pain, improve the ECV success rate, and improve satisfaction in nulliparous women at term during the period of ECV. Furthermore, it is also well tolerated with few adverse events.

  3. A multi-centre cohort study shows no association between experienced violence and labour dystocia in nulliparous women at term

    Directory of Open Access Journals (Sweden)

    Dykes Anna-Karin

    2011-02-01

    Full Text Available Abstract Background Although both labour dystocia and domestic violence during pregnancy are associated with adverse maternal and fetal outcome, evidence in support of a possible association between experiences of domestic violence and labour dystocia is sparse. The aim of this study was to investigate whether self-reported history of violence or experienced violence during pregnancy is associated with increased risk of labour dystocia in nulliparous women at term. Methods A population-based multi-centre cohort study. A self-administrated questionnaire collected at 37 weeks of gestation from nine obstetric departments in Denmark. The total cohort comprised 2652 nulliparous women, among whom 985 (37.1% met the protocol criteria for dystocia. Results Among the total cohort, 940 (35.4% women reported experience of violence, and among these, 66 (2.5% women reported exposure to violence during their first pregnancy. Further, 39.5% (n = 26 of those had never been exposed to violence before. Univariate logistic regression analysis showed no association between history of violence or experienced violence during pregnancy and labour dystocia at term, crude OR 0.91, 95% CI (0.77-1.08, OR 0.90, 95% CI (0.54-1.50, respectively. However, violence exposed women consuming alcoholic beverages during late pregnancy had increased odds of labour dystocia, crude OR 1.45, 95% CI (1.07-1.96. Conclusions Our findings indicate that nulliparous women who have a history of violence or experienced violence during pregnancy do not appear to have a higher risk of labour dystocia at term, according to the definition of labour dystocia in this study. Additional research on this topic would be beneficial, including further evaluation of the criteria for labour dystocia.

  4. A multi-centre cohort study shows no association between experienced violence and labour dystocia in nulliparous women at term.

    Science.gov (United States)

    Finnbogadóttir, Hafrún; Dejin-Karlsson, Elisabeth; Dykes, Anna-Karin

    2011-02-21

    Although both labour dystocia and domestic violence during pregnancy are associated with adverse maternal and fetal outcome, evidence in support of a possible association between experiences of domestic violence and labour dystocia is sparse. The aim of this study was to investigate whether self-reported history of violence or experienced violence during pregnancy is associated with increased risk of labour dystocia in nulliparous women at term. A population-based multi-centre cohort study. A self-administrated questionnaire collected at 37 weeks of gestation from nine obstetric departments in Denmark. The total cohort comprised 2652 nulliparous women, among whom 985 (37.1%) met the protocol criteria for dystocia. Among the total cohort, 940 (35.4%) women reported experience of violence, and among these, 66 (2.5%) women reported exposure to violence during their first pregnancy. Further, 39.5% (n = 26) of those had never been exposed to violence before. Univariate logistic regression analysis showed no association between history of violence or experienced violence during pregnancy and labour dystocia at term, crude OR 0.91, 95% CI (0.77-1.08), OR 0.90, 95% CI (0.54-1.50), respectively. However, violence exposed women consuming alcoholic beverages during late pregnancy had increased odds of labour dystocia, crude OR 1.45, 95% CI (1.07-1.96). Our findings indicate that nulliparous women who have a history of violence or experienced violence during pregnancy do not appear to have a higher risk of labour dystocia at term, according to the definition of labour dystocia in this study. Additional research on this topic would be beneficial, including further evaluation of the criteria for labour dystocia.

  5. A multi-centre cohort study shows no association between experienced violence and labour dystocia in nulliparous women at term

    Science.gov (United States)

    2011-01-01

    Background Although both labour dystocia and domestic violence during pregnancy are associated with adverse maternal and fetal outcome, evidence in support of a possible association between experiences of domestic violence and labour dystocia is sparse. The aim of this study was to investigate whether self-reported history of violence or experienced violence during pregnancy is associated with increased risk of labour dystocia in nulliparous women at term. Methods A population-based multi-centre cohort study. A self-administrated questionnaire collected at 37 weeks of gestation from nine obstetric departments in Denmark. The total cohort comprised 2652 nulliparous women, among whom 985 (37.1%) met the protocol criteria for dystocia. Results Among the total cohort, 940 (35.4%) women reported experience of violence, and among these, 66 (2.5%) women reported exposure to violence during their first pregnancy. Further, 39.5% (n = 26) of those had never been exposed to violence before. Univariate logistic regression analysis showed no association between history of violence or experienced violence during pregnancy and labour dystocia at term, crude OR 0.91, 95% CI (0.77-1.08), OR 0.90, 95% CI (0.54-1.50), respectively. However, violence exposed women consuming alcoholic beverages during late pregnancy had increased odds of labour dystocia, crude OR 1.45, 95% CI (1.07-1.96). Conclusions Our findings indicate that nulliparous women who have a history of violence or experienced violence during pregnancy do not appear to have a higher risk of labour dystocia at term, according to the definition of labour dystocia in this study. Additional research on this topic would be beneficial, including further evaluation of the criteria for labour dystocia. PMID:21338523

  6. The Effect of Message-Framing on Breastfeeding Self-Efficacy Among Nulliparous Women in Shushtar, Iran.

    Science.gov (United States)

    Merdasi, Fatemeh; Araban, Marzieh; Saki, Malehi Amal

    2017-01-01

    Exclusive breastfeeding for 6 months and continuing it for 2 years, along with complementary feeding, are the primary objectives of public health plans and nutrition around the world. Self-efficacy is a theoretical framework that could be a strong predictive for breastfeeding. This study aimed to determine the effect of message-framing on self-efficacy of breastfeeding in nulliparous women in Shushtar. This quasi-experimental study was conducted in 2015 on 210 nulliparous women in Shushtar (Iran). The participants were randomly allocated into intervention and control groups. The study tool was the short form of breastfeeding self-efficacy scale that was completed on arrival of the study (days 3-5), at the end of week four and at the end of week eight. Data were analyzed by SPSS 19, using Chi-square, ANOVA, and repeated measurements. Mean age of participants was 24.52 years old with standard deviation of 95.4. Mean score of breastfeeding self-efficacy in gain-framed group at days 3-5, week four and week eight was 47.94, 57.43 and 52.8 respectively; in loss-framed group it was 47.76, 56.11 and 52.64 respectively; and in control group it was 45.16, 48.68 and 45.31 respectively. No significant difference was observed between the score of average self-efficacy of days 3-5 and week eight in control group (p=0.93). However, in gain-framed group (p=0.001) and loss-framed group (p=0.004), a significant difference was observed. Results of this study showed that message-framing promotes breastfeeding self-efficacy in nulliparous women and in this regard, there is no difference between gain-framed and loss-framed messages.

  7. Pelvic floor muscle strength evaluation in different body positions in nulliparous healthy women and its correlation with sexual activity

    Directory of Open Access Journals (Sweden)

    Monica Orsi Gameiro

    2013-12-01

    Full Text Available Objective The aim of this study was to assess pelvic floor muscle (PFM strength in different body positions in nulliparous healthy women and its correlation with sexual activity. Materials and Methods Fifty healthy nulliparous women with mean age of 23 years were prospectively studied. Subjective evaluation of PFM was assessed by transvaginal digital palpation (TDP of anterior and posterior areas regarding the vaginal introitus. A perineometer with inflatable vaginal probe was used to assess the PFM strength in four different positions: supine with extended lower limbs (P1; bent-knee supine (P2; sitting (P3; standing (P4. Results Physical activity, 3 times per week, was reported by 58% of volunteers. Sexual activity was observed in 80% of women and 82% of them presented orgasm. The average body mass index (BMI was 21.76 kg/m2, considered as normal according World Health Organization (WHO. We observed that 68% of volunteers were conscious about the PFM contraction. TDP showed concordance of 76% when anterior and posterior areas were compared (p = 0.00014. There was not correlation between PFM strength and orgasm in subjective evaluation. The PFM strength was significantly higher in standing position when compared with the other positions (p < 0.000. No statistical difference was observed between orgasm and PFM strength when objective evaluations were performed. Conclusions There was concordance between anterior and posterior areas in 76% of cases when subjective PFM strength was assessed. In objective evaluation, higher PFM strength was observed when volunteers were standing. No statistical correlation was observed between PFM strength and orgasm in nulliparous healthy women.

  8. [C-section rate in low-risk women: a useful indicator to compare hospitals attending deliveries with different risks].

    Science.gov (United States)

    Librero, Julián; Peiró, Salvador; Belda, Ana; Calabuig, Julia

    2014-01-01

    the C-section rate has been criticized as a performance indicator for not considering that different hospitals manage deliveries with diverse risks. In this work we explore the characteristics of a new indicator restricted to low C-section risk deliveries. retrospective cohort of all births (n=214,611) in all public hospitals during 2005-2010 in the Valencia Region, Spain (source: minimum basic dataset). A low-risk subpopulation consisting of women under-35, no history of c-section, between 37 and 41 gestational weeks, and with a single fetus, with cephalic presentation and normal weight (2500-3999 g) was constructed. We analyzed variability in the new indicator, its correlation with the crude indicator and, using multilevel logistic regression models, the presence of residual risks. a total of 117 589 births (58.4% of the whole deliveries) were identified as low C-section risk. The c-section rate in these women was 11.9% (24.4% for all deliveries) ranging between hospitals from 7.0% to 28.9%. The c-section rate in low-risk and total deliveries correlated strongly (r=0.88). The remaining risks in the population of low risk did not alter the hospital effect on the c-section rate. the percentage of C-section in low risk women include a high volume of deliveries, correlated with the crude indicator and residual risks are not differentially influenced by hospitals, being a useful indicator for monitoring the quality of obstetric care in the National Health System.

  9. [Fear of childbirth among nulliparous women: Relations with pain during delivery, post-traumatic stress symptoms, and postpartum depressive symptoms].

    Science.gov (United States)

    Gosselin, P; Chabot, K; Béland, M; Goulet-Gervais, L; Morin, A J S

    2016-04-01

    Fear of childbirth is common in women who are pregnant with their first child and is associated with important consequences such as abortions and miscarriages. Twenty percent of nulliparous women seem to exhibit a mild or moderate fear, while 6% present an excessive and irrational fear known as tocophobia. Tocophobia is suggested to be associated with many negative consequences such as postpartum depression (PPD) and Post-traumatic stress (PTS). However, there is little empirical evidence to support these relationships. Recently, Fairbrother and Woody (2007) did not observe a link between the fear of childbirth and symptoms of PPD and PTS in nulliparous women. Some results, near the significance level, could be explained by a lack of statistical power. The present study focused on the link between the fear of childbirth and the process of delivery, the perception of pain, PPD and PTS. More specifically, it aimed to test three hypotheses: (i) fear of childbirth will be linked to the process of delivery, especially regarding the perception of pain, the use of anaesthesia and the use of Caesarean section; (ii) a high level of fear of childbirth will be associated with more negative postpartum consequences (namely PPD/PTS symptoms); (iii) the process of delivery and pain will also be related to post-delivery symptoms. Mediation effects were tested. Data from a longitudinal study were used to meet the hypotheses. A total of 176 nulliparous pregnant women responded to questionnaires at two time measurements (during pregnancy and at 5weeks postpartum). Fear of childbirth is related to the perception of pain at birth among women delivering vaginally, in the absence of anaesthesia. It is also linked to symptoms of PPD and PTS, regardless of whether or not anaesthesia was used. Fear of childbirth also appears to be strongly associated to symptoms of PTS in women who have experienced an unplanned caesarean section. Thus, symptoms of postpartum PTS could play a mediating role

  10. CAREM-25: a low-risk nuclear option

    International Nuclear Information System (INIS)

    Baron, Jorge H.; Nunez Mac Leod, J.E.; Rivera, S.S.

    2000-01-01

    The future use of nuclear energy for electricity production is assumed as a viable alternative at present, mainly taking into account the high environmental impact of the fossil fuel alternatives (greenhouse effect, acid rain). In the worldwide context, however, it is desirable that the next generation of nuclear power stations to be safer than the present ones. To demonstrate the safety level of a particular nuclear installation, the Risk Analysis (or Probabilistic Safety Assessment) is the most appropriate tool. Quantitative risk estimations can be performed with PSA. The risk can be split as the product of two factors: the first one takes into account the occurrence probability of accidental sequences that involve the release of radioactive material, and the second takes into account the magnitude and consequences of such a release. In the present work, the reduction of both factors is analyzed. The probability is reduced by the use of simpler and more reliable systems to perform the safety functions, and the consequence by the use of small power production units, provided with passive mitigation systems and long response times. The work is illustrated with a risk comparison for electricity production with CAREM-25 units, towards classic production units (Atucha II). The results are based on PSAs performed for both plants. The conclusions show an effective risk reduction (both in probability and in consequence) for the innovative CAREM-25 plant, coming to doses so low as to prevent any acute effect in the nearby population. (author)

  11. Nonvisible tumors on multiparametric magnetic resonance imaging does not predict low-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Seung Hwan Lee

    2015-12-01

    Conclusions: Even though cancer foci were not visualized by postbiopsy MRI, the pathological tumor volumes and extent of GS upgrading were relatively high. Therefore, nonvisible tumors by multiparametric MRI do not appear to be predictive of low-risk PCA.

  12. Preventive dentistry: practitioners' recommendations for low-risk patients compared with scientific evidence and practice guidelines.

    Science.gov (United States)

    Frame, P S; Sawai, R; Bowen, W H; Meyerowitz, C

    2000-02-01

    The purpose of this article is to compare published evidence supporting procedures to prevent dental caries and periodontal disease, in low-risk patients, with the actual preventive recommendations of practicing dentists. Methods included (1) a survey questionnaire of general dentists practicing in western New York State concerning the preventive procedures they would recommend and at what intervals for low-risk children, young adults, and older adults; and (2) review of the published, English-language literature for evidence supporting preventive dental interventions. The majority of dentists surveyed recommended semiannual visits for visual examination and probing to detect caries (73% to 79%), and scaling and polishing to prevent periodontal disease (83% to 86%) for low-risk patients of all ages. Bite-wing radiographs were recommended for all age groups at annual or semiannual intervals. In-office fluoride applications were recommended for low-risk children at intervals of 6 to 12 months by 73% of dentists but were recommended for low-risk older persons by only 22% of dentists. Application of sealants to prevent pit and fissure caries was recommended for low-risk children by 22% of dentists. Literature review found no studies comparing different frequencies of dental examinations and bite-wing radiographs to determine the optimal screening interval in low-risk patients. Two studies of the effect of scaling and polishing on the prevention of periodontal disease found no benefit from more frequent than annual treatments. Although fluoride is clearly a major reason for the decline in the prevalence of dental caries, there are no studies of the incremental benefit of in-office fluoride treatments for low-risk patients exposed to fluoridated water and using fluoridated toothpaste. Comparative studies using outcome end points are needed to determine the optimal frequency of dental examinations and bite-wing radiographs for the early detection of caries, and of scaling

  13. Different pituitary. beta. -endorphin and adrenal cortisol response to ethanol in individuals with high and low risk for future development of alcoholism

    Energy Technology Data Exchange (ETDEWEB)

    Gianoulakis, C.G.; Beliveau, D.; Angelogianni, P.; Meaney, M.; Thavundayil, J.; Tawar, V.; Dumas, M. (McGill Univ., Quebec (Canada))

    1989-01-01

    The purpose of the present studies was to investigate the activity of the adrenal gland and the pituitary {beta}-endorphin system in individuals from families with a 3 generation history of alcoholism, High Risk group, or from families without history of alcoholism, Low Risk group. On the day of testing, blood sample was taken at 9:00 a.m., then the subject drank a placebo drink or an ethanol solution. Additional blood samples were taken at 15, 45 and 120 minutes post-drink. Results indicated that individuals of the High Risk group had lower basal levels of {beta}-endorphin like immunoreactivity ({beta}-EPLIR) than individuals of the Low Risk group. The dose of 0.5 g ethanol/kg B.Wt. induced an induce an increase in the plasma content of {beta}-EPLIR of the High Risk group, but not of the Low Risk group. In the Low Risk group ethanol did not induce an increase above the 9:00 a.m. levels, however, it attenuated the {beta}-endorphin decrease overtime, observed following the placebo drink. Analysis of {beta}-endorphin-like peptides in the plasma of the High Risk group, with Sephadex G-75 chromatography indicated that the major component of the plasma {beta}-EPLIR was {beta}-lipotropin. Plasma cortisol levels, following ethanol intake, presented a small increase in the High Risk group but not in the Low Risk group.

  14. Risk factors and birth outcomes of anaemia in early pregnancy in a nulliparous cohort.

    Directory of Open Access Journals (Sweden)

    Gwinyai Masukume

    Full Text Available Anaemia in pregnancy is a major public health and economic problem worldwide, that contributes to both maternal and fetal morbidity and mortality.The aim of the study was to calculate the prevalence of anaemia in early pregnancy in a cohort of 'low risk' women participating in a large international multicentre prospective study (n = 5 609, to identify the modifiable risk factors for anaemia in pregnancy in this cohort, and to compare the birth outcomes between pregnancies with and without anaemia in early gestation.The study is an analysis of data that were collected prospectively during the Screening for Pregnancy Endpoints study. Anaemia was defined according to the World Health Organization's definition of anaemia in pregnancy (haemoglobin < 11g/dL. Binary logistic regression with adjustment for potential confounders (country, maternal age, having a marital partner, ethnic origin, years of schooling, and having paid work was the main method of analysis.The hallmark findings were the low prevalence of anaemia (2.2%, that having no marital partner was an independent risk factor for having anaemia (OR 1.34, 95% CI 1.01-1.78, and that there was no statistically significant effect of anaemia on adverse pregnancy outcomes (small for gestational age, pre-tem birth, mode of delivery, low birth weight, APGAR score < 7 at one and five minutes. Adverse pregnancy outcomes were however more common in those with anaemia than in those without.In this low risk healthy pregnant population we found a low anaemia rate. The absence of a marital partner was a non-modifiable factor, albeit one which may reflect a variety of confounding factors, that should be considered for addition to anaemia's conceptual framework of determinants. Although not statistically significant, clinically, a trend towards a higher risk of adverse pregnancy outcomes was observed in women that were anaemic in early pregnancy.

  15. Risk factors and birth outcomes of anaemia in early pregnancy in a nulliparous cohort.

    Science.gov (United States)

    Masukume, Gwinyai; Khashan, Ali S; Kenny, Louise C; Baker, Philip N; Nelson, Gill

    2015-01-01

    Anaemia in pregnancy is a major public health and economic problem worldwide, that contributes to both maternal and fetal morbidity and mortality. The aim of the study was to calculate the prevalence of anaemia in early pregnancy in a cohort of 'low risk' women participating in a large international multicentre prospective study (n = 5 609), to identify the modifiable risk factors for anaemia in pregnancy in this cohort, and to compare the birth outcomes between pregnancies with and without anaemia in early gestation. The study is an analysis of data that were collected prospectively during the Screening for Pregnancy Endpoints study. Anaemia was defined according to the World Health Organization's definition of anaemia in pregnancy (haemoglobin prevalence of anaemia (2.2%), that having no marital partner was an independent risk factor for having anaemia (OR 1.34, 95% CI 1.01-1.78), and that there was no statistically significant effect of anaemia on adverse pregnancy outcomes (small for gestational age, pre-tem birth, mode of delivery, low birth weight, APGAR score pregnancy outcomes were however more common in those with anaemia than in those without. In this low risk healthy pregnant population we found a low anaemia rate. The absence of a marital partner was a non-modifiable factor, albeit one which may reflect a variety of confounding factors, that should be considered for addition to anaemia's conceptual framework of determinants. Although not statistically significant, clinically, a trend towards a higher risk of adverse pregnancy outcomes was observed in women that were anaemic in early pregnancy.

  16. The Effect of Acupressure on Sanyinjiao and Hugo Points on Labor Pain in Nulliparous Women : A Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Reza Heshmat

    2013-06-01

    Full Text Available Introduction:Most women have experienced child birth and its pain, which is inevitable. If this pain is not controlled it leads to prolonged labor and injury to the mother and fetus. This study was conducted to identify the effect of acupressure on sanyinjiao and hugo points on delivery pain in nulliparous women. Methods:This was a randomized controlled clinical trial on 84 nulliparous women in hospitals of Ardebil, Iran. The participants were divided by randomized blocks of 4 and 6 into two groups. The intervention was in the form of applying pressure at sanyinjiao and hugo points based on different dilatations. The intensity of the pain before and after the intervention was recorded by visual scale of pain assessment. To determine the effect of pressure on the intensity of labor pain, analytical descriptive test was conducted in SPSS (version 13. Results:There was a significant decrease in mean intensity of pain after each intervention in the experimental group with different dilatations (4, 6, 8, and 10 cm. Moreover, the Student’s independent t-test results indicated that the mean intensity of pain in the experimental group after the intervention in all four dilatations was significantly lower than the control group. Repeated measures ANOVA test indicated that in both experimental and control groups in four time periods, there was a statistically significant difference. Conclusion:Acupressure on sanyinjiao and hugo points decreases the labor pain. Therefore, this method can be used effectively in the labor process.

  17. Effect of early amniotomy on dystocia risk and cesarean delivery in nulliparous women: a randomized clinical trial.

    Science.gov (United States)

    Ghafarzadeh, Masoomeh; Moeininasab, Samira; Namdari, Mehrdad

    2015-08-01

    Artificial rupture of amniotic membranes (amniotomy) which induces or accelerates labor is the most common obstetrical procedure. There is controversy about the effect of early amniotomy on dystocia and cesarean delivery. The study aim was to determine the effect of early amniotomy on the risk of dystocia and cesarean delivery in nulliparous women. This randomized controlled clinical trial was conducted on 300 nulliparous women. They were randomly assigned into the experimental (early amniotomy; artificial amniotomy at cervical dilation ≤ 4 cm) and control (routine management) groups (each 150 women). Length of labor, dystocia, cesarean delivery, placental abruption, and umbilical cord prolapse were compared between the groups. Early amniotomy shortened labor duration significantly in experimental group (7.5 ± 0.7 h) compared to control group (9.9 ± 1.0 h) (P Dystocia (6.7 vs. 25.3 %, P dystocia 80.6 % (95 % CI 58.6-90.1 %) and the odds of cesarean section 81.7 % (95 % CI 66.2-90.1 %). Early amniotomy was associated with lower rate of dystocia and cesarean delivery as well as shorter duration of labor.

  18. Training through gametherapy promotes coactivation of the pelvic floor and abdominal muscles in young women, nulliparous and continents

    Directory of Open Access Journals (Sweden)

    Valeria Regina Silva

    Full Text Available ABSTRACT Introduction and objectives: Several studies have been investigated co-activation can enhance the effectveness of PFM training protocols allowing preventive and therapeutic goals in pelvic floor dysfunctions. The objective of the present study was to investigate if an abdominal-pelvic protocol of training (APT using gametherapy would allow co-activation of PFM and transversus abdominis/oblique internal (TrA/OI muscles. Patients and methods: Twenty-five nulliparous, continent, young females, with median age 24.76 (±3.76 years were evaluated using digital palpation (DP of PFM and surface electromyography of PFM and TrA/OI simultaneously, during maximal voluntary contraction (MVC, alternating PFM and TrA/OI contraction requests. All women participated on a supervised program of APT using gametherapy, that included exercises of pelvic mobilization associated to contraction of TrA/OI muscles oriented by virtual games, for 30 minutes, three times a week, in a total of 10 sessions. Electromyographic data were processed and analyzed by ANOVA - analysis of variance. Results: When MVC of TrA/OI was solicited, it was observed simultaneous increase of electromyographic activity of PFM (p=0.001 following ATP. However, EMG activity did not change significantly during MVC of PFM. Conclusion: Training using gametherapy allowed better co-activation of pelvic floor muscles in response to contraction of TrA, in young nulliparous and continent women.

  19. Nulliparity enhances the risk of second primary malignancy of the breast in a cohort of women treated for thyroid cancer

    Directory of Open Access Journals (Sweden)

    Milazzo Francesca

    2011-08-01

    Full Text Available Abstract Background Many studies have reported an increased risk of developing a second primary malignancy (SPM of the breast in women treated for thyroid cancer. In this study, we investigated several potential risk factors for this association. The aim of this retrospective cohort study was to identify a subgroup of women surgically treated for papillary thyroid cancer that may benefit from more careful breast cancer screening. Methods A total of 101 women surgically treated for papillary thyroid cancer from 1996 to 2009 with subsequent follow-up were interviewed by phone regarding personal risk factors and lifestyle habits. Only 75 questionnaires could be evaluated due to a 25.7% rate of patients not retrieved or refusing the interview. Data analysis was performed using a multivariate logistic model. Results The standardised incidence ratio (SIR for breast cancer was 3.58 (95% IC 1.14 - 8.37. Our data suggest a protective effect of multiparity on the development of a SPM of the breast (O.R. 0.15; 95% IC 0.25 - 0.86. Significant associations were not found with other known risk factors including Body Mass Index (BMI, age at first tumour, concurrent metabolic diseases, smoking, physical activity and familiarity. Conclusions This study confirms that a higher incidence of SPM of the breast is observed in women treated for papillary thyroid cancer. Additionally, this risk is increased by nulliparity, thus a strict breast screening program for nulliparous women treated for thyroid cancer may be advisable.

  20. Perfluoroalkyl substances during pregnancy and validated preeclampsia among nulliparous women in the Norwegian Mother and Child Cohort Study.

    Science.gov (United States)

    Starling, Anne P; Engel, Stephanie M; Richardson, David B; Baird, Donna D; Haug, Line S; Stuebe, Alison M; Klungsøyr, Kari; Harmon, Quaker; Becher, Georg; Thomsen, Cathrine; Sabaredzovic, Azemira; Eggesbø, Merete; Hoppin, Jane A; Travlos, Gregory S; Wilson, Ralph E; Trogstad, Lill I; Magnus, Per; Longnecker, Matthew P

    2014-04-01

    Perfluoroalkyl substances (PFAS) are persistent and ubiquitous environmental contaminants, and human exposure to these substances may be related to preeclampsia, a common pregnancy complication. Previous studies have found serum concentrations of PFAS to be positively associated with pregnancy-induced hypertension and preeclampsia in a population with high levels of exposure to perfluorooctanoate. Whether this association exists among pregnant women with background levels of PFAS exposure is unknown. Using data from the Norwegian Mother and Child Cohort Study conducted by the Norwegian Institute of Public Health, we carried out a study of nulliparous pregnant women enrolled in 2003-2007 (466 cases, 510 noncases) to estimate associations between PFAS concentrations and an independently validated diagnosis of preeclampsia. We measured levels of 9 PFAS in maternal plasma extracted midpregnancy; statistical analyses were restricted to 7 PFAS that were quantifiable in more than 50% of samples. In proportional hazards models adjusted for maternal age, prepregnancy body mass index (weight (kg)/height (m)(2)), educational level, and smoking status, we observed no strongly positive associations between PFAS levels and preeclampsia. We found an inverse association between preeclampsia and the highest quartile of perfluoroundecanoic acid concentration relative to the lowest quartile (hazard ratio = 0.55, 95% confidence interval: 0.38, 0.81). Overall, our findings do not support an increased risk of preeclampsia among nulliparous Norwegian women with background levels of PFAS exposure.

  1. Comparison of delayed versus immediate pushing during second stage of labor for nulliparous women with epidural anesthesia.

    Science.gov (United States)

    Gillesby, Erica; Burns, Suzan; Dempsey, Amy; Kirby, Shirley; Mogensen, Kami; Naylor, Kelly; Petrella, Joann; Vanicelli, Rebecca; Whelan, Breon

    2010-01-01

    To determine if the use of delayed pushing after the onset of the second stage of labor decreases the time of active pushing and decreases maternal fatigue. Randomized clinical trial. Labor and delivery unit of a not-for-profit community hospital. Convenience sample of nulliparous laboring women with epidural anesthesia. Immediate or delayed pushing (2 hours) during the second stage of labor at the time of complete cervical dilatation. The length of pushing, total length of the second stage, and maternal fatigue. A total of 77 women were studied (immediate pushing group=39; delayed pushing=38). The immediate pushing group averaged 94 (± 57) minutes in active pushing, while the delayed pushing group averaged 68 (± 46) minutes, a statistically significant difference (p=.04). No significant differences were found in fatigue scores between the immediate and delayed pushing groups (p>.05). We found that by delaying the onset of active pushing for 2 hours after the beginning of the second stage of labor, the time that nulliparous women with epidural anesthesia spent in active pushing was significantly decreased by 27%. Although the delayed pushing group rested for up to 2 hours, the total time in the second stage of labor averaged only 59 minutes longer than the immediate pushing group. © 2010 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.

  2. Regional Brain Responses Are Biased Toward Infant Facial Expressions Compared to Adult Facial Expressions in Nulliparous Women.

    Science.gov (United States)

    Li, Bingbing; Cheng, Gang; Zhang, Dajun; Wei, Dongtao; Qiao, Lei; Wang, Xiangpeng; Che, Xianwei

    2016-01-01

    Recent neuroimaging studies suggest that neutral infant faces compared to neutral adult faces elicit greater activity in brain areas associated with face processing, attention, empathic response, reward, and movement. However, whether infant facial expressions evoke larger brain responses than adult facial expressions remains unclear. Here, we performed event-related functional magnetic resonance imaging in nulliparous women while they were presented with images of matched unfamiliar infant and adult facial expressions (happy, neutral, and uncomfortable/sad) in a pseudo-randomized order. We found that the bilateral fusiform and right lingual gyrus were overall more activated during the presentation of infant facial expressions compared to adult facial expressions. Uncomfortable infant faces compared to sad adult faces evoked greater activation in the bilateral fusiform gyrus, precentral gyrus, postcentral gyrus, posterior cingulate cortex-thalamus, and precuneus. Neutral infant faces activated larger brain responses in the left fusiform gyrus compared to neutral adult faces. Happy infant faces compared to happy adult faces elicited larger responses in areas of the brain associated with emotion and reward processing using a more liberal threshold of p facial expressions compared to adult facial expressions among nulliparous women, and this bias may be modulated by individual differences in Interest-In-Infants and perspective taking ability.

  3. Peripheral QCT: a low risk procedure to identify women predisposed to osteoporosis

    International Nuclear Information System (INIS)

    Mueller, A.; Rueegsegger, E.; Rueegsegger, P.

    1989-01-01

    A low-risk procedure is described for the precise quantitation of changes of trabecular and cortical bone density at peripheral measuring sites. The method is based on quantitative computed tomography (QCT). Bone parameters are calculated for a sample volume common to all examinations of a patient. This is achieved by matching stacks of tomograms according to the cross sectional area of the bone measured. With the help of a special-purpose CT system the described procedure enables a reproducibility for trabecular and cortical bone parameters of 0.3% (1 SD) at a local radiation dose of of 0.1 mSv (10 mrem). The method was used to assess the individual changes in bone density of 39 perimenopausal women during an observation period of 2 to 3 years. The results are grouped according to their menstrual state. Regularly menstruating women experience minute or no changes in bone density. After menopause the interindividual differences are considerable: some women lose bone excessively, others remain relatively stable. The frequency distribution of the rate of bone loss appears to be bimodal. Hence women can be classified in fast losers and slow losers. We conclude that the rate of bone loss may be most helpful in the identification of those women predisposed to osteoporosis. (author)

  4. Comparison of the MASCC and CISNE scores for identifying low-risk neutropenic fever patients: analysis of data from three emergency departments of cancer centers in three continents.

    Science.gov (United States)

    Ahn, Shin; Rice, Terry W; Yeung, Sai-Ching J; Cooksley, Tim

    2018-05-01

    Patients with febrile neutropenia are a heterogeneous group with a minority developing serious medical complications. Outpatient management of low-risk febrile neutropenia has been shown to be safe and cost-effective. Scoring systems, such as the Multinational Association for Supportive Care in Cancer (MASCC) score and Clinical Index of Stable Febrile Neutropenia (CISNE), have been developed and validated to identify low-risk patients. We aimed to compare the performance of these two scores in identifying low-risk febrile neutropenic patients. We performed a pooled analysis of patients presenting with febrile neutropenia to three tertiary cancer emergency centers in the USA, UK, and South Korea in 2015. The primary outcome measures were the occurrence of serious complications. Admission to an intensive care unit (ICU) and 30-day mortality were secondary outcomes. The predictive performance of each score was analyzed. Five hundred seventy-one patients presented with febrile neutropenia. With MASCC risk index, 508 (89.1%) were classified as low-risk febrile neutropenia, compared to 60 (10.5%) with CISNE classification. Overall, the MASCC score had a greater discriminatory power in the detection of low-risk patients than the CISNE score (AUC 0.772, 95% CI 0.726-0.819 vs. 0.681, 95% CI 0.626-0.737, p = 0.0024). Both MASCC and CISNE scores have reasonable discriminatory value in predicting patients with low-risk febrile neutropenia. Risk scores should be used in conjunction with clinical judgment for the identification of patients suitable for outpatient management of neutropenic fever. Developing more accurate scores, validated in prospective settings, will be useful in facilitating more patients being managed in an outpatient setting.

  5. Low-risk susceptibility alleles in 40 human breast cancer cell lines

    International Nuclear Information System (INIS)

    Riaz, Muhammad; Elstrodt, Fons; Hollestelle, Antoinette; Dehghan, Abbas; Klijn, Jan GM; Schutte, Mieke

    2009-01-01

    Low-risk breast cancer susceptibility alleles or SNPs confer only modest breast cancer risks ranging from just over 1.0 to1.3 fold. Yet, they are common among most populations and therefore are involved in the development of essentially all breast cancers. The mechanism by which the low-risk SNPs confer breast cancer risks is currently unclear. The breast cancer association consortium BCAC has hypothesized that the low-risk SNPs modulate expression levels of nearby located genes. Genotypes of five low-risk SNPs were determined for 40 human breast cancer cell lines, by direct sequencing of PCR-amplified genomic templates. We have analyzed expression of the four genes that are located nearby the low-risk SNPs, by using real-time RT-PCR and Human Exon microarrays. The SNP genotypes and additional phenotypic data on the breast cancer cell lines are presented. We did not detect any effect of the SNP genotypes on expression levels of the nearby-located genes MAP3K1, FGFR2, TNRC9 and LSP1. The SNP genotypes provide a base line for functional studies in a well-characterized cohort of 40 human breast cancer cell lines. Our expression analyses suggest that a putative disease mechanism through gene expression modulation is not operative in breast cancer cell lines

  6. Prevalence of anal incontinence during pregnancy and 1 year after delivery in a cohort of primiparous women and a control group of nulliparous women

    DEFF Research Database (Denmark)

    Svare, Jens A; Hansen, Bent B; Lose, Gunnar

    2016-01-01

    INTRODUCTION: The aim of the study was to examine the prevalence of anal incontinence (AI) during pregnancy and 1 year after delivery in primiparous women and to compare it with the prevalences in nulliparous women. MATERIAL AND METHODS: A validated questionnaire regarding AI was filled in by 101...

  7. Fear of childbirth and risk for birth complications in nulliparous women in the Danish National Birth Cohort

    DEFF Research Database (Denmark)

    Laursen, M; Johansen, C; Hedegaard, M

    2009-01-01

    nulliparous women in spontaneous labour with a single fetus in cephalic presentation at term following an uncomplicated pregnancy. METHODS: Data were collected during 1997-2003 from computer-assisted telephone interviews twice in pregnancy linked with national health registers. MAIN OUTCOME MEASURES: Risk...... for emergency caesarean section of women who feared childbirth; risk for dystocia/protracted labour or fetal distress of women who feared childbirth. RESULTS: Fear of childbirth in early (16 weeks, 6 +/- 29 days) and late (31 weeks, 4 +/- 21 days) pregnancy was associated with emergency caesarean section: OR, 1.......23 (1.05-1.47) and 1.32 (1.13-1.55), respectively. When fear of childbirth was expressed at both interviews, the OR was 1.43 (1.13-1.80). Women who feared childbirth had an increased risk for dystocia or protracted labour (OR, 1.33; 1.15-1.54), but not for fetal distress (OR, 0.94; 0...

  8. Second trimester hepatic rupture in a 35 year old nulliparous woman with HELLP syndrome: a case report.

    LENUS (Irish Health Repository)

    Kelly, J

    2009-01-01

    The HELLP syndrome (haemolysis, elevated liver blood tests and low platelets) is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10-20% of cases with severe preeclampsia. Hepatic capsular rupture is a rare yet dramatic complication of HELLP syndrome. The majority of cases occur in multiparous women over the age of 30. Classically it presents with acute onset right upper quadrant pain in the presence of constitutional symptoms such as vomiting and pyrexia. However, symptoms and signs are usually non specific. Spontaneous hepatic rupture can be preceded by signs of hypovolaemic shock; yet the diagnosis is infrequently made prior to emergent laparotomy. We present the case of a 35 year old nulliparous woman with a second trimester gestational hepatic rupture associated with HELLP syndrome. We briefly discuss the aetiology, diagnostic difficulties and treatment options associated with this rare presentation.

  9. External cephalic version for breech presentation with or without spinal analgesia in nulliparous women at term: a randomized controlled trial.

    Science.gov (United States)

    Weiniger, Carolyn F; Ginosar, Yehuda; Elchalal, Uriel; Sharon, Einav; Nokrian, Malka; Ezra, Yossef

    2007-12-01

    To compare the success of external cephalic version using spinal analgesia with no analgesia among nulliparas. A prospective randomized controlled trial was performed in a tertiary referral center delivery suite. Nulliparous women at term requesting external cephalic version for breech presentation were randomized to receive spinal analgesia (7.5 mg bupivacaine) or no analgesia before the external cephalic version. An experienced obstetrician performed the external cephalic version. Primary outcome was successful conversion to vertex presentation. Seventy-four women were enrolled, and 70 analyzed (36 spinal, 34 no analgesia). Successful external cephalic version occurred among 24 of 36 (66.7%) women randomized to receive spinal analgesia compared with 11 of 34 (32.4%) without, P=.004 (95% confidence interval [CI] of the difference: 0.0954-0.5513). External cephalic version with spinal analgesia resulted in a lower visual analog pain score, 1.76+/-2.74 compared with 6.84+/-3.08 without, Pexternal cephalic version success was 4.0-fold higher when performed with spinal analgesia P=.02 (95% CI, odds ratio [OR] 1.2-12.9). Complete breech presentation before attempting external cephalic version increased the odds of success 8.2-fold, P=.001 (95% CI, OR 2.2-30.3). Placental position, estimated fetal weight, and maternal weight did not contribute to the success rate when spinal analgesia was used. There were no cases of placental abruption or fetal distress. Administration of spinal analgesia significantly increases the success rate of external cephalic version among nulliparous women at term, which allows possible normal vaginal delivery. ClinicalTrials.gov, www.clinicaltrials.gov, NCT00119184 I.

  10. Effects of entonox in comparison of lidocaine on pain severity during episiotomy incision in nulliparous women: A randomized control trial

    Directory of Open Access Journals (Sweden)

    Azam Honarmandpour

    2017-01-01

    Full Text Available Background & Aim: Episiotomy is one of the most common surgical procedures in obstetrics, which requires analgesia. Entonox gas is known to have analgesic and sedative properties. However, no studies have been found on the analgesic effects of Entonox on episiotomy incision. Therefore, this study aimed to compare the effects of Entonox and lidocaine on pain intensity during episiotomy incision in nulliparous women. Materials and Methods: This randomized controlled trial was conducted on 120 term nulliparous women, who met the inclusion criteria. Subjects were selected by randomized sampling and equally divided into two groups of intervention and control (n=60. In the intervention group, Entonox gas was applied two minutes before episiotomy incision until the end of the procedure. On the other hand, the control group received 5 ml of lidocaine 2% as routine care before episiotomy incision. Data were collected using visual analogue scale to compare the study groups in terms of pain intensity. In addition, patient satisfaction with pain management technique during episiotomy and side effects of Entonox were assessed. Data analysis was performed in SPSS version 22 using Mann-Whitney U and Chi-square tests, and P value of less than 0.05 was considered statistically significant. Results: In this study, no significant difference was observed between the intervention and control groups regarding pain intensity (P=0.52. Moreover, no significant difference was observed in the satisfaction level of the two groups (P=0.70. Conclusion: According to the results of this study, Entonox could be used as an effective and noninvasive alternative to lidocaine to reduce pain during episiotomy incision without significant side effects.

  11. Assessment Of The Effects Of Increased Intra Venous Hydration On The Course Of Labor In Nulliparous Term Pregnancies

    Directory of Open Access Journals (Sweden)

    m.h. alavi

    2005-11-01

    Full Text Available Physiologists have shown that increased fluids improve skeletal muscle performance in prolonged exercise. Typical orders provide for 125 mL of intravenous fluids per hour in patients taking limited oral fluids during labor. Our purpose in this study was to determine whether increased intravenous fluids affect the progress oflabor. In a prospective randomized institutional clinical trial, one-hundred ninety-four nulliparous women with uncomplicated singleton gestations at term in spontaneous active labor with dilatation 2-5 em and a cephalic presentation were selected. 82 were designed to receive 250 mL per hour of intravenous normal saline in dextrose water (first group, and 112 to receive 125 mL per hour of the same solution (2nd or control group. Prerandomization variables such as mother's age, weight, previous pregnancy history, general health, sex and weight of the newborn, rupture of the membranes and presenting part were balanced between the two groups. The frequency of labor lasting> 10 hours was statistically higher in the 125mL group ([16.7%] vs [7.4%] p< 0.0002. This study showed that increasing fluid administration for nulliparous women in labor is associated with a shorter duration of the first stage and possibly less need for augmentation of uterine contraction ( [4.8% vs 6.25%] p= 0.002.Thus dehydration in labor may be a contributing factor for dysfunctional labor and need for cesarean-section, and oxytocin infusion.

  12. Effects of aromatherapy with Rosa damascena on nulliparous women's pain and anxiety of labor during first stage of labor.

    Science.gov (United States)

    Hamdamian, Sepideh; Nazarpour, Soheila; Simbar, Masoumeh; Hajian, Sepideh; Mojab, Faraz; Talebi, Atefeh

    2018-03-01

    Reducing labor pain and anxiety is one of the most important goals of maternity care. This study aimed to assess the effects of aromatherapy with Rosa damascena on pain and anxiety in the first stage of labor among nulliparous women. This was a randomized clinical trial of 110 nulliparous women. The eligible participants were randomly assigned to two groups of aromatherapy and control in an Iranian maternity hospital. The participants received 0.08 mL of Rosa damascena essence in the aromatherapy group and 0.08 mL of normal saline in the control group, every 30 min. Pain was measured 3 times, once each at three stages of cervical dilation (4-5, 6-7, and 8-10 cm). Anxiety was measured twice, once each at two stages of cervical dilation (4-7 and 8-10 cm). The tools for data collection were the Spielberger anxiety questionnaire, numerical pain rating scale, demographic and obstetric questionnaire, and an observational checklist. Data analyses included the t-test, Mann-Whitney U test and Chi-square test. Severity of labor pain and severity of anxiety were used as primary outcome measures. Labor and delivery characteristics (including number of contractions, duration of contractions in second stage, Bishop score, augmentation by oxytocin, Apgar score, and mode of delivery), demographic characteristics, and fertility information were used as secondary outcome measures. Pain severity in the group receiving aromatherapy with R. damascena was significantly lower than in the control group after treatment at each pain assessment (cervical dilation of 4-5, 6-7, and 8-10 cm; P labor. Aromatherapy with R. damascena is a convenient and effective method for pain and anxiety reduction during the first stage of labor. Iranian Registry of Clinical Trial: IRCT201306258801N3. Copyright © 2018 Shanghai Changhai Hospital. Published by Elsevier B.V. All rights reserved.

  13. Determinants of prenatal health care utilisation by low-risk women : A prospective cohort study

    NARCIS (Netherlands)

    Feijen-de Jong, Esther I.; Jansen, Danielle E. M. C.; Baarveld, Frank; Boerleider, Agatha W.; Spelten, Evelien; Schellevis, Francois; Reijneveld, Sijmen A.

    Background: Prenatal health care is pivotal in providing adequate prevention and care to pregnant women. Aim: We examined the determinants of inadequate prenatal health care utilisation by low-risk women in primary midwifery-led care in the Netherlands. Methods: We used longitudinal data from the

  14. Determinants of prenatal health care utilisation by low-risk women: a prospective cohort study.

    NARCIS (Netherlands)

    Feijen-de Jong, E.I.; Jansen, D.E.M.C.; Baarveld, F.; Boerleider, A.W.; Spelten, E.; Schellevis, F.; Reijneveld, S.A.

    2015-01-01

    Background: Prenatal health care is pivotal in providing adequate prevention and care to pregnant women. Aim: We examined the determinants of inadequate prenatal health care utilisation by low-risk women in primary midwifery-led care in the Netherlands. Methods: We used longitudinal data from the

  15. Determinants of prenatal health care utilisation by low-risk women: A prospective cohort study

    NARCIS (Netherlands)

    Feijen-de Jong, E.I.; Jansen, D.E.M.C.; Baarveld, F.; Boerleider, A.W.; Spelten, E.; Schellevis, F.; Reijneveld, S.A.

    2015-01-01

    Background: Prenatal health care is pivotal in providing adequate prevention and care to pregnant women. Aim: We examined the determinants of inadequate prenatal health care utilisation by low-risk women in primary midwifery-led care in the Netherlands. Methods: We used longitudinal data from the

  16. 29 CFR 99.530 - Criteria for a low-risk auditee.

    Science.gov (United States)

    2010-07-01

    ... management of Federal awards and provide a waiver. (c) There were no deficiencies in internal control which... periods) in which they were classified as Type A programs: (1) Internal control deficiencies which were... 29 Labor 1 2010-07-01 2010-07-01 true Criteria for a low-risk auditee. 99.530 Section 99.530 Labor...

  17. 7 CFR 3052.530 - Criteria for a low-risk auditee.

    Science.gov (United States)

    2010-01-01

    ... management of Federal awards and provide a waiver. (c) There were no deficiencies in internal control which... periods) in which they were classified as Type A programs: (1) Internal control deficiencies which were... 7 Agriculture 15 2010-01-01 2010-01-01 false Criteria for a low-risk auditee. 3052.530 Section...

  18. 76 FR 16234 - Prompt Corrective Action; Amended Definition of Low-Risk Assets

    Science.gov (United States)

    2011-03-23

    ...; Amended Definition of Low-Risk Assets AGENCY: National Credit Union Administration (NCUA). ACTION: Final... to reflect the absence of credit risk. Having considered the public comments addressing the Interim...), (f) and (g); 12 CFR 702.204(a)-(b). For a credit union that is subject to an additional Risk-Based...

  19. 75 FR 66298 - Prompt Corrective Action; Amended Definition of Low-Risk Assets

    Science.gov (United States)

    2010-10-28

    ...; Amended Definition of Low-Risk Assets AGENCY: National Credit Union Administration (NCUA). ACTION: Interim...-weighting of zero, reflecting the absence of credit risk. The amendment will expand the definition of ``low... exists today, the NGNs held by a natural person credit union would fall within the ``investments'' risk...

  20. Peripheral arterial tonometry cannot detect patients at low risk of coronary artery disease

    NARCIS (Netherlands)

    M.M. van den Heuvel (Mieke); O. Sorop (Oana); P. Musters (Paul); R.T. van Domburg (Ron); T.W. Galema (Tjebbe); D.J.G.M. Duncker (Dirk); W.J. van der Giessen (Wim); K. Nieman (Koen)

    2015-01-01

    textabstractBackground Endothelial dysfunction precedes coronary artery disease (CAD) and can be measured by peripheral arterial tonometry (PAT). We examined the applicability of PAT to detect a low risk of CAD in a chest pain clinic. Methods In 93 patients, PAT was performed resulting in reactive

  1. High- and Low-Risk Characteristics of Youth: The Five Cs of Competency.

    Science.gov (United States)

    McWhirter, J. Jeffries; And Others

    1994-01-01

    Identifies and discusses five basic skill strengths or skill deficits that mark critical difference between low-risk and high-risk youth. The "Five Cs of Competency" described include critical school competencies, concept of self and self-esteem, communication skills, coping ability, and control. Contends that these characteristics discriminate…

  2. Biomarkers and low risk in heart failure. Data from COACH and TRIUMPH

    NARCIS (Netherlands)

    Meijers, Wouter C.; de Boer, Rudolf A.; van Veldhuisen, Dirk J.; Jaarsma, Tiny; Hillege, Hans L.; Maisel, Alan S.; Di Somma, Salvatore; Voors, Adriaan A.; Peacock, W. Frank

    2015-01-01

    AimTraditionally, risk stratification in heart failure (HF) emphasizes assessment of high risk. We aimed to determine if biomarkers could identify patients with HF at low risk for death or HF rehospitalization. Methods and resultsThis analysis was a substudy of The Coordinating Study Evaluating

  3. Active surveillance can reduce overtreatment in patients with low-risk prostate cancer

    DEFF Research Database (Denmark)

    Thomsen, Frederik Birkebæk; Røder, Martin Andreas; Hvarness, Helle

    2013-01-01

    The incidence of prostate cancer in Denmark rose approximately 50% from 2000 to 2009 in parallel with the introduction of prostate-specific antigen (PSA)-testing. Available evidence indicates a significant overtreatment of patients with low-risk prostate cancer. Active surveillance has been...

  4. Client experiences with perinatal healthcare for high-risk and low-risk women

    NARCIS (Netherlands)

    van Stenus, Cherelle M.V.; Boere-Boonekamp, Magda M.; Kerkhof, Erna F.G.M.; Need, Ariana

    2018-01-01

    Problem: It is unknown if client experiences with perinatal healthcare differ between low-risk and high-risk women. Background: In the Netherlands, risk selection divides pregnant women into low- and high-risk groups. Receiving news that a pregnancy or childbirth has an increased likelihood of

  5. Bad experience, good birthing: Dutch low-risk pregnant women with a history of sexual abuse

    NARCIS (Netherlands)

    van der Hulst, Leonie A. M.; Bonsel, Gouke J.; Eskes, Martine; Birnie, Erwin; van Teijlingen, Edwin; Bleker, Otto P.

    2006-01-01

    OBJECTIVE: The long-term effects on women in childbirth with a history of sexual abuse have only been studied to a limited degree. We estimated the prevalence of lifetime experience among low-risk pregnant women (non-clinical) in The Netherlands as well as the association with (1) psycho-social

  6. Mother-Child Interactional Patterns in High- and Low-Risk Mothers.

    Science.gov (United States)

    Dolz, Laura; Cerezo, M. Angeles; Milner, Joel S.

    1997-01-01

    A study of 10 high-risk (of child physical abuse) and 10 demographically similar low-risk Spanish mother-child dyads investigated interactional patterns in the home. High-risk mothers made fewer neutral approaches to their children, displayed more negative behaviors toward their children, and made more indiscriminate responses to their children's…

  7. The impact of the fee-for-service reimbursement system on the ...

    African Journals Online (AJOL)

    The impact of the fee-for-service reimbursement system on the utilisation of health services: Part III. A comparison of caesarean section rates in white nulliparous women in the private and public sectors.

  8. The impact of acute and chronic strenuous exercise on pelvic floor muscle strength and support in nulliparous healthy women.

    Science.gov (United States)

    Middlekauff, Monique L; Egger, Marlene J; Nygaard, Ingrid E; Shaw, Janet M

    2016-09-01

    Strenuous physical activity, which is known to increase intraabdominal pressure and theoretically places stress on the pelvic floor, may affect pelvic support in nulliparous women. The aims of this study were to: (1) examine the differences in maximal vaginal descent (MVD), vaginal resting pressure (VRP), and pelvic floor muscle strength (PFMS) between women who habitually perform strenuous exercise vs women who refrain from performing strenuous exercise; and (2) compare MVD, VRP, and PFMS before and immediately following physical activity in the strenuous and nonstrenuous groups separately. Participants were healthy nulliparous women ages 18-35 years who were habitual strenuous or nonstrenuous exercisers. Women in the strenuous group participated in CrossFit (CrossFit, Inc., Washington, DC) at least 3 days per week for at least 6 months. We assessed anthropometric and body composition values using standardized procedures. Participants completed the Pelvic Organ Prolapse Quantification examination and pelvic muscle strength assessment before and again within 15 minutes of completing exercise (CrossFit for the strenuous group and self-paced walking for the nonstrenuous). A research nurse masked to study group assignment recorded MVD, defined as the greatest value of anterior, posterior, or apical support, and VRP and PFMS using a perineometer. Maximal PFMS was recorded as the highest pressure measured in 3 vaginal contraction trials. Data were analyzed using parametric and nonparametric tests as appropriate. P < .05 was considered significant. Seventy nulliparous women participated in the study, 35 in each group. The mean age was 24.77 ± 4.3 years. Compared to the nonstrenuous group, strenuous participants were heavier (64.70 ± 7.78 kg vs 60.6 ± 8.99 kg, P = .027), had lower percent body fat (23.36 ± 5.88% vs 27.55 ± 7.07%, P = .003), and had higher handgrip strength (20.78 ± 5.97 kg vs 16.04 ± 11.04 kg, P = .001). Before exercise, there were no

  9. Cost-effective treatment of low-risk carcinoma not invading bladder muscle.

    Science.gov (United States)

    Green, David A; Rink, Michael; Cha, Eugene K; Xylinas, Evanguelos; Chughtai, Bilal; Scherr, Douglas S; Shariat, Shahrokh F; Lee, Richard K

    2013-03-01

    Study Type - Therapy (cost effectiveness analysis) Level of Evidence 2a What's known on the subject? and What does the study add? Bladder cancer is one of the costliest malignancies to treat throughout the life of a patient. The most cost-effective management for low-risk non-muscle-invasive bladder cancer is not known. The current study shows that employing cystoscopic office fulguration for low-risk appearing bladder cancer recurrences can materially impact the cost-effectiveness of therapy. In a follow-up protocol where office fulguration is routinely employed for low-risk bladder cancers, peri-operative intravesical chemotherapy may not provide any additional cost-effectiveness benefit. To examine the cost-effectiveness of fulguration vs transurethral resection of bladder tumour (TURBT) with and without perioperative intravesical chemotherapy (PIC) for managing low-risk carcinoma not invading bladder muscle (NMIBC). Low-risk NMIBC carries a low progression rate, lending support to the use of office-based fulguration for small recurrences rather than traditional TURBT. A Markov state transition model was created to simulate treatment of NMIBC with vs without PIC, with recurrence treated by formal TURBT vs treatment with fulguration. Costing data were obtained from the Medicare Resource Based Relative Value Scale. Data regarding the success of PIC were obtained from the peer-reviewed literature, as were corresponding utilities for bladder cancer-related procedures. Sensitivity analyses were performed. At 5-year follow-up, a strategy of fulguration without PIC was the most cost-effective (mean cost-effectiveness = US $654.8/quality-adjusted life year), despite a lower recurrence rate with PIC. Both fulguration strategies dominated each TURBT strategy. Sensitivity analysis showed that fulguration without PIC dominated all other strategies when the recurrence rate after PIC was increased to ≥14.2% per year. Similarly, the cost-effectiveness of TURBT becomes more

  10. Self-hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness.

    Science.gov (United States)

    Downe, S; Finlayson, K; Melvin, C; Spiby, H; Ali, S; Diggle, P; Gyte, G; Hinder, S; Miller, V; Slade, P; Trepel, D; Weeks, A; Whorwell, P; Williamson, M

    2015-08-01

    (Primary) To establish the effect of antenatal group self-hypnosis for nulliparous women on intra-partum epidural use. Multi-method randomised control trial (RCT). Three NHS Trusts. Nulliparous women not planning elective caesarean, without medication for hypertension and without psychological illness. Randomisation at 28-32 weeks' gestation to usual care, or to usual care plus brief self-hypnosis training (two × 90-minute groups at around 32 and 35 weeks' gestation; daily audio self-hypnosis CD). Follow up at 2 and 6 weeks postnatal. Primary: epidural analgesia. Secondary: associated clinical and psychological outcomes; cost analysis. Six hundred and eighty women were randomised. There was no statistically significant difference in epidural use: 27.9% (intervention), 30.3% (control), odds ratio (OR) 0.89 [95% confidence interval (CI): 0.64-1.24], or in 27 of 29 pre-specified secondary clinical and psychological outcomes. Women in the intervention group had lower actual than anticipated levels of fear and anxiety between baseline and 2 weeks post natal (anxiety: mean difference -0.72, 95% CI -1.16 to -0.28, P = 0.001); fear (mean difference -0.62, 95% CI -1.08 to -0.16, P = 0.009) [Correction added on 7 July 2015, after first online publication: 'Mean difference' replaced 'Odds ratio (OR)' in the preceding sentence.]. Postnatal response rates were 67% overall at 2 weeks. The additional cost in the intervention arm per woman was £4.83 (CI -£257.93 to £267.59). Allocation to two-third-trimester group self-hypnosis training sessions did not significantly reduce intra-partum epidural analgesia use or a range of other clinical and psychological variables. The impact of women's anxiety and fear about childbirth needs further investigation. © 2015 The Authors. BJOG An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists.

  11. Re: What is the best treatment to reduce the need for caesarean section in nulliparous women at term with delayed first stage of labour?

    DEFF Research Database (Denmark)

    Boie, Sidsel; Glavind, Julie; Uldbjerg, Niels

    2017-01-01

    The authors pose the question - What is the best treatment to reduce the need for caesarean section in nulliparous women at term with delayed first stage of labour? and state in their paper that "There is no consensus on the optimal dose regimen of oxytocin for delay in the first stage of labour...... in nulliparous women at term (37-42 weeks’ gestation) to reduce unplanned caesarean section and increase vaginal birth with minimal adverse events". However, they describe only low and high dose oxytocin regimens and fail to acknowledge that no oxytocin at all is associated with a spontaneous delivery just...... as often as when oxytocin is given (1,2) or that discontinuation of oxytocin once the active phase of labour is reached can result in higher spontaneous delivery rates than continuing oxytocin (3,4). The paper in its list of trials (box 2) only describes those addressing high and low dose oxytocin, which...

  12. Do Ontarians drink in moderation? a baseline assessment against Canadian low risk drinking guidelines.

    Science.gov (United States)

    Bondy, S J; Ashley, M J; Rehm, J T; Walsh, G

    1999-01-01

    We used the 1997 Ontario Drug Monitor, a population-based, random-digit dialing survey of 2,776 adults, to obtain a baseline assessment of alcohol drinking by Ontarians against the 1997 low-risk drinking guidelines of the Addiction Research Foundation and the Canadian Centre on Substance Abuse. Average weekly alcohol consumption and the frequency of exceeding the daily limit, estimated using the graduated frequency scale, were determined for the population overall, and by sex and age group (18-44 and 45+ years). Most Ontarians drank alcohol in a pattern associated with a low risk of health consequences. About 10% of women and 25% of men drank in a style associated with some increase in acute or long-term risk. Younger men were most likely to drink in a risky pattern. Most drinkers of middle age or older, for whom cardiovascular disease is a significant health risk, consumed alcohol in a pattern associated with cardiovascular benefit.

  13. Predictive value of late decelerations for fetal acidemia in unselective low-risk pregnancies.

    Science.gov (United States)

    Sameshima, Hiroshi; Ikenoue, Tsuyomu

    2005-01-01

    We evaluated the clinical significance of late decelerations (LD) of intrapartum fetal heart rate (FHR) monitoring to detect low pH (LD (occasional, 50%; recurrent, > or = 50%) and severity (reduced baseline FHR accelerations and variability) of LD, and low pH (test, and one-way analysis of variance with the Bonferroni/Dunn test. In the 5522 low-risk pregnancies, 301 showed occasional LD and 99 showed recurrent LD. Blood gases and pH values deteriorated as the incidence of LD increased and as baseline accelerations or variability was decreased. Positive predictive value for low pH (LD, and > 50% in recurrent LD with no baseline FHR accelerations and reduced variability. In low-risk pregnancies, information on LD combined with acceleration and baseline variability enables us to predict the potential incidence of fetal acidemia.

  14. Willingness to pay for a cure of low-risk melanoma patients in Germany.

    Science.gov (United States)

    Augustin, Matthias; Blome, Christine; Forschner, Andrea; Gutzmer, Ralf; Hauschild, Axel; Heinzerling, Lucie; Livingstone, Elisabeth; Loquai, Carmen; Schadendorf, Dirk; Utikal, Jochen; Wagner, Tobias; Wilden, Sophia; Kähler, Katharina C

    2018-01-01

    Malignant melanoma is potentially life-threatening but in most cases curable if detected early. Willingness to pay (WTP) is a preference-based construct that reflects burden of disease by assessment of the monetary value for a hypothetical cure from disease. Since WTP (directly as total amount of money) has not been assessed so far in patients with low risk melanoma, it was interesting to gain insights in this patient population and then, in a second step, compare it directly with the WTP of their treating dermato-oncologists. WTP was assessed in 125 patients with low-risk melanoma and additionally in 105 treating physicians, asking for the one-time and continuous payments they would be willing to make for a sustainable cure, both as absolute sums and as percentages of monthly income. The median WTP based on one-time payment was €10,000 for patients and €100,000 for physicians; relative numbers were 100% versus 300% of monthly income. For continuous monthly payments, WTP was €500 for patients and €1000 for physicians, relative numbers 25% and 50% of income, respectively. Even after controlling for income differences, there was a significantly higher WTP in physicians for all four questions. Compared to patients with chronic skin diseases such as vitiligo, rosacea, atopic eczema and psoriasis, patients with low-risk melanoma showed a significantly higher WTP. Our data suggest that there is a relevant burden of disease even in patients with low-risk tumors. Higher WTP of physicians underlines the prevalence of differences in disease perception.

  15. Allergy Testing in Children With Low-Risk Penicillin Allergy Symptoms.

    Science.gov (United States)

    Vyles, David; Adams, Juan; Chiu, Asriani; Simpson, Pippa; Nimmer, Mark; Brousseau, David C

    2017-08-01

    Penicillin allergy is commonly reported in the pediatric emergency department (ED). True penicillin allergy is rare, yet the diagnosis results from the denial of first-line antibiotics. We hypothesize that all children presenting to the pediatric ED with symptoms deemed to be low-risk for immunoglobulin E-mediated hypersensitivity will return negative results for true penicillin allergy. Parents of children aged 4 to 18 years old presenting to the pediatric ED with a history of parent-reported penicillin allergy completed an allergy questionnaire. A prespecified 100 children categorized as low-risk on the basis of reported symptoms completed penicillin allergy testing by using a standard 3-tier testing process. The percent of children with negative allergy testing results was calculated with a 95% confidence interval. Five hundred ninety-seven parents completed the questionnaire describing their child's reported allergy symptoms. Three hundred two (51%) children had low-risk symptoms and were eligible for testing. Of those, 100 children were tested for penicillin allergy. The median (interquartile range) age at testing was 9 years (5-12). The median (interquartile range) age at allergy diagnosis was 1 year (9 months-3 years). Rash (97 [97%]) and itching (63 [63%]) were the most commonly reported allergy symptoms. Overall, 100 children (100%; 95% confidence interval 96.4%-100%) were found to have negative results for penicillin allergy and had their labeled penicillin allergy removed from their medical record. All children categorized as low-risk by our penicillin allergy questionnaire were found to have negative results for true penicillin allergy. The utilization of this questionnaire in the pediatric ED may facilitate increased use of first-line penicillin antibiotics. Copyright © 2017 by the American Academy of Pediatrics.

  16. First-line chemotherapy in low-risk gestational trophoblastic neoplasia.

    LENUS (Irish Health Repository)

    Alazzam, Mo'iad

    2012-01-01

    This is an update of a Cochrane review that was first published in Issue 1, 2009. Gestational trophoblastic neoplasia (GTN) is a rare but curable disease arising in the fetal chorion during pregnancy. Most women with low-risk GTN will be cured by evacuation of the uterus with or without single-agent chemotherapy. However, chemotherapy regimens vary between treatment centres worldwide and the comparable benefits and risks of these different regimens are unclear.

  17. Spirituality and low-risk consumption of alcohol in young adults

    OpenAIRE

    Díaz Heredia, Luz Patricia; Muñoz Sánchez, Alba Idaly

    2013-01-01

    The relationship between spirituality and health, as well as it effect on adopting healthy behaviors, is a topic of interest for nursing and, in general, for social and life sciences. Spirituality, as a human realm, is a relevant research theme that is often related to the promotion of health in individuals. Studies indicate that spirituality is related to mental and physical health, being a protective and promoting factor of healthy behaviors, among them low-risk consumption of alcohol in yo...

  18. Isolated port-site metastasis after surgical staging for low-risk endometrioid endometrial cancer: A case report.

    Science.gov (United States)

    Mautone, Daniele; Dall'asta, Andrea; Monica, Michela; Galli, Letizia; Capozzi, Vito Andrea; Marchesi, Federico; Giordano, Giovanna; Berretta, Roberto

    2016-07-01

    Port-site metastases (PSMs) are well-known potential complications of laparoscopic surgery for gynaecologic malignancies. The present case study reports PSM following laparoscopic surgery for Stage IA Grade 1 endometrioid endometrial cancer (EEC). The recurrence developed within 7 months following primary surgery and required surgical excision followed by adjuvant chemo-radio therapy. After 9 months, the patient remains disease-free. PSMs are rare complications following laparoscopic surgery. Amongst the 23 cases of endometrial cancer PSMs reported so far, only 4 followed EEC Stage IA Grade 1-2. The present study reports a rare case of PSM after Stage IA Grade 1 EEC. The clinical and prognostic relevance of PSMs has not been identified so far; and it is not known whether PSMs represent a local recurrence or a systemic recurrence. Surgeons should be aware that even low-risk EEC may be followed by PSMs and should take steps to prevent these rare recurrences.

  19. Image-Guided Hypofractionated Radiotherapy in Low-Risk Prostate Cancer Patients

    Directory of Open Access Journals (Sweden)

    Maurizio Valeriani

    2014-01-01

    Full Text Available Aim. To evaluate efficacy and toxicity of image-guided hypofractionated radiotherapy (HFRT in the treatment of low-risk prostate cancer. Outcomes and toxicities of this series of patients were compared to another group of 32 low-risk patients treated with conventional fractionation (CFRT. Methods. Fifty-nine patients with low-risk prostate cancer were analysed. Total dose for the prostate and proximal seminal vesicles was 60 Gy delivered in 20 fractions. Results. The median follow-up was 30 months. The actuarial 4-year overall survival, biochemical free survival, and disease specific survival were 100%, 97.4%, and 97.4%, respectively. Acute grade 1-2 gastrointestinal (GI and genitourinary (GU toxicity rates were 11.9% and 40.7%, respectively. Grade 1 GI and GU late toxicity rates were 8.5% and 13.6%, respectively. No grade ≥2 late toxicities were recorded. Acute grade 2-3 GU toxicity resulted significantly lower (P=0.04 in HFRT group compared to the CFRT group. The cumulative 4-year incidence of grade 1-2 GU toxicity was significantly higher (P<0.001 for HFRT patients. Conclusions. Our study demonstrated that hypofractionated regimen provided excellent biochemical control in favorable risk prostate cancer patients. The incidence of GI and GU toxicity was low. However, HFRT presented higher cumulative incidence of low-grade late GU toxicity than CFRT.

  20. Visual performance in preterm infants with brain injuries compared with low-risk preterm infants.

    Science.gov (United States)

    Leonhardt, Merçè; Forns, Maria; Calderón, Caterina; Reinoso, Marta; Gargallo, Estrella

    2012-08-01

    Neonatal brain injuries are the main cause of visual deficit produced by damage to posterior visual pathways. While there are several studies of visual function in low-risk preterm infants or older children with brain injuries, research in children of early age is lacking. To assess several aspects of visual function in preterm infants with brain injuries and to compare them with another group of low-risk preterm infants of the same age. Forty-eight preterm infants with brain injuries and 56 low-risk preterm infants. The ML Leonhardt Battery of Optotypes was used to assess visual functions. This test was previously validated at a post-menstrual age of 40 weeks in newborns and at 30-plus weeks in preterm infants. The group of preterm infants with brain lesions showed a delayed pattern of visual functions in alertness, fixation, visual attention and tracking behavior compared to infants in the healthy preterm group. The differences between both groups, in the visual behaviors analyzed were around 30%. These visual functions could be identified from the first weeks of life. Our results confirm the importance of using a straightforward screening test with preterm infants in order to assess altered visual function, especially in infants with brain injuries. The findings also highlight the need to provide visual stimulation very early on in life. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  1. Governmental standard drink definitions and low-risk alcohol consumption guidelines in 37 countries.

    Science.gov (United States)

    Kalinowski, Agnieszka; Humphreys, Keith

    2016-07-01

    One of the challenges of international alcohol research and policy is the variability in and lack of knowledge of how governments in different nations define a standard drink and low-risk drinking. This study gathered such information from governmental agencies in 37 countries. A pool of 75 countries that might have definitions was created using World Health Organization (WHO) information and the authors' own judgement. Structured internet searches of relevant terms for each country were supplemented by efforts to contact government agencies directly and to consult with alcohol experts in the country. Most of the 75 national governments examined were not identified as having adopted a standard drink definition. Among the 37 that were so identified, the modal standard drink size was 10 g pure ethanol, but variation was wide (8-20 g). Significant variability was also evident for low-risk drinking guidelines, ranging from 10-42 g per day for women and 10-56 g per day for men to 98-140 g per week for women and 150-280 g per week for men. Researchers working and communicating across national boundaries should be sensitive to the substantial variability in 'standard' drink definitions and low-risk drinking guidelines. The potential impact of guidelines, both in general and in specific national cases, remains an important question for public health research. © 2016 Society for the Study of Addiction.

  2. [Postoperative radioiodine ablation in patients with low risk differentiated thyroid carcinoma].

    Science.gov (United States)

    Díez, Juan J; Grande, Enrique; Iglesias, Pedro

    2015-01-06

    Most patients with newly diagnosed differentiated thyroid carcinoma have tumors with low risk of mortality and recurrence. Standard therapy has been total or near total thyroidectomy followed by postoperative radioiodine remnant ablation (RRA). Although RRA provides benefits, current clinical guidelines do not recommend it universally, since an increase in disease-free survival or a decrease in mortality in low risk patients has not been demonstrated so far. Advancements in our understanding of the biological behavior of thyroid cancer have been translated into the clinic in a personalized approach to the patients based on their individual risk of recurrence and mortality. Current evidence suggests that RRA is not indicated in most low-risk patients, especially those with papillary carcinomas smaller than 1cm, without extrathyroidal extension, unfavorable histology, lymph node involvement or distant metastases. Follow-up of these patients with serial measurements of serum thyroglobulin and neck ultrasound is adequate. Careful evaluation of all risk factors of clinical relevance will allow a more realistic assessment of each individual patient. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  3. A randomized controlled trial comparing parenteral normal saline with and without 5% dextrose on the course of labor in nulliparous women.

    Science.gov (United States)

    Sharma, Chanderdeep; Kalra, Jasvinder; Bagga, Rashmi; Kumar, Praveen

    2012-12-01

    The objective of this study was to compare intravenous normal saline with and without 5% dextrose on the course of labor in nulliparous women in active phase of spontaneous labor. In a randomized controlled trial, term, nulliparous women with singleton pregnancy in active labor were randomized into one of two groups receiving either normal saline or normal saline alternating with 5% dextrose at rate of 175 ml/h. The primary outcome was total length of labor from onset of study fluid in vaginally delivered women. Maternal and neonatal outcomes were also analyzed. Of 250 women enrolled, in vaginally delivered subjects, there was significant difference in the duration of labor (p=0.0) and prolonged labor (p=0.01), with favorable results for women in 5% dextrose alternating with normal saline. No statistically significant differences were observed in the cesarean section rates between the groups. The cord pH was significantly higher in neonates born to women in 5% dextrose alternating with normal saline infusion as compared to normal saline alone (p=0.01), however, no neonate in the study had acidemia. Administration of a 5% dextrose solution alternating with normal saline is a better parenteral fluid for significantly decreasing duration of labor in term vaginally delivered nulliparous women in spontaneous active labor as compared to normal saline alone.

  4. ACCUMULATION OF SELECTED METALS IN UMBILICAL CORD BLOOD OF NULLIPAROUS AND MULTIPAROUS WOMEN AND CORRELATION WITH THE NEWBORN´S PARAMETERS

    Directory of Open Access Journals (Sweden)

    Iwona Kozikowska

    2012-08-01

    Full Text Available The aim of this study was to determine the content of magnesium, copper, cadmium and iron in umbilical cord blood of the newborns depending on the number of pregnancies. It was established correlations between average concentrations these metals in cord blood and newborn’s parameters. The study material was collected immediately after delivery from the Department of Obstetrics and Gynecology in Bytom. The cord blood was taken from 99 women between 29-40 years old. Women were divided into two groups: nulliparous and multiparous. The concentration of metals in the cord blood was determined by flame atomic absorption spectrometry (FAAS. The conducted study demonstrates that magnesium, copper, cadmium and iron were noted in all tissues, both nulliparous women and multiparous mothers. The maximum concentration of cadmium in umbilical cord blood was observed among multiparous mothers (2.229 mg.kg-1 d.m.. In group of nulliparous women was observed higher concentration of Fe, Mg and Cu in umbilical cord blood than in multiparous mothers. It was noted some statistically significant correlation between iron, copper and newborn’s parameters. Parity influences the concentration of cadmium in umbilical cord blood with higher level found in multiparous women. Average content of iron in cord blood did not decrease with parity, it indicate that this element is preferentially taken up by the child.

  5. Effect of Inhalation of Aroma of Geranium Essence on Anxiety and Physiological Parameters during First Stage of Labor in Nulliparous Women: a Randomized Clinical Trial

    Directory of Open Access Journals (Sweden)

    Fahimeh Rashidi Fakari

    2015-06-01

    Full Text Available Introduction: Anxiety increases significantly during labor, especially among nulliparous women. Such anxiety may affect the progress of labor and physiological parameters. The use of essential oils of aromatic plants, or aromatherapy, is a non-invasive procedure that can decrease childbirth anxiety. This study examined the effect of inhalation of the aroma of geranium essential oil on the level of anxiety and physiological parameters of nulliparous women in the first stage of labor. Methods: In study, was carried out on 100 nulliparous women admitted to Bent al-Hoda Hospital in the city of Bojnord in North Khorasan province of Iran during 2012-2013. The women were randomly assigned to two groups of equal size, one experimental group (geranium essential oil and one control (placebo group. Anxiety levels were measured using Spielberger’s questionnaire before and after intervention. Physiological parameters (systolic and diastolic blood pressure, respiratory rate, pulse rate were also measured before and after intervention in both groups. Data analysis was conducted using the x2 test, paired t-test, Mann-Whitney U test, and Wilcox on test on SPSS 11.5. Results: The mean anxiety score decreased significantly after inhalation of the aroma of geranium essential oil. There was also a significant decrease in diastolic blood pressure.Conclusion: Aroma of essential oil of geraniums can effectively reduce anxiety during labor and can be recommended as a non-invasive anti-anxiety aid during childbirth.

  6. Second trimester hepatic rupture in a 35 year old nulliparous woman with HELLP syndrome: a case report

    Directory of Open Access Journals (Sweden)

    O'Brien N

    2009-06-01

    Full Text Available Abstract The HELLP syndrome (haemolysis, elevated liver blood tests and low platelets is a serious complication in pregnancy characterized by haemolysis, elevated liver enzymes and low platelet count occurring in 0.5 to 0.9% of all pregnancies and in 10–20% of cases with severe preeclampsia. Hepatic capsular rupture is a rare yet dramatic complication of HELLP syndrome. The majority of cases occur in multiparous women over the age of 30. Classically it presents with acute onset right upper quadrant pain in the presence of constitutional symptoms such as vomiting and pyrexia. However, symptoms and signs are usually non specific. Spontaneous hepatic rupture can be preceded by signs of hypovolaemic shock; yet the diagnosis is infrequently made prior to emergent laparotomy. We present the case of a 35 year old nulliparous woman with a second trimester gestational hepatic rupture associated with HELLP syndrome. We briefly discuss the aetiology, diagnostic difficulties and treatment options associated with this rare presentation.

  7. Urinary incontinence during pregnancy and 1 year after delivery in primiparous women compared with a control group of nulliparous women

    DEFF Research Database (Denmark)

    Hansen, Bent Brandt; Svare, Jens; Viktrup, Lars

    2012-01-01

    , the prevalence of any type of urinary incontinence in the primiparous group was 32.1%, compared to 13.8% in the control group. Adjusted OR¿=¿3.3 (95%CI¿=¿2.4-4.4). One year after delivery, the prevalence in the primiparous group was 29.3%, compared to 16.6% in the control group. Adjusted OR¿=¿2.5 (95%CI¿=¿1......AIMS: To investigate the impact of the first pregnancy and delivery on the prevalence and types of urinary incontinence during pregnancy and 1 year after delivery. METHODS: The study was a prospective cohort study with a control group. Primiparous women, who delivered in our department from June...... 2003 to July 2005, participated. The women filled out a questionnaire 2-3 days after the delivery and a new questionnaire after 1 year. The questionnaires comprised basic characteristics and symptoms of urinary incontinence. An attempted age-matched control group of nulliparous women was included...

  8. Influence of Grand Multiparity on the Levels of Insulin, Glucose and HOMA-IR in Comparison with Nulliparity and Primiparity.

    Science.gov (United States)

    Eldin Ahmed Abdelsalam, Kamal; Alobeid M Elamin, Abdelsamee

    2017-01-01

    It is to compare the levels of fasting glucose and insulin as well as insulin resistance in grand multiparas with primiparity and nulliparity. Fasting blood samples were collected from 100 non-pregnant ladies as control group, 100 primiparity pregnant women and 100 grand multiparity pregnant women. Glucose (FBS) and insulin (FSI) concentrations were measured by Hitachi 912 full automated Chemistry Analyzer (Roche Diagnostics, Germany) as manufacturer procedure. Insulin resistance was calculated following the formula: FBG (mg dL-1)×FSI (μU mL-1)/405. This study found a significant reduction in glucose level in primiparity when compared to control group but it was increased significantly in multiparity comparing to primiparity and control. Insulin level showed significant high concentrations in pregnant women and increased significantly in grand multiparas comparing to primiparas and controls. As a result of that, HOMA-IR was increased significantly by increasing of parity. Also, there was a significant increase in fasting insulin and a decrease in insulin sensitivity with parity with association to age and obesity. Grand multiparity is associated with an increased risk of subsequent clinical insulin resistance (HOMA-IR).

  9. The effect of type and volume of fluid hydration on labor duration of nulliparous women: a randomized controlled trial.

    Science.gov (United States)

    Garmi, Gali; Zuarez-Easton, Sivan; Zafran, Noah; Ohel, Iris; Berkovich, Ilanit; Salim, Raed

    2017-06-01

    Type and volume of fluid administered for intrapartum maintenance had been reported to differently affect labor length, delivery mode, and cord artery pH and glucose level. We aimed to compare the effect of three different fluid regimens on labor duration. In a randomized trial, healthy nulliparous in labor were randomized into one of three intravenous fluid regimens: group 1, the reference group, lactated Ringer's solution infused at a rate of 125 mL/h; group 2, lactated Ringer's solution infused at a rate of 250 mL/h; group 3, 0.9% saline solution boosted with 5% glucose, infused at a rate of 125 mL/h. The primary outcome was labor length from enrollment until delivery. Between December 2010 and July 2015, 300 women were randomized to one of the three groups. Demographic and baseline obstetric characteristics were comparable between the groups. There was no significant difference in the time from enrollment to delivery (p = 0.62). Furthermore, there were no significant differences in second stage duration (p = 0.73), mode of delivery (p = 0.21), cord artery pH and glucose level between the groups. Increasing the intravenous volume of lactated Ringer's solution or substituting to fluid containing 5% glucose solution does not affect labor length. ClinicalTrials.gov, http://www.clinicaltrials.gov , NCT01242293.

  10. The degree of labor pain at the time of epidural analgesia in nulliparous women influences the obstetric outcome.

    Science.gov (United States)

    Woo, Jae Hee; Kim, Jong Hak; Lee, Guie Yong; Baik, Hee Jung; Kim, Youn Jin; Chung, Rack Kyung; Yun, Du Gyun; Lim, Chae Hwang

    2015-06-01

    The increased pain at the latent phase can be associated with dysfunctional labor as well as increases in cesarean delivery frequency. We aimed to research the effect of the degree of pain at the time of epidural analgesia on the entire labor process including the mode of delivery. We performed epidural analgesia to 102 nulliparous women on patients' request. We divided the group into three based on NRS (numeric rating scale) at the moment of epidural analgesia; mild pain, NRS 1-4; moderate pain, NRS 5-7; severe pain, NRS 8-10. The primary outcome was the mode of delivery (normal labor or cesarean delivery). There were significant differences in the mode of delivery among groups. Patients with severe labor pain had a significantly higher cesarean delivery compared to patients with moderate labor pain (P = 0.006). The duration of the first and second stage of labor, fetal heart rate, use of oxytocin and premature rupture of membranes had no differences in the three groups. Our research showed that the degree of pain at the time of epidural analgesia request might influence the rate of cesarean delivery. Further research would be necessary for clarifying the mechanism that the augmentation of pain affects the mode of delivery.

  11. Omission of Breast Radiotherapy in Low-risk Luminal A Breast Cancer: Impact on Health Care Costs.

    Science.gov (United States)

    Han, K; Yap, M L; Yong, J H E; Mittmann, N; Hoch, J S; Fyles, A W; Warde, P; Gutierrez, E; Lymberiou, T; Foxcroft, S; Liu, F F

    2016-09-01

    The economic burden of cancer care is substantial, including steep increases in costs for breast cancer management. There is mounting evidence that women age ≥ 60 years with grade I/II T1N0 luminal A (ER/PR+, HER2- and Ki67 ≤ 13%) breast cancer have such low local recurrence rates that adjuvant breast radiotherapy might offer limited value. We aimed to determine the total savings to a publicly funded health care system should omission of radiotherapy become standard of care for these patients. The number of women aged ≥ 60 years who received adjuvant radiotherapy for T1N0 ER+ HER2- breast cancer in Ontario was obtained from the provincial cancer agency. The cost of adjuvant breast radiotherapy was estimated through activity-based costing from a public payer perspective. The total saving was calculated by multiplying the estimated number of luminal A cases that received radiotherapy by the cost of radiotherapy minus Ki-67 testing. In 2010, 748 women age ≥ 60 years underwent surgery for pT1N0 ER+ HER2- breast cancer; 539 (72%) underwent adjuvant radiotherapy, of whom 329 were estimated to be grade I/II luminal A subtype. The cost of adjuvant breast radiotherapy per case was estimated at $6135.85; the cost of Ki-67 at $114.71. This translated into an annual saving of about $2.0million if radiotherapy was omitted for all low-risk luminal A breast cancer patients in Ontario and $5.1million across Canada. There will be significant savings to the health care system should omission of radiotherapy become standard practice for women with low-risk luminal A breast cancer. Copyright © 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  12. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births

    NARCIS (Netherlands)

    de jonge, A.; van der Goes, B. Y.; Ravelli, A. C. J.; Amelink-Verburg, M. P.; Mol, B. W.; Nijhuis, J. G.; Bennebroek Gravenhorst, J.; Buitendijk, S. E.

    2009-01-01

    OBJECTIVE: To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care. DESIGN: A nationwide cohort study. SETTING: The entire Netherlands. POPULATION: A total of 529,688 low-risk women

  13. Biomarkers and low risk in heart failure. Data from COACH and TRIUMPH.

    Science.gov (United States)

    Meijers, Wouter C; de Boer, Rudolf A; van Veldhuisen, Dirk J; Jaarsma, Tiny; Hillege, Hans L; Maisel, Alan S; Di Somma, Salvatore; Voors, Adriaan A; Peacock, W Frank

    2015-12-01

    Traditionally, risk stratification in heart failure (HF) emphasizes assessment of high risk. We aimed to determine if biomarkers could identify patients with HF at low risk for death or HF rehospitalization. This analysis was a substudy of The Coordinating Study Evaluating Outcomes of Advising and Counselling in Heart Failure (COACH) trial. Enrolment of HF patients occurred before discharge. We defined low risk as the absence of death and/or HF rehospitalizations at 180 days. We tested a diverse group of 29 biomarkers on top of a clinical risk model, with and without N-terminal pro-B-type natriuretic peptide (NT-proBNP), and defined the low risk biomarker cut-off at the 10th percentile associated with high positive predictive value. The best performing biomarkers together with NT-proBNP and cardiac troponin I (cTnI) were re-evaluated in a validation cohort of 285 HF patients. Of 592 eligible COACH patients, the mean (± SD) age was 71 (± 11) years and median (IQR) NT-proBNP was 2521 (1301-5634) pg/mL. Logistic regression analysis showed that only galectin-3, fully adjusted, was significantly associated with the absence of events at 180 days (OR 8.1, 95% confidence interval 1.06-50.0, P = 0.039). Galectin-3, showed incremental value when added to the clinical risk model without NT-proBNP (increase in area under the curve from 0.712 to 0.745, P = 0.04). However, no biomarker showed significant improvement by net reclassification improvement on top of the clinical risk model, with or without NT-proBNP. We confirmed our results regarding galectin-3, NT-proBNP, and cTnI in the independent validation cohort. We describe the value of various biomarkers to define low risk, and demonstrate that galectin-3 identifies HF patients at (very) low risk for 30-day and 180-day mortality and HF rehospitalizations after an episode of acute HF. Such patients might be safely discharged. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of

  14. Use of advanced treatment technologies among men at low risk of dying from prostate cancer.

    Science.gov (United States)

    Jacobs, Bruce L; Zhang, Yun; Schroeck, Florian R; Skolarus, Ted A; Wei, John T; Montie, James E; Gilbert, Scott M; Strope, Seth A; Dunn, Rodney L; Miller, David C; Hollenbeck, Brent K

    2013-06-26

    The use of advanced treatment technologies (ie, intensity-modulated radiotherapy [IMRT] and robotic prostatectomy) for prostate cancer is increasing. The extent to which these advanced treatment technologies have disseminated among patients at low risk of dying from prostate cancer is uncertain. To assess the use of advanced treatment technologies, compared with prior standards (ie, traditional external beam radiation treatment [EBRT] and open radical prostatectomy) and observation, among men with a low risk of dying from prostate cancer. Using Surveillance, Epidemiology, and End Results (SEER)-Medicare data, we identified a retrospective cohort of men diagnosed with prostate cancer between 2004 and 2009 who underwent IMRT (n = 23,633), EBRT (n = 3926), robotic prostatectomy (n = 5881), open radical prostatectomy (n = 6123), or observation (n = 16,384). Follow-up data were available through December 31, 2010. The use of advanced treatment technologies among men unlikely to die from prostate cancer, as assessed by low-risk disease (clinical stage ≤T2a, biopsy Gleason score ≤6, and prostate-specific antigen level ≤10 ng/mL), high risk of noncancer mortality (based on the predicted probability of death within 10 years in the absence of a cancer diagnosis), or both. In our cohort, the use of advanced treatment technologies increased from 32% (95% CI, 30%-33%) to 44% (95% CI, 43%-46%) among men with low-risk disease (P risk of noncancer mortality (P use of these advanced treatment technologies among men with both low-risk disease and high risk of noncancer mortality increased from 25% (95% CI, 23%-28%) to 34% (95% CI, 31%-37%) (P use of advanced treatment technologies for men unlikely to die from prostate cancer increased from 13% (95% CI, 12%-14%), or 129.2 per 1000 patients diagnosed with prostate cancer, to 24% (95% CI, 24%-25%), or 244.2 per 1000 patients diagnosed with prostate cancer (P risk disease, high risk of noncancer mortality, or both, the use of

  15. National Trends and Predictors of Androgen Deprivation Therapy Use in Low-Risk Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yang, David D. [Harvard Medical School, Boston, Massachusetts (United States); Muralidhar, Vinayak [Department of Medicine, Harvard Medical School, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States); Mahal, Brandon A. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Labe, Shelby A.; Nezolosky, Michelle D.; Vastola, Marie E.; King, Martin T.; Martin, Neil E.; Orio, Peter F. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States); Choueiri, Toni K. [Department of Medical Oncology, Harvard Medical School, Boston, Massachusetts (United States); Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States); Trinh, Quoc-Dien [Division of Urological Surgery, Harvard Medical School, Boston, Massachusetts (United States); Brigham and Women' s Hospital, Boston, Massachusetts (United States); Spratt, Daniel E. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); University of Michigan, Ann Arbor, Michigan (United States); Hoffman, Karen E. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Feng, Felix Y. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); Departments of Urology & Medicine and Helen Diller Family Comprehensive Cancer Center, University of California at San Francisco, San Francisco, California (United States); and others

    2017-06-01

    Purpose: Androgen deprivation therapy (ADT) is not recommended for low-risk prostate cancer because of its lack of benefit and potential for harm. We evaluated the incidence and predictors of ADT use in low-risk disease. Methods and Materials: Using the National Cancer Database, we identified 197,957 patients with low-risk prostate cancer (Gleason score of 3 + 3 = 6, prostate-specific antigen level <10 ng/mL, and cT1-T2a) diagnosed from 2004 to 2012 with complete demographic and treatment information. We used multiple logistic regression to evaluate predictors of ADT use and Cox regression to examine its association with all-cause mortality. Results: Overall ADT use decreased from 17.6% in 2004 to 3.5% in 2012. In 2012, 11.5% of low-risk brachytherapy patients and 7.6% of external beam radiation therapy patients received ADT. Among 82,352 irradiation-managed patients, predictors of ADT use included treatment in a community versus academic cancer program (adjusted odds ratio [AOR], 1.60; 95% confidence interval [CI], 1.50-1.71; P<.001; incidence, 14.0% vs 6.0% in 2012); treatment in the South (AOR, 1.51), Midwest (AOR, 1.81), or Northeast (AOR, 1.90) versus West (P<.001); and brachytherapy use versus external beam radiation therapy (AOR, 1.32; 95% CI, 1.27-1.37; P<.001). Among 25,196 patients who did not receive local therapy, predictors of primary ADT use included a Charlson-Deyo comorbidity score of ≥2 versus 0 (AOR, 1.42; 95% CI, 1.06-1.91; P=.018); treatment in a community versus academic cancer program (AOR, 1.61; 95% CI, 1.37-1.90; P<.001); and treatment in the South (AOR, 1.26), Midwest (AOR, 1.52), or Northeast (AOR, 1.28) versus West (P≤.008). Primary ADT use was associated with increased all-cause mortality in patients who did not receive local therapy (adjusted hazard ratio, 1.28; 95% CI, 1.14-1.43; P<.001) after adjustment for age and comorbidity. Conclusions: ADT use in low-risk prostate cancer has declined nationally but may remain an issue

  16. Using low-risk factors to generate non-integrated human induced pluripotent stem cells from urine-derived cells.

    Science.gov (United States)

    Wang, Linli; Chen, Yuehua; Guan, Chunyan; Zhao, Zhiju; Li, Qiang; Yang, Jianguo; Mo, Jian; Wang, Bin; Wu, Wei; Yang, Xiaohui; Song, Libing; Li, Jun

    2017-11-02

    Because the lack of an induced pluripotent stem cell (iPSC) induction system with optimal safety and efficiency limits the application of these cells, development of such a system is important. To create such an induction system, we screened a variety of reprogrammed plasmid combinations and multiple compounds and then verified the system's feasibility using urine cells from different individuals. We also compared large-scale iPSC chromosomal variations and expression of genes associated with genomic stability between this system and the traditional episomal system using karyotype and quantitative reverse transcription polymerase chain reaction analyses. We developed a high-efficiency episomal system, the 6F/BM1-4C system, lacking tumorigenic factors for human urine-derived cell (hUC) reprogramming. This system includes six low-risk factors (6F), Oct4, Glis1, Klf4, Sox2, L-Myc, and the miR-302 cluster. Transfected hUCs were treated with four compounds (4C), inhibitor of lysine-demethylase1, methyl ethyl ketone, glycogen synthase kinase 3 beta, and histone deacetylase, within a short time period. Comparative analysis revealed significantly decreased chromosomal variation in iPSCs and significantly increased Sirt1 expression compared with iPSCs induced using the traditional episomal system. The 6F/BM1-4C system effectively induces reprogramming of urine cells in samples obtained from different individuals. iPSCs induced using the 6F/BM1-4C system are more stable at the cytogenetic level and have potential value for clinical application.

  17. A pharmacoeconomic analysis of the use of single MMC instillation in low risk NMIBC in Italy

    Directory of Open Access Journals (Sweden)

    Renzo Colombo

    2013-03-01

    Full Text Available BACKGROUND: Bladder cancer accounts for 5-10% of all cancers in Europe and up to 85% patients presents a noninvasive tumor, whose treatment of choice is the transurethral bladder resection (TURB paired with adjuvant intravesical chemotherapy or immunotherapy. Despite several clinical trials showed that this treatment is safe and decreases recurrences by 17% to 44% this practice is limited for many reasons. The study objective is to analyze the economical advantages of the single immediate post operative Mitomycin C instillation in Non Muscle-invasive Bladder Cancer (NMIBC low-risk patients.METHODS: A cost-benefit analysis was performed evaluating the economical gain that would raised from a scenario with a single immediate post operative mitomycin C instillation in each low-risk NMIBC patient who underwent to TURB. Net present value and cost-benefit ratio were calculated and sensitivity analyses were performed. Base case analysis was performed considering tumor recurrence rate reduction of 11.7% and a TURB costs of 2,167.0 €, while sensitivity analyses were performed using a recurrence rate reduction of 19.2% and 15.0% and a TURB cost of 2,472.93 €. The discount rate was 2%.RESULTS: The single immediate post operative instillation of mitomycin C resulted to be cost-beneficial with a cost-benefit ratio that goes from 0.48 to 0.79 when compared to TURB alone raising a Net Present Value that goes from 660,284.39 € to 2,650,530.79 €.CONCLUSION: This study demonstrates that even assuming conservative parameters for recurrence rates reduction, a single immediate post operative mitomycin C instillation in low risk NMIBC patients would lower not only the recurrence rate but also the caring cost for bladder cancer.

  18. Unilateral Prostate Cancer Cannot be Accurately Predicted in Low-Risk Patients

    International Nuclear Information System (INIS)

    Isbarn, Hendrik; Karakiewicz, Pierre I.; Vogel, Susanne

    2010-01-01

    Purpose: Hemiablative therapy (HAT) is increasing in popularity for treatment of patients with low-risk prostate cancer (PCa). The validity of this therapeutic modality, which exclusively treats PCa within a single prostate lobe, rests on accurate staging. We tested the accuracy of unilaterally unremarkable biopsy findings in cases of low-risk PCa patients who are potential candidates for HAT. Methods and Materials: The study population consisted of 243 men with clinical stage ≤T2a, a prostate-specific antigen (PSA) concentration of <10 ng/ml, a biopsy-proven Gleason sum of ≤6, and a maximum of 2 ipsilateral positive biopsy results out of 10 or more cores. All men underwent a radical prostatectomy, and pathology stage was used as the gold standard. Univariable and multivariable logistic regression models were tested for significant predictors of unilateral, organ-confined PCa. These predictors consisted of PSA, %fPSA (defined as the quotient of free [uncomplexed] PSA divided by the total PSA), clinical stage (T2a vs. T1c), gland volume, and number of positive biopsy cores (2 vs. 1). Results: Despite unilateral stage at biopsy, bilateral or even non-organ-confined PCa was reported in 64% of all patients. In multivariable analyses, no variable could clearly and independently predict the presence of unilateral PCa. This was reflected in an overall accuracy of 58% (95% confidence interval, 50.6-65.8%). Conclusions: Two-thirds of patients with unilateral low-risk PCa, confirmed by clinical stage and biopsy findings, have bilateral or non-organ-confined PCa at radical prostatectomy. This alarming finding questions the safety and validity of HAT.

  19. Perioperative pulmonary aspiration is infrequent and low risk in pediatric anesthetic practice.

    Science.gov (United States)

    Kelly, Christopher J; Walker, Robert W M

    2015-01-01

    Recent studies have reported perioperative pulmonary aspiration in pediatric practice to be an uncommon problem associated with low morbidity and mortality. This paper examines the recent publications in both the adult and pediatric literature and looks at some of the potential risk factors involved, both patient and anesthetic, in the development of aspiration of gastric contents. We also look at the risk of severe morbidity following pulmonary aspiration and speculate on possible reasons behind the assertion that pulmonary aspiration in pediatric anesthetic practice is rare and a low-risk event. © 2014 John Wiley & Sons Ltd.

  20. A case series of Nasopharyngeal Carcinoma among Indians, a low risk population, in Perak State, Malaysia.

    Science.gov (United States)

    Anusha, B; Philip, R; Norain, K; Harvinder, S; Gurdeep, S M

    2012-12-01

    Nasopharyngeal carcinoma (NPC) is rare among people of Indian ethnicity. A short retrospective case review of clinical records of Indian patients diagnosed with nasopharyngeal carcinoma in a period of 5 years was conducted. Their slides were further subjected to EBV encoded RNA (EBER) - In- situ Hybridization (ISH). The histologic subtype was nonkeratinizing carcinoma in all 4 patients. All were Epstein Barr Virus (EBV) positive. We believe that the crucial factor responsible for nasopharyngeal carcinoma is genetics; either a genetic susceptibility among high risk groups or genetic resistance/immunity in low risk groups. Further genetic studies are required to look for somatic or inherited chromosomal mutations among the various risk populations.

  1. Clinically low-risk prostate cancer: evaluation with transrectal doppler ultrasound and functional magnetic resonance imaging

    Directory of Open Access Journals (Sweden)

    Maria Inês Novis

    2011-01-01

    Full Text Available OBJECTIVES: To evaluate transrectal ultrasound, amplitude Doppler ultrasound, conventional T2-weighted magnetic resonance imaging, spectroscopy and dynamic contrast-enhanced magnetic resonance imaging in localizing and locally staging low-risk prostate cancer. INTRODUCTION: Prostate cancer has been diagnosed at earlier stages and the most accepted classification for low-risk prostate cancer is based on clinical stage T1c or T2a, Gleason score <6, and prostate-specific antigen (PSA <10 ng/ml. METHODS: From 2005 to 2006, magnetic resonance imaging was performed in 42 patients, and transrectal ultrasound in 26 of these patients. Seven patients were excluded from the study. Mean patient age was 64.94 years and mean serum PSA was 6.05 ng/ml. The examinations were analyzed for tumor identification and location in prostate sextants, detection of extracapsular extension, and seminal vesicle invasion, using surgical pathology findings as the gold standard. RESULTS: Sixteen patients (45.7% had pathologically proven organ-confined disease, 11 (31.4% had positive surgical margin, 8 (28.9% had extracapsular extension, and 3 (8.6% presented with extracapsular extension and seminal vesicle invasion. Sensitivity, specificity, positive predictive value (PPV, negative predictive value (NPV and accuracy values for localizing low-risk prostate cancer were 53.1%, 48.3%, 63.4%, 37.8% and 51.3% for transrectal ultrasound; 70.4%, 36.2%, 65.1%, 42.0% and 57.7% for amplitude Doppler ultrasound; 71.5%, 58.9%, 76.6%, 52.4% and 67.1% for magnetic resonance imaging; 70.4%, 58.7%, 78.4%, 48.2% and 66.7% for magnetic resonance spectroscopy; 67.2%, 65.7%, 79.3%, 50.6% and 66.7% for dynamic contrast-enhanced magnetic resonance imaging, respectively. Sensitivity, specificity, PPV, NPV and accuracy values for detecting extracapsular extension were 33.3%, 92%, 14.3%, 97.2% and 89.7% for transrectal ultrasound and 50.0%, 77.6%, 13.7%, 95.6% and 75.7% for magnetic resonance imaging

  2. Effects of early augmentation of labour with amniotomy and oxytocin in nulliparous women: a meta-analysis.

    Science.gov (United States)

    Fraser, W; Vendittelli, F; Krauss, I; Bréart, G

    1998-02-01

    To estimate the effects among nulliparae of early augmentation with amniotomy and oxytocin on caesarean delivery, and on other indicators of maternal and neonatal morbidity including transfusion. Apgar score manual and computerised searches. Two unpublished studies were identified through direct communication with the investigators. Twelve trials were identified which compared a policy of early labour augmentation including amniotomy followed by oxytocin with a less active form of management. Two methodologically unacceptable studies were excluded. Studies were grouped according to whether they admitted only women with abnormal progress (therapy trials: n = 3) or accepted women with normal labour (prevention trials: n = 7). Unstratified analysis did not provide support for the hypothesis that early augmentation reduces the risk of caesarean section (typical odds ratio [OR] 0.9; 95% CI 0.7-1.1). The typical odds ratio for prevention trials was similar to that obtained in the unstratified analysis (typical OR 0.9, 95% CI 0.7-1.2). Although only a small number of women have been randomised in therapy trials, a trend toward a reduction in the rate of caesarean section with early intervention was seen in this group (typical OR 0.6, 95% CI 0.2-1.4). Early augmentation does not appear to provide benefit over a more conservative form of management in the context of care of nulliparous women with mild delays in the progress of labour. In the context of established delay in labour, an active policy of augmentation may reduce the risk of caesarean section. However, only three small trials have been performed in this context, and they do not have adequate power to allow firm conclusions to be drawn.

  3. Elective induction of labor at 39 weeks among nulliparous women: The impact on maternal and neonatal risk.

    Science.gov (United States)

    Sinkey, Rachel G; Lacevic, Jasmin; Reljic, Tea; Hozo, Iztok; Gibson, Kelly S; Odibo, Anthony O; Djulbegovic, Benjamin; Lockwood, Charles J

    2018-01-01

    Optimal management of pregnancies at 39 weeks gestational age is unknown. Therefore, we sought to perform a comparative effectiveness analysis of elective induction of labor (eIOL) at 39 weeks among nulliparous women with non-anomalous singleton, vertex fetuses as compared to expectant management (EM) which included IOL for medical or obstetric indications or at 41 weeks in undelivered mothers. A Monte Carlo micro-simulation model was constructed modeling two mutually exclusive health states: eIOL at 39 weeks, or EM with IOL for standard medical or obstetrical indications or at 41 weeks if undelivered. Health state distribution probabilities included maternal and perinatal outcomes and were informed by a review of the literature and data derived from the Consortium of Safe Labor. Analyses investigating preferences for maternal versus infant health were performed using weighted utilities. Primary outcome was determining which management strategy posed less maternal and neonatal risk. Secondary outcomes were rates of cesarean deliveries, maternal morbidity and mortality, stillbirth, neonatal morbidity and mortality, and preferences regarding the importance of maternal and perinatal health. A management strategy of eIOL at 39 weeks resulted in less maternal and neonatal risk as compared to EM with IOL at 41 weeks among undelivered patients. Cesarean section rates were higher in the EM arm (35.9% versus 13.9%, p39 week eIOL still resulted in fewer cesarean deliveries as compared to EM (8.0% versus 26.1%, p39 week eIOL was favored over EM. Mathematical modeling revealed that eIOL at 39 weeks resulted in lower population risks as compared to EM with induction of labor at 41 weeks. Specifically, eIOL at 39 weeks resulted in a lower cesarean section rate, lower rates of maternal morbidity, fewer stillbirths and neonatal deaths, and lower rates of neonatal morbidity.

  4. A preliminary study to assess the impact of maternal age on stress-related variables in healthy nulliparous women.

    Science.gov (United States)

    García-Blanco, Ana; Monferrer, Alberto; Grimaldos, Jorge; Hervás, David; Balanzá-Martínez, Vicent; Diago, Vicente; Vento, Máximo; Cháfer-Pericás, Consuelo

    2017-04-01

    Childbearing age has progressively increased in industrialized countries. The impact of this delay on motherhood, however, requires further research. The study sample included a prospective cohort of healthy nulliparous pregnant women aged between 18 and 40 years (n=148) assessed at 38 weeks gestation (Time#1, T1), 48h after birth (Time#2, T2), and 3 months after birth (Time#3, T3). The effect of age on psychological, biological, and social variables was evaluated. Maternal psychological symptoms in terms of depression and anxiety were assessed at T1-T3; and parenting stress at T3. Stress biomarkers (cortisol, α-amylase) were determined in mothers at T1-T3. Questionnaires addressing social functioning (i.e., family functioning, maternal attitudes, and social support) were conducted at T3. Bayesian additive models were used to analyze the data. Depressive symptoms showed a steep increase starting from 35 years of age at T1 and an U-shaped relationship with a minimum around 30 years old at T3. The same results were observed for parenting stress. Cortisol levels increased sharply from 30 years of age at T3. Family functioning, maternal attitudes, and social support improved moderately from 30 years of age. Prenatal depressive symptoms were higher in older women, but postpartum depressive symptoms and parenting stress increased in both younger and older women. Nevertheless, cortisol levels just increased in older ages at postpartum. In contrast, social functioning (family functioning, maternal attitudes, and social support) improved with age. We conclude that these social advantages may compensate for other disadvantages of delayed childbearing (i.e., depressive symptoms, parenting stress, and high cortisol level). Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Evaluating the use of antibiotic prophylaxis during open reduction and internal fixation surgery in patients at low risk of surgical site infection.

    Science.gov (United States)

    Xu, Sheng-Gen; Mao, Zhao-Guang; Liu, Bin-Sheng; Zhu, Hui-Hua; Pan, Hui-Lin

    2015-02-01

    Widespread overuse and inappropriate use of antibiotics contribute to increasingly antibiotic-resistant pathogens and higher health care costs. It is not clear whether routine antibiotic prophylaxis can reduce the rate of surgical site infection (SSI) in low-risk patients undergoing orthopaedic surgery. We designed a simple scorecard to grade SSI risk factors and determined whether routine antibiotic prophylaxis affects SSI occurrence during open reduction and internal fixation (ORIF) orthopaedic surgeries in trauma patients at low risk of developing SSI. The SSI risk scorecard (possible total points ranged from 5 to 25) was designed to take into account a patient's general health status, the primary cause of fractures, surgical site tissue condition or wound class, types of devices implanted, and surgical duration. Patients with a low SSI risk score (≤8 points) who were undergoing clean ORIF surgery were divided into control (routine antibiotic treatment, cefuroxime) and evaluation (no antibiotic treatment) groups and followed up for 13-17 months after surgery. The infection rate was much higher in patients with high SSI risk scores (≥9 points) than in patients with low risk scores assigned to the control group (10.7% vs. 2.2%, Prisk score. Implementation of this scoring system could guide the rational use of perioperative antibiotics and ultimately reduce antibiotic resistance, health care costs, and adverse reactions to antibiotics. Copyright © 2014 Elsevier Ltd. All rights reserved.

  6. The genesis of breast cancer is a two-step phenomenon. II. Dissociation of two biomarkers in cancer patients from a low risk area of Japan.

    Science.gov (United States)

    Kodama, M; Kodama, T; Murakami, M; Kobayashi, S; Akita, T; Nakamura, Y

    1992-01-01

    The association of dual steroidal disorders with breast cancer, as proposed on the basis of a case-control study in a high risk area of Japan, was tested for its validity in breast cancer patients from a low risk area of Japan. A state of glucocorticoid excess, the first hormonal trait of a breast cancer patient, was assessed using a urinary steroid parameter (a reduction of the androsterone to tetrahydrocortisol ratio by definition), and/or using a physical parameter (an elevation of the waist to hip circumference ratio by definition). Inclination to ovulation failure, the second hormonal trait, was tested using another urinary steroid parameter (a specified disorder of progestin metabolism by definition), and/or a demographic parameter (a reduction in the number of live births by definition). Results obtained are as follows: 1) premenopausal breast cancer patients from a low risk area were found to have the second trait but not the first trait, as tested using 2 parameters for each trait. 2) Postmenopausal cancer patients from a low risk area as well as pre- and post-menopausal cancer patients from a high risk area had both the 2 hormonal traits. 3) There was no discrepancy of results between any 2 test systems with the identification of 2 hormonal traits in 4 cancer patient groups. The significance of the dissociation of 2 hormonal traits, as observed in premenopausal cancer patients from a low risk area, is discussed in favor of the two-step carcinogenesis theory. Possible interaction of heredity and environment in the genesis of breast cancer is also taken into consideration.

  7. Pathological and Biochemical Outcomes among African-American and Caucasian Men with Low Risk Prostate Cancer in the SEARCH Database: Implications for Active Surveillance Candidacy.

    Science.gov (United States)

    Leapman, Michael S; Freedland, Stephen J; Aronson, William J; Kane, Christopher J; Terris, Martha K; Walker, Kelly; Amling, Christopher L; Carroll, Peter R; Cooperberg, Matthew R

    2016-11-01

    Racial disparities in the incidence and risk profile of prostate cancer at diagnosis among African-American men are well reported. However, it remains unclear whether African-American race is independently associated with adverse outcomes in men with clinical low risk disease. We retrospectively analyzed the records of 895 men in the SEARCH (Shared Equal Access Regional Cancer Hospital) database in whom clinical low risk prostate cancer was treated with radical prostatectomy. Associations of African-American and Caucasian race with pathological biochemical recurrence outcomes were examined using chi-square, logistic regression, log rank and Cox proportional hazards analyses. We identified 355 African-American and 540 Caucasian men with low risk tumors in the SEARCH cohort who were followed a median of 6.3 years. Following adjustment for relevant covariates African-American race was not significantly associated with pathological upgrading (OR 1.33, p = 0.12), major upgrading (OR 0.58, p = 0.10), up-staging (OR 1.09, p = 0.73) or positive surgical margins (OR 1.04, p = 0.81). Five-year recurrence-free survival rates were 73.4% in African-American men and 78.4% in Caucasian men (log rank p = 0.18). In a Cox proportional hazards analysis model African-American race was not significantly associated with biochemical recurrence (HR 1.11, p = 0.52). In a cohort of patients at clinical low risk who were treated with prostatectomy in an equal access health system with a high representation of African-American men we observed no significant differences in the rates of pathological upgrading, up-staging or biochemical recurrence. These data support continued use of active surveillance in African-American men. Upgrading and up-staging remain concerning possibilities for all men regardless of race. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  8. Factors Associated With Mortality in Low-Risk Pediatric Critical Care Patients in The Netherlands.

    Science.gov (United States)

    Verlaat, Carin W; Visser, Idse H; Wubben, Nina; Hazelzet, Jan A; Lemson, Joris; van Waardenburg, Dick; van der Heide, Douwe; van Dam, Nicolette A; Jansen, Nicolaas J; van Heerde, Mark; van der Starre, Cynthia; van Asperen, Roelie; Kneyber, Martin; van Woensel, Job B; van den Boogaard, Mark; van der Hoeven, Johannes

    2017-04-01

    To determine differences between survivors and nonsurvivors and factors associated with mortality in pediatric intensive care patients with low risk of mortality. Retrospective cohort study. Patients were selected from a national database including all admissions to the PICUs in The Netherlands between 2006 and 2012. Patients less than 18 years old admitted to the PICU with a predicted mortality risk lower than 1% according to either the recalibrated Pediatric Risk of Mortality or the Pediatric Index of Mortality 2 were included. None. In total, 16,874 low-risk admissions were included of which 86 patients (0.5%) died. Nonsurvivors had more unplanned admissions (74.4% vs 38.5%; p < 0.001), had more complex chronic conditions (76.7% vs 58.8%; p = 0.001), were more often mechanically ventilated (88.1% vs 34.9%; p < 0.001), and had a longer length of stay (median, 11 [interquartile range, 5-32] d vs median, 3 [interquartile range, 2-5] d; p < 0.001) when compared with survivors. Factors significantly associated with mortality were complex chronic conditions (odds ratio, 3.29; 95% CI, 1.97-5.50), unplanned admissions (odds ratio, 5.78; 95% CI, 3.40-9.81), and admissions in spring/summer (odds ratio, 1.67; 95% CI, 1.08-2.58). Nonsurvivors in the PICU with a low predicted mortality risk have recognizable risk factors including complex chronic condition and unplanned admissions.

  9. Stereotactic body radiotherapy for low-risk prostate cancer: five-year outcomes

    Directory of Open Access Journals (Sweden)

    King Christopher R

    2011-01-01

    Full Text Available Abstract Purpose Hypofractionated, stereotactic body radiotherapy (SBRT is an emerging treatment approach for prostate cancer. We present the outcomes for low-risk prostate cancer patients with a median follow-up of 5 years after SBRT. Method and Materials Between Dec. 2003 and Dec. 2005, a pooled cohort of 41 consecutive patients from Stanford, CA and Naples, FL received SBRT with CyberKnife for clinically localized, low-risk prostate cancer. Prescribed dose was 35-36.25 Gy in five fractions. No patient received hormone therapy. Kaplan-Meier biochemical progression-free survival (defined using the Phoenix method and RTOG toxicity outcomes were assessed. Results At a median follow-up of 5 years, the biochemical progression-free survival was 93% (95% CI = 84.7% to 100%. Acute side effects resolved within 1-3 months of treatment completion. There were no grade 4 toxicities. No late grade 3 rectal toxicity occurred, and only one late grade 3 genitourinary toxicity occurred following repeated urologic instrumentation. Conclusion Five-year results of SBRT for localized prostate cancer demonstrate the efficacy and safety of shorter courses of high dose per fraction radiation delivered with SBRT technique. Ongoing clinical trials are underway to further explore this treatment approach.

  10. Foot length measurements of newborns of high and low risk pregnancies

    Directory of Open Access Journals (Sweden)

    Ana Karina Marques Salge

    Full Text Available Abstract OBJECTIVE Comparing foot length measurements of newborns in high and low risk pregnancies at a public hospital in Goiânia, GO, Brazil. METHOD A cross-sectional study carried out between April, 2013 and May, 2015, with a sample consisting of 180 newborns; 106 infants of women from high-risk pregnancies and 74 of women from low-risk pregnancies. Data were descriptively analyzed. Foot length measurement was performed using a stiff transparent plastic ruler, graduated in millimeters. The length of both feet was measured from the tip of the hallux (big toe to the end of the heel. RESULTS A statistically significant relationship was found between the foot length and newborn’s weight, between the cephalic and thoracic perimeters in the high-risk group and between the cephalic perimeter in the control group. CONCLUSION There is a need for creating cut-off points to identify newborns with intrauterine growth disorders using foot length.

  11. Milk intake is not associated with low risk of diabetes or overweight-obesity

    DEFF Research Database (Denmark)

    Bergholdt, Helle K M; Nordestgaard, Børge G; Ellervik, Christina

    2015-01-01

    BACKGROUND: High dairy/milk intake has been associated with a low risk of type 2 diabetes observationally, but whether this represents a causal association is unknown. OBJECTIVE: We tested the hypothesis that high milk intake is associated with a low risk of type 2 diabetes and of overweight-obesity......, observationally and genetically. DESIGN: In 97,811 individuals from the Danish general population, we examined the risk of incident type 2 diabetes and of overweight-obesity by milk intake observationally and by LCT-13910 C/T genotype [polymorphism (rs4988235) upstream from the lactase (LCT) gene], where TT...... and TC genotypes are associated with lactase persistence and CC with nonpersistence. RESULTS: Observationally for any compared with no milk intake, the HR for type 2 diabetes was 1.10 (95% CI: 0.98, 1.24; P = 0.11), whereas the OR for overweight-obesity was 1.06 (1.02, 1.09; P = 0.002). Median milk...

  12. Vaginal flora alterations and clinical symptoms in low-risk pregnant women.

    Science.gov (United States)

    Gondo, Fausto; da Silva, Márcia G; Polettini, Jossimara; Tristao, Andréa da R; Peracoli, José C; Witkin, Steven S; Rudge, Marilza V C

    2011-01-01

    To evaluate associations between alterations in vaginal flora and clinical symptoms in low-risk pregnant women. Vaginal specimens from 245 pregnant women were analyzed by microscopy for vaginal flora. Signs and symptoms of vaginal infection were determined by patient interviews and gynecologic examinations. Abnormal vaginal flora was identified in 45.7% of the subjects. The final clinical diagnoses were bacterial vaginosis (21.6%), vaginal candidosis (10.2%), intermediate vaginal flora (5.2%), aerobic vaginitis (2.9%), mixed flora (2.9%) and other abnormal findings (2.9%). The percentage of women with or without clinical signs or symptoms was not significantly different between these categories. The presence of vaginal odor or vaginal discharge characteristics was not diagnostic of any specific flora alteration; pruritus was highly associated with candidosis (p vaginal odor was associated with bacterial vaginosis (p = 0.0026). The prevalence of atypical vaginal flora is common in our low-risk pregnant population and is not always associated with pathology. The occurrence of specific signs or symptoms does not always discriminate between women with different types of atypical vaginal flora or between those with abnormal and normal vaginal flora. Copyright © 2010 S. Karger AG, Basel.

  13. Ureteral diameter in low-risk vesicoureteral reflux in infancy and childhood

    International Nuclear Information System (INIS)

    Hellstroem, M.; Hjaelmaas, K.; Jacobsson, B.; Jodal, U.; Oestra Sjukhuset, Goeteborg; Oestra Sjukhuset, Goeteborg

    1986-01-01

    In order to improve the accuracy of the grading of vesicoureteral reflux (VUR), reference values for ureteral diameter at micturition cystourethrography (MCUG) were established in infants and children with low-risk VUR. Low-risk VUR was defined as VUR not associated with infection, obstruction, calculi, duplication, malformations (except for hypospadia) or neurogenic bladder disturbances. Forty-six children (age 1 day - 14 years) were selected by examining the records of 12000 MCUG:s performed 1960-1983. Ureteral diameter was measured at the widest point of the ureter on the films from MCUG:s and urographies. Ureteral diameter was slightly larger at MCUG than at urography in the same individuals but the difference was not significant. The ureteral diameter at MCUG also correlated closely to normal values at urography in a previous study. It is proposed that the reference values obtained at MCUG in the present investigation can be used for the differentiation between dilatation and no dilatation in the grading of VUR. (orig.)

  14. High-Risk and Low-Risk Human Papillomavirus and the Absolute Risk of Cervical Intraepithelial Neoplasia or Cancer

    DEFF Research Database (Denmark)

    Thomsen, Louise T; Frederiksen, Kirsten; Munk, Christian

    2014-01-01

    OBJECTIVE: To determine the absolute risk of cervical intraepithelial neoplasia (CIN) grade 3 or cervical cancer (CIN 3 or worse) after detection of low-risk human papillomavirus (HPV) and after a negative high-risk HPV test. METHODS: In this prospective cohort study, consecutive liquid......-based cervical cytology samples were collected from women screened for cervical cancer in Copenhagen, Denmark, during 2002-2005. Samples were tested with a clinical test for 13 high-risk and five low-risk HPV types. The cohort (N=35,539; aged 14-90 years) was monitored in a nationwide pathology register for up...... cytology. Detection of low-risk HPV does not predict CIN 3 or worse. Cervical cancer screening should not include testing for low-risk HPV types. LEVEL OF EVIDENCE: II....

  15. Trichomonas vaginalis infection in a low-risk women attended in Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre

    Directory of Open Access Journals (Sweden)

    Norhayati Moktar

    2016-08-01

    Conclusions: The present study reported zero incidence rate of trichomoniasis. The low incidence rate was postulated due to all women who participated in this study were categorized into a low-risk group.

  16. A Systematic Approach to Discussing Active Surveillance with Patients with Low-risk Prostate Cancer.

    Science.gov (United States)

    Ehdaie, Behfar; Assel, Melissa; Benfante, Nicole; Malhotra, Deepak; Vickers, Andrew

    2017-06-01

    Physicians report difficulty convincing patients with prostate cancer about the merits of active surveillance (AS); as a result, a majority of patients unnecessarily choose to undergo radical treatment. To develop and evaluate a systematic approach for physicians to counsel patients with low-risk prostate cancer to increase acceptance of AS. A systematic counseling approach was developed and piloted in one clinic. Then five surgeons participated in a 1-h training session in which they learned about the approach. A total of 1003 patients with Gleason 3+3 prostate cancer were included in the study. We compared AS rates for 761 patients who were counseled over a 24-mo period before the training intervention with AS rates for 242 patients who were counseled over a 12-mo period afterwards, controlling for temporal trends and case mix. A systematic approach for communicating the merits of AS using appropriate framing techniques derived from principles studied by negotiation scholars. The rate of AS acceptance by patients for management of low-risk prostate cancer. In the pilot phase, 81 of 86 patients (94%) accepted AS after counseling by the physician who developed the counseling approach. In the subsequent study, the cohort for the training intervention comprised 1003 consecutive patients, 80% of whom met the Epstein criteria for very low-risk disease. The proportion of patients who selected AS increased from 69% before the training intervention to 81% afterwards. After adjusting for time trends and case mix, the rate of AS after the intervention was 9.1% higher (95% confidence interval -0.4% to 19.4%) than expected, a relative reduction of approximately 30% in the risk of unnecessary curative treatment. A systematic approach to counseling can be taught to physicians in a 1-h lecture. We found evidence that even this minimal intervention can decrease overtreatment. Our novel approach offers a framework to help address cancer screening-related overtreatment that occurs

  17. [Draft of the best medical treatment in patients with low-risk thyroid cancer].

    Science.gov (United States)

    Vlček, Petr; Nováková, Dagmar; Vejvalka, Jan; Zimák, Jaroslav; Křenek, Martin; Vošmiková, Květuše; Smutný, Svatopluk; Bavor, Petr; Astl, Jaromír; Lukáš, Jindřich

    2015-09-01

    The incidence of well-differentiated low-risk thyroid cancer have increased globally over the last three decades. Thyroid cancer treatment relates to a suitable surgical procedure and the use of adjuvant radio-iodine therapy in selected patients. Evaluation of prognostic factors and risk stratification are critical for determining appropriate treatment. Survival of patients with low-risk thyroid cancer is excellent. Appropriate choice of medical treatment resulted in full recovery in most patients. Relapse risk increases with the size of the primary tumor, along with the findings of the risk factors in men. Our study included a total of 1 980 patients in whom were diagnosed T1a and T1b tumors between the years 2003 to 2012. The population included 1 675 women (84.6 %) of average age of 45.22 years and 305 men (15.4 %) of average age of 50.0 years. The bulk of the file represented papillary carcinomas (1 868; 94.4 %), and smaller group of follicular carcinomas (112; 5.6 %). Patients were divided into four groups according to tumor size. Patients were evaluated according to risk factors: unifocality no other risk factors, multifocality - more bearings in thyroid tumor, metastases in regional lymph nodes, distant metastases or combination of risk factors. Group A: In the monitored set of 678 patients with papillary and follicular microcarcinoma up to 5 mm, during histological input, the findings revealed one bearing (unifocal type of cancer) in 566 patients. Multifocality was found in 112 patients, local nodal metastasis were demonstrated in 24 cases and pulmonary metastasis was discove-red in 1 case. Group B: In this group there were 576 study patients with papillary and follicular microcarcinoma size of 5-10 mm. Histological findings were captured input one bearing carcinoma in 434 patients, 142 patients with multifocality, in 53 cases of local nodal metastasis, and 1 case of bone metastases. Group C: In this group there were 467 study patients with papillary

  18. The selection of low-risk design guidelines for energetic events

    International Nuclear Information System (INIS)

    Fergusson, Donald; Marchaterre, John; Graham, John

    1982-01-01

    This paper recommends the establishment of specific design guidelines for protection against potential, but low probability, energetic events. These guidelines recognize the plant protective features incorporated to prevents such events, as well as the inherent capability of the plant to accommodate a certain level of energy release. Further, their application is recommended within the context of necessary standardized and agreed upon acceptance criteria which are less restrictive than ASME code requirements. The paper provides the background upon which the selection of the design is made, including the characterization of energetic events dependent on various core-design parameters, and including the necessity of a low-risk design balanced between prevention of accidents and the mitigation of consequences

  19. Providing reliable equipment to IAEA through a low risk transition plan

    International Nuclear Information System (INIS)

    Green, L.; Weinstock, E.V.; Karlin, E.W.

    1988-01-01

    The development and production of safeguards equipment is a complex process containing many potential pitfalls between the conceptual design and its implementation in the field. The conditions for equipment use are especially demanding. At the same time, the consequences of failure may be serious. Repeated failure may result in the loss of credibility of safeguards. Expensive back up measures such as re-verification of inventories may be required. Inspectors may come to distrust the equipment. Finally, the expense of maintaining the equipment may be excessive. It is therefore essential that the process for bringing equipment for the conceptual stage to actual routine use minimizes the risk of producing equipment that is unsuitable for the job. Fortunately, approaches for accomplishing this have already been developed in both the industrial and commercial sectors. One such approach, the Low Risk Transition Plan (LRTP) is described to show it can be applied to the production of reliable safeguards equipment

  20. Drinking patterns and adherence to "low-risk" guidelines among community-residing older adults.

    Science.gov (United States)

    Lewis, Ben; Garcia, Christian C; Nixon, Sara Jo

    2018-06-01

    Older adults constitute a rapidly expanding proportion of the U.S. Contemporary studies note the increasing prevalence of alcohol consumption in this group. Thus, understanding alcohol effects, consumption patterns, and associated risks in aging populations constitute critical areas of study with increasing public health relevance. Participants (n = 643; 292 women; ages 21-70) were community residing adult volunteers. Primary measures of interest included four patterns of alcohol consumption (average [oz./day]; typical quantity [oz./occasion]; frequency [% drinking days]; and maximal quantity [oz.]). Regression analyses explored associations between these measures, age, and relevant covariates. Subsequent between-group analyses investigated differences between two groups of older adults and a comparator group of younger adults, their adherance to "low-risk" guidelines, and whether alcohol-associated risks differed by age and adherence pattern. Average consumption did not vary by age or differ between age groups. In contrast, markedly higher frequencies and lower quantities of consumption were observed with increasing age. These differences persisted across adherence categories and were evident even in the oldest age group. Exceeding "low-risk" guidelines was associated with greater risk for alcohol-related problems among the older groups. These results emphasize the utility of considering underlying constituent patterns of consumption in older drinkers. Findings highlight difficulties in identifying problem drinking among older adults and contribute to the few characterizations of "risky" drinking patterns in this group. Taken together, our data contribute to literatures of import for the design and enhancement of screening, prevention, and education initiatives directed toward aging adults. Copyright © 2018. Published by Elsevier B.V.

  1. Determinants of prenatal health care utilisation by low-risk women: a prospective cohort study.

    Science.gov (United States)

    Feijen-de Jong, Esther I; Jansen, Danielle E M C; Baarveld, Frank; Boerleider, Agatha W; Spelten, Evelien; Schellevis, François; Reijneveld, Sijmen A

    2015-06-01

    Prenatal health care is pivotal in providing adequate prevention and care to pregnant women. We examined the determinants of inadequate prenatal health care utilisation by low-risk women in primary midwifery-led care in the Netherlands. We used longitudinal data from the population-based DELIVER study with 20 midwifery practices across the Netherlands in 2009 and 2010 as the experimental setting. The participants were 3070 pregnant women starting pregnancy care in primary midwifery care. We collected patient-reported data on potential determinants of prenatal care utilisation derived from the Andersen model. Prenatal health care utilisation was measured by a revised version of the Kotelchuck Index, which measures a combination of care entry and number of visits. Low-risk pregnant women (not referred during pregnancy) were more likely to use prenatal care inadequately if they intended to deliver at a hospital, if they did not use folic acid adequately periconceptionally, or if they were exposed to cigarette smoke during pregnancy. Among those who were referred to secondary care, women reporting a chronic illnesses or disabilities, and women who did not use folic acid periconceptionally were more likely to make inadequate use of prenatal care. Inadequate prenatal health care use in primary midwifery care is more likely in specific groups, and the risk groups differ when women are referred to secondary care. The findings suggest routes that can target interventions to women who are at risk of not adequately using prenatal prevention and care services. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  2. Outcome of pregnancy subsequent to chemotherapy with actinomycin-D in low risk gestational trophoblastic neoplasia

    Directory of Open Access Journals (Sweden)

    Soheila Aminimoghaddam

    2017-07-01

    Methods: A retrospective cohort study was conducted on patients with GTN who were referred to Firoozgar and Mirza Koochak Khan teaching hospitals during 10 years, starting from 2004. The inclusion criterion was patients with low-risk persistent GTN after molar pregnancy, EP, and abortion, that treated with single agent chemotherapy actinomycin-D. After following the patients for 12 months, patients with serum βHCG lower than 5 mIU/ml, who intended to have child were allowed to become pregnant. The following items were observed in the study: age, body mass index (BMI, parity, chemotherapy duration, and pregnancy outcomes such as spontaneous abortion or preterm labor, pre-eclampsia, stillbirth, fetal malformation, and repeated molar pregnancy. Results: 74 patients were monitored, 83.78% of them had uncomplicated pregnancy and labor, 4.05% had the abortion, 4.05% had second molar pregnancy, 2.7% had pre-eclampsia, 5.40% had preterm labor. Moreover, stillbirth and malformation did not occur in this study even after chemotherapy treatment. There was not any significant correlation between age, BMI, parity, and chemotherapy duration with pregnancy outcomes. Conclusion: The outcomes of pregnancy after chemotherapy with actinomycin-D is similar to the general population who did not have chemotherapy. The abortion rate and repeated molar pregnancy were similar between population and sample too. Thus, the study shows that the cured patients with low-risk GTN have as much chance of having a normal pregnancy as normal women. In other words, treatment with actinomycin-D does not have any adverse effect in future pregnancies.

  3. Prospective Validation of Modified NEXUS Cervical Spine Injury Criteria in Low-risk Elderly Fall Patients

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    John Tran

    2016-05-01

    Full Text Available Introduction: The National Emergency X-radiography Utilization Study (NEXUS criteria are used extensively in emergency departments to rule out C-spine injuries (CSI in the general population. Although the NEXUS validation set included 2,943 elderly patients, multiple case reports and the Canadian C-Spine Rules question the validity of applying NEXUS to geriatric populations. The objective of this study was to validate a modified NEXUS criteria in a low-risk elderly fall population with two changes: a modified definition for distracting injury and the definition of normal mentation. Methods: This is a prospective, observational cohort study of geriatric fall patients who presented to a Level I trauma center and were not triaged to the trauma bay. Providers enrolled non-intoxicated patients at baseline mental status with no lateralizing neurologic deficits. They recorded midline neck tenderness, signs of trauma, and presence of other distracting injury. Results: We enrolled 800 patients. One patient fall event was excluded due to duplicate enrollment, and four were lost to follow up, leaving 795 for analysis. Average age was 83.6 (range 65-101. The numbers in parenthesis after the negative predictive value represent confidence interval. There were 11 (1.4% cervical spine injuries. One hundred seventeen patients had midline tenderness and seven of these had CSI; 366 patients had signs of trauma to the face/neck, and 10 of these patients had CSI. Using signs of trauma to the head/neck as the only distracting injury and baseline mental status as normal alertness, the modified NEXUS criteria was 100% sensitive (CI [67.9-100] with a negative predictive value of 100 (98.7-100. Conclusion: Our study suggests that a modified NEXUS criteria can be safely applied to low-risk elderly falls.

  4. Prospective Validation of Modified NEXUS Cervical Spine Injury Criteria in Low-risk Elderly Fall Patients.

    Science.gov (United States)

    Tran, John; Jeanmonod, Donald; Agresti, Darin; Hamden, Khalief; Jeanmonod, Rebecca K

    2016-05-01

    The National Emergency X-radiography Utilization Study (NEXUS) criteria are used extensively in emergency departments to rule out C-spine injuries (CSI) in the general population. Although the NEXUS validation set included 2,943 elderly patients, multiple case reports and the Canadian C-Spine Rules question the validity of applying NEXUS to geriatric populations. The objective of this study was to validate a modified NEXUS criteria in a low-risk elderly fall population with two changes: a modified definition for distracting injury and the definition of normal mentation. This is a prospective, observational cohort study of geriatric fall patients who presented to a Level I trauma center and were not triaged to the trauma bay. Providers enrolled non-intoxicated patients at baseline mental status with no lateralizing neurologic deficits. They recorded midline neck tenderness, signs of trauma, and presence of other distracting injury. We enrolled 800 patients. One patient fall event was excluded due to duplicate enrollment, and four were lost to follow up, leaving 795 for analysis. Average age was 83.6 (range 65-101). The numbers in parenthesis after the negative predictive value represent confidence interval. There were 11 (1.4%) cervical spine injuries. One hundred seventeen patients had midline tenderness and seven of these had CSI; 366 patients had signs of trauma to the face/neck, and 10 of these patients had CSI. Using signs of trauma to the head/neck as the only distracting injury and baseline mental status as normal alertness, the modified NEXUS criteria was 100% sensitive (CI [67.9-100]) with a negative predictive value of 100 (98.7-100). Our study suggests that a modified NEXUS criteria can be safely applied to low-risk elderly falls.

  5. Distinct evolutionary mechanisms for genomic imbalances in high-risk and low-risk neuroblastomas

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    Gisselsson David

    2007-09-01

    Full Text Available Abstract Background Neuroblastoma (NB is the most common extracranial solid tumour of childhood. Several genomic imbalances correlate to prognosis in NB, with structural rearrangements, including gene amplification, in a near-diploid setting typically signifying high-risk tumours and numerical changes in a near-triploid setting signifying low-risk tumours. Little is known about the temporal sequence in which these imbalances occur during the carcinogenic process. Methods We have reconstructed the appearance of cytogenetic imbalances in 270 NBs by first grouping tumours and imbalances through principal component analysis and then using the number of imbalances in each tumour as an indicator of evolutionary progression. Results Tumours clustered in four sub-groups, dominated respectively by (1 gene amplification in double minute chromosomes and few other aberrations, (2 gene amplification and loss of 1p sequences, (3 loss of 1p and other structural aberrations including gain of 17q, and (4 whole-chromosome gains and losses. Temporal analysis showed that the structural changes in groups 1–3 were acquired in a step-wise fashion, with loss of 1p sequences and the emergence of double minute chromosomes as the earliest cytogenetic events. In contrast, the gains and losses of whole chromosomes in group 4 occurred through multiple simultaneous events leading to a near-triploid chromosome number. Conclusion The finding of different temporal patterns for the acquisition of genomic imbalances in high-risk and low-risk NBs lends strong support to the hypothesis that these tumours are biologically diverse entities, evolving through distinct genetic mechanisms.

  6. Pathogenetic rationale for the use of immunomodulating and systemic enzyme therapy in treatment of nulliparous women with endometrioid ovary tumors

    Directory of Open Access Journals (Sweden)

    O S Shapoval

    2015-01-01

    Резюме Современный подход выбора варианта лечения и оценки его эффективности у нерожавших женщин с эндометриоидными кистами состоит в формировании оптимальной патогенетически обоснованной терапии с учетом особенностей заболевания не только на системном, органном и тканевом уровнях, а и с учетом клеточно-молекулярных особенностей функционирования организма. В связи с этим целью нашей работы являлось выявление эффективности применения различных схем лечения нерожавших женщин с опухолеподобными образованиями яичников с учетом особенностей иммунного статуса. При исследовании иммунного статуса у нерожавших женщин с опухолеподобными эндометриоидными образованиями яичников (n=30 была выявлена несостоятельность фагоцитарной системы, дисбаланс Т- и В-клеточного иммунитета, дизиммуноглобулинемия. основываясь на выявленных изменениях, пациенткам была назначена патогенетически обоснованная комбинированная терапия, включающая, помимо традиционной схемы лечения, назначение иммуномодуляторов и системной энзимотерапии. Результаты лечения свидетельствуют о полной нормализации показателей фагоцитарной, Т- и В-клеточной и, частично, гуморальной систем. Ключевые слова: иммуномодулирующая терапия, нерожавшие женщины, опухолеподобные эндометриоидные образования яичников.

  7. Patient perceptions of risky drinking: Knowledge of daily and weekly low-risk guidelines and standard drink sizes.

    Science.gov (United States)

    Sprague, Debra J; Vinson, Daniel C

    2017-01-01

    Effective intervention for risky drinking requires that clinicians and patients know low-risk daily and weekly guidelines and what constitutes a "standard drink." The authors hypothesized that most patients lack this knowledge, and that education is required. Following primary care visits, patients completed anonymous exit questionnaires that included the 3 Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questions, "How many drinks (containing alcohol) can you safely have in one day?" and questions about size, in ounces, of a standard drink of wine, beer, and liquor. Descriptive analyses were done in Stata. Of 1,331 respondents (60% female, mean age: 49.6, SD = 17.5), 21% screened positive on the AUDIT-C for risky drinking. Only 10% of those accurately estimated daily low-risk limits, with 9% accurate on weekly limits, and half estimated low-risk limits at or below guidelines. Fewer than half who checked "Yes" to "Do you know what a 'standard drink' is?" provided accurate answers for beer, wine, or liquor. Patients with a positive screen were twice as likely to say they knew what a standard drink is, but only a third gave accurate estimates. When asked about plans in the next month regarding change in drinking behavior, 23% with a positive AUDIT-C indicated they were at least considering a change. Most patients in primary care don't know specifics of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for low-risk drinking. Exploring patient perceptions of low-risk guidelines and current drinking behavior may reveal discrepancies worth discussing. For risky drinkers, most of whom don't know daily and weekly low-risk guidelines or standard drink sizes, education can be vital in intervening. Findings suggest the need for detailed and explicit social marketing and communication on exactly what low-risk drinking entails.

  8. Does acupuncture used in nulliparous women reduce time from prelabour rupture of membranes at term to active phase of labour? A randomised controlled trial.

    Science.gov (United States)

    Selmer-Olsen, Tone; Lydersen, Stian; Mørkved, Siv

    2007-01-01

    To assess if acupuncture influences the onset of labour and the need for induction after prelabour rupture of membranes (PROM) in nulliparous women. Further, to investigate a possible effect of acupuncture on the woman's wellbeing. In a randomised controlled trial (RCT), 106 nulliparous women with PROM were allocated to an acupuncture group (AG) or a control group (CG). The outcome measures were time from PROM to onset of active phase of labour, and rate of inductions if labour was absent after 2 days. The women's self-reported wellbeing was registered on a Visual Analogue Scale (VAS). There was no statistically significant difference between the 2 groups regarding time from PROM to active phase (median times in AG versus CG: 15 versus 20.5 h, p=0.34). Additionally, there was no difference between the 2 groups in the need for induction. We found no significant differences in self-reported wellbeing, but the women receiving acupuncture considered their treatment to be more positive than the controls (p=0.003). No adverse effects were reported. Acupuncture treatment used in nulliparas after PROM showed no significant effect in reducing time to active labour or in reducing rate of inductions. There was no change in wellbeing as a result of acupuncture, but it was considered positive to receive this kind of treatment while waiting for labour to begin.

  9. Comparison of the effect of aromatherapy with Jasminum officinale and Salvia officinale on pain severity and labor outcome in nulliparous women

    Science.gov (United States)

    Kaviani, Maasumeh; Maghbool, Shahla; Azima, Sara; Tabaei, Mohammad Hosein

    2014-01-01

    Background: Using non-pharmacological pain relief methods for reducing labor pain has always been one of the major concerns in obstetrics and gynecology. Objective: Comparing the effects of aromatherapy with jasmine and salvia on pain severity and labor outcome in nulliparous women. Materials and Methods: In this randomized clinical trial, 156 nulliparous women in labor were randomly selected and divided into salvia, jasmine, and control groups (52 in each group). The study duration was 6 months (from October 2009 to March 2010). Each group underwent aromatherapy using an incense mask for 15 min (distilled water for the control group). Pain severity was measured before and 30 and 60 min after the incense aromatherapy. Also, duration of the first and second stages of labor, first- and fifth-minute APGAR scores of the baby, and the frequency of labor type were measured and recorded in each group. Results: In comparison to the other groups, pain severity and duration of the first and second stages of labor were significantly lower in the aromatherapy group of salvia 30 min after the intervention (P = 0.001). However, no significant difference was found among the three groups regarding pain severity 60 min after the aromatherapy, first- and fifth-minute APGAR scores of the baby, and the frequency of labor type. Conclusions: The results of the present study indicated that aromatherapy with saliva had beneficial effects on pain relief, shortened the labor stages, and had no negative impact on the baby's APGAR score. PMID:25558267

  10. The effect of inflatable obstetric belts in nulliparous pregnant women receiving patient-controlled epidural analgesia during the second stage of labor.

    Science.gov (United States)

    Kim, Jong-Woon; Kim, Yoon Ha; Cho, Hye Yon; Shin, Hee-Young; Shin, Jong Chul; Choi, Sea Kyung; Lee, Keun-Young; Song, Ji-Eun; Lee, Pil-Ryang

    2013-11-01

    The aim of this study was to evaluate the effect of inflatable obstetric belts on uterine fundal pressure in the management of the second stage of labor. Between July 2009 and December 2010, 188 nulliparous women with a singleton pregnancy at term were enrolled and only one dropped. The participants were randomized to receive either standard care (control group, n = 91) or uterine fundal pressure by the Labor Assister (Baidy M-520/Curexo, Inc., Seoul, Korea; active group, n = 97) during the second stage of labor in addition to standard care. The Labor Assister is an inflatable obstetric belt that is synchronized to apply constant fundal pressure during a uterine contraction. The primary endpoint was duration of the second stage of labor in women who delivered vaginally (control, n = 80 versus active, n = 93). It was not analyzed in women who delivered by cesarean section (n = 14) and delivered precipitously (n = 1). The secondary outcomes are perinatal outcomes and perineal laceration. Participants received patient-controlled epidural analgesia. The 93 women in the active group spent less time in the second stage of labor when compared to the 80 women in the control group (46.51 ± 28.01 min versus 75.02 ± 37.48 min, p labor without complications in nulliparous women who receive patient-controlled epidural analgesia.

  11. Pre-Feedback Risk Expectancies and Reception of Low-Risk Health Feedback: Absolute and Comparative Lack of Reassurance.

    Science.gov (United States)

    Gamp, Martina; Renner, Britta

    2016-11-01

    Personalised health-risk assessment is one of the most common components of health promotion programs. Previous research on responses to health risk feedback has commonly focused on the reception of bad news (high-risk feedback). The reception of low-risk feedback has been comparably neglected since it is assumed that good news is reassuring and readily received. However, field studies suggest mixed responses to low-risk health feedback. Accordingly, we examine whether pre-feedback risk expectancies can mitigate the reassuring effects of good news. In two studies (N = 187, N = 565), after assessing pre-feedback risk expectancies, participants received low-risk personalised feedback about their own risk of developing (the fictitious) Tucson Chronic Fatigue Syndrome (TCFS). Study 2 also included peer TCFS risk status feedback. Afterwards, self- and peer-related risk perception for TCFS was assessed. In both studies, participants who expected to be at high risk but received good news (unexpected low-risk feedback) showed absolute lack of reassurance. Specifically, they felt at significantly greater TCFS risk than participants who received expected good news. Moreover, the unexpected low-risk group even believed that their risk was as high as (Study 1) or higher (Study 2) than that of their peers (comparative lack of reassurance). Results support the notion that high pre-feedback risk expectancies can mitigate absolute and comparative reassuring effects of good news. © 2016 The International Association of Applied Psychology.

  12. Absence of survival benefit of radioactive iodine (RAI) after thyroidectomy in low risk differentiated thyroid cancer (DTC) patients

    International Nuclear Information System (INIS)

    Schwartz, C.; Fieffe, S.; Pochart, J.M.; Bonnetain, F.; Gauthier, M.; Cueff, A.; Crevisy, E.; Dygai-Cochet, I.; Toubeau, M.

    2012-01-01

    After thyroidectomy, the goal of the first dose of radioactive iodine (RAI) is remnant ablation to facilitate the initial staging with the post-therapy scan and to facilitate the early detection of recurrences. The purpose of this study is to the survival benefit of RAI in low-risk thyroid cancer patients. Using Cancer thyroid registry of Marne Ardennes (1041 patients) and hospital data base of centre Leclerc (257 patients), we included all differentiated thyroid cancer (DTC) patients at low risk from 1975 to 2005. Median follow-up was 10.3 years, during which 19 recurrences, 61 other malignant diseases and 105 deaths were registered. 387 patients (30%) received no RAI and 911 had RAI (70%). If we confirmed that some clinical characteristics were associated with RAI intake, the study failed to demonstrate any survival benefit of RAI in low risk DTC patients

  13. Absence of survival benefit of radioactive iodine (RAI) after thyroidectomy in low risk differentiated thyroid cancer (DTC) patients

    Energy Technology Data Exchange (ETDEWEB)

    Schwartz, C.; Fieffe, S.; Pochart, J.M. [Endocrinology Nuclear Medicine, Institut Jean Godinot, Reims (France); Bonnetain, F.; Gauthier, M.; Cueff, A. [Statistics and Epidemiology, Centre Georges Francois Leclerc, Dijon (France); Crevisy, E.; Dygai-Cochet, I.; Toubeau, M. [Nuclear Medicine, Centre Georges Francois Leclerc, Dijon (France)

    2012-07-01

    After thyroidectomy, the goal of the first dose of radioactive iodine (RAI) is remnant ablation to facilitate the initial staging with the post-therapy scan and to facilitate the early detection of recurrences. The purpose of this study is to the survival benefit of RAI in low-risk thyroid cancer patients. Using Cancer thyroid registry of Marne Ardennes (1041 patients) and hospital data base of centre Leclerc (257 patients), we included all differentiated thyroid cancer (DTC) patients at low risk from 1975 to 2005. Median follow-up was 10.3 years, during which 19 recurrences, 61 other malignant diseases and 105 deaths were registered. 387 patients (30%) received no RAI and 911 had RAI (70%). If we confirmed that some clinical characteristics were associated with RAI intake, the study failed to demonstrate any survival benefit of RAI in low risk DTC patients

  14. HTLV-I/II and blood donors: determinants associated with seropositivity in a low risk population

    Directory of Open Access Journals (Sweden)

    Bernadette Catalan Soares

    2003-08-01

    Full Text Available OBJECTIVE: Blood donors in Brazil have been routinely screened for HTLV-I/II since 1993. A study was performed to estimate the prevalence of HTLV-I/II infection in a low risk population and to better understand determinants associated with seropositivity. METHODS: HTLV-I/II seropositive (n=135, indeterminate (n=167 and seronegative blood donors (n=116 were enrolled in an open prevalence prospective cohort study. A cross-sectional epidemiological study of positive, indeterminate and seronegative HTLV-I/II subjects was conducted to assess behavioral and environmental risk factors for seropositivity. HTLV-I/II serological status was confirmed using enzyme-linked immunosorbent assay (EIA and Western blot (WB. RESULTS: The three groups were not homogeneous. HTLV-I/II seropositivity was associated to past blood transfusion and years of schooling, a marker of socioeconomic status, and use of non-intravenous illegal drugs. CONCLUSIONS: The study results reinforce the importance of continuous monitoring and improvement of blood donor selection process.

  15. Early psychomotor development of low-risk preterm infants: Influence of gestational age and gender.

    Science.gov (United States)

    Romeo, Domenico M; Brogna, Claudia; Sini, Francesca; Romeo, Mario G; Cota, Francesco; Ricci, Daniela

    2016-07-01

    The influence of gestational age and gender in the neurodevelopment of infants during the first year of age is not yet fully elucidated. The purpose of this study was to identify the early occurrence of neurodevelopmental differences, between very preterm, late preterm and term born infants and the possible influence of the gender on the neurodevelopment in early infancy. A total of 188 low-risk infants, 69 very preterms, 71 late-preterms, and 48 term infants were assessed at 3, 6, 9, 12 months corrected age using the Hammersmith Infant Neurological Examination (HINE). At two years of age infants performed the Mental Developmental Index (MDI) of the Bayley Scales of Infant Development. The main results indicate that both very preterms and late-preterms showed significant lower global scores than term born infants at each evaluation (p development of infants assessed during the first 2 years of life. Copyright © 2016 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

  16. Periodontal disease and some adverse perinatal outcomes in a cohort of low risk pregnant women

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    Cecatti Jose G

    2010-11-01

    Full Text Available Abstract Objective To evaluate the association of periodontal disease (PD in pregnancy with some adverse perinatal outcomes. Method This cohort study included 327 pregnant women divided in groups with or without PD. Indexes of plaque and gingival bleeding on probing, probing pocket depth, clinical attachment level and gingival recession were evaluated at one periodontal examination below 32 weeks of gestation. The rates of preterm birth (PTB, low birth weight (LBW, small for gestational age (SGA neonates and prelabor rupture of membranes (PROM were evaluated using Risk Ratios (95%CI and Population Attributable Risk Fractions. Results PD was associated with a higher risk of PTB (RRadj. 3.47 95%CI 1.62-7.43, LBW (RRadj. 2.93 95%CI 1.36-6.34 and PROM (RRadj. 2.48 95%CI 1.35-4.56, but not with SGA neonates (RR 2.38 95%CI 0.93 - 6.10. Conclusions PD was a risk factor for PT, LBW and PROM among Brazilian low risk pregnant women.

  17. Maternal and newborn morbidity by birth facility among selected United States 2006 low-risk births.

    Science.gov (United States)

    Wax, Joseph R; Pinette, Michael G; Cartin, Angelina; Blackstone, Jacquelyn

    2010-02-01

    We sought to evaluate perinatal morbidity by delivery location (hospital, freestanding birth center, and home). Selected 2006 US birth certificate data were accessed online from the Centers for Disease Control and Prevention. Low-risk maternal and newborn outcomes were tabulated and compared by birth facility. A total of 745,690 deliveries were included, of which 733,143 (97.0%) occurred in hospital, 4661 (0.6%) at birth centers, and 7427 (0.9%) at home. Compared with hospital deliveries, home and birthing center deliveries were associated with more frequent prolonged and precipitous labors. Home births experienced more frequent 5-minute Apgar scores home and birthing center deliveries were associated with less frequent chorioamnionitis, fetal intolerance of labor, meconium staining, assisted ventilation, neonatal intensive care unit admission, and birthweight Home births are associated with a number of less frequent adverse perinatal outcomes at the expense of more frequent abnormal labors and low 5-minute Apgar scores. Copyright 2010 Mosby, Inc. All rights reserved.

  18. Placental histological inflammation and reproductive tract infections in a low risk pregnant population in Latvia.

    Science.gov (United States)

    Rezeberga, Dace; Lazdane, Gunta; Kroica, Juta; Sokolova, Ludmila; Donders, Gilbert G G

    2008-01-01

    To investigate the correlation of reproductive tract infections (RTI) and endogenous vaginal flora at first antenatal consultation with placental histological inflammation. In a follow-up study, 154 low risk women with no miscarriage risk factors were examined for the presence of Neisseria gonorrhoeae, Trichomonas vaginalis, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Gardnerella vaginalis, Streptococcus agalactiae (GBS), Staphylococcus aureus, Enterococcus faecalis (GDS) and bacterial vaginosis (BV). At delivery, outcome data were collected and the histology of the placenta was studied. Some 85 (56.3%) of all pregnant women had RTI or endogenous vaginal flora. Placental histological inflammation correlated with genital tract colonisation with G. vaginalis (p =0.013), BV (p =0.031), S. aureus (p =0.04) and aerobic vaginitis (p =0.017). BV and BV-related G. vaginalis correlated with the presence of parietal and placental chorioamnionitis in 53.8 and 43.5% of cases. Genital tract colonisation with GDS and other aerobic flora in combination with inflammatory vaginitis correlated with the presence of funisitis in 33.3 and 40.0% of cases. Mycoplasmas increased the risk for intrauterine infection only when present in combination with other RTIs (p =0.023). Histological placental inflammation is associated with both BV and genital tract colonisation with aerobic bacteria, while funisitis is associated with colonisation of aerobic bacteria at first prenatal visit before the 17th gestational week.

  19. Obesity and pregnancy: a transversal study from a low-risk maternity.

    Science.gov (United States)

    Calderon, Ana Carolina S; Quintana, Silvana M; Marcolin, Alessandra C; Berezowski, Aderson T; Brito, Luiz Gustavo O; Duarte, Geraldo; Cavalli, Ricardo C

    2014-07-28

    Obesity is a public health problem and is increasing in all populations, including pregnant women. It influences maternal and neonatal outcomes; however, data are scarce in developing countries. We aimed to compare perinatal results between obese and non-obese pregnant women in a low-risk maternity. Transversal study of 1,779 40-week-pregnancies from 2005 to 2009 that completed a standard questionnaire with sociodemographic, obstetrical and neonatal variables and performed an ultrasound with amniotic fluid index (AFI) measurement and foetal vitality (FBP, non-stress test). They were analysed about their association with obesity on pregnancy. When compared with non-obese women, the group of obese patients had higher systolic (118.1 vs 109.2 mmHg; p < 0.01) and diastolic (76.6 vs 70.4 mmHg; p < 0.01) pressure levels, AFI (12.52 vs. 9.61 cm; p = 0.02), presence of meconium on labour (20.52 vs. 14.67%; p = 0.02), birthweight (3602 vs. 3437 g; p < 0.01) and caesarean section (39.74 vs. 29.98%, p < 0.01). Labour induction before 40 weeks in the antenatal period associated with foetal weight estimation should be considered as a recommendation for decreasing high percentages of caesarean delivery found in obese women.

  20. Identifying Emergency Department Patients at Low Risk for a Variceal Source of Upper Gastrointestinal Hemorrhage.

    Science.gov (United States)

    Klein, Lauren R; Money, Joel; Maharaj, Kaveesh; Robinson, Aaron; Lai, Tarissa; Driver, Brian E

    2017-11-01

    Assessing the likelihood of a variceal versus nonvariceal source of upper gastrointestinal bleeding (UGIB) guides therapy, but can be difficult to determine on clinical grounds. The objective of this study was to determine if there are easily ascertainable clinical and laboratory findings that can identify a patient as low risk for a variceal source of hemorrhage. This was a retrospective cohort study of adult ED patients with UGIB between January 2008 and December 2014 who had upper endoscopy performed during hospitalization. Clinical and laboratory data were abstracted from the medical record. The source of the UGIB was defined as variceal or nonvariceal based on endoscopic reports. Binary recursive partitioning was utilized to create a clinical decision rule. The rule was internally validated and test characteristics were calculated with 1,000 bootstrap replications. A total of 719 patients were identified; mean age was 55 years and 61% were male. There were 71 (10%) patients with a variceal UGIB identified on endoscopy. Binary recursive partitioning yielded a two-step decision rule (platelet count > 200 × 10 9 /L and an international normalized ratio [INR] study must be externally validated before widespread use, patients presenting to the ED with an acute UGIB with platelet count of >200 × 10 9 /L and an INR of upper gastrointestinal hemorrhage. © 2017 by the Society for Academic Emergency Medicine.

  1. Upright versus lying down position in second stage of labour in nulliparous women with low dose epidural: BUMPES randomised controlled trial.

    Science.gov (United States)

    2017-10-18

    Objective  To determine whether being upright in the second stage of labour in nulliparous women with a low dose epidural increases the chance of spontaneous vaginal birth compared with lying down. Design  Multicentre pragmatic individually randomised controlled trial. Setting  41 UK hospital labour wards. Participants  3093 nulliparous women aged 16 or older, at term with a singleton cephalic presentation and in the second stage of labour with epidural analgesia. Interventions  Women were allocated to an upright or lying down position, using a secure web based randomisation service, stratified by centre, with no masking of participants or clinicians to the trial interventions. Main outcome measures  The primary outcome was spontaneous vaginal birth. Women were analysed in the groups into which they were randomly allocated, regardless of position recorded at any time during the second stage of labour (excluding women with no valid consent, who withdrew, or who did not reach second stage before delivery). Secondary outcomes included mode of birth, perineal trauma, infant Apgar score women were randomised and 3093 (95.6%) included in the primary analysis (1556 in the upright group and 1537 in the lying down group). Significantly fewer spontaneous vaginal births occurred in women in the upright group: 35.2% (548/1556) compared with 41.1% (632/1537) in the lying down group (adjusted risk ratio 0.86, 95% confidence interval 0.78 to 0.94). This represents a 5.9% absolute increase in the chance of spontaneous vaginal birth in the lying down group (number needed to treat 17, 95% confidence interval 11 to 40). No evidence of differences was found for most of the secondary maternal, neonatal, or longer term outcomes including instrumental vaginal delivery (adjusted risk ratio 1.08, 99% confidence interval 0.99 to 1.18), obstetric anal sphincter injury (1.27, 0.88 to 1.84), infant Apgar score labour results in more spontaneous vaginal births in nulliparous women with

  2. Foot length measurements of newborns of high and low risk pregnancies.

    Science.gov (United States)

    Salge, Ana Karina Marques; Rocha, Érika Lopes; Gaíva, Maria Aparecida Munhoz; Castral, Thaíla Correa; Guimarães, Janaína Valadares; Xavier, Raphaela Maioni

    2017-03-09

    Comparing foot length measurements of newborns in high and low risk pregnancies at a public hospital in Goiânia, GO, Brazil. A cross-sectional study carried out between April, 2013 and May, 2015, with a sample consisting of 180 newborns; 106 infants of women from high-risk pregnancies and 74 of women from low-risk pregnancies. Data were descriptively analyzed. Foot length measurement was performed using a stiff transparent plastic ruler, graduated in millimeters. The length of both feet was measured from the tip of the hallux (big toe) to the end of the heel. A statistically significant relationship was found between the foot length and newborn's weight, between the cephalic and thoracic perimeters in the high-risk group and between the cephalic perimeter in the control group. There is a need for creating cut-off points to identify newborns with intrauterine growth disorders using foot length. Comparar as medidas do comprimento hálux-calcâneo de recém-nascidos em gestações de alto e baixo risco em um hospital público de Goiânia, GO. Estudo transversal, realizado no período de abril de 2013 a maio de 2015, cuja amostra constituiu-se de 180 recém-nascidos, 106 filhos de mulheres com gestação de alto risco e 74 de mulheres com gestação de baixo risco. Os dados foram analisados descritivamente. A medida do comprimento hálux-calcâneo foi realizada utilizando-se de régua plástica transparente rígida, graduada em milímetros. Foram medidos ambos os pés, aferindo-se o comprimento da ponta do hálux até a extremidade do calcâneo. Foi encontrada relação estatisticamente significante entre o comprimento hálux-calcâneo e o peso do recém-nascido, entre os perímetros cefálico e torácico no grupo de alto risco e entre o perímetro cefálico no grupo controle. Existe necessidade da criação de pontos de corte para identificar recém-nascidos com desvios de crescimento intrauterino utilizando-se do comprimento hálux-calcâneo. Comparar las mediciones

  3. Ultrasonographic study and Doppler flow velocimetry of maternal kidneys and liver in low-risk pregnancy

    Energy Technology Data Exchange (ETDEWEB)

    Daher, Cibele Helena; Gomes, Andrea Cavalanti; Kobayashi, Sergio; Chammas, Maria Cristina, E-mail: cibeledaher@hotmail.com [Universidade de Sao Paulo (In-Rad/HC-FMUSP), Sao Paulo, SP (Brazil). Hospital das Clinicas. Inst. de Radiologia; Cerri, Giovanni Guido [Universidade de Sao Paulo (FMUSP), Sao Paulo, SP (Brazil). Fac. de Medicina

    2015-05-15

    Objective: longitudinal study with B-mode ultrasonography and Doppler ultrasonography of maternal kidneys and liver in low-risk pregnancy, to establish and quantify normality parameters, correlating them with physiological changes. Materials and methods: twenty-five pregnant women were assessed and selected to participate in the study, each of them undergoing four examinations at the first, second, third trimesters and postpartum. Results: findings during pregnancy were the following: increased renal volume, pyelocaliceal dilatation with incidence of 45.4% in the right kidney, and 9% in the left kidney; nephrolithiasis, 18.1% in the right kidney, 13.6% in the left kidney. With pyelocaliceal dilatation, mean values for resistivity index were: 0.68 for renal arteries; 0.66 for segmental arteries; 0.64 for interlobar arteries; 0.64 for arcuate arteries. Without pyelocaliceal dilatation, 0.67 for renal arteries; 0.64 for segmental arteries; 0.63 for interlobar arteries; and 0.61 for arcuate arteries. Portal vein flow velocities presented higher values in pregnancy, with mean value for maximum velocity of 28.9 cm/s, and 22.6 cm/s postpartum. The waveform pattern of the right hepatic vein presented changes persisting in the postpartum period in 31.8% of the patients. Cholelithiasis was observed in 18.1% of the patients. Conclusion: alterations in renal volume, pyelocaliceal dilatation, nephrolithiasis, cholelithiasis, changes in portal vein flow velocity, alterations in waveform pattern of the right hepatic vein, proved to be significant. (author)

  4. Applicator-guided volumetric-modulated arc therapy for low-risk endometrial cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cilla, Savino, E-mail: savinocilla@gmail.com [Medical Physics Unit, Fondazione di ricerca e cura “Giovanni Paolo II,” Università Cattolica del Sacro Cuore, Campobasso (Italy); Macchia, Gabriella [Radiation Oncology Unit, Fondazione di ricerca e cura “Giovanni Paolo II,” Università Cattolica del Sacro Cuore, Campobasso (Italy); Sabatino, Domenico [Medical Physics Unit, Fondazione di ricerca e cura “Giovanni Paolo II,” Università Cattolica del Sacro Cuore, Campobasso (Italy); Digesù, Cinzia; Deodato, Francesco [Radiation Oncology Unit, Fondazione di ricerca e cura “Giovanni Paolo II,” Università Cattolica del Sacro Cuore, Campobasso (Italy); Piermattei, Angelo [Physics Institute, Università Cattolica del Sacro Cuore, Rome (Italy); De Spirito, Marco [Medical Physics Unit, Fondazione di ricerca e cura “Giovanni Paolo II,” Università Cattolica del Sacro Cuore, Campobasso (Italy); Morganti, Alessio G. [Radiation Oncology Unit, Fondazione di ricerca e cura “Giovanni Paolo II,” Università Cattolica del Sacro Cuore, Campobasso (Italy); Radiation Oncology Unit, Università Cattolica del Sacro Cuore, Rome (Italy)

    2013-04-01

    The aim of this study was to report the feasibility of volumetric-modulated arc therapy (VMAT) in the postoperative irradiation of the vaginal vault. Moreover, the VMAT technique was compared with 3D conformal radiotherapy (3D-CRT) and fixed-field intensity-modulated radiotherapy (IMRT), in terms of target coverage and organs at risk sparing. The number of monitor units and the delivery time were analyzed to score the treatment efficiency. All plans were verified in a dedicated solid water phantom using a 2D array of ionization chambers. Twelve patients with endometrial carcinoma who underwent radical hystero-adenexectomy and fixed-field IMRT treatments were retrospectively included in this analysis; for each patient, plans were compared in terms of dose-volume histograms, homogeneity index, and conformity indexes. All techniques met the prescription goal for planning target volume coverage, with VMAT showing the highest level of conformity at all dose levels. VMAT resulted in significant reduction of rectal and bladder volumes irradiated at all dose levels compared with 3D-CRT. No significant differences were found with respect to IMRT. Moreover, a significant improvement of the dose conformity was reached by VMAT technique not only at the 95% dose level (0.74 vs. 0.67 and 0.62) but also at 50% and 75% levels of dose prescription. In addition, VMAT plans showed a significant reduction of monitor units by nearly 28% with respect to IMRT, and reduced treatment time from 11 to <3 minutes for a single 6-Gy fraction. In conclusion, VMAT plans can be planned and carried out with high quality and efficiency for the irradiation of vaginal vault alone, providing similar or better sparing of organs at risk to fixed-field IMRT and resulting in the most efficient treatment option. VMAT is currently our standard approach for radiotherapy of low-risk endometrial cancer.

  5. Thyroid nodules with minimal cystic changes have a low risk of malignancy

    International Nuclear Information System (INIS)

    Na, Dong Gyu; Kim, Dae Sik; Kim, Soo Jin; Kim, Ji Hoon

    2016-01-01

    The goal of this study was to determine the risk of malignancy of thyroid nodules with minimal cystic changes. A total of consecutive 1,000 thyroid nodules (≥1 cm) with final diagnoses from two institutions were included in this study. The risk of malignancy of thyroid nodules was analyzed according to the internal content, which was categorized as purely solid, minimally cystic (cystic changes ≤10%), and partially cystic (cystic changes >10%). We also assessed the risk of malignancy of nodules with minimal cystic changes depending on echogenicity and presence of any suspicious ultrasonografic (US) features. The overall frequency of purely solid, minimally cystic, and partially cystic nodules was 730/1,000 (73%), 61/1,000 (6.1%), and 209/1,000 (20.9%), respectively, with risks of malignancy of 14.8% (108/730), 3.3% (2/61), and 3.3% (7/209), respectively. The risk of malignancy of nodules with minimal cystic changes was significantly lower than that of purely solid nodules (P=0.013). The risk of malignancy of nodules with minimal cystic changes was also lower than that of purely solid nodules in the group of hypoechoic nodules (P=0.063) and in the group of nodules with suspicious US features (P=0.028), but was not significantly different from that of partially cystic nodules regardless of echogenicity or the presence of suspicious US features (P≥0.652). Thyroid nodules with minimal cystic changes have a low risk of malignancy, similar to that of partially cystic nodules regardless of echogenicity or the presence of suspicious US features. The US lexicon could define solid nodules as nodules with purely solid internal content in order to enhance the accuracy of estimated risks of malignancy

  6. Utilization of prostate brachytherapy for low risk prostate cancer: Is the decline overstated?

    Science.gov (United States)

    Safdieh, Joseph; Wong, Andrew; Weiner, Joseph P; Schwartz, David; Schreiber, David

    2016-08-01

    Several prior studies have suggested that brachytherapy utilization has markedly decreased, coinciding with the recent increased utilization of intensity modulated radiation therapy, as well as an increase in urologist-owned centers. We sought to investigate the brachytherapy utilization in a large, hospital-based registry. Men with prostate cancer diagnosed between 2004-2012 and treated with either external beam radiation and/or prostate brachytherapy were abstracted from the National Cancer Database. In order to be included, men had to be clinically staged as T1c-T2aNx-0Mx-0, Gleason 6, PSA ≤ 10.0 ng/ml. Descriptive statistics were used to analyze brachytherapy utilization over time and were compared via χ(2). Multivariate logistic regression was used to assess for covariables associated with increased brachytherapy usage. There were 89,413 men included in this study, of which 37,054 (41.6%) received only external beam radiation, and 52,089 (58.4%) received prostate brachytherapy. The use of brachytherapy declined over time from 62.9% in 2004 to 51.3% in 2012 (p facilities (60.8% in 2004 to 47.0% in 2012, p facilities (63.7% in 2004 to 53.0% in 2012, p facilities than those who lived further. The use of intensity modulated radiation therapy increased during this same time period from 18.4% in 2004 to 38.2% in 2012 (p usage. In this hospital-based registry, prostate brachytherapy usage has declined for low risk prostate cancer as intensity modulated radiation therapy usage has increased. However, it still remains the treatment of choice for 51.3% of patients as of 2012.

  7. Association of Trichomonas vaginalis and cytological abnormalities of the cervix in low risk women.

    Directory of Open Access Journals (Sweden)

    Gilbert G G Donders

    Full Text Available OBJECTIVE: Is Trichomonas vaginalis (TV an inducing factor for the development of (pre-cancerous lesions of the cervix? DESIGN: Cross sectional study. SETTING: Screening healthy Belgian women with low infection risk. SAMPLE: 63,251 consecutive liquid based cervical samples. METHODS: Real time quantitative PCR for presence of TV, 18 HPV types and Pap smear analysis of cytologic abnormalities. MAIN OUTCOME MEASURES: Association of TV and HPV with cervix dysplasia. RESULTS: The overall prevalence of TV DNA was 0.37%, of low risk HPV 2%, of high risk HPV 13.2%, and 8.8 % had cytological abnormalities. Both LR-HPV and HR-HPV were significantly associated with all cytological abnormalities. Presence of TV was associated with LR- and HR-HPV, ASC-US and HSIL, but not with other abnormalities. All women with TV and HSIL also had HR-HPV, while the latter was present in only 59% of women with TV and ASC-US. Amongst HPV negative women, TV was found in 1.3% of women with ASC-US, but only in 0.03% of women with normal cytology (OR 4.2, CL95% 2.1-8.6. In HR-HPV positive women, presence of TV increased the likelihood of cytological abnormalities somewhat (P=0.05, mainly due to an increase in ASC-US and LSIL, but not HSIL. CONCLUSIONS: We conclude that TV infection is associated with both LR and HR-HPV infection of the cervix, as well as with ASC-US and HSIL. TV is a concomitant STI, but is not thought to be a co-factor in the causation of HSIL and cervical cancer. However, TV may cause false positive diagnoses of ASC-US.

  8. Ultrasonographic study and Doppler flow velocimetry of maternal kidneys and liver in low-risk pregnancy

    International Nuclear Information System (INIS)

    Daher, Cibele Helena; Gomes, Andrea Cavalanti; Kobayashi, Sergio; Chammas, Maria Cristina; Cerri, Giovanni Guido

    2015-01-01

    Objective: longitudinal study with B-mode ultrasonography and Doppler ultrasonography of maternal kidneys and liver in low-risk pregnancy, to establish and quantify normality parameters, correlating them with physiological changes. Materials and methods: twenty-five pregnant women were assessed and selected to participate in the study, each of them undergoing four examinations at the first, second, third trimesters and postpartum. Results: findings during pregnancy were the following: increased renal volume, pyelocaliceal dilatation with incidence of 45.4% in the right kidney, and 9% in the left kidney; nephrolithiasis, 18.1% in the right kidney, 13.6% in the left kidney. With pyelocaliceal dilatation, mean values for resistivity index were: 0.68 for renal arteries; 0.66 for segmental arteries; 0.64 for interlobar arteries; 0.64 for arcuate arteries. Without pyelocaliceal dilatation, 0.67 for renal arteries; 0.64 for segmental arteries; 0.63 for interlobar arteries; and 0.61 for arcuate arteries. Portal vein flow velocities presented higher values in pregnancy, with mean value for maximum velocity of 28.9 cm/s, and 22.6 cm/s postpartum. The waveform pattern of the right hepatic vein presented changes persisting in the postpartum period in 31.8% of the patients. Cholelithiasis was observed in 18.1% of the patients. Conclusion: alterations in renal volume, pyelocaliceal dilatation, nephrolithiasis, cholelithiasis, changes in portal vein flow velocity, alterations in waveform pattern of the right hepatic vein, proved to be significant. (author)

  9. Association of Trichomonas vaginalis and cytological abnormalities of the cervix in low risk women.

    Science.gov (United States)

    Donders, Gilbert G G; Depuydt, Christophe E; Bogers, John-Paul; Vereecken, Annie J

    2013-01-01

    Is Trichomonas vaginalis (TV) an inducing factor for the development of (pre-)cancerous lesions of the cervix? Cross sectional study. Screening healthy Belgian women with low infection risk. 63,251 consecutive liquid based cervical samples. Real time quantitative PCR for presence of TV, 18 HPV types and Pap smear analysis of cytologic abnormalities. Association of TV and HPV with cervix dysplasia. The overall prevalence of TV DNA was 0.37%, of low risk HPV 2%, of high risk HPV 13.2%, and 8.8 % had cytological abnormalities. Both LR-HPV and HR-HPV were significantly associated with all cytological abnormalities. Presence of TV was associated with LR- and HR-HPV, ASC-US and HSIL, but not with other abnormalities. All women with TV and HSIL also had HR-HPV, while the latter was present in only 59% of women with TV and ASC-US. Amongst HPV negative women, TV was found in 1.3% of women with ASC-US, but only in 0.03% of women with normal cytology (OR 4.2, CL95% 2.1-8.6). In HR-HPV positive women, presence of TV increased the likelihood of cytological abnormalities somewhat (P=0.05), mainly due to an increase in ASC-US and LSIL, but not HSIL. We conclude that TV infection is associated with both LR and HR-HPV infection of the cervix, as well as with ASC-US and HSIL. TV is a concomitant STI, but is not thought to be a co-factor in the causation of HSIL and cervical cancer. However, TV may cause false positive diagnoses of ASC-US.

  10. Acceptability of a novel vaginal microbicide during a safety trial among low-risk women.

    Science.gov (United States)

    Bentley, M E; Morrow, K M; Fullem, A; Chesney, M A; Horton, S D; Rosenberg, Z; Mayer, K H

    2000-01-01

    The increasing recognition that women who are unable or unwilling to discuss or use condoms with their sexual partners need female-controlled methods for preventing sexually transmitted diseases (STDs), including HIV, has led to considerable focus on the development of vaginal microbicides. While many such products are being tested for safety and effectiveness, clinical trials generally overlook another key factor in a product's impact on infection rates-its acceptability to users. A Phase I clinical trial of a microbicidal gel included an assessment of the product's acceptability among 27 low-risk participants. Information on acceptability was gathered from structured interviews, participants' daily diaries and unstructured exit interviews. Participants reported only minor side effects of product use, such as itching, burning and difficulty urinating; two women developed candida infections while participating in the study. None of the side effects could be conclusively linked to use of the gel. Some women noted product discharge and messiness as drawbacks of the method, but this experience varied according to how often the women applied the gel. For example, one-third of those who used it once daily said that at least some of the time, it was too "wet or drippy," compared with two-thirds of women who inserted the gel twice a day. However, participants considered these "nuisance factors" that could be outweighed by the potential protective characteristics of the product. The majority reported that they would use the product if it were available and proven efficacious, and if they perceived that they were at risk of STD infection. Additional testing of this product is urgently needed. Furthermore, as other products approach Phase I testing, acceptability assessments should be a key component of clinical trials.

  11. Benefit of early discharge among patients with low-risk pulmonary embolism.

    Directory of Open Access Journals (Sweden)

    Li Wang

    Full Text Available Clinical guidelines recommend early discharge of patients with low-risk pulmonary embolism (LRPE. This study measured the overall impact of early discharge of LRPE patients on clinical outcomes and costs in the Veterans Health Administration population. Adult patients with ≥1 inpatient diagnosis for pulmonary embolism (PE (index date between 10/2011-06/2015, continuous enrollment for ≥12 months pre- and 3 months post-index date were included. PE risk stratification was performed using the simplified Pulmonary Embolism Stratification Index. Propensity score matching (PSM was used to compare 90-day adverse PE events (APEs [recurrent venous thromboembolism, major bleed and death], hospital-acquired complications (HACs, healthcare utilization, and costs among short (≤2 days versus long length of stay (LOS. Net clinical benefit was defined as 1 minus the combined rate of APE and HAC. Among 6,746 PE patients, 95.4% were men, 22.0% were African American, and 1,918 had LRPE. Among LRPE patients, only 688 had a short LOS. After 1:1 PSM, there were no differences in APE, but short LOS had fewer HAC (1.5% vs 13.3%, 95% CI: 3.77-19.94 and bacterial pneumonias (5.9% vs 11.7%, 95% CI: 1.24-3.23, resulting in better net clinical benefit (86.9% vs 78.3%, 95% CI: 0.84-0.96. Among long LOS patients, HACs (52 exceeded APEs (14 recurrent DVT, 5 bleeds. Short LOS incurred lower inpatient ($2,164 vs $5,100, 95% CI: $646.8-$5225.0 and total costs ($9,056 vs $12,544, 95% CI: $636.6-$6337.7. LRPE patients with short LOS had better net clinical outcomes at lower costs than matched LRPE patients with long LOS.

  12. Quantification of CT images for the classification of high- and low-risk pancreatic cysts

    Science.gov (United States)

    Gazit, Lior; Chakraborty, Jayasree; Attiyeh, Marc; Langdon-Embry, Liana; Allen, Peter J.; Do, Richard K. G.; Simpson, Amber L.

    2017-03-01

    Pancreatic cancer is the most lethal cancer with an overall 5-year survival rate of 7%1 due to the late stage at diagnosis and the ineffectiveness of current therapeutic strategies. Given the poor prognosis, early detection at a pre-cancerous stage is the best tool for preventing this disease. Intraductal papillary mucinous neoplasms (IPMN), cystic tumors of the pancreas, represent the only radiographically identifiable precursor lesion of pancreatic cancer and are known to evolve stepwise from low-to-high-grade dysplasia before progressing into an invasive carcinoma. Observation is usually recommended for low-risk (low- and intermediate-grade dysplasia) patients, while high-risk (high-grade dysplasia and invasive carcinoma) patients undergo resection; hence, patient selection is critically important in the management of pancreatic cysts.2 Radiologists use standard criteria such as main pancreatic duct size, cyst size, or presence of a solid enhancing component in the cyst to optimally select patients for surgery.3 However, these findings are subject to a radiologist's interpretation and have been shown to be inconsistent with regards to the presence of a mural nodule or solid component.4 We propose objective classification of risk groups based on quantitative imaging features extracted from CT scans. We apply new features that represent the solid component (i.e. areas of high intensity) within the cyst and extract standard texture features. An adaptive boost classifier5 achieves the best performance with area under receiver operating characteristic curve (AUC) of 0.73 and accuracy of 77.3% for texture features. The random forest classifier achieves the best performance with AUC of 0.71 and accuracy of 70.8% with the solid component features.

  13. Low Risk of Cervical Cancer/Precancer Among Most Women Under Surveillance Postcolposcopy.

    Science.gov (United States)

    Demarco, Maria; Cheung, Li C; Kinney, Walter K; Wentzensen, Nicolas; Lorey, Thomas S; Fetterman, Barbara; Poitras, Nancy E; Befano, Brian; Castle, Philip E; Schiffman, Mark

    2018-04-01

    To inform impending postcolposcopy guidelines, this analysis examined the subsequent risk of CIN 3+ among women with a grade lower than CIN 2 (< CIN 2) colposcopy results, taking into account the referring results that brought them to colposcopy and cotest results postcolposcopy. We analyzed 107,005 women from 25 to 65 years old, recommended for colposcopy at Kaiser Permanente Northern California. We estimated absolute risks of CIN 3+ among women: (1) recommended for colposcopy (precolposcopy), (2) following colposcopy and with histology results < CIN 2 (postcolposcopy), and (3) with cotest results 12 months after a < CIN 2 colposcopy (return cotest). After colposcopy showing < CIN 2 (n = 69,790; 87% of the women at colposcopy), the 1-year risk of CIN 3+ was 1.2%, compared with 6.3% at the time of colposcopy recommendation. Negative cotest results 1 year after colposcopy identified a large group (37.1%) of women whose risk of CIN 3+ (i.e., <0.2% at 3 years after postcolposcopy cotest) was comparable with women with normal cytology in the screening population. These risks are consistent with current guidelines recommending repeat cotesting 12 months after colposcopy < CIN 2 and a 3-year return for women with a negative postcolposcopy cotest. Most women are at low risk of subsequent CIN 3+ after a colposcopy showing < CIN 2, especially those who are human papillomavirus-negative postcolposcopy, consistent with current management guidelines for repeat testing intervals. Before the finalizing the upcoming guidelines, we will consider additional rounds of postcolposcopy cotesting.

  14. Prostate MRI findings in patients treated for testosterone deficiency while on active surveillance for low-risk prostate cancer

    Science.gov (United States)

    Hashimoto, Takeshi; Rahul, Krishnan; Takeda, Toshikazu; Benfante, Nicole; Mulhall, John P.; Hricak, Hedvig; Eastham, James A.; Vargas, Hebert Alberto

    2017-01-01

    Objective To investigate the multiparametric prostate magnetic resonance imaging (mpMRI) findings in patients treated with testosterone replacement therapy (TRT) while on active surveillance (AS) for low-risk prostate cancer. Methods We retrospectively reviewed 12 patients who underwent mpMRI before and after TRT while on AS. Changes in serum testosterone level, prostate specific antigen (PSA), prostate biopsy findings, prostate volume and Prostate Imaging Reporting and Data System Version 2 (PI-RADSv2) score before and after TRT were summarized. Results Following TRT, there was a significant increase in serum testosterone (516.5 ng/dl vs. 203.0 ng/dl), PSA (4.2 ng/ml vs. 3.3 ng/ml) and prostate volume (55.2 cm3 vs. 39.4 cm3). Two patients had biopsy progression during the study periods. The PI-RADSv2 scores before and after TRT were unchanged in 10/12 patients; none of these demonstrated biopsy progression on post TRT. The PI-RADSv2 scores increased after TRT in 2/12 patients; both showed Gleason score upgrade on follow-up biopsy. One of these two patients underwent radical treatment due to clinical progression. The area under the curve calculated from PI-RADSv2 score after TRT was 0.90, which was better than that calculated from post TRT PSA level (0.48). Conclusions After TRT, mpMRI findings remained stable in patients without biopsy progression, while PI-RADSv2 score increase was identified in patients with Gleason score upgrade on follow-up biopsy. PMID:27665357

  15. Urinary incontinence in very young and mostly nulliparous women with a history of regular organised high-impact trampoline training: occurrence and risk factors.

    Science.gov (United States)

    Eliasson, Kerstin; Edner, Ann; Mattsson, Eva

    2008-05-01

    The aim of this study was to examine the occurrence of urinary incontinence (UI) in mostly nulliparous women with a history of regular organised trampoline training as adolescents and to identify possible predictors. Female trampolinists in Sweden with licence for trampolining between 1995--1999 (n = 305), with a median age of 21 (range 18-44) years answered retrospectively a validated questionnaire. Competition with double somersaults had been performed by 85 women, the "competition group" (CG), while 220 women comprised the "recreational group" (RG). Of the trampolinists with UI during trampolining, 76% continued to leak. In CG, 57% and, in RG, 48% reported current UI. Strong predictors for UI were inability to interrupt micturition (p trampolining (p trampolining after menarche increased the risk of UI (p trampolining cannot be ruled out.

  16. Anxiety and depression in breast cancer patients at low risk of recurrence compared with the general population: a valid comparison?

    NARCIS (Netherlands)

    Groenvold, M.; Fayers, P. M.; Sprangers, M. A.; Bjorner, J. B.; Klee, M. C.; Aaronson, N. K.; Bech, P.; Mouridsen, H. T.

    1999-01-01

    Breast cancer and its treatment have been associated with psychological morbidity. In this study our aim was to quantify the excess anxiety and depression resulting from breast cancer. We compared 538 newly diagnosed breast cancer patients at low risk of recurrence (87.0% responded) to 872 women

  17. Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study

    NARCIS (Netherlands)

    de Jonge, J.; Mesman, J.A.J.M.; Manniën, J.; Zwart, J.J.; van Dillen, J.; van Roosmalen, J.

    2013-01-01

    Objectives: To test the hypothesis that low risk women at the onset of labour with planned home birth have a higher rate of severe acute maternal morbidity than women with planned hospital birth, and to compare the rate of postpartum haemorrhage and manual removal of placenta. Design: Cohort study

  18. Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands.

    NARCIS (Netherlands)

    Wiegers, T.A.; Keirse, M.J.N.C.; Zee, J. van der; Berghs, G.A.H.

    1996-01-01

    Objective: To investigate the relation between the intended place of birth (home or hospital) and perinatal outcome in women with low risk pregnancies after controlling for parity and social, medical, and obstetric background. Design: Analysis of prospective data from midwives and their clients.

  19. High incidence of pseudotumours after hip resurfacing even in low risk patients; results from an intensified MRI screening protocol.

    NARCIS (Netherlands)

    Weegen, W. van der; Smolders, J.M.; Sijbesma, T.; Hoekstra, H.J.; Brakel, K.; Susante, J.L.C. van

    2013-01-01

    We intensified our screening protocol for the presence of pseudotumours in a consecutive series of patients with a hip resurfacing arthroplasty (HRA), to establish whether we should be alert to the presence of 'silent' pseudotumours. Patients categorised with high risk (11 hips) and low risk (10

  20. Identification of patients with low-risk pulmonary embolism suitable for outpatient treatment using the pulmonary embolism severity index (PESI).

    LENUS (Irish Health Repository)

    McCabe, A

    2013-06-01

    There is increasing evidence that outpatient treatment of patients with low-risk stable pulmonary embolism (PE) is safe, effective and potentially reduces costs. It is not clear how many patients presenting to an Irish Emergency Department (ED) are potentially suitable for outpatient management.

  1. Adverse outcomes in maternity care for women with a low risk profile in The Netherlands: a case series analysis

    NARCIS (Netherlands)

    Martijn, L.; Jacobs, A.; Amelink-Verburg, M.; Wentzel, R.; Buitendijk, S.; Wensing, M.

    2013-01-01

    BACKGROUND: This study aimed to perform a structural analysis of determinants of risk of critical incidents in care for women with a low risk profile at the start of pregnancy with a view on improving patient safety. METHODS: We included 71 critical incidents in primary midwifery care and subsequent

  2. [Adverse outcomes in maternity care for women with a low risk profile in The Netherlands: a case series analysis

    NARCIS (Netherlands)

    Martijn, L.M.; Jacobs, A.; Amelink-Verburg, M.P.; Wentzel, R.; Buitendijk, S.E.; Wensing, M.

    2014-01-01

    BACKGROUND: This study aimed to perform a structural analysis of determinants of risk of critical incidents in care for women with a low risk profile at the start of pregnancy with a view on improving patient safety. METHODS: We included 71 critical incidents in primary midwifery care and subsequent

  3. Types of pelvic floor dysfunctions in nulliparous, vaginal delivery, and cesarean section female patients with obstructed defecation syndrome identified by echodefecography.

    Science.gov (United States)

    Murad-Regadas, Sthela M; Regadas, Francisco Sérgio P; Rodrigues, Lusmar V; Oliveira, Leticia; Barreto, Rosilma G L; de Souza, Marcellus H L P; Silva, Flavio Roberto S

    2009-10-01

    This study aims to show pelvic floor dysfunctions in women with obstructed defecation syndrome (ODS), comparing nulliparous to those with vaginal delivery or cesarean section using the echodefecography (ECD). Three hundred seventy female patients with ODS were reviewed retrospectively and were divided in Group I-105 nulliparous, Group II-165 had at least one vaginal delivery, and Group III-comprised of 100 patients delivered only by cesarean section. All patients had been submitted to ECD to identify pelvic floor dysfunctions. No statistical significance was found between the groups with regard to anorectocele grade. Intussusception was identified in 40% from G I, 55.0% from G II, and 30.0% from G III, with statistical significance between Groups I and II. Intussusception was associated with significant anorectocele in 24.8%, 36.3%, and 18% patients from G I, II, and III, respectively. Anismus was identified in 39.0% from G I, 28.5% from G II, and 60% from G III, with statistical significance between Groups I and III. Anismus was associated with significant anorectocele in 22.8%, 15.7%, and 24% patients from G I, II, and III, respectively. Sigmoidocele/enterocele was identified in 7.6% from G I, 10.9% G II, and was associated with significant rectocele in 3.8% and 7.3% patients from G I and II, respectively. The distribution of pelvic floor dysfunctions showed no specific pattern across the groups, suggesting the absence of a correlation between these dysfunctions and vaginal delivery.

  4. Life satisfaction, general well-being and costs of treatment for severe fear of childbirth in nulliparous women by psychoeducative group or conventional care attendance.

    Science.gov (United States)

    Rouhe, Hanna; Salmela-Aro, Katariina; Toivanen, Riikka; Tokola, Maiju; Halmesmäki, Erja; Saisto, Terhi

    2015-05-01

    Fear of childbirth is a common reason for seeking cesarean section. It is important to consider outcomes and costs associated with alternative treatment and delivery mode. We compared well-being and costs of group psychoeducation and conventional care for fear of childbirth. Randomized controlled trial. A total of 371 nulliparous women scoring over the 95th centile in the Wijma Delivery Expectancy Questionnaire (W-DEQ) during the first trimester. Finland, data from obstetrical patient records and questionnaires. Randomization to group psychoeducation with relaxation (six sessions during pregnancy, one after childbirth, n = 131), or surveillance and referral on demand (n = 240). All costs in maternity care during pregnancy, delivery and postnatally according to Diagnoses Related Groups. Life satisfaction and general well-being 3 months after childbirth (by a Satisfaction with Life Scale and Well-being Visual Analogue Scale). The groups did not differ in total direct costs (€3786/woman in psychoeducative group and €3830/woman in control group), nor in life satisfaction or general well-being. Although only 76 (30%) of the women assigned to the surveillance were referred to special maternity care and 36 (15%) attended advanced prenatal classes, costs in the psychoeducation group did not exceed the costs of the controls, mostly because of the greater number of uncomplicated vaginal deliveries (63% vs. 47%, p = 0.005). Through an association with safer childbirth and equal well-being after delivery, psychoeducative group treatment for nulliparous women with fear of childbirth can be a recommended choice for the same overall costs as conventional treatment. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  5. Quantifying the Transition from Active Surveillance to Watchful Waiting Among Men with Very Low-risk Prostate Cancer.

    Science.gov (United States)

    Van Hemelrijck, Mieke; Garmo, Hans; Lindhagen, Lars; Bratt, Ola; Stattin, Pär; Adolfsson, Jan

    2017-10-01

    Active surveillance (AS) is commonly used for men with low-risk prostate cancer (PCa). When life expectancy becomes too short for curative treatment to be beneficial, a change from AS to watchful waiting (WW) follows. Little is known about this change since it is rarely documented in medical records. To model transition from AS to WW and how this is affected by age and comorbidity among men with very low-risk PCa. National population-based healthcare registers were used for analysis. Using data on PCa characteristics, age, and comorbidity, a state transition model was created to estimate the probability of changes between predefined treatments to estimate transition from AS to WW. Our estimates indicate that 48% of men with very low-risk PCa starting AS eventually changed to WW over a life course. This proportion increased with age at time of AS initiation. Within 10 yr from start of AS, 10% of men aged 55 yr and 50% of men aged 70 yr with no comorbidity at initiation changed to WW. Our prevalence simulation suggests that the number of men on WW who were previously on AS will eventually stabilise after 30 yr. A limitation is the limited information from clinical follow-up visits (eg, repeat biopsies). We estimated that changes from AS to WW become common among men with very low-risk PCa who are elderly. This potential change to WW should be discussed with men starting on AS. Moreover, our estimates may help in planning health care resources allocated to men on AS, as the transition to WW is associated with lower demands on outpatient resources. Changes from active surveillance to watchful waiting will become more common among men with very low-risk prostate cancer. These observations suggest that patients need to be informed about this potential change before they start on active surveillance. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  6. Quantifying the benefits of achieving or maintaining long-term low risk profile for cardiovascular disease: The Doetinchem Cohort Study.

    Science.gov (United States)

    Hulsegge, Gerben; Smit, Henriëtte A; van der Schouw, Yvonne T; Daviglus, Martha L; Verschuren, W M Monique

    2015-10-01

    Studies investigating the relation between risk profiles and cardiovascular disease have measured risk at baseline only. We investigated maintenance and changes of risk profiles over time and their potential impact on incident cardiovascular disease. Population-based cohort study. Risk factors were measured at baseline (1987-1991) among 5574 cardiovascular disease-free adults aged 20-59 years. They were classified into four risk categories according to smoking status, presence of diabetes and widely accepted cut-off values for blood pressure, total cholesterol/HDL-ratio and body mass index. Categories were subdivided (maintenance, deterioration, improvement) based on risk factor levels at six and 11 years of follow-up. Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) for cardiovascular disease incidence 5-10 years following the risk-change period were fitted using Cox proportional hazards models. Only 12% of participants were low risk at baseline, and only 7% maintained it. Participants who maintained a low risk profile over 11 years had seven times lower risk of cardiovascular disease (HR: 0.14, 95% CI: 0.05-0.41) than participants with long-term high risk profile, whereas those low risk at baseline whose profile deteriorated had three times lower risk (HR: 0.36, 95% CI: 0.18-0.71). Our results suggest that, within each baseline risk profile group, compared with a stable profile, improving profiles may be associated with up to two-fold lower HRs, and deteriorating profiles with about two-fold higher HRs. Our study, using long-term risk profiles, demonstrates the full benefits of low risk profile. These findings underscore the importance of achieving and maintaining low risk from young adulthood onwards. © The European Society of Cardiology 2014.

  7. Identification of Patients at Very Low Risk of Local Recurrence After Breast-Conserving Surgery

    Energy Technology Data Exchange (ETDEWEB)

    Smith, Sally L., E-mail: ssmith11@bccancer.bc.ca [Radiation Therapy Program and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, British Columbia (Canada); Truong, Pauline T. [Radiation Therapy Program and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, British Columbia (Canada); Lu, Linghong; Lesperance, Mary [Department of Mathematics and Statistics, University of Victoria, Victoria, British Columbia (Canada); Olivotto, Ivo A. [Division of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta (Canada)

    2014-07-01

    Purpose: To identify clinical and pathological factors that identify groups of women with stage I breast cancer with a 5-year risk of local recurrence (LR) ≤1.5% after breast-conserving therapy (BCS) plus whole-breast radiation therapy (RT). Methods and Materials: Study subjects were 5974 patients ≥50 years of age whose cancer was diagnosed between 1989 and 2006, and were referred with pT1 pN0 invasive breast cancer treated with BCS and RT. Cases of 5- and 10-year LR were examined using Kaplan-Meier methods. Recursive partitioning analysis was performed in patients treated with and without endocrine therapy to identify combinations of factors associated with a 5-year LR risk ≤1.5%. Results: The median follow-up was 8.61 years. Median age was 63 years of age (range, 50 to 91). Overall 5-year LR was 1.5% (95% confidence interval [CI], 1.2%-1.9%) and 10-year LR was 3.4% (95% CI, 2.8%-4.0%). Of 2830 patients treated with endocrine therapy, patient subsets identified with 5-year LR ≤1.5% included patients with grade 1 histology (n=1038; LR, 0.2%; 95% CI, 0%-0.5%) or grade 2 histology plus ≥60 years of age (n=843; LR, 0.5%; 95% CI, 0%-1.0%). Ten-year LR for these groups were 0.8% (95% CI, 0.1%-1.6%) and 0.9% (95% CI, 0.2%-1.6%), respectively. Of 3144 patients treated without endocrine therapy, patients with grade 1 histology plus clear margins had 5-year LR ≤1.5% (n=821; LR, 0.6%; 95% CI, 0.1%-1.2%). Ten-year LR for this group was 2.2% (95% CI, 1.0%-3.4%). Conclusions: Histologic grade, age, margin status, and use of endocrine therapy identified 45% of a population-based cohort of female patients over age 50 with stage I breast cancer with a 5-year LR risk ≤1.5% after BCS plus RT. Prospective study is needed to evaluate the safety of omitting RT in patients with such a low risk of LR.

  8. Utilization of prostate brachytherapy for low risk prostate cancer: Is the decline overstated?

    Directory of Open Access Journals (Sweden)

    Joseph Safdieh

    2016-08-01

    Full Text Available Purpose : Several prior studies have suggested that brachytherapy utilization has markedly decreased, coinciding with the recent increased utilization of intensity modulated radiation therapy, as well as an increase in urologist-owned centers. We sought to investigate the brachytherapy utilization in a large, hospital-based registry. Material and methods: Men with prostate cancer diagnosed between 2004-2012 and treated with either external beam radiation and/or prostate brachytherapy were abstracted from the National Cancer Database. In order to be included, men had to be clinically staged as T1c-T2aNx-0Mx-0, Gleason 6, PSA ≤ 10.0 ng/ml. Descriptive statistics were used to analyze brachytherapy utilization over time and were compared via χ2. Multivariate logistic regression was used to assess for covariables associated with increased brachytherapy usage. Results : There were 89,413 men included in this study, of which 37,054 (41.6% received only external beam radiation, and 52,089 (58.4% received prostate brachytherapy. The use of brachytherapy declined over time from 62.9% in 2004 to 51.3% in 2012 (p < 0.001. This decline was noted in both academic facilities (60.8% in 2004 to 47.0% in 2012, p < 0.001 as well as in non-academic facilities (63.7% in 2004 to 53.0% in 2012, p < 0.001. The decline was more pronounced in patients who lived closer to treatment facilities than those who lived further. The use of intensity modulated radiation therapy increased during this same time period from 18.4% in 2004 to 38.2% in 2012 (p < 0.001. On multivariate analysis, treatment at an academic center, increasing age, decreasing distance from the treatment center, and years of diagnosis from 2006-2012 were significantly associated with reduced brachytherapy usage. Conclusions : In this hospital-based registry, prostate brachytherapy usage has declined for low risk prostate cancer as intensity modulated radiation therapy usage has increased. However, it still

  9. Auto-segmentation of low-risk clinical target volume for head and neck radiation therapy.

    Science.gov (United States)

    Yang, Jinzhong; Beadle, Beth M; Garden, Adam S; Gunn, Brandon; Rosenthal, David; Ang, Kian; Frank, Steven; Williamson, Ryan; Balter, Peter; Court, Laurence; Dong, Lei

    2014-01-01

    To investigate atlas-based auto-segmentation methods to improve the quality of the delineation of low-risk clinical target volumes (CTVs) of unilateral tonsil cancers. Sixteen patients received intensity modulated radiation therapy for left tonsil tumors. These patients were treated by a total of 8 oncologists, who delineated all contours manually on the planning CT image. We chose 6 of the patients as atlas cases and used atlas-based auto-segmentation to map each the atlas CTV to the other 10 patients (test patients). For each test patient, the final contour was produced by combining the 6 individual segmentations from the atlases using the simultaneous truth and performance level estimation algorithm. In addition, for each test patient, we identified a single atlas that produced deformed contours best matching the physician's manual contours. The auto-segmented contours were compared with the physician's manual contours using the slice-wise Hausdorff distance (HD), the slice-wise Dice similarity coefficient (DSC), and a total volume overlap index. No single atlas consistently produced good results for all 10 test cases. The multiatlas segmentation achieved a good agreement between auto-segmented contours and manual contours, with a median slice-wise HD of 7.4 ± 1.0 mm, median slice-wise DSC of 80.2% ± 5.9%, and total volume overlap of 77.8% ± 3.3% over the 10 test cases. For radiation oncologists who contoured both the test case and one of the atlas cases, the best atlas for a test case had almost always been contoured by the oncologist who had contoured that test case, indicating that individual physician's practice dominated in target delineation and was an important factor in optimal atlas selection. Multiatlas segmentation may improve the quality of CTV delineation in clinical practice for unilateral tonsil cancers. We also showed that individual physician's practice was an important factor in selecting the optimal atlas for atlas-based auto

  10. Financial impact of outpatient clinic radioiodine therapy with sodium iodide I-131 for the treatment of patients with differentiated low-risk thyroid carcinoma in relation to hospital doses

    International Nuclear Information System (INIS)

    Berenguer, P.F.; Chang, T.M.C.; Silva, R.A.M.; Neto, A.H.D.; Belo, I.B.; Santos, M.A.P.

    2017-01-01

    Differential thyroid carcinoma (CDT) is the most prevalent endocrine malignancy in the world, with an excellent prognosis and a 10-year survival rate of over 95%. By 2013, the lowest activity of I-131 authorized by the Brazilian Unified Health System (SUS) in the therapy of patients with low-risk CDT was 3,700 MBq, requiring hospitalization. Recent studies have shown similar effectiveness between low and high doses of I-131 in the treatment of low-risk CDT. In 2014, the Ministry of Health included in the list of SUS procedures the use of lower activities (1,110 MBq and 1,850 MBq) for this purpose. The Brazilian National Nuclear Energy Commission (CNEN) also authorized the outpatient use of activity up to 1,850 MBq of I-131. Objective: To evaluate the financial impact of the adoption of ambulatory radioiodine therapy in patients with CDT of low-risk when compared to the hospital dose. Methods: Analysis of patients with CDT low-risk who were treated with an outpatient dose of I-131 from August / 2014 to January / 2017 at a nuclear medicine service in Recife, PE, Brazil. The cost of outpatient versus hospital doses was calculated. Results: A total of 289 patients underwent low doses of iodine therapy were evaluated, resulting in a savings of R$227,793.80. Conclusion: Outpatient radioiodine therapy in the treatment of patients with CDT of low-risk resulted in a 61.10% reduction in SUS expense, in addition to enabling faster care

  11. The Design and Operation of Suborbital Low Cost and Low Risk Vehicle to the Edge of Space (SOLVES)

    Science.gov (United States)

    Ridzuan Zakaria, Norul; Nasrun, Nasri; Rashidy Zulkifi, Mohd; Izmir Yamin, Mohd; Othman, Jamaludin; Rafidi Zakaria, Norul

    2013-09-01

    Inclusive in the planning of Spaceport Malaysia are 2 local suborbital vehicles development. One of the vehicles is called SOLVES or Suborbital Low Cost and Low Risk Vehicle to the Edge of Space. The emphasis on the design and operation of SOLVES is green and robotic technology, where both green technology and robotic technology are used to protect the environment and enhance safety. As SOLVES climbs, its center of gravity stabilizes and remains at the bottom as its propellant being used until it depletes, due to the position of the vehicle's passenger cabin and its engines at its lower end. It will reach 80km from sea level generally known as "the edge of space" due to its momentum although its propellant will be depleted at a lower altitude. As the suborbital vehicle descends tail first, its wings automatically extend and rotate at horizontal axes perpendicular to the fuselage. These naturally and passively rotating wings ensure controlled low velocity and stable descend of the vehicle. The passenger cabin also rotates automatically at a steady low speed at the centerline of its fuselage as it descends, caused naturally by the lift force, enabling its passengers a surrounding 360 degrees view. SOLVES is steered automatically to its landing point by an electrical propulsion system with a vectoring nozzle. The electrical propulsion minimizes space and weight and is free of pollution and noise. Its electrical power comes from a battery aided by power generated by the naturally rotating wings. When the vehicle lands, it is in the safest mode as its propellant is depleted and its center of gravity remains at the bottom of its cabin. The cabin, being located at the bottom of the fuselage, enables very convenient, rapid and safe entry and exit of its passengers. SOLVES will be a robotic suborbital vehicle with green technology. The vehicle will carry 4 passengers and each passenger will be trained to land the vehicle manually if the fully automated landing system fails

  12. Audit of a new model of birth care for women with low risk pregnancies in South Africa: the primary care onsite midwife-led birth unit (OMBU).

    Science.gov (United States)

    Hofmeyr, George Justus; Mancotywa, Thozeka; Silwana-Kwadjo, Nomvula; Mgudlwa, Batembu; Lawrie, Theresa A; Gülmezoglu, Ahmet Metin

    2014-12-20

    South Africa's health system is based on the primary care model in which low-risk maternity care is provided at community health centres and clinics, and 'high-risk' care is provided at secondary/tertiary hospitals. This model has the disadvantage of delays in the management of unexpected intrapartum complications in otherwise low-risk pregnancies, therefore, there is a need to re-evaluate the models of birth care in South Africa. To date, two primary care onsite midwife-led birth units (OMBUs) have been established in the Eastern Cape. OMBUs are similar to alongside midwifery units but have been adapted to the South African health system in that they are staffed, administered and funded by the primary care service. They allow women considered to be at 'low risk' to choose between birth in a community health centre and birth in the OMBU. The purpose of this audit was to evaluate the impact of establishing an OMBU at Frere Maternity Hospital in East London, South Africa, on maternity services. We conducted an audit of routinely collected data from Frere Maternity Hospital over two 12 month periods, before and after the OMBU opened. Retrospectively retrieved data included the number of births, maternal and perinatal deaths, and mode of delivery. After the OMBU opened at Frere Maternity Hospital, the total number of births on the hospital premises increased by 16%. The total number of births in the hospital obstetric unit (OU) dropped by 9.3%, with 1611 births out of 7375 (22%) occurring in the new OMBU. The number of maternal and perinatal deaths was lower in the post-OMBU period compared with the pre-OMBU period. These improvements cannot be assumed to be the result of the intervention as observational studies are prone to bias. The mortality data should be interpreted with caution as other factors such as change in risk profile may have contributed to the death reductions. There are many additional advantages for women, hospital staff and primary care staff with

  13. Joint Attention Development in Low-risk Very Low Birth Weight Infants at Around 18 Months of Age.

    Science.gov (United States)

    Yamaoka, Noriko; Takada, Satoshi

    2016-10-18

    The purpose of this study was to clarify the developmental characteristics of joint attention in very low birth weight (VLBW) infants with a low risk of complications. Section B of the Checklist for Autism in Toddlers (CHAT) was administered to 31 VLBW and 45 normal birth weight (NBW) infants aged 18-22 months, while the sessions were recorded with a video camera. A semi-structured observation scale was developed to assess infants' joint attention from the video footage, and was shown to be reliable. VLBW, compared to NBW, infants showed significantly poorer skills in 2 of 4 items on responding to joint attention, and in 6 of 10 items on initiating joint attention. VLBW infants need more clues in order to produce joint attention. The difficulty was attributed to insufficient verbal and fine motor function skills. Continuous follow-up evaluation is essential for both high-risk and low-risk VLBW infants and their parents.

  14. Thyrotropin Suppressive Therapy for Low-Risk Small Thyroid Cancer: A Propensity Score-Matched Cohort Study.

    Science.gov (United States)

    Park, Suyeon; Kim, Won Gu; Han, Minkyu; Jeon, Min Ji; Kwon, Hyemi; Kim, Mijin; Sung, Tae-Yon; Kim, Tae Yong; Kim, Won Bae; Hong, Suck Joon; Shong, Young Kee

    2017-09-01

    Thyrotropin (TSH) suppression has improved the clinical outcomes of patients with differentiated thyroid cancer (DTC). However, the efficacy of TSH suppressive therapy (TST) is unclear in patients with low-risk DTC. This study aimed to evaluate the efficacy of TST and optimal TSH levels of patients with low-risk DTC. This retrospective propensity score-matched cohort study included DTC patients (n = 446) who underwent lobectomy from 2002 to 2008 with or without TST (TST group and No-TST group). Disease-free survival (DFS) and dynamic risk stratification were compared between both groups using serum TSH levels. Approximately 74% of TST patients and 11% of No-TST patients had suppressed serum TSH levels (<2 mIU/L). The median follow-up period was 8.6 years. During follow-up, the disease recurred in 10 (2.7%) patients, with no significant difference in DFS between the groups (p = 0.63). The proportion of patients with excellent treatment response was similar between the TST (65.2%) and No-TST (64.4%) groups. Incomplete biochemical response was noted in 17.2% of the TST group patients and 9.4% of the No-TST group patients. No significant difference was observed in the DFS between both groups by comparing serum TSH level (p = 0.57). TST did not improve clinical outcomes, and serum TSH levels were not associated with recurrence in patients with low-risk small DTC. No clinical benefits were shown for TSH suppression in low-risk patients who underwent lobectomy. Thus, levothyroxine is not necessary for patients without evidence of hypothyroidism.

  15. Accuracy of simple urine tests for diagnosis of urinary tract infections in low-risk pregnant women

    OpenAIRE

    Feitosa,Danielle Cristina Alves; Silva,Márcia Guimarães da; Parada,Cristina Maria Garcia de Lima

    2009-01-01

    Anatomic and physiological alterations during pregnancy predispose pregnant women to urinary tract infections (UTI). This study aimed to identify the accuracy of the simple urine test for UTI diagnosis in low-risk pregnant women. Diagnostic test performance was conducted in Botucatu, SP, involving 230 pregnant women, between 2006 and 2008. Results showed 10% UTI prevalence. Sensitivity, specificity and accuracy of the simple urine test were 95.6%, 63.3% and 66.5%, respectively, in relation to...

  16. [FRAX® thresholds to identify people with high or low risk of osteoporotic fracture in Spanish female population].

    Science.gov (United States)

    Azagra, Rafael; Roca, Genís; Martín-Sánchez, Juan Carlos; Casado, Enrique; Encabo, Gloria; Zwart, Marta; Aguyé, Amada; Díez-Pérez, Adolf

    2015-01-06

    To detect FRAX(®) threshold levels that identify groups of the population that are at high/low risk of osteoporotic fracture in the Spanish female population using a cost-effective assessment. This is a cohort study. Eight hundred and sixteen women 40-90 years old selected from the FRIDEX cohort with densitometry and risk factors for fracture at baseline who received no treatment for osteoporosis during the 10 year follow-up period and were stratified into 3 groups/levels of fracture risk (low20%) according to the real fracture incidence. The thresholds of FRAX(®) baseline for major osteoporotic fracture were: low riskX-ray absorptiometry (DXA-scan) for FRAX(®)≥ 5 (Intermediate and high risk) to reclassify by FRAX(®) with DXA-scan at high/low risk. These thresholds select 17.5% of women for DXA-scan and 10% for treatment. With these thresholds of FRAX(®), compared with the strategy of opportunistic case finding isolated risk factors, would improve the predictive parameters and reduce 82.5% the DXA-scan, 35.4% osteoporosis prescriptions and 28.7% cost to detect the same number of women who suffer fractures. The use of FRAX ® thresholds identified as high/low risk of osteoporotic fracture in this calibration (FRIDEX model) improve predictive parameters in Spanish women and in a more cost-effective than the traditional model based on the T-score ≤ -2.5 of DXA scan. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

  17. Development of quality indicators for low-risk labor care provided by midwives using a RAND-modified Delphi method.

    Science.gov (United States)

    Ueda, Kayo; Ohtera, Shosuke; Kaso, Misato; Nakayama, Takeo

    2017-09-22

    In childbirth, most deliveries are low-risk, defined as spontaneous labor at full term without special high-risk facts or complications, especially in high-resource countries where maternal and perinatal mortality rates are very low. Indeed, the majority of mothers and infants have no serious conditions during labor. However, the quality of care provided is not assured, and performance may vary by birthing facility and provider. The overuse of technology in childbirth in some parts of the world is almost certainly based on assumptions like, "something can go wrong at any minute." There is a need to assess the quality of care provided for mothers and infants in low-risk labor. We aimed to develop specific quality indicators for low-risk labor care provided primarily by midwives in Japan. We used a RAND-modified Delphi method, which integrates evidence review with expert consensus development. The procedure comprises five steps: (1) literature review, including clinical practice guidelines, to extract and develop quality indicator candidates; (2) formation of a multidisciplinary panel; (3) independent panel ratings (Round 1); (4) panel meeting and independent panel ratings (Round 2); and (5) independent panel ratings (Round 3). The three independent panel ratings (Rounds 1-3) were held between July and December 2012. The assembled multidisciplinary panel comprised eight clinicians (two pediatricians, three obstetricians, and three midwives) and three mothers who were nonclinicians. Evidentiary review extracted 166 key recommendations from 32 clinical practice guidelines, and 31 existing quality indicators were added. After excluding duplicate recommendations and quality indicators, the panel discussed 25 candidate indicators. Of these, 18 were adopted, one was modified, six were not adopted, and four were added during the meeting, respectively. We established 23 quality indicators for low-risk labor care provided by midwives in labor units in Japan.

  18. Association of spiritual/religious coping with depressive symptoms in high- and low-risk pregnant women.

    Science.gov (United States)

    Vitorino, Luciano M; Chiaradia, Raíssa; Low, Gail; Cruz, Jonas Preposi; Pargament, Kenneth I; Lucchetti, Alessandra L G; Lucchetti, Giancarlo

    2018-02-01

    To investigate the role of spiritual/religious coping (SRC) on depressive symptoms in high- and low-risk pregnant women. Spiritual/religious coping is associated with physical and mental health outcomes. However, only few studies investigated the role of these strategies during pregnancy and whether low- and high-risk pregnant women have different coping mechanisms. This study is a cross-sectional comparative study. This study included a total of 160 pregnant women, 80 with low-risk pregnancy and 80 with high-risk pregnancy. The Beck Depression Inventory, the brief SRC scale and a structured questionnaire on sociodemographic and obstetric aspects were used. General linear model regression analysis was used to identify the factors associated with positive and negative SRC strategies in both groups of pregnant women. Positive SRC use was high, whereas negative SRC use was low in both groups. Although we found no difference in SRC strategies between the two groups, negative SRC was associated with depression in women with high-risk pregnancy, but not in those with low-risk pregnancy. Furthermore, positive SRC was not associated with depressive symptoms in both groups. Results showed that only the negative SRC strategies of Brazilian women with high-risk pregnancies were associated with worsened mental health outcomes. Healthcare professionals, obstetricians and nurse midwives should focus on the use of negative SRC strategies in their pregnant patients. © 2017 John Wiley & Sons Ltd.

  19. A pilot audit of a protocol for ambulatory investigation of predicted low-risk patients with possible pulmonary embolism.

    Science.gov (United States)

    McDonald, A H; Murphy, R

    2011-09-01

    Patients with possible pulmonary embolism (PE) commonly present to acute medical services. Research has led to the identification of low-risk patients suitable for ambulatory management. We report on a protocol designed to select low-risk patients for ambulatory investigation if confirmatory imaging is not available that day. The protocol was piloted in the Emergency Department and Medical Assessment Area at the Royal Infirmary of Edinburgh. We retrospectively analysed electronic patient records in an open observational audit of all patients managed in the ambulatory arm over five months of use. We analysed 45 patients' records. Of these, 91.1% required imaging to confirm or refute PE, 62.2% received a computed tomography pulmonary angiogram (CTPA). In 25% of patients, PE was confirmed with musculoskeletal pain (22.7%), and respiratory tract infection (15.9%) the next most prevalent diagnoses. Alternative diagnoses was provided by CTPA in 32% of cases. We identified no adverse events or readmissions but individualised follow-up was not attempted. The data from this audit suggests this protocol can be applied to select and manage low-risk patients suitable for ambulatory investigation of possible PE. A larger prospective comparative study would be required to accurately define the safety and effectiveness of this protocol.

  20. Perinatal outcomes of low-risk planned home and hospital births under midwife-led care in Japan.

    Science.gov (United States)

    Hiraizumi, Yoshie; Suzuki, Shunji

    2013-11-01

    It has not been extensively studied whether planned home and planned hospital births under primary midwife-led care increase risk of adverse events among low-risk women in Japan. A retrospective cohort study was performed to compare perinatal outcome between 291 women who were given primary midwife-led care during labor and 217 women who were given standard obstetric shared care. Among 291 women with primary midwife-led care, 168 and 123 chose home deliver and hospital delivery, respectively. Perinatal outcomes included length of labor of 24 h or more, augmentation of labor pains, delivery mode, severe perineal laceration, postpartum hemorrhage of 1000 mL or more, maternal fever of 38°C or more and neonatal asphyxia (Apgar score, home delivery (34 vs 21%, P = 0.011). There were no significant differences in the incidence of adverse perinatal outcomes between women with obstetric shared care and women with primary midwife-led care (regardless of being hospital delivery or home delivery). Approximately one-quarter of low-risk women with primary midwife-led care required obstetric care during labor or postpartum. However, primary midwife-led care during labor at home and hospital for low-risk pregnant women was not associated with adverse perinatal outcomes in Japan. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

  1. Results of allogeneic stem cell transplantation in the Spanish MDS registry: prognostic factors for low risk patients.

    Science.gov (United States)

    Díez Campelo, M; Sánchez-Barba, M; de Soria, V Gómez-García; Martino, R; Sanz, G; Insunza, A; Bernal, T; Duarte, R; Amigo, M L; Xicoy, B; Tormo, M; Iniesta, F; Bailén, A; Benlloch, L; Córdoba, I; López-Villar, O; Del Cañizo, M C

    2014-10-01

    Although new agents have been approved for the treatment of MDS, the only curative approach is allogeneic hematopoietic stem cell transplantation (HSCT) and thus, in particular circumstances this procedure has been proposed as a treatment option for low risk patients. We have retrospectively analyzed the results of HSCT in 291 patients from the Spanish MDS registry with special attention to low risk MDS (LR-MDS) in order to define the variables that could impact their clinical evolution after transplantation. At 2 years OS was 51% and EFS was 50% (95% CI 0.7-4.5 years for OS and 95% CI 0.1-3.9 years for EFS). Among 43 LR-MDS, transplant-related mortality was 28%. At 3 years, OS was 67% (95% CI 264.7-8927.2 days for OS) and EFS was 64% (95% CI 0-9697.2 days for EFS). In the multivariate analysis only cytogenetics retained statistical significant effect on both OS (p=.047) and EFS (p=.046). Conditioning regimen could improve outcome among this subset of patients (OS 86% and RFS 100% for patients receiving RIC regimen). The present study confirms that specific disease characteristic as well as transplant characteristics have a significant impact on transplant outcome. Regarding low risk patients a non-myeloablative conditioning would be preferable especially in cases without high-risk cytogenetics. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Rising cesarean deliveries among apparently low-risk mothers at university teaching hospitals in Jordan: analysis of population survey data, 2002–2012

    Science.gov (United States)

    Rifai, Rami Al

    2014-01-01

    cesarean delivery, particularly in UTHs, indicates that many cesarean deliveries may increasingly be performed without any medical indication. More vigilant monitoring of data from routine health information systems is needed to reduce unnecessary cesarean deliveries in apparently low-risk groups. PMID:25276577

  3. Setting up low-risk bone marrow transplantation for children with thalassemia may facilitate pediatric cancer care

    Directory of Open Access Journals (Sweden)

    Lawrence B Faulkner

    2013-01-01

    Full Text Available Background: In many South Asian countries there is shortage of centers providing care for pediatric malignancies. This report describes the experience of the Cure2Children Foundation (C2C in supporting, both financially and professionally, the startup of two bone marrow transplant (BMT centers, one in Pakistan and one in India, for the cure of transfusion-dependent thalassemia. Even though transplantation is generally considered as a more complex and advanced step relatively to basic pediatric cancer care, the authors argue that BMT for low-risk thalassemia patients with a matched sibling is a relatively simple procedure amenable to focused training. Materials and Methods: Since 2008 the C2C, an Italian Nongovernmental Organization (NGO, has supported a BMT network in Pakistan. The primary aim of this project was to assess feasibility, outcomes, and costs of matched-related BMT for thalassemia in young low-risk children employing a well established and quite tolerable strategy employed in Italy. This initiative relied primarily on focused training and task-shift strategies within a structured cooperation program. The initial success of that strategy led to its replication in India with 100 total BMTs performed over the past 4 years, 91 of which were for thalassemia major. Results: Low-risk matched-related BMT in children younger than 5 years could deliver a 92% thalassemia-free survival with 100% performance score and no extensive chronic graft versus host disease (GVHD, for an average cost of 10,000 USD per BMT. Within an existing hospital facility, 50,000 USD were sufficient to renovate and fully equip a 2-3 bedded start up BMT unit capable of performing safe low-risk compatible marrow transplantation. Conclusions: In low resource settings matched-related low-risk BMT for thalassemia can be performed with outcomes comparable to richer countries and with a fraction of the costs. Within structured and intensive cooperation, good outcomes can be

  4. Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study.

    Science.gov (United States)

    Hutton, Eileen K; Reitsma, Angela H; Kaufman, Karyn

    2009-09-01

    Midwives in Ontario, Canada, provide care in the home and hospital and are required to submit data for all births to the Ontario Ministry of Health database. The purpose of this study was to compare maternal and perinatal/neonatal mortality and morbidity and intrapartum intervention rates for women attended by Ontario midwives who planned a home birth compared with similar low-risk women who planned a hospital birth between 2003 and 2006. The database provided outcomes for all women planning a home birth at the onset of labor (n = 6,692) and for a cohort, stratified by parity, of similar low-risk women planning a hospital birth. The rate of perinatal and neonatal mortality was very low (1/1,000) for both groups, and no difference was shown between groups in perinatal and neonatal mortality or serious morbidity (2.4% vs 2.8%; relative risk [RR], 95% confidence intervals [CI]: 0.84 [0.68-1.03]). No maternal deaths were reported. All measures of serious maternal morbidity were lower in the planned home birth group as were rates for all interventions including cesarean section (5.2% vs 8.1%; RR [95% CI]: 0.64 [0.56, 0.73]). Nulliparas were less likely to deliver at home, and had higher rates of ambulance transport from home to hospital than multiparas planning home birth and had rates of intervention and outcomes similar to, or lower than, nulliparas planning hospital births. Midwives who were integrated into the health care system with good access to emergency services, consultation, and transfer of care provided care resulting in favorable outcomes for women planning both home or hospital births.

  5. Chronic sacroiliac joint and pelvic girdle dysfunction in a 35-year-old nulliparous woman successfully managed with multimodal and multidisciplinary approach.

    Science.gov (United States)

    Jonely, Holly; Brismée, Jean-Michel; Desai, Mehul J; Reoli, Rachel

    2015-02-01

    Sacroiliac joint pain and dysfunction affect 15-25% of patients reporting low back pain, including reports of spontaneous, idiopathic, traumatic, and non-traumatic onsets. The poor reliability and validity associated with diagnostic clinical and imaging techniques leads to challenges in diagnosing and managing sacroiliac joint dysfunction. A 35-year-old nulliparous female with a 14-year history of right sacroiliac joint dysfunction was managed using a multimodal and multidisciplinary approach when symptoms failed to resolve after 2 months of physical therapy. The plan of care included four prolotherapy injections, sacroiliac joint manipulation into nutation, pelvic girdle belting, and specific stabilization exercises. The patient completed 20 physical therapy sessions over a 12-month period. At 6 months, the patient's Oswestry Disability Questionnaire score was reduced from 34% to 14%. At 1-year follow-up, her score was 0%. The patient's rating of pain on a numeric rating scale decreased to an average of 4/10 at 6 months and 0/10 at 1-year follow-up. A multidisciplinary and multimodal approach for the management of chronic sacroiliac joint dysfunction appeared successful in a single-case design at 1-year follow-up.

  6. Clinical prediction in early pregnancy of infants small for gestational age by customised birthweight centiles: findings from a healthy nulliparous cohort.

    Directory of Open Access Journals (Sweden)

    Lesley M E McCowan

    Full Text Available Small for gestational age (SGA infants comprise up to 50% of all stillbirths and a minority are detected before birth. We aimed to develop and validate early pregnancy predictive models for SGA infants.5628 participants from SCOPE, a prospective study of nulliparous pregnant women, were interviewed at 15 ± 1 weeks' gestation. Fetal anthropometry, uterine and umbilical Doppler studies were performed at 20 ± 1 weeks'. The cohort was divided into training (n = 3735 and validation datasets (n = 1871. All-SGA (birthweight 12 months to conceive, university student, cigarette smoking, proteinuria, daily vigorous exercise and diastolic blood pressure ≥ 80. Recreational walking ≥ 4 times weekly, rhesus negative blood group and increasing random glucose were protective. AUC for clinical risk factors was 0.63. Fetal abdominal or head circumference z scores <10(th centile and increasing uterine artery Doppler resistance at 20 ± 1 weeks' were associated with increased risk. Addition of these parameters increased the AUC to 0.69. Clinical predictors of Normotensive and Hypertensive-SGA were sub-groups of All-SGA predictors and were quite different. The combined clinical and ultrasound AUC for Normotensive and Hypertensive-SGA were 0.69 and 0.82 respectively.Predictors for SGA of relevance to clinical practice were identified. The identity and predictive potential differed in normotensive women and those who developed hypertension.

  7. When to stop pushing: effects of duration of second-stage expulsion efforts on maternal and neonatal outcomes in nulliparous women with epidural analgesia.

    Science.gov (United States)

    Le Ray, Camille; Audibert, François; Goffinet, François; Fraser, William

    2009-10-01

    The purpose of this study was to assess the influence of the duration of active second-stage labor on maternal and neonatal outcomes. Secondary analysis of the Pushing Early Or Pushing Late with Epidural trial that included 1862 nulliparous women with epidural analgesia who were in the second stage of labor. According to duration of active second-stage labor, we estimated the proportion of spontaneous vaginal deliveries (SVD) with a newborn infant without signs of asphyxia (5-minute Apgar score > or =7 and arterial pH >7.10). We also analyzed maternal and neonatal outcomes according to the duration of expulsive efforts. Relative to the first hour of expulsive efforts, the chances of a SVD of a newborn infant without signs of asphyxia decreased significantly every hour (1- to 2-hour adjusted odds ratio, 0.4; 95% confidence interval [CI], 0.3-0.6; 2- to 3-hour adjusted odds ratio, 0.1; 95% CI, 0.09-0.2; >3-hour adjusted odds ratio, 0.03; 95% CI, 0.02-0.05). The risk of postpartum hemorrhage and intrapartum fever increased significantly after 2 hours of pushing. Faced with a decreasing probability of SVD and increased maternal risk of morbidity after 2 hours, we raise the question as to whether expulsive efforts should be continued after this time.

  8. Safety and cost benefit of an ambulatory program for patients with low-risk neutropenic fever at an Australian centre.

    Science.gov (United States)

    Teh, Benjamin W; Brown, Christine; Joyce, Trish; Worth, Leon J; Slavin, Monica A; Thursky, Karin A

    2018-03-01

    Neutropenic fever (NF) is a common complication of cancer chemotherapy. Patients at low risk of medical complications from NF can be identified using a validated risk assessment and managed in an outpatient setting. This is a new model of care for Australia. This study described the implementation of a sustainable ambulatory program for NF at a tertiary cancer centre over a 12-month period. Peter MacCallum Cancer Centre introduced an ambulatory care program in 2014, which identified low-risk NF patients, promoted early de-escalation to oral antibiotics, and early discharge to a nurse-led ambulatory program. Patients prospectively enrolled in the ambulatory program were compared with a historical-matched cohort of patients from 2011 for analysis. Patient demographics, clinical variables (cancer type, recent chemotherapy, treatment intent, site of presentation) and outcomes were collected and compared. Total cost of inpatient admissions was determined from diagnosis-related group (DRG) codes and applied to both the prospective and historical cohorts to allow comparisons. Twenty-five patients were managed in the first year of this program with a reduction in hospital median length of stay from 4.0 to 1.1 days and admission cost from Australian dollars ($AUD) 8580 to $AUD2360 compared to the historical cohort. Offsetting salary costs, the ambulatory program had a net cost benefit of $AUD 71895. Readmission for fever was infrequent (8.0%), and no deaths were reported. Of relevance to hospitals providing cancer care, feasibility, safety, and cost benefits of an ambulatory program for low-risk NF patients have been demonstrated.

  9. Pattern recognition and functional neuroimaging help to discriminate healthy adolescents at risk for mood disorders from low risk adolescents.

    Science.gov (United States)

    Mourão-Miranda, Janaina; Oliveira, Leticia; Ladouceur, Cecile D; Marquand, Andre; Brammer, Michael; Birmaher, Boris; Axelson, David; Phillips, Mary L

    2012-01-01

    There are no known biological measures that accurately predict future development of psychiatric disorders in individual at-risk adolescents. We investigated whether machine learning and fMRI could help to: 1. differentiate healthy adolescents genetically at-risk for bipolar disorder and other Axis I psychiatric disorders from healthy adolescents at low risk of developing these disorders; 2. identify those healthy genetically at-risk adolescents who were most likely to develop future Axis I disorders. 16 healthy offspring genetically at risk for bipolar disorder and other Axis I disorders by virtue of having a parent with bipolar disorder and 16 healthy, age- and gender-matched low-risk offspring of healthy parents with no history of psychiatric disorders (12-17 year-olds) performed two emotional face gender-labeling tasks (happy/neutral; fearful/neutral) during fMRI. We used Gaussian Process Classifiers (GPC), a machine learning approach that assigns a predictive probability of group membership to an individual person, to differentiate groups and to identify those at-risk adolescents most likely to develop future Axis I disorders. Using GPC, activity to neutral faces presented during the happy experiment accurately and significantly differentiated groups, achieving 75% accuracy (sensitivity = 75%, specificity = 75%). Furthermore, predictive probabilities were significantly higher for those at-risk adolescents who subsequently developed an Axis I disorder than for those at-risk adolescents remaining healthy at follow-up. We show that a combination of two promising techniques, machine learning and neuroimaging, not only discriminates healthy low-risk from healthy adolescents genetically at-risk for Axis I disorders, but may ultimately help to predict which at-risk adolescents subsequently develop these disorders.

  10. Retrospective comparison of the Low Risk Ankle Rules and the Ottawa Ankle Rules in a pediatric population.

    Science.gov (United States)

    Ellenbogen, Amy L; Rice, Amy L; Vyas, Pranav

    2017-09-01

    A recent multicenter prospective Canadian study presented prospective evidence supporting the Low Risk Ankle Rules (LRAR) as a means of reducing the number of ankle radiographs ordered for children presenting with an ankle injury while maintaining nearly 100% sensitivity. This is in contrast to a previous prospective study which showed that this rule yielded only 87% sensitivity. It is important to further investigate the LRAR and compare them with the already validated Ottawa Ankle Rules (OAR) to potentially curb healthcare costs and decrease unnecessary radiation exposure without compromising diagnostic accuracy. We conducted a retrospective chart review of 980 qualifying patients ages 12months to 18years presenting with ankle injury to a commonly staffed 310 bed children's hospital and auxiliary site pediatric emergency department. There were 28 high-risk fractures identified. The Ottawa Ankle Rules had a sensitivity of 100% (95% CI 87.7-100), specificity of 33.1% (95% CI 30.1-36.2), and would have reduced the number of ankle radiographs ordered by 32.1%. The Low Risk Ankle Rules had a sensitivity of 85.7% (95% CI 85.7-96), specificity of 64.9% (95% CI 61.8-68), and would have reduced the number of ankle radiographs ordered by 63.1%. The latter rule missed 4 high-risk fractures. The Low Risk Ankle Rules may not be sensitive enough for use in Pediatric Emergency Departments, while the Ottawa Ankle Rules again demonstrated 100% sensitivity. Further research on ways to implement the Ottawa Ankle Rules and maximize its ability to decrease wait times, healthcare costs, and improve patient satisfaction are needed. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Relationship between polycythemia and in-hospital mortality in chronic obstructive pulmonary disease patients with low-risk pulmonary embolism

    Science.gov (United States)

    Guo, Lu; Chughtai, Aamer Rasheed; Jiang, Hongli; Gao, Lingyun; Yang, Yan; Yang, Yang; Liu, Yuejian

    2016-01-01

    Backgrounds Pulmonary embolism (PE) is frequent in subjects with chronic obstructive pulmonary disease (COPD) and associated with high mortality. This multi-center retrospective study was performed to investigate if secondary polycythemia is associated with in-hospital mortality in COPD patients with low-risk PE. Methods We identified COPD patients with proven PE between October, 2005 and October, 2015. Patients in risk classes III–V on the basis of the PESI score were excluded. We extracted demographic, clinical and laboratory information at the time of admission from medical records. All subjects were followed until hospital discharge to identify all-cause mortality. Results We enrolled 629 consecutive patients with COPD and PE at low risk: 132 of them (21.0%) with and 497 (79.0%) without secondary polycythemia. Compared with those without polycythemia, the polycythemia group had significantly lower forced expiratory volume in one second (FEV1) level (0.9±0.3 vs. 1.4±0.5, P=0.000), lower PaO2 and SpO2 as well as higher PaCO2 (P=0.03, P=0.03 and P=0.000, respectively). COPD patients with polycythemia had a higher proportion of arrhythmia in electrocardiogram (ECG) (49.5% vs. 35.7%, P=0.02), a longer hospital duration time (15.3±10.1 vs. 9.7±9.1, P=0.001), a higher mechanical ventilation rate (noninvasive and invasive, 51.7% vs. 30.3%, P=0.04 and 31.0% vs. 7.9%, P=0.04, respectively), and a higher in-hospital mortality (12.1% vs. 6.6%, P=0.04). Multivariate logistic regression analysis revealed that polycythemia was associated with mortality in COPD patients with low-risk PE (adjusted OR 1.11; 95% CI, 1.04–1.66). Conclusions Polycythemia is an independent risk factor for all-cause in-hospital mortality in COPD patients with PE at low risk. PMID:28066591

  12. Clinical governance and research ethics as barriers to UK low-risk population-based health research?

    Directory of Open Access Journals (Sweden)

    Douglas Flora

    2008-11-01

    Full Text Available Abstract Background Since the Helsinki Declaration was introduced in 1964 as a code of practice for clinical research, it has generally been agreed that research governance is also needed in the field of public health and health promotion research. Recently, a range of factors led to the development of more stringent bureaucratic procedures, governing the conduct of low-risk population-based health research in the United Kingdom. Methods Our paper highlights a case study of the application process to medical research ethics committees in the United Kingdom for a study of the promotion of physical activity by health care providers. The case study presented here is an illustration of the challenges in conducting low-risk population-based health research. Results Our mixed-methods approach involved a questionnaire survey of and semi-structured interviews with health professionals (who were all healthy volunteers. Since our study does not involve the participation of either patients or the general population, one would expect the application to the relevant research ethics committees to be a formality. This proved not to be the case! Conclusion Research ethics committees could be counter-productive, rather than protecting the vulnerable in the research process, they can stifle low-risk population-based health research. Research ethics in health services research is first and foremost the responsibility of the researcher(s, and we need to learn to trust health service researchers again. The burden of current research governance regulation to address the perceived ethical problems is neither appropriate nor adequate. Senior researchers/academics need to educate and train students and junior researchers in the area of research ethics, whilst at the same time reducing pressures on them that lead to unethical research, such as commercial funding, inappropriate government interference and the pressure to publish. We propose that non-invasive low-risk

  13. Defining the implant treatment volume for patients with low risk prostate cancer: does the anterior base need to be treated?

    International Nuclear Information System (INIS)

    D'Amico, Anthony V.; Davis, Ann; Vargas, Sara O.; Renshaw, Andrew A.; Jiroutek, Michael; Richie, Jerome P.

    1999-01-01

    Purpose: An increased incidence of acute urinary retention has been reported after interstitial prostate radiation therapy when the anterior base of the prostate gland receives 100% of the prescription dose. The frequency of prostate cancer in this location as a function of the pre-treatment prostate specific antigen (PSA), biopsy Gleason score, and 1992 American Joint Commission on Cancer Staging (AJCC) was determined. Methods and Materials: One hundred four men treated at the Brigham and Women's Hospital with radical prostatectomy for clinically localized prostate cancer between 1995-1996 comprised the study population. Prostatectomy specimens were whole mounted and the location of each tumor foci enumerated. Results: Of 269 foci of prostate cancer found in 39 low-risk prostate cancer patients (PSA 1c,2a ), a single focus (0.37%) was noted in the anterior base. Conversely, 20/355 (5.6%) and 18/251 (7.2%) tumor foci were noted in the anterior base in 43 patients with intermediate risk and 24 patients with high-risk disease, respectively. Conclusions: A new definition of the treatment volume excluding the anterior base for low-risk prostate cancer patients may be justified

  14. Applying decision tree for identification of a low risk population for type 2 diabetes. Tehran Lipid and Glucose Study.

    Science.gov (United States)

    Ramezankhani, Azra; Pournik, Omid; Shahrabi, Jamal; Khalili, Davood; Azizi, Fereidoun; Hadaegh, Farzad

    2014-09-01

    The aim of this study was to create a prediction model using data mining approach to identify low risk individuals for incidence of type 2 diabetes, using the Tehran Lipid and Glucose Study (TLGS) database. For a 6647 population without diabetes, aged ≥20 years, followed for 12 years, a prediction model was developed using classification by the decision tree technique. Seven hundred and twenty-nine (11%) diabetes cases occurred during the follow-up. Predictor variables were selected from demographic characteristics, smoking status, medical and drug history and laboratory measures. We developed the predictive models by decision tree using 60 input variables and one output variable. The overall classification accuracy was 90.5%, with 31.1% sensitivity, 97.9% specificity; and for the subjects without diabetes, precision and f-measure were 92% and 0.95, respectively. The identified variables included fasting plasma glucose, body mass index, triglycerides, mean arterial blood pressure, family history of diabetes, educational level and job status. In conclusion, decision tree analysis, using routine demographic, clinical, anthropometric and laboratory measurements, created a simple tool to predict individuals at low risk for type 2 diabetes. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  15. Infant Feeding Attitudes and Practices of Spanish Low-Risk Expectant Women Using the IIFAS (Iowa Infant Feeding Attitude Scale).

    Science.gov (United States)

    Cotelo, María Del Carmen Suárez; Movilla-Fernández, María Jesús; Pita-García, Paula; Novío, Silvia

    2018-04-22

    The Iowa Infant Feeding Attitude Scale (IIFAS) has been shown to have good psychometric properties for English-speaking populations, but it has not been validated among low-risk pregnant women in Spain. The aim of this study was to assess the reliability and validity of the translated version of the IIFAS in order to examine infant feeding attitudes in Spanish women with an uncomplicated pregnancy. Low-risk expectant women ( n = 297) were recruited from eight primary public health care centres in Galicia (Spain). Questionnaires including both socio-demographic and breastfeeding characteristics and items about infant feeding were administered during the third trimester. Participants were contacted by telephone during the postpartum period to obtain information regarding their infant feeding status. Prediction validity and internal consistency were assessed. The translated IIFAS (69.76 ± 7.75), which had good psychometric properties (Cronbach's alpha = 0.785; area under the curve (AUC) of the receiver operating characteristic (ROC) curve = 0.841, CI 95% = 0.735⁻0.948), showed more positive attitudes towards breastfeeding than towards formula feeding, especially among mothers who intended to exclusively breastfeed. This scale was also useful for inferring the intent to breastfeed and duration of breastfeeding. This study provides evidence that the IIFAS is a reliable and valid tool for assessing infant feeding attitudes in Spanish women with an uncomplicated pregnancy.

  16. Results of implementation of a hospital-based strategy to reduce cesarean delivery among low-risk women in Canada.

    Science.gov (United States)

    Shoemaker, Esther S; Bourgeault, Ivy L; Cameron, Carol; Graham, Ian D; Hutton, Eileen K

    2017-11-01

    To assess the cesarean delivery (CD) rate among low-risk pregnancies before and after implementation of a hospital-based program in Canada. A prospective before-and-after study was conducted to assess the effects of the CARE (CAesarean REduction) strategy, which was developed and implemented at Markham Stouffville Hospital, Toronto, ON, Canada, in 2010 to reduce CD among low-risk women. Hospital records were reviewed to identify changes in the proportions of CD performed during 12 months (April 2009-March 2010) before implementation of the CARE strategy versus 12 months after implementation (April 2012-March 2013) at Markham Stouffville Hospital and 36 hospitals of the same level in the same province. At the intervention hospital, 30.3% (964/3181) of women underwent CD in 2009-2010, compared with 26.4% (803/3045) in 2012-2013 (difference -3.9%, PImplementation of the CARE strategy reduced rates of CD among the target population. © 2017 International Federation of Gynecology and Obstetrics.

  17. Comparison of frequency of obesity in high risk non diabetic young individuals with low risk non diabetic young individuals

    International Nuclear Information System (INIS)

    Shaikh, M.A.; Kumar, R.; Ghori, R.A.

    2011-01-01

    Objective: To assess the body mass index and waist circumferences of high risk non diabetic young individuals and compare them with low risk non diabetic young individuals. Method: A cross sectional, case control comparative study was conducted in the department of medicine, LUMHS from January 2008 to March 2009. Five hundred individuals 20-40 years of age were selected and divided into two groups i.e. Group A: high risk (250 individuals) and Group B: low risk (250 individuals) on the basis of same age and gender. Group A included those who had positive family history of type 2 DM in first degree relatives while group B had no family history of type 2 DM in first degree relatives. The blood pressure, BMI and Waist Circumference was measured and Fasting Blood Sugar was estimated in each individual. In each group 125 (50%) were males and 125 (50%) were females. Results: In group A 58% and in group B 28.8% individuals represented raised BMI whereas 42% in group A and 36% in group B individuals showed an increased waist circumference. Mean fasting blood glucose was significantly higher in Group A than in Group B (P=0.001). Conclusion: Impaired Fasting Glucose is strongly associated with family history of type 2 diabetes mellitus. Presence of obesity specially in high risk non-diabetic young individuals emphasize the need for routine health screening for early institution of preventive measures. (author)

  18. Validity Assessment of Low-risk SCORE Function and SCORE Function Calibrated to the Spanish Population in the FRESCO Cohorts.

    Science.gov (United States)

    Baena-Díez, José Miguel; Subirana, Isaac; Ramos, Rafael; Gómez de la Cámara, Agustín; Elosua, Roberto; Vila, Joan; Marín-Ibáñez, Alejandro; Guembe, María Jesús; Rigo, Fernando; Tormo-Díaz, María José; Moreno-Iribas, Conchi; Cabré, Joan Josep; Segura, Antonio; Lapetra, José; Quesada, Miquel; Medrano, María José; González-Diego, Paulino; Frontera, Guillem; Gavrila, Diana; Ardanaz, Eva; Basora, Josep; García, José María; García-Lareo, Manel; Gutiérrez-Fuentes, José Antonio; Mayoral, Eduardo; Sala, Joan; Dégano, Irene R; Francès, Albert; Castell, Conxa; Grau, María; Marrugat, Jaume

    2018-04-01

    To assess the validity of the original low-risk SCORE function without and with high-density lipoprotein cholesterol and SCORE calibrated to the Spanish population. Pooled analysis with individual data from 12 Spanish population-based cohort studies. We included 30 919 individuals aged 40 to 64 years with no history of cardiovascular disease at baseline, who were followed up for 10 years for the causes of death included in the SCORE project. The validity of the risk functions was analyzed with the area under the ROC curve (discrimination) and the Hosmer-Lemeshow test (calibration), respectively. Follow-up comprised 286 105 persons/y. Ten-year cardiovascular mortality was 0.6%. The ratio between estimated/observed cases ranged from 9.1, 6.5, and 9.1 in men and 3.3, 1.3, and 1.9 in women with original low-risk SCORE risk function without and with high-density lipoprotein cholesterol and calibrated SCORE, respectively; differences were statistically significant with the Hosmer-Lemeshow test between predicted and observed mortality with SCORE (P cardiovascular mortality observed in the Spanish population. Despite the acceptable discrimination capacity, prediction of the number of fatal cardiovascular events (calibration) was significantly inaccurate. Copyright © 2017 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  19. The reliability of transabdominal cervical length measurement in a low-risk obstetric population: Comparison with transvaginal measurement.

    Science.gov (United States)

    Peng, Cheng-Ran; Chen, Chie-Pein; Wang, Kuo-Gon; Wang, Liang-Kai; Chen, Chen-Yu; Chen, Yi-Yung

    2015-04-01

    To determine the correlation between transabdominal (TA) and transvaginal (TV) cervical length measurement in a low-risk obstetric population in Taiwan. Women with a singleton pregnancy between 20 weeks and 24 weeks of gestation underwent postvoid TA and TV cervical length measurements. Differences between the measurements obtained using the two methods were evaluated. Two hundred and five women agreed to participate in the study. Paired TA and TV measurements were obtained in 174 women. The mean TA cervical length was 36.0 ± 4.9 mm and the mean TV cervical length was 37.6 ± 5.4 mm. The mean TA cervical length was shorter than the mean TV cervical length by 1.6 mm. The 5(th) percentile of TA and TV cervical length was 29 mm and 29.1 mm, respectively. The discrepancies between the two methods were not significantly correlated with maternal body mass index (BMI). All women with TV cervical length women in the present study, and the TA cervical length was closely correlated with the TV cervical length. The use of TA ultrasound could be an effective initial tool for cervical length screening in low-risk pregnant women. TA cervical length TV ultrasound. Copyright © 2015. Published by Elsevier B.V.

  20. Infant Feeding Attitudes and Practices of Spanish Low-Risk Expectant Women Using the IIFAS (Iowa Infant Feeding Attitude Scale

    Directory of Open Access Journals (Sweden)

    María del Carmen Suárez Cotelo

    2018-04-01

    Full Text Available The Iowa Infant Feeding Attitude Scale (IIFAS has been shown to have good psychometric properties for English-speaking populations, but it has not been validated among low-risk pregnant women in Spain. The aim of this study was to assess the reliability and validity of the translated version of the IIFAS in order to examine infant feeding attitudes in Spanish women with an uncomplicated pregnancy. Low-risk expectant women (n = 297 were recruited from eight primary public health care centres in Galicia (Spain. Questionnaires including both socio-demographic and breastfeeding characteristics and items about infant feeding were administered during the third trimester. Participants were contacted by telephone during the postpartum period to obtain information regarding their infant feeding status. Prediction validity and internal consistency were assessed. The translated IIFAS (69.76 ± 7.75, which had good psychometric properties (Cronbach’s alpha = 0.785; area under the curve (AUC of the receiver operating characteristic (ROC curve = 0.841, CI95% = 0.735–0.948, showed more positive attitudes towards breastfeeding than towards formula feeding, especially among mothers who intended to exclusively breastfeed. This scale was also useful for inferring the intent to breastfeed and duration of breastfeeding. This study provides evidence that the IIFAS is a reliable and valid tool for assessing infant feeding attitudes in Spanish women with an uncomplicated pregnancy.

  1. The impact of ultrasonographic placental architecture on antenatal course, labor and delivery in a low-risk primigravid population.

    LENUS (Irish Health Repository)

    Cooley, Sharon M

    2012-02-01

    OBJECTIVE: To ascertain the impact of placental architecture on antenatal course and labor delivery in a low-risk primigravid population. METHODS: This study involves prospective recruitment of 1011 low-risk primigravids with placental ultrasound at 22?24 weeks and 36 weeks. Detailed postnatal review of all mothers and infants was undertaken. Retrospective analysis of ultrasound and clinical outcome data was performed. RESULTS: Eight hundred ten women with complete outcome data were available. Anterior placentation was statistically associated with intrauterine growth restriction (IUGR) and preterm birth and fundal placentation was significantly associated with a higher incidence of pregnancy-induced hypertension and infants with a birthweight less than the 9th centile. Placental infarcts in the third trimester was significantly increased in cases complicated by pre-eclampsia (PET) and in cases with fetal acidosis. Placental calcification was associated a 40-fold increase in the incidence of IUGR. Placental lakes in the second trimester were more prevalent in patients with threatened miscarriage. Increased placental thickness was associated with a higher rate of fetal acidosis. The Grannum grade of the placenta was higher with threatened first or second trimester loss, PET and in infants born less than 9th centile for gestation. CONCLUSION: Placental site and architecture impact on the incidence of maternal and fetal disease.

  2. Permafrost degradation and methane: low risk of biogeochemical climate-warming feedback

    International Nuclear Information System (INIS)

    Gao Xiang; Adam Schlosser, C; Sokolov, Andrei; Anthony, Katey Walter; Zhuang Qianlai; Kicklighter, David

    2013-01-01

    Climate change and permafrost thaw have been suggested to increase high latitude methane emissions that could potentially represent a strong feedback to the climate system. Using an integrated earth-system model framework, we examine the degradation of near-surface permafrost, temporal dynamics of inundation (lakes and wetlands) induced by hydro-climatic change, subsequent methane emission, and potential climate feedback. We find that increases in atmospheric CH 4 and its radiative forcing, which result from the thawed, inundated emission sources, are small, particularly when weighed against human emissions. The additional warming, across the range of climate policy and uncertainties in the climate-system response, would be no greater than 0.1 ° C by 2100. Further, for this temperature feedback to be doubled (to approximately 0.2 ° C) by 2100, at least a 25-fold increase in the methane emission that results from the estimated permafrost degradation would be required. Overall, this biogeochemical global climate-warming feedback is relatively small whether or not humans choose to constrain global emissions. (letter)

  3. Design Requirements for Unmanned Rotorcraft Used in Low-Risk Concepts of Operation

    Science.gov (United States)

    Hayhurst, Kelly J.; Maddalon, Jeffrey M.; Neogi, Natasha A.; Verstynen, Harry A.

    2016-01-01

    This technical report presents the results of the second of two research studies on design and performance requirements supporting airworthiness certification of midrange unmanned aircraft systems (UAS) intended for commercial use. The two studies focused attention on UAS in the middle of the multidimensional spectrum of UAS; that is, UAS with attributes and capabilities exceeding the criteria to operate under Part 107 of the Federal Aviation Regulations (FARs), but without the design or operational capabilities to comply with the airworthiness standards for commercially-operated manned aircraft. The goal of the two studies was to help address the gap in airworthiness standards for some UAS that fall between the extremes.

  4. Human Papillomavirus - Prevalence of High-Risk and Low-Risk Types among Females Aged 14-59 Years, National Health and ...

    Science.gov (United States)

    ... Archive Data & Statistics Sexually Transmitted Diseases Figure 45. Human Papillomavirus — Prevalence of High-risk and Low-risk ... on the STD Data and Statistics page . * HPV = human papillomavirus. NOTE: Error bars indicate 95% confidence interval. ...

  5. The onset, recurrence and associated obstetric risk factors for urinary incontinence in the first 18 months after a first birth: an Australian nulliparous cohort study.

    Science.gov (United States)

    Gartland, D; Donath, S; MacArthur, C; Brown, S J

    2012-10-01

    To investigate the contribution of obstetric risk factors to persistent urinary incontinence (UI) between 4 and 18 months postpartum. Prospective pregnancy cohort. Six metropolitan public hospitals in Victoria, Australia. A total of 1507 nulliparous women recruited to the Maternal Health Study in early pregnancy (≤24 weeks of gestation). Data from hospital records and self-administered questionnaires/telephone interviews at ≤24 and 30-32 weeks of gestation and at 3, 6, 9, 12 and 18 months postpartum analysed using logistic regression. Persistent UI 4-18 months postpartum in women continent before pregnancy. Of the women who were continent before pregnancy, 44% reported UI 4-18 months postpartum, and 25% reported persistent UI (symptoms at multiple follow ups). Compared with spontaneous vaginal birth, women who had a caesarean before labour (adjusted odds ratio [aOR] 0.4, 95% confidence interval [95% CI] 0.2-0.9), in first-stage labour (aOR 0.4, 95% CI 0.2-0.6) or in second-stage labour (aOR 0.4, 95% CI 0.2-1.0) were less likely to report persistent UI 4-18 months postpartum. Prolonged second-stage labour in women who had an operative vaginal birth was associated with increased likelihood of UI (aOR 2.5, 95% CI 1.3-4.6). Compared with women who were continent in pregnancy, women reporting UI in pregnancy had a seven-fold increase in odds of persistent UI (aOR 7.4, 95% CI 5.1-10.7). Persistent UI is common after childbirth and is more likely following prolonged labour in combination with operative vaginal birth. The majority of women reporting persistent UI at 4-18 months postpartum also experienced symptoms in pregnancy. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

  6. Effects of prolonged second stage, method of birth, timing of caesarean section and other obstetric risk factors on postnatal urinary incontinence: an Australian nulliparous cohort study.

    Science.gov (United States)

    Brown, S J; Gartland, D; Donath, S; MacArthur, C

    2011-07-01

    To investigate the contribution of prolonged labour, method of birth, timing of caesarean section and other obstetric risk factors to postpartum urinary incontinence. Prospective pregnancy cohort. Six metropolitan public hospitals in Victoria, Australia. A total of 1507 nulliparous women recruited to the maternal health study in early pregnancy (≤24 weeks). Data from hospital medical records and self-administered questionnaires/telephone interviews at ≤24 and 30-32 weeks of gestation and 3 months postpartum analysed using univariable and multivariable logistic regression. Urinary incontinence 3 months postpartum in women continent before the index pregnancy. Of the women continent before pregnancy, 26% reported new incontinence at 3 months postpartum. Compared with women who had a spontaneous vaginal birth, women who had a caesarean section before labour (adjusted odds ratio [OR] 0.2, 95% CI 0.1-0.5) or in the first stage of labour (adjusted OR 0.2, 95% CI 0.1-0.4) were less likely to be incontinent 3 months postpartum. Adjusted OR for incontinence after caesarean section in the second stage of labour compared with spontaneous vaginal birth was 0.5 (95% CI 0.2-1.0). Prolonged second stage labour was associated with increased likelihood of postpartum incontinence in women who had a spontaneous vaginal birth (adjusted OR 1.9, 95% CI 1.1-3.4) or operative vaginal birth (adjusted OR 1.7, 95% CI 1.0-2.8). In addition to pregnancy itself, physiological changes associated with the second stage of labour appear to play a role in postpartum urinary incontinence. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.

  7. Physical health after childbirth and maternal depression in the first 12 months post partum: results of an Australian nulliparous pregnancy cohort study.

    Science.gov (United States)

    Woolhouse, Hannah; Gartland, Deirdre; Perlen, Susan; Donath, Susan; Brown, Stephanie J

    2014-03-01

    to investigate the relationship between maternal physical health problems and depressive symptoms in the first year after childbirth. prospective pregnancy cohort study. Melbourne, Victoria, Australia. 1507 nulliparous women. women were recruited from six public hospitals between six and 24 weeks gestation. Written questionnaires were completed at recruitment and at three, six and 12 months post partum. Edinburgh Postnatal Depression Scale (EPDS); standardised measures of urinary and faecal incontinence, a checklist of symptoms for other physical health problems. overall, 16.1% of women reported depressive symptoms during the first 12 months post partum, with point prevalence at three, six and 12 months post partum of 6.9%, 8.8% and 7.8% respectively. The most commonly reported physical health problems in the first three months were tiredness (67%), back pain (47%), breast problems (37%), painful perineum (30%), and urinary incontinence (29%). Compared with women reporting 0-2 health problems in the first three months post partum, women reporting 5 or more health problems had a six-fold increase in likelihood of reporting concurrent depressive symptoms at three months post partum (Adjusted OR=6.69, 95% CI=3.0-15.0) and a three-fold increase in likelihood of reporting subsequent depressive symptoms at 6-12 months post partum (Adjusted OR=3.43, 95% CI 2.1-5.5). poor physical health in the early postnatal period is associated with poorer mental health throughout the first 12 months post partum. Early intervention to promote maternal mental health should incorporate assessment and intervention to address common postnatal physical health problems. Copyright © 2013 Elsevier Ltd. All rights reserved.

  8. Detecting Breech Presentation Before Labour: Lessons From a Low-Risk Maternity Clinic.

    Science.gov (United States)

    Ressl, Bill; O'Beirne, Maeve

    2015-08-01

    Evaluation of fetal position is an important part of prenatal care. A woman with a breech presentation may need referral for external cephalic version, for assisted breech delivery, or to schedule a Caesarean section. In many centres, a breech presentation undetected until labour will result in an emergency Caesarean section, a less desirable alternative for both the mother and the health care system. The anecdotal reports of undiagnosed breech presentations at a busy maternity clinic prompted a study to quantify the missed breech presentations and to evaluate the effectiveness of the current detection process, with the aim of allowing no more than 1% of breech presentations to remain undetected until labour. We performed a retrospective analysis of 102 breech deliveries over a 14 month period to quantify missed breech presentations, and used a prospective physician survey documenting how fetal presentation was determined at 186 prenatal visits over four months to analyze the current detection process. We found that approximately 8% of breech presentations were undetected until labour. We concluded that within the limitations of the small sample size evaluated, the current practice of using a vaginal examination to verify fetal presentation determined by abdominal palpation (Leopold's manoeuvres) may not be more accurate than abdominal palpation alone. The current detection process resulted in an unacceptably high rate of missed breech presentations. The results of this study prompted the clinic's acquisition of bedside ultrasound capability to assess fetal position.

  9. A low-risk aqueous lithium salt blanket for engineering test reactors

    International Nuclear Information System (INIS)

    Gierszewski, P.

    1986-09-01

    A simple blanket concept is proposed based on 1-3 wt.% lithium dissolved as a salt in low temperature (80 degrees C) and low pressure (0.1 MPa) water. This concept can provide, for example, a 0.5 tritium breeding ratio with 60% steel structure and 70% coverage. The use of neutron multipliers, other structural materials (especially zirconium alloys), higher coverage and higher lithium salt concentrations allows tritium breeding ratios over unity if necessary. Other advantages of this concept include the simple shield-like geometry, substantial structural volume for mechanical strength, excellent heat transfer ability of water coolant, efficient neutron and gamma shielding through the combination of high-Z structure and low-Z water, and conventional tritium recovery and control technology. This concept could initially provide the shielding needs for an engineering test reactor and later, by the addition of lithium salt and tritium recovery systems, also provide tritium breeding. This staged operation and liquid breeder/coolant allows control over the tritium inventory in the device without machine disassembly. 14 refs

  10. Randomized trial of pragmatic education for low-risk COPD patients: impact on hospitalizations and emergency department visits.

    Science.gov (United States)

    Siddique, Haamid H; Olson, Raymond H; Parenti, Connie M; Rector, Thomas S; Caldwell, Michael; Dewan, Naresh A; Rice, Kathryn L

    2012-01-01

    Most interventions aimed at reducing hospitalizations and emergency department (ED) visits in patients with chronic obstructive pulmonary disease (COPD) have employed resource-intense programs in high-risk individuals. Although COPD is a progressive disease, little is known about the effectiveness of proactive interventions aimed at preventing hospitalizations and ED visits in the much larger population of low-risk (no known COPD-related hospitalizations or ED visits in the prior year) patients, some of whom will eventually become high-risk. We tested the effect of a simple educational and self-efficacy intervention (n = 2243) versus usual care (n = 2182) on COPD/breathing-related ED visits and hospitalizations in a randomized study of low-risk patients at three Veterans Affairs (VA) medical centers in the upper Midwest. Administrative data was used to track VA admissions and ED visits. A patient survey was used to determine health-related events outside the VA. Rates of COPD-related VA hospitalizations in the education and usual care group were not significantly different (3.4 versus 3.6 admissions per 100 person-years, respectively; 95% CI of difference -1.3 to 1.0, P = 0.77). The much higher patient-reported rates of non-VA hospitalizations for breathing-related problems were lower in the education group (14.0 versus 19.0 per 100 person-years; 95% CI -8.6 to -1.4, P = 0.006). Rates of COPD-related VA ED visits were not significantly different (6.8 versus 5.3; 95% CI -0.1 to 3.0, P = 0.07), nor were non-VA ED visits (32.4 versus 36.5; 95% CI -9.3 to 1.1, P = 0.12). All-cause VA admission and ED rates did not differ. Mortality rates (6.9 versus 8.3 per 100 person-years, respectively; 95% CI -3.0 to 0.4, P = 0.13) did not differ. An educational intervention that is practical for large numbers of low-risk patients with COPD may reduce the rate of breathing-related hospitalizations. Further research that more closely tracks hospitalizations to non-VA facilities is

  11. Randomized Phase III Noninferiority Study Comparing Two Radiotherapy Fractionation Schedules in Patients With Low-Risk Prostate Cancer

    Science.gov (United States)

    Dignam, James J.; Amin, Mahul B.; Bruner, Deborah W.; Low, Daniel; Swanson, Gregory P.; Shah, Amit B.; D’Souza, David P.; Michalski, Jeff M.; Dayes, Ian S.; Seaward, Samantha A.; Hall, William A.; Nguyen, Paul L.; Pisansky, Thomas M.; Faria, Sergio L.; Chen, Yuhchyau; Koontz, Bridget F.; Paulus, Rebecca; Sandler, Howard M.

    2016-01-01

    Purpose Conventional radiotherapy (C-RT) treatment schedules for patients with prostate cancer typically require 40 to 45 treatments that take place from > 8 to 9 weeks. Preclinical and clinical research suggest that hypofractionation—fewer treatments but at a higher dose per treatment—may produce similar outcomes. This trial was designed to assess whether the efficacy of a hypofractionated radiotherapy (H-RT) treatment schedule is no worse than a C-RT schedule in men with low-risk prostate cancer. Patients and Methods A total of 1,115 men with low-risk prostate cancer were randomly assigned 1:1 to C-RT (73.8 Gy in 41 fractions over 8.2 weeks) or to H-RT (70 Gy in 28 fractions over 5.6 weeks). This trial was designed to establish (with 90% power and an α of .05) that treatment with H-RT results in 5-year disease-free survival (DFS) that is not worse than C-RT by more than 7.65% (H-RT/C-RT hazard ratio [HR] < 1.52). Results A total of 1,092 men were protocol eligible and had follow-up information; 542 patients were assigned to C-RT and 550 to H-RT. Median follow-up was 5.8 years. Baseline characteristics were not different according to treatment assignment. The estimated 5-year DFS was 85.3% (95% CI, 81.9 to 88.1) in the C-RT arm and 86.3% (95% CI, 83.1 to 89.0) in the H-RT arm. The DFS HR was 0.85 (95% CI, 0.64 to 1.14), and the predefined noninferiority criterion that required that DFS outcomes be consistent with HR < 1.52 was met (P < .001). Late grade 2 and 3 GI and genitourinary adverse events were increased (HR, 1.31 to 1.59) in patients who were treated with H-RT. Conclusion In men with low-risk prostate cancer, the efficacy of 70 Gy in 28 fractions over 5.6 weeks is not inferior to 73.8 Gy in 41 fractions over 8.2 weeks, although an increase in late GI/genitourinary adverse events was observed in patients treated with H-RT. PMID:27044935

  12. Attitudes toward anticoagulant treatment among nonvalvular atrial fibrillation patients at high risk of stroke and low risk of bleed

    Directory of Open Access Journals (Sweden)

    Crivera C

    2016-05-01

    Full Text Available Concetta Crivera,1 Winnie W Nelson,1 Jeff R Schein,1 Edward A Witt2 1Janssen Scientific Affairs, LLC, Raritan, 2Kantar Health, Princeton, NJ, USA Background: Atrial fibrillation (AF is associated with an increased risk of stroke. Anticoagulant (AC therapies are effective at treating AF, but carry with them an increased risk of bleed. Research suggests that a large proportion of AF patients who have high risk of stroke and low risk of bleeding are not currently receiving AC treatment. The goal of this study was to understand the reasons why these patients do not engage in this potentially life-saving treatment.Method: Through a self-report online survey, using validated instruments, 1,184 US adults who self-reported a diagnosis of AF were screened for the risk of stroke and bleed. Of these patients, 230 (19.4% were at high risk of stroke, low risk of bleed, and not currently using an AC treatment, and were asked follow-up questions to assess their reasons for nontreatment, attitudes toward treatment, and attitudes toward dosing regimens.Results: The most common reasons patients stopped AC treatment were concerns regarding bleeding (27.8% and other medical concerns (26.6%, whereas the most common reason cited for not being prescribed an AC in the first place was the use of antiplatelet therapy as an alternative (57.1%. In both cases, potentially erroneous decisions regarding perceived stoke and/or bleeding risk were also a factor. Finally, the largest factors regarding attitudes toward treatment and dosing regimen were instructions from an authority figure (eg, physician, pharmacist and ease of use, respectively.Conclusion: Results suggest that many AF patients who are at high risk of stroke but at low risk of bleed may not be receiving AC due to potentially inaccurate beliefs about risk. This study also found that AF patients place trust in physicians above other factors such as cost when making treatment decisions. Increased education of

  13. Periodontal Disease and Adverse Pregnancy Outcomes: A Prospective Study in a Low-Risk Population.

    Science.gov (United States)

    Soucy-Giguère, Laurence; Tétu, Amélie; Gauthier, Simon; Morand, Marianne; Chandad, Fatiha; Giguère, Yves; Bujold, Emmanuel

    2016-04-01

    Periodontal disease has been associated with systemic inflammation and adverse pregnancy outcomes, including preeclampsia and preterm birth. To examine the relationship between periodontal disease in early pregnancy and the risk of amniotic inflammation, preterm birth, and preeclampsia. We performed a prospective cohort study of women undergoing amniocentesis for fetal karyotype between 15 and 24 weeks' gestation. Participants underwent periodontal examination by a certified dentist, and a sample of amniotic fluid was collected. Periodontal disease was defined as the presence of one or more sites with probing depths ≥ 4 mm and ≥ 10% bleeding on probing. Matrix metalloproteinase-8 and interleukin-6 concentrations in the amniotic fluid were measured. Medical charts were reviewed for perinatal outcomes. Univariate and multivariate logistic regression analyses were used to assess the association between periodontal disease and adverse pregnancy outcomes. We recruited 273 women at a median gestational age of 16 weeks (range 15 to 24), and 258 (95%) agreed to undergo periodontal examination. Periodontal disease was observed in 117 of the participants (45%). We observed no significant association between periodontal disease and preterm birth (relative risk [RR] 2.27; 95% CI 0.74 to 6.96) or spontaneous preterm birth (RR 0.90; 95% CI 0.20 to 4.11). However, women with periodontal disease were more likely to develop preeclampsia, and this association remained significant after adjustment for potential confounders (adjusted RR 5.89; 95% CI 1.24 to 28.05). Periodontal disease was not associated with significant differences in the intra-amniotic concentration of matrix metalloproteinase-8 (13.0 ± 46.6 vs 5.7 ± 10.4 ng/mL, P = 0.098) or interleukin-6 (3.3 ± 20.3 vs 1.0 ± 1.6 ng/mL, P = 0.23), although a non-significant trend was observed. Periodontal disease is associated with preeclampsia but not with spontaneous preterm birth. The current study cannot exclude an

  14. The Effect of Parenting Style on Social Smiling in Infants at High and Low Risk for ASD.

    Science.gov (United States)

    Harker, Colleen M; Ibañez, Lisa V; Nguyen, Thanh P; Messinger, Daniel S; Stone, Wendy L

    2016-07-01

    This study examined how parenting style at 9 months predicts growth in infant social engagement (i.e., social smiling) between 9 and 18 months during a free-play interaction in infants at high (HR-infants) and low (LR-infants) familial risk for autism spectrum disorder (ASD). Results indicated that across all infants, higher levels of maternal responsiveness were concurrently associated with higher levels of social smiling, while higher levels of maternal directiveness predicted slower growth in social smiling. When accounting for maternal directiveness, which was higher in mothers of HR-infants, HR-infants exhibited greater growth in social smiling than LR-infants. Overall, each parenting style appears to make a unique contribution to the development of social engagement in infants at high- and low-risk for ASD.

  15. Differences in Neural Correlates of Speech Perception in 3 Month Olds at High and Low Risk for Autism Spectrum Disorder.

    Science.gov (United States)

    Edwards, Laura A; Wagner, Jennifer B; Tager-Flusberg, Helen; Nelson, Charles A

    2017-10-01

    In this study, we investigated neural precursors of language acquisition as potential endophenotypes of autism spectrum disorder (ASD) in 3-month-old infants at high and low familial ASD risk. Infants were imaged using functional near-infrared spectroscopy while they listened to auditory stimuli containing syllable repetitions; their neural responses were analyzed over left and right temporal regions. While female low risk infants showed initial neural activation that decreased over exposure to repetition-based stimuli, potentially indicating a habituation response to repetition in speech, female high risk infants showed no changes in neural activity over exposure. This finding may indicate a potential neural endophenotype of language development or ASD specific to females at risk for the disorder.

  16. Identifying emergency department patients with chest pain who are at low risk for acute coronary syndromes [digest].

    Science.gov (United States)

    Markel, David; Kim, Jeremy

    2017-07-21

    Though a minority of patients presenting to the emergency department with chest pain have acute coronary syndromes,identifying the patients who may be safely discharged and determining whether further testing is needed remains challenging. From the prehospital care setting to disposition and follow-up, this systematic review addresses the fundamentals of the emergency department evaluation of patients determined to be at low risk for acute coronary syndromes or adverse outcomes. Clinical risk scores are discussed, as well as the evidence and indications for confirmatory testing. The emerging role of new technologies, such as high-sensitivity troponin assays and advanced imaging techniques, are also presented. [Points & Pearls is a digest of Emergency Medicine Practice].

  17. Outcomes of Low-Risk Ductal Carcinoma In Situ in Southeast Asian Women Treated With Breast Conservation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Wong, Fuh Yong, E-mail: fuhyong@yahoo.com [Department of Radiation Oncology, National Cancer Centre Singapore (Singapore); Wang, Fuqiang [Department of Radiation Oncology, National Cancer Centre Singapore (Singapore); Chen, John Ju [Department of Cancer Informatics, National Cancer Centre Singapore (Singapore); Tan, Chiew Har [Department of Radiation Oncology, National Cancer Centre Singapore (Singapore); Tan, Puay Hoon [Department of Pathology, Singapore General Hospital (Singapore)

    2014-04-01

    Purpose: To examine the outcomes of Southeast Asian (SEA) women with low-risk ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS) and adjuvant radiation therapy. Methods and Materials: Retrospective chart reviews of patients treated with BCS for DCIS from 1995 to 2011 were performed. Patients meeting the selection criteria from Eastern Cooperative Oncology Group 5194 were included. Most patients received adjuvant radiation therapy (RT) consisting of whole-breast RT delivered to 50 Gy followed by a 10-Gy boost to the tumor bed. Results: Of 744 patients with pathologic diagnosis of pure DCIS identified, 273 met the selection criteria: low-intermediate grade (LIG), n=219; high grade (HG), n=54. Median follow-up for these patients was 60 months. There were 8 ipsilateral breast tumor recurrences (IBTRs) in total, 7 of which were DCIS. The estimated actuarial IBTR rates at 5 and 10 years for the entire cohort are 1.8% and 4.3%, respectively. Of the 219 patients with LIG DCIS, 210 received RT and 9 did not. There were 7 IBTRs in LIG DCIS, 2 among the 9 patients who did not receive RT. The IBTR rates in LIG DCIS at 5 and 10 years are 2.3% and 4.2%, respectively. All patients with HG DCIS received RT. There was only 1 IBTR occurring beyond 5 years, giving an estimated IBTR rate of 4.5% at 10 years. Conclusions: SEA women with screen-detected DCIS have exceedingly low rates of IBTR after BCS, comparable to that observed in reports of similar patients with low-risk DCIS treated with adjuvant radiation.

  18. Outcomes of Low-Risk Ductal Carcinoma In Situ in Southeast Asian Women Treated With Breast Conservation Therapy

    International Nuclear Information System (INIS)

    Wong, Fuh Yong; Wang, Fuqiang; Chen, John Ju; Tan, Chiew Har; Tan, Puay Hoon

    2014-01-01

    Purpose: To examine the outcomes of Southeast Asian (SEA) women with low-risk ductal carcinoma in situ (DCIS) treated with breast-conserving surgery (BCS) and adjuvant radiation therapy. Methods and Materials: Retrospective chart reviews of patients treated with BCS for DCIS from 1995 to 2011 were performed. Patients meeting the selection criteria from Eastern Cooperative Oncology Group 5194 were included. Most patients received adjuvant radiation therapy (RT) consisting of whole-breast RT delivered to 50 Gy followed by a 10-Gy boost to the tumor bed. Results: Of 744 patients with pathologic diagnosis of pure DCIS identified, 273 met the selection criteria: low-intermediate grade (LIG), n=219; high grade (HG), n=54. Median follow-up for these patients was 60 months. There were 8 ipsilateral breast tumor recurrences (IBTRs) in total, 7 of which were DCIS. The estimated actuarial IBTR rates at 5 and 10 years for the entire cohort are 1.8% and 4.3%, respectively. Of the 219 patients with LIG DCIS, 210 received RT and 9 did not. There were 7 IBTRs in LIG DCIS, 2 among the 9 patients who did not receive RT. The IBTR rates in LIG DCIS at 5 and 10 years are 2.3% and 4.2%, respectively. All patients with HG DCIS received RT. There was only 1 IBTR occurring beyond 5 years, giving an estimated IBTR rate of 4.5% at 10 years. Conclusions: SEA women with screen-detected DCIS have exceedingly low rates of IBTR after BCS, comparable to that observed in reports of similar patients with low-risk DCIS treated with adjuvant radiation

  19. Factors contributing to postpartum blood-loss in low-risk mothers through expectant management in Japanese birth centres.

    Science.gov (United States)

    Eto, Hiromi; Hasegawa, Ayako; Kataoka, Yaeko; Porter, Sarah E

    2017-08-01

    To describe aspects of expectant midwifery care for low-risk women conducted in midwifery-managed birth centres during the first two critical hours after delivery and to compare differences between midwifery care, client factors and postpartum blood loss volume. As a secondary analysis from a larger study, this descriptive retrospective study examined data from birth records of 4051 women who birthed from 2001 to 2006 at nine (21%) of the 43 midwifery centres in Tokyo. Nonparametric and parametric analyses identified factors related to increased blood loss. Interviews to establish sequence of midwifery care were conducted. The midwifery centres provided care based on expectant management principles from birth to after expulsion of the placenta. Approximately 63.3% of women were within the normal limits of blood loss volume under 500g. A minority of women (12.9%) experienced blood loss between 500 and 800g and 4% had blood loss exceeding 1000g. Blood loss volume tended to increase with infant birth weight and duration of delivery. The total blood loss volume was significantly higher for primiparas than for multiparas during the critical two hours after delivery and for immediately after delivery, yet blood loss volume was significantly higher for multiparas than for primiparas during the first hour after delivery. Preventive uterine massage and umbilical cord clamping after placenta expulsion resulted in statistically significant less blood loss. Identified were two patterns of midwifery care based on expectant management principles from birth to after expulsion of the placenta. The practice of expectant management was not a significant factor for increased postpartum blood loss. These results detail specific midwifery practices and highlight the clinical significance of expectant management with low risk pregnant women experiencing a normal delivery. Copyright © 2016 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  20. Less-Restrictive Food Intake During Labor in Low-Risk Singleton Pregnancies: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Ciardulli, Andrea; Saccone, Gabriele; Anastasio, Hannah; Berghella, Vincenzo

    2017-03-01

    To evaluate benefits and harms of food intake during labor. Electronic databases such as MEDLINE and ClinicalTrials.gov were searched from their inception until October 2016. We included randomized trials comparing a policy of less-restrictive food intake with a policy of more restrictive food intake during labor. The primary outcome was the mean duration of labor. Meta-analysis was performed using the random-effects model of DerSimonian and Laird to produce summary treatment effects in terms of either a relative risk or a mean difference with 95% confidence interval (CI). Ten trials, including 3,982 laboring women, were included. All the studies involved laboring singletons considered at low risk because they had no obstetric or medical complications that would increase the likelihood of cesarean delivery. In three studies, women were allowed to select from a low-residue diet throughout the course of labor. One study had honey date syrup as the allowed food intake. Five studies had carbohydrate drinks as food intake in labor. The last one was the only trial that allowed unrestrictive food intake. In the included studies, all women in the intervention group were allowed the assigned food intake until delivery, whereas women in a control group were allowed only ice chips, water, or sips of water until delivery. A policy of less-restrictive food intake was associated with a significantly shorter duration of labor (mean difference -16 minutes, 95% CI -25 to -7). No other benefits or harms in obstetric or neonatal outcome were noticed. Regurgitation during general anesthesia and Mendelson syndrome did not occur in either group. Women with low-risk singleton pregnancies who were allowed to eat more freely during labor had a shorter duration of labor. A policy of less-restrictive food intake during labor did not influence other obstetric or neonatal outcomes nor did it increase the incidence of vomiting. Operative delivery rates were similar.

  1. The value of routine mid-trimester ultrasound in low-risk pregnancies at primary care level

    Directory of Open Access Journals (Sweden)

    B van Dyk

    2008-12-01

    Full Text Available This study investigated the effect of routine second-trimester ultrasound scanning on obstetric management and pregnancy outcomes. This was an open cluster, randomised, controlled trial. Clusters of women with low-risk pregnancies presenting in the second trimester were randomised to receive an ultrasound scan followed by usual antenatal care, or to an unscanned control group undergoing conventional antenatal care only. Out of the 962 women randomised, follow-up was successful for 804 (83.6%, with 416 allocated to the ultrasound scan group and 388 controls. There were no significant differences between the ultrasound scan group and the control group in terms of prenatal hospitalisation, mode of delivery, miscarriage, perinatal mortality rate and low birthweight rate. Ultrasound dating was associated with a lower rate of induction of labour for post-term pregnancy (1.4% vs. 3.6%; P=0.049. However, ultrasound scanning in low-risk pregnancies was not associated with improvements in pregnancy outcome. Opsomming Hierdie studie het die effek van roetine mid-trimester ultraklankskandering op swangerskapsorg en –uitkomste ondersoek. Dit was ’n oop tros, lukrake, beheerde proef. Groepe vroue met laerisikoswanger- skap in die midtrimester is lukraak toegewys vir ’n ultraklank-skandering, gevolg deur voorgeskrewe voorgeboor-tesorg, of vir ’n kontrolegroep wat voorgeboortesorg volgens nasionaal voorgeskrewe protokol sonder skandering ontvang het. Van die 962 vroue wat aan die steekproef deelgeneem het kon data vir 804 (83.6% suksesvol opgevolg word, met 416 in die ultraklankgroep en 388 in die kontrolegroep. Geen beduidende verskille is tussen die twee groepe gevind ten opsigte van voorgeboorte-hospitalisasie, geboortemetode, miskraamstatistiek, perinatale komplikasies of laegeboortegewig nie. Ultraklankdatering van swangerskappe is met minder kraaminduksie (1.4% teen 3.6%; P=0.049 vir natrimesterswangerskap geassosieer. Roetine ultraklankskandering

  2. Life-time risk of mortality due to different levels of alcohol consumption in seven European countries: implications for low-risk drinking guidelines.

    Science.gov (United States)

    Shield, Kevin D; Gmel, Gerrit; Gmel, Gerhard; Mäkelä, Pia; Probst, Charlotte; Room, Robin; Rehm, Jürgen

    2017-09-01

    Low-risk alcohol drinking guidelines require a scientific basis that extends beyond individual or group judgements of risk. Life-time mortality risks, judged against established thresholds for acceptable risk, may provide such a basis for guidelines. Therefore, the aim of this study was to estimate alcohol mortality risks for seven European countries based on different average daily alcohol consumption amounts. The maximum acceptable voluntary premature mortality risk was determined to be one in 1000, with sensitivity analyses of one in 100. Life-time mortality risks for different alcohol consumption levels were estimated by combining disease-specific relative risk and mortality data for seven European countries with different drinking patterns (Estonia, Finland, Germany, Hungary, Ireland, Italy and Poland). Alcohol consumption data were obtained from the Global Information System on Alcohol and Health, relative risk data from meta-analyses and mortality information from the World Health Organization. The variation in the life-time mortality risk at drinking levels relevant for setting guidelines was less than that observed at high drinking levels. In Europe, the percentage of adults consuming above a risk threshold of one in 1000 ranged from 20.6 to 32.9% for women and from 35.4 to 54.0% for men. Life-time risk of premature mortality under current guideline maximums ranged from 2.5 to 44.8 deaths per 1000 women in Finland and Estonia, respectively, and from 2.9 to 35.8 deaths per 1000 men in Finland and Estonia, respectively. If based upon an acceptable risk of one in 1000, guideline maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men. If low-risk alcohol guidelines were based on an acceptable risk of one in 1000 premature deaths, then maximums for Europe should be 8-10 g/day for women and 15-20 g/day for men, and some of the current European guidelines would require downward revision. © 2017 Society for the Study of Addiction.

  3. Screening for fetal growth restriction with universal third trimester ultrasonography in nulliparous women in the Pregnancy Outcome Prediction (POP) study: a prospective cohort study.

    Science.gov (United States)

    Sovio, Ulla; White, Ian R; Dacey, Alison; Pasupathy, Dharmintra; Smith, Gordon C S

    2015-11-21

    Fetal growth restriction is a major determinant of adverse perinatal outcome. Screening procedures for fetal growth restriction need to identify small babies and then differentiate between those that are healthy and those that are pathologically small. We sought to determine the diagnostic effectiveness of universal ultrasonic fetal biometry in the third trimester as a screening test for small-for-gestational-age (SGA) infants, and whether the risk of morbidity associated with being small differed in the presence or absence of ultrasonic markers of fetal growth restriction. The Pregnancy Outcome Prediction (POP) study was a prospective cohort study of nulliparous women with a viable singleton pregnancy at the time of the dating ultrasound scan. Women participating had clinically indicated ultrasonography in the third trimester as per routine clinical care and these results were reported as usual (selective ultrasonography). Additionally, all participants had research ultrasonography, including fetal biometry at 28 and 36 weeks' gestational age. These results were not made available to participants or treating clinicians (universal ultrasonography). We regarded SGA as a birthweight of less than the 10th percentile for gestational age and screen positive for SGA an ultrasonographic estimated fetal weight of less than the 10th percentile for gestational age. Markers of fetal growth restriction included biometric ratios, utero-placental Doppler, and fetal growth velocity. We assessed outcomes for consenting participants who attended research scans and had a livebirth at the Rosie Hospital (Cambridge, UK) after the 28 weeks' research scan. Between Jan 14, 2008, and July 31, 2012, 4512 women provided written informed consent of whom 3977 (88%) were eligible for analysis. Sensitivity for detection of SGA infants was 20% (95% CI 15-24; 69 of 352 fetuses) for selective ultrasonography and 57% (51-62; 199 of 352 fetuses) for universal ultrasonography (relative sensitivity 2

  4. Outcomes of peptic ulcer bleeding following treatment with proton pump inhibitors in routine clinical practice: 935 patients with high- or low-risk stigmata.

    Science.gov (United States)

    Lanas, Angel; Carrera-Lasfuentes, Patricia; García-Rodríguez, Luis A; García, Santiago; Arroyo-Villarino, María Teresa; Ponce, Julio; Bujanda, Luis; Calleja, José L; Polo-Tomas, Mónica; Calvet, Xavier; Feu, Faust; Perez-Aisa, Angeles

    2014-10-01

    To assess rates of further bleeding, surgery and mortality in patients hospitalized owing to peptic ulcer bleeding. Consecutive patients hospitalized for peptic ulcer bleeding and treated with a proton pump inhibitor (PPI) (esomeprazole or pantoprazole) were identified retrospectively in 12 centers in Spain. Patients were included if they had high-risk stigmata (Forrest class Ia-IIb, underwent therapeutic endoscopy and received intravenous PPI ≥120 mg/day for ≥24 h) or low-risk stigmata (Forrest class IIc-III, underwent no therapeutic endoscopy and received intravenous or oral PPI [any dose]). Of 935 identified patients, 58.3% had high-risk stigmata and 41.7% had low-risk stigmata. After endoscopy, 88.3% of high-risk patients and 22.1% of low-risk patients received intravenous PPI therapy at doses of at least 160 mg/day. Further bleeding within 72 h occurred in 9.4% and 2.1% of high- and low-risk patients, respectively (p peptic ulcer bleeding and treated with PPIs, patients with high-risk stigmata have a higher risk of further bleeding and surgery, but not of death, than those with low-risk stigmata.

  5. Monotherapy of aspirin or warfarin for prevention of ischemic stroke in low-risk atrial fibrillation: A Easter Asian population-based study.

    Science.gov (United States)

    Liu, Chieh-Yu; Chen, Hui-Chun

    2018-05-02

    This study aimed to investigate the effectiveness of monotherapy aspirin and warfarin for stroke prevention in low-risk atrial fibrillation (AF) by using a population-based cohort study in Taiwan. A newly diagnosed low-risk AF patient cohort were identified by using National Health Insurance Research Database (NHIRD) in Taiwan in 2008. The study cohort was observed with a follow-up of 2 years to examine the onset of ischemic stroke (IS) (to 2010). The longitudinal data were analyzed by using generalized estimation equations (GEE). A total of 8,065 newly-diagnosed low-risk AF patients were identified in 2008. 7.4% were prescribed with aspirin and 4.6% were prescribed with warfarin. The GEE results showed that low-risk AF patients with hypertension who received warfarin were associated with a statistically significant 58.4% reduction of IS risk (OR = 0.416, p = 0.024, 95% CI 0.194-0.891). Additionally, low-risk AF patients with hyperlipidemia who received warfarin were associated with a 69.3% reduction of IS risk (OR = 0.307, p = 0.044, 95% CI 0.097-0.969). Warfarin is suggested to be prescribed in preventing ischemic stroke for low-stroke-risk atrial fibrillation patients with hypertension and hyperlipidemia.

  6. Planned home versus planned hospital births in women at low-risk pregnancy: A systematic review with meta-analysis.

    Science.gov (United States)

    Rossi, A Cristina; Prefumo, Federico

    2018-03-01

    New interest in home birth have recently arisen in women at low risk pregnancy. Maternal and neonatal morbidity of women planning delivery at home has yet to be comprehensively quantified. We aimed to quantify pregnancy outcomes following planned home (PHB) versus planned hospital birth (PHos). We did a systematic review of maternal and neonatal morbidity following planned home (PHB) versus planned hospital birth (PHos). We included prospective, retrospective, cohort and case-control studies of low risk pregnancy outcomes according to planning place of birth, identified from January 2000 to June 2017. We excluded studies in which high-risk pregnancy and composite morbidity were included. Outcomes of interest were: maternal and neonatal morbidity/mortality, medical interventions, and delivery mode. We pooled estimates of the association between outcomes and planning place of birth using meta-analyses. The study protocol is registered with PROSPERO, protocol number CRD42017058016. We included 8 studies of the 4294 records identified, consisting in 14,637 (32.6%) in PHB and 30,177 (67.4%) in PHos group. Spontaneous delivery was significantly higher in PHB than PHos group (OR: 2.075; 95%CI:1.654-2.063) group. Women in PHB group were less likely to undergo cesarean section compared with women in PHos (OR:0.607; 95%CI:0.553-0.667) group. PHB group was less likely to receive medical interventions than PHos group. The risk of fetal dystocia was lower in PHB than PHos group (OR:0.287; 95%CI:0.133-0.618). The risk of post-partum hemorrhage was lower in PHB than PHos group (OR:0.692; 95% CI.0.634-0.755). The two groups were similar with regard to neonatal morbidity and mortality. Births assisted at hospital are more likely to receive medical interventions, fetal monitoring and prompt delivery in case of obstetrical complications. Further studies are needed in order to clarify whether home births are as safe as hospital births. Copyright © 2018 Elsevier B.V. All rights

  7. Costs and effects of screening and treating low risk women with a singleton pregnancy for asymptomatic bacteriuria, the ASB study.

    Science.gov (United States)

    Kazemier, Brenda M; Schneeberger, Caroline; De Miranda, Esteriek; Van Wassenaer, Aleid; Bossuyt, Patrick M; Vogelvang, Tatjana E; Reijnders, Frans J L; Delemarre, Friso M C; Verhoeven, Corine J M; Oudijk, Martijn A; Van Der Ven, Jeanine A; Kuiper, Petra N; Feiertag, Nicolette; Ott, Alewijn; De Groot, Christianne J M; Mol, Ben Willem J; Geerlings, Suzanne E

    2012-06-21

    The prevalence of asymptomatic bacteriuria (ASB) in pregnancy is 2-10% and is associated with both maternal and neonatal adverse outcomes as pyelonephritis and preterm delivery. Antibiotic treatment is reported to decrease these adverse outcomes although the existing evidence is of poor quality. We plan a combined screen and treat study in women with a singleton pregnancy. We will screen women between 16 and 22 weeks of gestation for ASB using the urine dipslide technique. The dipslide is considered positive when colony concentration ≥105 colony forming units (CFU)/mL of a single microorganism or two different colonies but one ≥105 CFU/mL is found, or when Group B Streptococcus bacteriuria is found in any colony concentration. Women with a positive dipslide will be randomly allocated to receive nitrofurantoin or placebo 100 mg twice a day for 5 consecutive days (double blind). Primary outcomes of this trial are maternal pyelonephritis and/or preterm delivery before 34 weeks. Secondary outcomes are neonatal and maternal morbidity, neonatal weight, time to delivery, preterm delivery rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal admission days and costs. This trial will provide evidence for the benefit and cost-effectiveness of dipslide screening for ASB among low risk women at 16-22 weeks of pregnancy and subsequent nitrofurantoin treatment. Dutch trial registry: NTR-3068.

  8. Costs and effects of screening and treating low risk women with a singleton pregnancy for asymptomatic bacteriuria, the ASB study

    Directory of Open Access Journals (Sweden)

    Kazemier Brenda M

    2012-06-01

    Full Text Available Abstract Background The prevalence of asymptomatic bacteriuria (ASB in pregnancy is 2-10% and is associated with both maternal and neonatal adverse outcomes as pyelonephritis and preterm delivery. Antibiotic treatment is reported to decrease these adverse outcomes although the existing evidence is of poor quality. Methods/Design We plan a combined screen and treat study in women with a singleton pregnancy. We will screen women between 16 and 22 weeks of gestation for ASB using the urine dipslide technique. The dipslide is considered positive when colony concentration ≥105 colony forming units (CFU/mL of a single microorganism or two different colonies but one ≥105 CFU/mL is found, or when Group B Streptococcus bacteriuria is found in any colony concentration. Women with a positive dipslide will be randomly allocated to receive nitrofurantoin or placebo 100 mg twice a day for 5 consecutive days (double blind. Primary outcomes of this trial are maternal pyelonephritis and/or preterm delivery before 34 weeks. Secondary outcomes are neonatal and maternal morbidity, neonatal weight, time to delivery, preterm delivery rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal admission days and costs. Discussion This trial will provide evidence for the benefit and cost-effectiveness of dipslide screening for ASB among low risk women at 16–22 weeks of pregnancy and subsequent nitrofurantoin treatment. Trial registration Dutch trial registry: NTR-3068

  9. The effects of a "low-risk" diet on cell proliferation and enzymatic parameters of preneoplastic rat colon.

    Science.gov (United States)

    Goettler, D; Rao, A V; Bird, R P

    1987-01-01

    The relationship between various dietary constituents and colon cancer has been demonstrated by previous research. This study was conducted to investigate the combined effects of several dietary constituents on the preneoplastic stage of azoxymethane (AOM)-induced colon cancer in rats. A nutritionally adequate, "low-risk" (LR) diet was formulated through the modulation of dietary fat, fiber, protein, vitamins A and E, and selenium. Female F344 rats were given three weekly subcutaneous injections of AOM and were maintained on either the LR diet or a "high-risk" (HR) diet. After 12 weeks, the rats were killed and the following parameters were determined: pH of colon contents, fecal beta-glucuronidase activity, tissue ornithine decarboxylase (ODC) activity, and colonic labeling index. The pH of the colon contents and incremental labeling index were lower in the group given the LR diet and treated with AOM compared with the group given the HR diet and treated with AOM; however, no statistically significant dietary effects were observed for beta-glucuronidase and ODC activities. The results of this study indicated that the colons of rats fed the LR diet exhibited different proliferative characteristics than did the colons of rats fed the HR diet.

  10. Mycophenolate mofetil in low-risk renal transplantation in patients receiving no cyclosporine: a single-centre experience.

    LENUS (Irish Health Repository)

    Raheem, Omer A

    2011-05-28

    BACKGROUND: We assess our long-term experience with regards the safety and efficacy of Mycophenolate Mofetil (MMF) in our low risk renal transplant population and compared it retrospectively to Azathioprine (AZA) immunosuppressive regimen. Patients and methods. Between January 1999 and December 2005, 240 renal transplants received MMF as part of their immunosuppressive protocol (MMF group). AZA group of 135 renal transplants was included for comparative analysis (AZA group). Patients received Cyclosporine was excluded from this study. RESULTS: The incidence of biopsy proven 3-month acute rejections was 30 (12.5%) in MMF group and 22 (16%) in AZA group respectively (P = 0.307). Patient survival rates at 1 and 5 years for the MMF group were 97 and 94%, respectively, compared to 100% and 91% at 1 and 5 years respectively for the AZA group (P = 0.61). Graft survival rates at 1 and 5 years for the MMF group were 95 and 83%, respectively, compared to 97 and 84% at 1 and 5 years, respectively for the AZA group (P = 0.62). CONCLUSION: There was no difference in acute rejection episodes between MMF and AZA based immunotherapy. Additionally, we observed no significant difference concerning graft survival in the MMF group when compared to AZA group.

  11. Mycophenolate mofetil in low-risk renal transplantation in patients receiving no cyclosporine: a single-centre experience.

    LENUS (Irish Health Repository)

    2012-02-01

    BACKGROUND: We assess our long-term experience with regards the safety and efficacy of Mycophenolate Mofetil (MMF) in our low risk renal transplant population and compared it retrospectively to Azathioprine (AZA) immunosuppressive regimen. Patients and methods. Between January 1999 and December 2005, 240 renal transplants received MMF as part of their immunosuppressive protocol (MMF group). AZA group of 135 renal transplants was included for comparative analysis (AZA group). Patients received Cyclosporine was excluded from this study. RESULTS: The incidence of biopsy proven 3-month acute rejections was 30 (12.5%) in MMF group and 22 (16%) in AZA group respectively (P = 0.307). Patient survival rates at 1 and 5 years for the MMF group were 97 and 94%, respectively, compared to 100% and 91% at 1 and 5 years respectively for the AZA group (P = 0.61). Graft survival rates at 1 and 5 years for the MMF group were 95 and 83%, respectively, compared to 97 and 84% at 1 and 5 years, respectively for the AZA group (P = 0.62). CONCLUSION: There was no difference in acute rejection episodes between MMF and AZA based immunotherapy. Additionally, we observed no significant difference concerning graft survival in the MMF group when compared to AZA group.

  12. Psychological Distress in Healthy Low-Risk First-Time Mothers during the Postpartum Period: An Exploratory Study

    Directory of Open Access Journals (Sweden)

    Christina Murphey

    2017-01-01

    Full Text Available Psychological distress, defined as depression, anxiety, and insomnia in this study, can occur following the birth of a baby as new mothers, in addition to marked physiological changes, are faced with adapting to new roles and responsibilities. We investigated the cooccurrence of stress, depression, anxiety, and insomnia in mothers during the postpartum period; tested the feasibility of study methods and procedures for use in this population; and identified new mothers interest in using cranial electrotherapy stimulation (CES as an intervention for reducing psychological distress. We recruited healthy, low-risk, English speaking first-time mothers, ages 18–32 years, with healthy babies (N=33, within 12 months of an uncomplicated birth. Participants completed the PSS, HAM-D14, HAM-A17, and PSQI19. No problems were encountered with study procedures. Mothers reported a high interest (4.9 in the potential use of CES to treat or prevent the occurrence of psychological distress. All participants (N=33 reported moderate levels of depression and anxiety, while 75.8% (n=25 reported insomnia. PSS scores were within the norms for healthy women. Further research is recommended to investigate if our findings can be replicated or if different patterns of associations emerge. Implications for clinical practice are addressed.

  13. Trichomonas vaginalis infection in a low-risk women attended in Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre

    Institute of Scientific and Technical Information of China (English)

    Norhayati Moktar; Nor Liyana Ismail; Phoy Cheng Chun; Mohamad Asyrab Sapie; Nor Farahin Abdul Kahar; Yusof Suboh; Noraina Abdul Rahim; Nor Azlin Mohamed Ismail; Tengku Shahrul Anuar

    2016-01-01

    Objective: To investigate the presence of trichomoniasis among women attending the Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre.Methods: A total of 139 high vaginal swabs were taken from the subjects and sent to the laboratory in Amies gel transport media. The specimens were examined for the presence of Trichomonas vaginalis using wet mount, Giemsa staining and cultured in Diamond’s medium. Sociodemographic characteristics and gynaecological complaints were obtained in private using structured questionnaire applied by one investigator.Results: The median age was 32 years, with an interquartile interval of 9.96. Most of the subjects were Malays(76.9%) and the remaining were Chinese(15.1%), Indians(2.2%)and other ethnic groups(5.8%). One hundred and thirty eight(99.3%) of the women were married and 98.6% had less than 6 children. More than half(75.5%) of the women’s last child birth was less than 6 years ago. Forty seven percent of them were involved in supporting administrative work and 64.7% of the women gave a history of previous or current vaginal discharge.Conclusions: The present study reported zero incidence rate of trichomoniasis. The low incidence rate was postulated due to all women who participated in this study were categorized into a low-risk group.

  14. Trichomonas vaginalis infection in a low-risk women attended in Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre

    Institute of Scientific and Technical Information of China (English)

    Norhayati Moktar; Nor Liyana Ismail; Phoy Cheng Chun; Mohamad Asyrab Sapie; Nor Farahin Abdul Kahar; Yusof Suboh; Noraina Abdul Rahim; Nor Azlin Mohamed Ismail; Tengku Shahrul Anuar

    2016-01-01

    Objective: To investigate the presence of trichomoniasis among women attending the Obstetrics and Gynaecology Clinic, Universiti Kebangsaan Malaysia Medical Centre. Methods: A total of 139 high vaginal swabs were taken from the subjects and sent to the laboratory in Amies gel transport media. The specimens were examined for the presence of Trichomonas vaginalis using wet mount, Giemsa staining and cultured in Diamond's medium. Sociodemographic characteristics and gynaecological complaints were obtained in private using structured questionnaire applied by one investigator. Results: The median age was 32 years, with an interquartile interval of 9.96. Most of the subjects were Malays (76.9%) and the remaining were Chinese (15.1%), Indians (2.2%) and other ethnic groups (5.8%). One hundred and thirty eight (99.3%) of the women were married and 98.6%had less than 6 children. More than half (75.5%) of the women's last child birth was less than 6 years ago. Forty seven percent of them were involved in supporting administrative work and 64.7% of the women gave a history of previous or current vaginal discharge. Conclusions: The present study reported zero incidence rate of trichomoniasis. The low incidence rate was postulated due to all women who participated in this study were categorized into a low-risk group.

  15. Accuracy of simple urine tests for diagnosis of urinary tract infections in low-risk pregnant women.

    Science.gov (United States)

    Feitosa, Danielle Cristina Alves; da Silva, Márcia Guimarães; de Lima Parada, Cristina Maria Garcia

    2009-01-01

    Anatomic and physiological alterations during pregnancy predispose pregnant women to urinary tract infections (UTI). This study aimed to identify the accuracy of the simple urine test for UTI diagnosis in low-risk pregnant women. Diagnostic test performance was conducted in Botucatu, SP, involving 230 pregnant women, between 2006 and 2008. Results showed 10% UTI prevalence. Sensitivity, specificity and accuracy of the simple urine test were 95.6%, 63.3% and 66.5%, respectively, in relation to UTI diagnoses. The analysis of positive (PPV) and negative (NPV) predictive values showed that, when a regular simple urine test was performed, the chance of UTI occurrence was small (NPV 99.2%). In view of an altered result for such a test, the possibility of UTI existence was small (PPV 22.4%). It was concluded that the accuracy of the simple urine test as a diagnostic means for UTI was low, and that performing a urine culture is essential for appropriate diagnosis.

  16. Morbidity in early adulthood among low-risk very low birth weight children in Turkey: a preliminary study.

    Science.gov (United States)

    Can, Gülay; Bilgin, Leyla; Tatli, Burak; Saydam, Reyhan; Coban, Asuman; Ince, Zeynep

    2012-01-01

    The objective of this study was to assess low-risk very low birth weight (VLBW) children, before the era of modern neonatal intensive care in Turkey, during adolescence. Forty-one VLBW adolescents were compared with 40 adolescents who had normal birth weight. The physical and neuromotor development, educational achievement and psychosocial status were assessed at a mean age of 17 +/- 1.6 years. VLBW adolescents were shorter than normal birth weight adolescents (p = 0.01). A major neurological abnormality (cerebral palsy) was seen in 12% and a minor neurological abnormality (tremor, coordination, behavioral and speech disorders) in 17%. VLBW adolescents had higher rates of visual problems (56% vs. 5%). School failure was present in 27%. There were no differences in behavioral problems or quality of life between the two groups, but VLBW adolescents did have a lower self-esteem score. Neurodevelopment and growth sequelae were a significant problem in VLBW adolescents. As early intervention might help to prevent or ameliorate potential problems, long-term follow-up is essential.

  17. Poster - 47: A parametrized prediction model of rectal toxicity in focal SBRT of low risk prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Stevens, Todd; Bauman, Glenn [Saint John Regional Hospital, London Regional Cancer Program (Canada)

    2016-08-15

    There has been a recent trend towards watchful waiting in place of intervention for early stage prostate cancer (CaP). However, this approach can allow for disease progression, and subsequent whole-gland therapies such as prostatectomy and whole gland irradiation can result in functional deficits or rectal toxicities or both. A controversial alternative approach for this patient cohort is the use of focal therapy, where the treatment is focussed on an identified dominant index lesion (DIL). This work aims to investigate the treatment parameters for focal SBRT of the prostate under which clinically acceptable rectal NTCP levels can be achieved. For each of 25 low risk CaP patients, a hypothetical 2 cc DIL was modeled in the right-posterior quadrant of the prostate, and was used to build a PTV as the target for SBRT simulation. An SBRT prescriptions of 41 Gy and 37 Gy in 5 fractions were chosen, corresponding to the boost levels used in previous CaP dose escalation studies. DVH data were exported and used to calculate rectal NTCP values based on the Lyman-Kutcher-Burman (LKB) model using the QUANTEC reccommended model parameters. Rectal NTCP dependence on DIL-to-rectum separation, dose level, and DIL volume were investigated. The final goal of this ongoing work is to create a map of the maximum allowable prescription dose for a given patient geometry that achieves a clinically acceptable rectal NTCP level.

  18. Characterization of the transport signals that mediate the nucleocytoplasmic traffic of low risk HPV11 E7

    Energy Technology Data Exchange (ETDEWEB)

    McKee, Courtney H.; Onder, Zeynep; Ashok, Aditya; Cardoso, Rebeca; Moroianu, Junona, E-mail: moroianu@bc.edu

    2013-08-15

    We previously discovered that nuclear import of low risk HPV11 E7 is mediated by its zinc-binding domain via a pathway that is independent of karyopherins/importins (Piccioli et al., 2010. Virology 407, 100–109). In this study we mapped and characterized a leucine-rich nuclear export signal (NES), {sub 76}IRQLQDLLL{sub 84}, within the zinc-binding domain that mediates the nuclear export of HPV11 E7 in a CRM1-dependent manner. We also identified a mostly hydrophobic patch {sub 65}VRLVV{sub 69} within the zinc-binding domain that mediates nuclear import of HPV11 E7 via hydrophobic interactions with the FG-repeats domain of Nup62. Substitutions of hydrophobic residues to alanine within the {sub 65}VRLVV{sub 69} sequence disrupt the nuclear localization of 11E7, whereas the R66A mutation has no effect. Overall the data support a model of nuclear entry of HPV11 E7 protein via hydrophobic interactions with FG nucleoporins at the nuclear pore complex. - Highlights: • HPV11 E7 has a leucine-rich nuclear export signal that mediates its nuclear export via CRM1. • HPV11 E7 interacts via its unique cNLS with the FG domain of Nup62. • Identification of a hydrophobic patch essential for nuclear localization of HPV11 E7.

  19. Characterization of the transport signals that mediate the nucleocytoplasmic traffic of low risk HPV11 E7

    International Nuclear Information System (INIS)

    McKee, Courtney H.; Onder, Zeynep; Ashok, Aditya; Cardoso, Rebeca; Moroianu, Junona

    2013-01-01

    We previously discovered that nuclear import of low risk HPV11 E7 is mediated by its zinc-binding domain via a pathway that is independent of karyopherins/importins (Piccioli et al., 2010. Virology 407, 100–109). In this study we mapped and characterized a leucine-rich nuclear export signal (NES), 76 IRQLQDLLL 84 , within the zinc-binding domain that mediates the nuclear export of HPV11 E7 in a CRM1-dependent manner. We also identified a mostly hydrophobic patch 65 VRLVV 69 within the zinc-binding domain that mediates nuclear import of HPV11 E7 via hydrophobic interactions with the FG-repeats domain of Nup62. Substitutions of hydrophobic residues to alanine within the 65 VRLVV 69 sequence disrupt the nuclear localization of 11E7, whereas the R66A mutation has no effect. Overall the data support a model of nuclear entry of HPV11 E7 protein via hydrophobic interactions with FG nucleoporins at the nuclear pore complex. - Highlights: • HPV11 E7 has a leucine-rich nuclear export signal that mediates its nuclear export via CRM1. • HPV11 E7 interacts via its unique cNLS with the FG domain of Nup62. • Identification of a hydrophobic patch essential for nuclear localization of HPV11 E7

  20. Incidence of low risk human papillomavirus in oral cancer: a real time PCR study on 278 patients.

    Science.gov (United States)

    Palmieri, A; Scapoli, L; Martinelli, M; Pezzetti, F; Girardi, A; Spinelli, G; Lucchese, A; Carinci, F

    2011-01-01

    Squamous cell carcinoma is the most frequent malignant tumour of the oral cavity. It is widely known that tobacco and alcohol consumption are the major causes of the development of oral squamous cell carcinoma (OSCC). The human papilloma virus infection has also been postulated as a risk factor for squamous cell carcinoma, although conflicting results have been reported. The aim of this study is to evaluate the presence of high-risk and low-risk type human papillomavirus in a large sample of squamous cell carcinoma limited to the oral cavity by means of quantitative real-time polymerase chain reaction. Data were obtained from 278 squamous cell carcinoma limited to oral cavity proper. Sequencing revealed that 5 samples were positive for HPV type 16, 5 for HPV type 11, and 1 for HPV type 6. Human papillomavirus 11 was detected in 5 tumours out of the 278 examined. The prevalence rate for Human papillomavirus 11 was 1.8% (C.I. 0.7-3.9). The matched case-controls analysis indicated that the prevalence among controls did not significantly differ with respect to cases and that Human papillomavirus 11 alone did not correlate with squamous cell carcinoma.

  1. Impaired Expression of Focal Adhesion Kinase in Mesenchymal Stromal Cells from Low-Risk Myelodysplastic Syndrome Patients

    Directory of Open Access Journals (Sweden)

    Yuenv Wu

    2017-08-01

    Full Text Available The pathogenic role of mesenchymal stromal cells (MSCs in myelodysplastic syndromes (MDS development and progression has been investigated by numerous studies, yet, it remains controversial in some aspects (1, 2. In the present study, we found distinct features of MSCs from low-risk (LR-MDS stromal microenvironment as compared to those from healthy subjects. At the molecular level, focal adhesion kinase, a key tyrosine kinase in control of cell proliferation, survival, and adhesion process, was found profoundly suppressed in expression and activation in LR-MDS MSC. At a functional level, LR-MDS MSCs showed impaired growth and clonogenic capacity, which were independent of cellular senescence and apoptosis. The pro-adipogenic differentiation and attenuated osteogenic capacity along with reduced SDF-1 expression could be involved in creating an unfavorable microenvironment for hematopoiesis. In conclusion, our experiments support the theory that the stromal microenvironment is fundamentally altered in LR-MDS, and these preliminary data offer a new perspective on LR-MDS pathophysiology.

  2. Management of Adolescent Low-Risk Classical Hodgkin Lymphoma: Which Chemotherapy Backbone Gives the Best Chance of Omitting Radiotherapy Safely.

    Science.gov (United States)

    Algiraigri, Ali H; Essa, Mohammed F

    2016-03-01

    Even though more than 90% of adolescents with low-risk classical Hodgkin lymphoma (LRcHL) will be cured with first-line therapy, many will suffer serious late toxic effects from radiotherapy (RT). The goals for care have shifted toward minimizing late toxic effects without compromising the outstanding cure rates by adapting a risk and response-based therapy. Recent published and ongoing randomized clinical trials, using functional imaging, may allow for better identification of those patients for whom RT may be safely omitted while maintaining excellent cure rates. To evaluate the best chemotherapy regimens with a reasonable toxicity profile and that are expected to have a high chance of omitting RT based on a response-directed therapy while maintaining high cure rates, a mini review was conducted of the recent clinical trials in pediatric and adult LRcHL. The UK RAPID trial chemotherapy backbone (3 × ABVD) followed by a response-based positron emission tomography scan offers up to a 75% chance of safely omitting RT without compromising the cure rate, which remained well above 90%.

  3. Long-Term Outcomes From a Prospective Trial of Stereotactic Body Radiotherapy for Low-Risk Prostate Cancer

    International Nuclear Information System (INIS)

    King, Christopher R.; Brooks, James D.; Gill, Harcharan; Presti, Joseph C.

    2012-01-01

    Purpose: Hypofractionated radiotherapy has an intrinsically different normal tissue and tumor radiobiology. The results of a prospective trial of stereotactic body radiotherapy (SBRT) for prostate cancer with long-term patient-reported toxicity and tumor control rates are presented. Methods and Materials: From 2003 through 2009, 67 patients with clinically localized low-risk prostate cancer were enrolled. Treatment consisted of 36.25 Gy in 5 fractions using SBRT with the CyberKnife as the delivery technology. No patient received hormone therapy. Patient self-reported bladder and rectal toxicities were graded on the Radiation Therapy Oncology Group scale (RTOG). Results: Median follow-up was 2.7 years. There were no grade 4 toxicities. Radiation Therapy Oncology Group Grade 3, 2, and 1 bladder toxicities were seen in 3% (2 patients), 5% (3 patients), and 23% (13 patients) respectively. Dysuria exacerbated by urologic instrumentation accounted for both patients with Grade 3 toxicity. Urinary incontinence, complete obstruction, or persistent hematuria was not observed. Rectal Grade 3, 2, and 1 toxicities were seen in 0, 2% (1 patient), and 12.5% (7 patients), respectively. Persistent rectal bleeding was not observed. Low-grade toxicities were substantially less frequent with QOD vs. QD dose regimen (p = 0.001 for gastrointestinal and p = 0.007 for genitourinary). There were two prostate-specific antigen (PSA), biopsy-proven failures with negative metastatic workup. Median PSA at follow-up was 0.5 ± 0.72 ng/mL. The 4-year Kaplan-Meier PSA relapse-free survival was 94% (95% confidence interval, 85%–102%). Conclusion: Significant late bladder and rectal toxicities from SBRT for prostate cancer are infrequent. PSA relapse-free survival compares favorably with other definitive treatments. The current evidence supports consideration of stereotactic body radiotherapy among the therapeutic options for localized prostate cancer.

  4. Long-Term Outcomes From a Prospective Trial of Stereotactic Body Radiotherapy for Low-Risk Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    King, Christopher R., E-mail: crking@mednet.ucla.edu [Departments of Radiation Oncology and Urology, University of California Los Angeles School of Medicine, Los Angeles, CA (United States); Brooks, James D.; Gill, Harcharan; Presti, Joseph C. [Department of Urology, Stanford University School of Medicine, Stanford, CA (United States)

    2012-02-01

    Purpose: Hypofractionated radiotherapy has an intrinsically different normal tissue and tumor radiobiology. The results of a prospective trial of stereotactic body radiotherapy (SBRT) for prostate cancer with long-term patient-reported toxicity and tumor control rates are presented. Methods and Materials: From 2003 through 2009, 67 patients with clinically localized low-risk prostate cancer were enrolled. Treatment consisted of 36.25 Gy in 5 fractions using SBRT with the CyberKnife as the delivery technology. No patient received hormone therapy. Patient self-reported bladder and rectal toxicities were graded on the Radiation Therapy Oncology Group scale (RTOG). Results: Median follow-up was 2.7 years. There were no grade 4 toxicities. Radiation Therapy Oncology Group Grade 3, 2, and 1 bladder toxicities were seen in 3% (2 patients), 5% (3 patients), and 23% (13 patients) respectively. Dysuria exacerbated by urologic instrumentation accounted for both patients with Grade 3 toxicity. Urinary incontinence, complete obstruction, or persistent hematuria was not observed. Rectal Grade 3, 2, and 1 toxicities were seen in 0, 2% (1 patient), and 12.5% (7 patients), respectively. Persistent rectal bleeding was not observed. Low-grade toxicities were substantially less frequent with QOD vs. QD dose regimen (p = 0.001 for gastrointestinal and p = 0.007 for genitourinary). There were two prostate-specific antigen (PSA), biopsy-proven failures with negative metastatic workup. Median PSA at follow-up was 0.5 {+-} 0.72 ng/mL. The 4-year Kaplan-Meier PSA relapse-free survival was 94% (95% confidence interval, 85%-102%). Conclusion: Significant late bladder and rectal toxicities from SBRT for prostate cancer are infrequent. PSA relapse-free survival compares favorably with other definitive treatments. The current evidence supports consideration of stereotactic body radiotherapy among the therapeutic options for localized prostate cancer.

  5. Maternal Medical Complexity: Impact on Prenatal Health Care Spending among Women at Low Risk for Cesarean Section.

    Science.gov (United States)

    Cunningham, Shayna D; Herrera, Carolina; Udo, Ifeyinwa E; Kozhimannil, Katy B; Barrette, Eric; Magriples, Urania; Ickovics, Jeannette R

    Obstetric procedures are among the most expensive health care services, yet relatively little is known about health care spending among pregnant women, particularly the commercially-insured. The objective of this study was to examine the association between maternal medical complexity, as a result of having one or more comorbid conditions, and health care spending during the prenatal period among a national sample of 95,663 commercially-insured women at low risk for cesarean delivery. We conducted secondary analyses of 2010-2011 inpatient, outpatient, and professional claims for health care services from the Health Care Cost Institute. Allowed charges were summed for the prenatal and childbirth periods. Ordinary least squares regressions tested associations between maternal health conditions and health care expenditures during pregnancy. Thirty-four percent of pregnant women had one or more comorbidities; 8% had two or more. Pregnant women with one or more comorbidities had significantly higher allowed charges than those without comorbidities (p prenatal period was nearly three times higher for women with preexisting diabetes compared with women with no comorbid conditions. Average levels of prenatal period spending associated with maternal comorbidities were similar for women who had vaginal and cesarean deliveries. Patient characteristics accounted for 30% of the variance in prenatal period expenditures. The impact of maternal comorbidities, and in particular preexisting diabetes, on prenatal care expenditures should be taken into account as provider payment reforms, such as pay-for performance incentives and bundled payments for episodes of care, extend to maternal and child health-related services. Copyright © 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  6. Energy density at a buffet-style lunch differs for adolescents born at high and low risk of obesity.

    Science.gov (United States)

    Kral, Tanja V E; Stunkard, Albert J; Berkowitz, Robert I; Stettler, Nicolas; Stallings, Virginia A; Kabay, April; Faith, Myles S

    2009-12-01

    The energy density (ED; kcal/g) of foods, when manipulated in the laboratory, affects short-term energy intake. The aim of this study was to examine if, when given a choice, dietary ED (foods only) and energy intake (expressed as a percentage of subjects' estimated daily energy requirement; EER) at a self-selected, single meal differ for teens born with a different familial predisposition to obesity and as a function of their sex. Subjects (13 males, 17 females) were 12years of age and born at high risk (HR; n=15) or low risk (LR; n=15) for obesity based on maternal pre-pregnancy body mass index (BMI; kg/m(2)). The buffet meal, served for lunch and consumed ad libitum, consisted of a variety of foods and beverages with a range in ED. HR subjects consumed a more energy-dense meal (foods only) than LR subjects (1.84 vs. 1.42kcal/g; P=0.02) and males consumed a more energy-dense meal than females (1.83 vs. 1.43kcal/g; P=0.03). Total energy intake, when expressed as a percentage of subjects' daily EER, did not differ between HR and LR subjects (42% vs. 33%; P=0.16). Males, compared to females, consumed ~59% more energy from foods and beverages during the meal (46 vs. 29%; P=0.008). During a single multi-item lunch meal, teens with a familial predisposition to obesity and males, independent of their obesity risk status, self-selected a more energy-dense meal. Familial risk for obesity, through either genetic or environmental pathways, may facilitate a more energy-dense diet.

  7. The effect of ABO blood incompatibility on corneal transplant failure in conditions with low-risk of graft rejection.

    Science.gov (United States)

    Dunn, Steven P; Stark, Walter J; Stulting, R Doyle; Lass, Jonathan H; Sugar, Alan; Pavilack, Mark A; Smith, Patricia W; Tanner, Jean Paul; Dontchev, Mariya; Gal, Robin L; Beck, Roy W; Kollman, Craig; Mannis, Mark J; Holland, Edward J

    2009-03-01

    To determine whether corneal graft survival over a 5-year follow-up period was affected by ABO blood type compatibility in participants in the Cornea Donor Study undergoing corneal transplantation principally for Fuchs dystrophy or pseudophakic corneal edema, conditions at low-risk for graft rejection. Multi-center prospective, double-masked, clinical trial. ABO blood group compatibility was determined for 1,002 donors and recipients. During a 5-year follow-up period, episodes of graft rejection were documented, and graft failures were classified as to whether or not they were attributable to immunologic rejection. Endothelial cell density was determined by a central reading center for a subset of subjects. ABO donor-recipient incompatibility was not associated with graft failure attributable to any cause including graft failure because of rejection, or with the occurrence of a rejection episode. The 5-year cumulative incidence of graft failure attributable to rejection was 32 (6%) for recipients with ABO recipient-donor compatibility and 12 (4%) for those with ABO incompatibility (hazard ratio, 0.65; 95% confidence interval, 0.33 to 1.25; P = .20). The 5-year incidence for a definite rejection episode, irrespective of whether graft failure ultimately occurred, was 64 (12%) for ABO compatible compared with 25 (8%) for ABO incompatible cases (P = .09). Among clear grafts at 5 years, percent loss of endothelial cells was similar in ABO compatible and incompatible cases. In patients undergoing penetrating keratoplasty for Fuchs dystrophy or pseudophakic corneal edema, ABO matching is not indicated since ABO incompatibility does not increase the risk of transplant failure attributable to graft rejection.

  8. A Comparison of Postpartum Depression among Low-risk-pregnant Women with Emotion- and Problem-focused Coping Strategies

    Directory of Open Access Journals (Sweden)

    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.

  9. Planned home compared with planned hospital births in the Netherlands: intrapartum and early neonatal death in low-risk pregnancies.

    Science.gov (United States)

    van der Kooy, Jacoba; Poeran, Jashvant; de Graaf, Johanna P; Birnie, Erwin; Denktasş, Semiha; Steegers, Eric A P; Bonsel, Gouke J

    2011-11-01

    The purpose of our study was to compare the intrapartum and early neonatal mortality rate of planned home birth with planned hospital birth in community midwife-led deliveries after case mix adjustment. The perinatal outcome of 679,952 low-risk women was obtained from the Netherlands Perinatal Registry (2000-2007). This group represents all women who had a choice between home and hospital birth. Two different analyses were performed: natural prospective approach (intention-to-treat-like analysis) and perfect guideline approach (per-protocol-like analysis). Unadjusted and adjusted odds ratios (ORs) were calculated. Case mix was based on the presence of at least one of the following: congenital abnormalities, small for gestational age, preterm birth, or low Apgar score. We also investigated the potential risk role of intended place of birth. Multivariate stepwise logistic regression was used to investigate the potential risk role of intended place of birth. Intrapartum and neonatal death at 0-7 days was observed in 0.15% of planned home compared with 0.18% in planned hospital births (crude relative risk 0.80, 95% confidence interval [CI] 0.71-0.91). After case mix adjustment, the relation is reversed, showing nonsignificant increased mortality risk of home birth (OR 1.05, 95% CI 0.91-1.21). In certain subgroups, additional mortality may arise at home if risk conditions emerge at birth (up to 20% increase). Home birth, under routine conditions, is generally not associated with increased intrapartum and early neonatal death, yet in subgroups, additional risk cannot be excluded.

  10. Role of prostate specific antigen and immediate confirmatory biopsy in predicting progression during active surveillance for low risk prostate cancer.

    Science.gov (United States)

    Adamy, Ari; Yee, David S; Matsushita, Kazuhito; Maschino, Alexandra; Cronin, Angel; Vickers, Andrew; Guillonneau, Bertrand; Scardino, Peter T; Eastham, James A

    2011-02-01

    We evaluated predictors of progression after starting active surveillance, especially the role of prostate specific antigen and immediate confirmatory prostate biopsy. A total of 238 men with prostate cancer met active surveillance eligibility criteria and were analyzed for progression with time. Cox proportional hazards regression was used to evaluate predictors of progression. Progression was evaluated using 2 definitions, including no longer meeting 1) full and 2) modified criteria, excluding prostate specific antigen greater than 10 ng/ml as a criterion. Using full criteria 61 patients progressed during followup. The 2 and 5-year progression-free probability was 80% and 60%, respectively. With prostate specific antigen included in progression criteria prostate specific antigen at confirmatory biopsy (HR 1.29, 95% CI 1.14-1.46, p <0.0005) and positive confirmatory biopsy (HR 1.75, 95% CI 1.01-3.04, p = 0.047) were independent predictors of progression. Of the 61 cases 34 failed due to increased prostate specific antigen, including only 5 with subsequent progression by biopsy criteria. When prostate specific antigen was excluded from progression criteria, only 32 cases progressed, and 2 and 5-year progression-free probability was 91% and 76%, respectively. Using modified criteria as an end point positive confirmatory biopsy was the only independent predictor of progression (HR 3.16, 95% CI 1.41-7.09, p = 0.005). Active surveillance is feasible in patients with low risk prostate cancer and most patients show little evidence of progression within 5 years. There is no clear justification for treating patients in whom prostate specific antigen increases above 10 ng/ml in the absence of other indications of tumor progression. Patients considering active surveillance should undergo confirmatory biopsy to better assess the risk of progression. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  11. Can Single Positive Core Prostate Cancer at biopsy be Considered a Low-Risk Disease after Radical Prostatectomy?

    Directory of Open Access Journals (Sweden)

    Ricardo Kupka da Silva

    2013-12-01

    Full Text Available Purpose Single positive core in a prostate biopsy is usually associated with indolent prostate cancer (PCa and is one of the active surveillance (AS inclusion criteria. We investigated whether single positive core PCa at biopsy could define an archetype of low-risk disease. Materials and Methods A total of 1320 consecutive patients were enrolled. Among them, 249 patients with single positive core PCa were followed up, and the clinical and pathological parameters influencing prognosis were analyzed. Results Out of the 249 patients, 172 (69.0% had pathological findings ≥ pT2c and 87 (34.9% had an undergraded Gleason Score (GS based on the biopsy. Positive surgical margins (PSMs, extraprostatic extension (EPE and seminal vesicle invasion (SVI were found in 20.8%, 10.0% and 6.0% of patients, respectively. In a comparative analysis, we found that the PSA level, prostate weight and number of cores at biopsy are essential to correctly predict an indolent PCa. A total of 125 patients (67.3% with nonpalpable tumors became high-risk tumors (pT2c-T3. Analyzing only nonpalpable tumors with a GS of 6 at biopsy (156 patients, we noted that 106 (67.9% of cT1 progressed from cT1c to pT2c-pT3. Conclusions Single core PCa have clinically significant disease in the Radical Prostatectomy specimens, with considerable rates of overgrading for the GS, pT2c-pT3, PSMs, EPE and SVI. The treatment plan must be evaluated individually for patients with single core PCa and must take into account other prognostic factors when determining whether a patient should be managed with AS.

  12. Alcohol consumption and low-risk drinking guidelines among adults: a cross-sectional analysis from Alberta's Tomorrow Project.

    Science.gov (United States)

    Brenner, Darren R; Haig, Tiffany R; Poirier, Abbey E; Akawung, Alianu; Friedenreich, Christine M; Robson, Paula J

    2017-12-01

    Moderate to heavy alcohol consumption is a risk factor for all-cause mortality and cancer incidence. Although cross-sectional data are available through national surveys, data on alcohol consumption in Alberta from a large prospective cohort were not previously available. The goal of these analyses was to characterize the levels of alcohol consumption among adults from the Alberta's Tomorrow Project in the context of cancer prevention guidelines. Furthermore, we conducted analyses to examine the relationships between alcohol consumption and other high-risk or risk-related behaviours. Between 2001 and 2009, 31 072 men and women aged 35 to 69 years were enrolled into Alberta's Tomorrow Project, a large provincial cohort study. Data concerning alcohol consumption in the past 12 months were obtained from 26 842 participants who completed self-administered health and lifestyle questionnaires. We conducted cross-sectional analyses on daily alcohol consumption and cancer prevention guidelines for alcohol use in relation to sociodemographic factors. We also examined the combined prevalence of alcohol consumption and tobacco use, obesity and comorbidities. Approximately 14% of men and 12% of women reported alcohol consumption exceeding recommendations for cancer prevention. Higher alcohol consumption was reported in younger age groups, urban dwellers, those with higher incomes and those who consumed more red meat. Moreover, volume of daily alcohol consumption was positively associated with current tobacco use in both men and women. Overall, men were more likely to fall in the moderate and high-risk behavioural profiles and show higher daily alcohol consumption patterns compared to women. Despite public health messages concerning the adverse impact of alcohol consumption, a sizeable proportion of Alberta's Tomorrow Project participants consumed alcohol in excess of cancer prevention recommendations. Continued strategies to promote low-risk drinking among those who choose to

  13. Preferences for a third-trimester ultrasound scan in a low-risk obstetric population: a discrete choice experiment.

    Science.gov (United States)

    Lynn, Fiona A; Crealey, Grainne E; Alderdice, Fiona A; McElnay, James C

    2015-10-01

    Establish maternal preferences for a third-trimester ultrasound scan in a healthy, low-risk pregnant population. Cross-sectional study incorporating a discrete choice experiment. A large, urban maternity hospital in Northern Ireland. One hundred and forty-six women in their second trimester of pregnancy. A discrete choice experiment was designed to elicit preferences for four attributes of a third-trimester ultrasound scan: health-care professional conducting the scan, detection rate for abnormal foetal growth, provision of non-medical information, cost. Additional data collected included age, marital status, socio-economic status, obstetric history, pregnancy-specific stress levels, perceived health and whether pregnancy was planned. Analysis was undertaken using a mixed logit model with interaction effects. Women's preferences for, and trade-offs between, the attributes of a hypothetical scan and indirect willingness-to-pay estimates. Women had significant positive preference for higher rate of detection, lower cost and provision of non-medical information, with no significant value placed on scan operator. Interaction effects revealed subgroups that valued the scan most: women experiencing their first pregnancy, women reporting higher levels of stress, an adverse obstetric history and older women. Women were able to trade on aspects of care and place relative importance on clinical, non-clinical outcomes and processes of service delivery, thus highlighting the potential of using health utilities in the development of services from a clinical, economic and social perspective. Specifically, maternal preferences exhibited provide valuable information for designing a randomized trial of effectiveness and insight for clinical and policy decision makers to inform woman-centred care. © 2013 Blackwell Publishing Ltd.

  14. Maternal hormone levels and risk of cryptorchism among populations at high and low risk of testicular germ cell tumors.

    Science.gov (United States)

    McGlynn, Katherine A; Graubard, Barry I; Nam, Jun-Mo; Stanczyk, Frank Z; Longnecker, Matthew P; Klebanoff, Mark A

    2005-07-01

    Cryptorchism is one of the few well-described risk factors for testicular cancer. It has been suggested that both conditions are related to increased in utero estrogen exposure. The evidence supporting the "estrogen hypothesis" has been inconsistent, however. An alternative hypothesis suggests that higher in utero androgen exposure may protect against the development of cryptorchism and testicular cancer. In order to examine both hypotheses, we studied maternal hormone levels in two populations at diverse risks of testicular cancer; Black Americans (low-risk) and White Americans (high-risk). The study population of 200 mothers of cryptorchid sons and 200 mothers of noncryptorchid sons was nested within the Collaborative Perinatal Project, a cohort study of pregnant women and their children. Third trimester serum levels of estradiol (total, free, bioavailable), estriol, testosterone (total, free, bioavailable), sex hormone-binding globulin, alpha-fetoprotein, and the ratios of estradiols to testosterones were compared between the case and control mothers. The results found no significant differences in the levels of testosterone (total, free, bioavailable), alpha-fetoprotein, sex hormone-binding globulin, or in the ratios of estrogens to androgens. Total estradiol, however, was significantly lower in the cases versus the controls (P = 0.03) among all mothers and, separately, among White mothers (P = 0.05). Similarly, estriol was significantly lower among all cases (P = 0.05) and among White cases (P = 0.05). These results do not support either the estrogen or the androgen hypothesis. Rather, lower estrogens in case mothers may indicate that a placental defect increases the risk of cryptorchism and, possibly, testicular cancer.

  15. Attractive toxic sugar baits: Control of mosquitoes with the low risk active ingredient dinotefuran and potential impacts on non-target organisms in Morocco

    Science.gov (United States)

    We evaluated the efficacy of ATSB in the laboratory and the field with the low risk active ingredient dinotefuran against mosquito populations. Assays indicated that dinotefuran in solution with the sugar baits was ingested and resulted in high mortality of female Culex quinquefasciatus and Aedes a...

  16. Plasma IL-8 and IL-6 levels can be used to define a group with low risk of septicaemia among cancer patients with fever and neutropenia

    NARCIS (Netherlands)

    de Bont, ESJM; Vellenga, E; Swaanenburg, JCJM; Fidler, [No Value; Visser-van Brummen, PJ; Kamps, WA

    The standard therapy for patients with fever and chemotherapy-related neutropenia is hospitalization and infusion of broad-spectrum antibiotics. Early discharge of a defined group of patients at low risk for septicaemia would be of great advantage for these patients. Ih this study plasma

  17. Ultrasound assessment of placental function: the effectiveness of placental biometry in a low-risk population as a predictor of a small for gestational age neonate.

    LENUS (Irish Health Repository)

    McGinty, Patricia

    2012-07-01

    The aims of the study were to establish reference ranges for placental length and thickness in a low-risk obstetric population and to assess the likelihood of a small for gestational age (SGA) neonate on the basis of placental length at 18-24 weeks\\' gestation.

  18. Risk score for identifying adults with CSF pleocytosis and negative CSF Gram stain at low risk for an urgent treatable cause

    NARCIS (Netherlands)

    Hasbun, Rodrigo; Bijlsma, Merijn; Brouwer, Matthijs C.; Khoury, Nabil; Hadi, Christiane M.; van der Ende, Arie; Wootton, Susan H.; Salazar, Lucrecia; Hossain, Md Monir; Beilke, Mark; van de Beek, Diederik

    2013-01-01

    We aimed to derive and validate a risk score that identifies adults with cerebrospinal fluid (CSF) pleocytosis and a negative CSF Gram stain at low risk for an urgent treatable cause. Patients with CSF pleocytosis and a negative CSF Gram stain were stratified into a prospective derivation (n = 193)

  19. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.

    NARCIS (Netherlands)

    Brocklehurst, P.; Kwee, A.; Birthplace in England Collaborative Group

    2011-01-01

    Objective: To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. Design: Prospective cohort study. Setting: England: all NHS trusts providing intrapartum care at home,

  20. Plasma IL-8 and IL-6 levels can be used to define a group with low risk of septicaemia among cancer patients with fever and neutropenia

    NARCIS (Netherlands)

    de Bont, ESJM; Vellenga, E; Swaanenburg, JCJM; Fidler, [No Value; Visser-van Brummen, PJ; Kamps, WA

    1999-01-01

    The standard therapy for patients with fever and chemotherapy-related neutropenia is hospitalization and infusion of broad-spectrum antibiotics. Early discharge of a defined group of patients at low risk for septicaemia would be of great advantage for these patients. Ih this study plasma

  1. Predictive value of general movements' quality in low-risk infants for minor neurological dysfunction and behavioural problems at preschool age

    NARCIS (Netherlands)

    Bennema, Anne N; Schendelaar, Pamela; Seggers, Jorien; Haadsma, Maaike L; Heineman, Maas Jan; Hadders-Algra, Mijna

    Background: General movement (GM) assessment is a well-established tool to predict cerebral palsy in high-risk infants. Little is known on the predictive value of GM assessment in low-risk populations. Aims: To assess the predictive value of GM quality in early infancy for the development of the

  2. Preventing Preterm Birth with Progesterone in Women with a Short Cervical Length from a Low-Risk Population: A Multicenter Double-Blind Placebo-Controlled Randomized Trial

    NARCIS (Netherlands)

    van Os, M.A.; van der Ven, A.J.; Kleinrouweler, C.E.; Schuit, E.; Kazemier, B.M.; Verhoeven, C.J.M.; de Miranda, E.; van Wassenaer-Leemhuis, A.G.; Sikkema, J.M.; Woiski, M.D.; Bossuyt, P.M.; Pajkrt, E.; de Groot, C.J.M.; Mol, B.W.J.; Haak, M.C.

    2015-01-01

    Objective The objective of this study was to evaluate the effectiveness of vaginal progesterone in reducing adverse neonatal outcome due to preterm birth (PTB) in low-risk pregnant women with a short cervical length (CL). Study Design Women with a singleton pregnancy without a history of PTB

  3. Reduction of total labor length through the addition of parenteral dextrose solution in induction of labor in nulliparous: results of DEXTRONS prospective randomized controlled trial.

    Science.gov (United States)

    Paré, Josianne; Pasquier, Jean-Charles; Lewin, Antoine; Fraser, William; Bureau, Yves-André

    2017-05-01

    Prolonged labor is a significant cause of maternal and fetal morbidity and very few interventions are known to shorten labor course. Skeletal muscle physiology suggests that glucose supplementation might improve muscle performance in case of prolonged exercise and this situation is analogous to the gravid uterus during delivery. Therefore, it seemed imperative to evaluate the impact of adding carbohydrate supplements on the course of labor. We sought to provide evidence as to whether intravenous glucose supplementation during labor induction in nulliparous women can reduce total duration of active labor. We performed a single-center prospective double-blind randomized controlled trial comparing the use of parental intravenous dextrose 5% with normal saline to normal saline in induced nulliparous women. The study was conducted in a tertiary-level university hospital setting. Participants, caregivers, and those assessing the outcomes were blinded to group assignment. Inclusion criteria were singleton pregnancy at term with cephalic presentation and favorable cervix. Based on blocked randomization, patients were assigned to receive either 250 mL/h of intravenous dextrose 5% with normal saline or 250 mL/h of normal saline for the whole duration of induction, labor, and delivery. The primary outcome studied was the total length of active labor. Secondary outcomes included duration of the active phase of second stage of labor, the mode of delivery, Apgar scores, and arterial cord pH. In all, 100 patients were randomized into each group. A total of 193 patients (96 in the dextrose with normal saline group and 97 in the normal saline group) were analyzed in the study. The median total duration of labor was significantly less in the dextrose with normal saline group (499 vs 423 minutes, P = .024) than in the normal saline group. The probabilities of a woman being delivered at 200 minutes and 450 minutes were 18.8% and 77.1% in the dextrose with normal saline group vs 8

  4. Investigation of HOXA9 promoter methylation as a biomarker to distinguish oral cancer patients at low risk of neck metastasis

    International Nuclear Information System (INIS)

    Uchida, Kenichiro; Veeramachaneni, Ratna; Huey, Bing; Bhattacharya, Aditi; Schmidt, Brian L; Albertson, Donna G

    2014-01-01

    Metastasis to the cervical (neck) lymph nodes is one of the most significant clinical factors responsible for death from oral squamous cell carcinoma (SCC). Therefore, the lymph nodes are frequently removed when the tumor is excised (neck dissection), even though the majority of patients will not benefit from the extra surgery. Two subtypes of oral SCC distinguished by the presence of tumor genomic aberrations +3q, -8p, +8q and/or +20 differ in risk for metastasis – high for the 3q8pq20 subtype, harboring one or more of the aberrations and low for the non-3q8pq20 subtype, lacking these alterations. A prior analysis of the literature suggested genes differentially methylated in the two subtypes. Therefore, the goal of this study was to further investigate the methylation status of candidate biomarkers of the non-3q8pq20 subtype, and evaluate their utility for identifying patients at low risk for metastasis. Methylation status of genes in a cohort of 52 oral SCC patients with at least five year follow up was determined by pyrosequencing. Gene expression levels were determined by quantitative RT-PCR. Growth following re-expression of HOXA9 in cultured oral SCC cells was assessed by proliferation and colony formation assays. A pilot study evaluating methylation levels of HOXA9, MT1A and HOXA11 promoters in DNA from 12 tumors (six each of the 3q8pq20 and non-3q8pq20 subtypes) revealed that only HOXA9 was differentially methylated. Significant differences in methylation levels of HOXA9 were observed amongst the 52 oral SCCs with respect to genomic subtype and nodal status (p = 0.014, and p = 0.024, respectively, Wilcoxon rank sum test). High levels of HOXA9 methylation and low levels of expression in oral SCC cell lines were observed compared to HaCaT, a non-tumorigenic keratinocyte cell line. Re-expression of HOXA9 in the SCC4 oral cancer cell line resulted in diminished proliferation and colony formation. HOXA9 methylation is frequent in oral cancers and levels are

  5. Reference intervals for hemoglobin and hematocrit in a low-risk pregnancy cohort: implications of racial differences.

    Science.gov (United States)

    Chiossi, Giuseppe; Palomba, Stefano; Costantine, Maged M; Falbo, Angela I; Harirah, Hassan M; Saade, George R; La Sala, Giovanni B

    2018-03-23

    As anemia in pregnancy is associated with adverse perinatal outcomes, we sought to define the mean and the fifth percentile of Hb and Ht using a contemporary multiethnic large cohort of low-risk pregnancies, and assess potential racial differences. We conducted a retrospective cohort study on women who delivered between 1 January 2008 and 31 December 2013 in Reggio Emilia County, Italy. Linear mixed effects models were used to describe changes in mean Hb and Ht, while quantile regression with matrix-design bootstrap defined changes in the fifth percentile of Hb and Ht, controlling for race, maternal age, smoking, and pregnancy number. We analyzed 23,657 hemograms from 7318 pregnancies and 6870 women. Multivariate analysis showed that when compared to Caucasians', African women's mean Hb and Ht were respectively 0.24 (95%CI 0.3-0.17) g/dl and 0.7 (95%CI 0.8-0.5) % lower, while Asian mothers' were 0.11 (95%CI 0.19-0.03) g/dl and 0.3 (95%CI 0.5-0.1) % inferior. Similarly, both African and Asian women had lower fifth Ht percentiles (-1, 95%CI -1.3 to -0.6, and -0.4, 95%CI -0.7 to -0.04) than Caucasians, while African mothers also had lower fifth Hb percentile (0.3, 95%CI 0.5-0.1). The fifth percentile for Hb and Ht were, respectively, 11.3 (95%CI 11-11.5) g/dl and 32.8 (95%CI 32.3-33.4) % in the first trimester, 10.4 (95%CI 10.1-10.6) g/dl and 30.2 (95%CI 29.6-30.8) % in the second trimester, 10.1 (95%CI 9.8-10.3) g/dl and 30.6 (95%CI 30-31.1) % in the third trimester. We provided contemporary references to define anemia in pregnancy, and we confirmed that even in pregnancy, African and Asian women have lower Hb and Ht than Caucasian. Racial and population-specific references may have significant clinical and public health implication for more accurate disease diagnosis and appropriate treatment.

  6. Evaluation of a Low-risk Mild Traumatic Brain Injury and Intracranial Hemorrhage Emergency Department Observation Protocol.

    Science.gov (United States)

    Yun, Brian J; Borczuk, Pierre; Wang, Lulu; Dorner, Stephen; White, Benjamin A; Raja, Ali S

    2017-11-20

    ] = 0.25-0.82, p = 0.009) in the observation unit. After a stay in the EDOU, 26% (37/143) of patients required an inpatient admission before implementation of the protocol and 13% (20/153) of patients required an inpatient admission after protocol implementation. There was no statistically significant difference in log transformed EDOU length of stay (LOS) between the groups after adjusting for propensity score (p = 0.34). While there was no difference in EDOU LOS, implementing a low-risk mild TBI and ICH protocol in the EDOU may decrease the rate of inpatient admissions from the EDOU. A protocol-driven observation unit may help physicians by standardizing eligibility criteria and by providing guidance on management. As the propensity score method limits our ability to create a straightforward predictive model, a future larger study should validate the results. © 2017 by the Society for Academic Emergency Medicine.

  7. Decision Support and Shared Decision Making About Active Surveillance Versus Active Treatment Among Men Diagnosed with Low-Risk Prostate Cancer: a Pilot Study.

    Science.gov (United States)

    Myers, Ronald E; Leader, Amy E; Censits, Jean Hoffman; Trabulsi, Edouard J; Keith, Scott W; Petrich, Anett M; Quinn, Anna M; Den, Robert B; Hurwitz, Mark D; Lallas, Costas D; Hegarty, Sarah E; Dicker, Adam P; Zeigler-Johnson, Charnita M; Giri, Veda N; Ayaz, Hasan; Gomella, Leonard G

    2018-02-01

    This study aimed to explore the effects of a decision support intervention (DSI) and shared decision making (SDM) on knowledge, perceptions about treatment, and treatment choice among men diagnosed with localized low-risk prostate cancer (PCa). At a multidisciplinary clinic visit, 30 consenting men with localized low-risk PCa completed a baseline survey, had a nurse-mediated online DS session to clarify preference for active surveillance (AS) or active treatment (AT), and met with clinicians for SDM. Participants also completed a follow-up survey at 30 days. We assessed change in treatment knowledge, decisional conflict, and perceptions and identified predictors of AS. At follow-up, participants exhibited increased knowledge (p decision. Perceived support of the decision facilitated patient choice of AS.

  8. Progressive transfusion and growth factor independence with adjuvant sertraline in low risk myelodysplastic syndrome treated with an erythropoiesis stimulating agent and granulocyte-colony stimulating factor

    Directory of Open Access Journals (Sweden)

    Kirtan Nautiyal

    2015-01-01

    Full Text Available Refractoriness to growth factor therapy is commonly associated with inferior outcome in patients with low-risk myelodysplastic syndrome (LR-MDS who require treatment for cytopenias. However, the mechanisms leading to refractoriness are unknown. Here we describe a clinically depressed 74-year-old male with refractory cytopenia with multilineage dysplasia (RCMD and documented growth factor refractory anemia after erythropoeisis stimulating agent (ESA therapy, who attained transfusion and growth factor independence after the addition of sertraline to his medication regimen. Our case demonstrates hematological improvement-erythroid (HI-E in growth factor refractory, low risk MDS and highlights a potential mechanistic link between common inflammatory diseases and LR-MDS.

  9. Thymic epithelial tumors: Comparison of CT and MR imaging findings of low-risk thymomas, high-risk thymomas, and thymic carcinomas

    International Nuclear Information System (INIS)

    Sadohara, Junko; Fujimoto, Kiminori; Mueller, Nestor L.; Kato, Seiya; Takamori, Shinzo; Ohkuma, Kazuaki; Terasaki, Hiroshi; Hayabuchi, Naofumi

    2006-01-01

    Objective: To assess the CT and magnetic resonance (MR) imaging findings of thymic epithelial tumors classified according to the current World Health Organization (WHO) histologic classification and to determine useful findings in differentiating the main subtypes. Materials and methods: Sixty patients with thymic epithelial tumor who underwent both CT and MR imaging were reviewed retrospectively. All cases were classified according to the 2004 WHO classification. The following findings were assessed in each case on both CT and MRI: size of tumor, contour, perimeter of capsule; homogeneity, presence of septum, hemorrhage, necrotic or cystic component within tumor; presence of mediastinal lymphadenopathy, pleural effusion, and great vessel invasion. These imaging characteristics of 30 low-risk thymomas (4 type A, 12 type AB, and 14 type B1), 18 high-risk thymomas (11 type B2 and seven type B3), and 12 thymic carcinomas on CT and MR imaging were compared using the chi-square test. Comparison between CT and MR findings was performed by using McNemar test. Results: On both CT and MR imaging, thymic carcinomas were more likely to have irregular contours (P < .001), necrotic or cystic component (P < .05), heterogeneous contrast-enhancement (P < .05), lymphadenopathy (P < .0001), and great vessel invasion (P < .001) than low-risk and high-risk thymomas. On MR imaging, the findings of almost complete capsule, septum, and homogenous enhancement were more commonly seen in low-risk thymomas than high-risk thymomas and thymic carcinomas (P < .05). MR imaging was superior to CT in the depiction of capsule, septum, or hemorrhage within tumor (all comparison, P < .05). Conclusion: The presence of irregular contour, necrotic or cystic component, heterogeneous enhancement, lymphadenopathy, and great vessel invasion on CT or MR imaging are strongly suggestive of thymic carcinomas. On MR imaging, the findings of contour, capsule, septum, and homogenous enhancement are helpful in

  10. Comparative effectiveness of laparoscopic versus open prostatectomy for men with low-risk prostate cancer: a matched case-control study

    Science.gov (United States)

    Patel, Amil; Kim, Sinae; Kim, Isaac Yi; Goyal, Sharad

    2017-01-01

    Background: Little data exist on effect of undergoing laparoscopic prostatectomy(LP) versus open prostatectomy(OP) upon 30-day mortality rates among low-risk prostate cancer patients. Materials and methods: Using the National Cancer Database, we identified men (2004 to 2013) with biopsy-proven, low-risk prostate cancer who met the eligibility criteria: N0, M0, T-stage≤2A, PSA≤10 ng/mL, and Gleason score=6. We utilized a 1:N matched case-control study, with cases and controls matched by race, insurance status, Charlson-Deyo comorbidity score, surgical margin status, and facility type to investigate the short-term comparative effectiveness of LP versus OP. Results: Among the 448,773 patients in the National Cancer Database with low-risk prostate cancer, 116,359 patients met the above inclusion criteria. The target group was restricted to patients who received LP or OP, thus, leaving 44,720 patients for the study. The use of LP (compared with OP) was associated with patients with privately insured patients, treatment at an academic/research centers, high-volume hospitals, and white race (all Popen) was estimated at 0.31 (95% confidence interval, 0.135–0.701; P<0.05). Thus, the risk of death within 30 days was 69% lower with LP compared with OP. Conclusions: We found that the 30-day mortality rate among low-risk prostate cancer patients is significantly lower among patients who received LP when compared with OP, with various clinicopathologic parameters associated with its preferential use. PMID:29177226

  11. Anal Cytology and Human Papillomavirus Genotyping in Women With a History of Lower Genital Tract Neoplasia Compared With Low-Risk Women.

    Science.gov (United States)

    Robison, Katina; Cronin, Beth; Bregar, Amy; Luis, Christine; DiSilvestro, Paul; Schechter, Steven; Pisharodi, Latha; Raker, Christina; Clark, Melissa

    2015-12-01

    To compare the prevalence of abnormal anal cytology and high-risk human papillomavirus (HPV) among women with a history of HPV-related genital neoplasia with women without a history of HPV-related genital neoplasia. A cross-sectional cohort study was performed from December 2012 to February 2014. Women were recruited from outpatient clinics at an academic medical center. Women with a history of high-grade cervical, vulvar, or vaginal cytology, dysplasia, or cancer were considered the high-risk group. Women with no history of high-grade anogenital dysplasia or cancer were considered the low-risk group. Human immunodeficiency virus-positive women were excluded. Anal cytology and HPV genotyping were performed. Women with abnormal anal cytology were referred for high-resolution anoscopy. There were 190 women in the high-risk group and 83 in the low-risk group. The high-risk group was slightly older: 57 years compared with 47 years (P=.045); 21.7% of low-risk women had abnormal anal cytology compared with 41.2% of high-risk women (P=.006). High-risk HPV was detected in the anal canal of 1.2% of the low-risk group compared with 20.8% of the high-risk group (PHuman immunodeficiency virus-negative women with a history of lower genital tract neoplasia are more likely to have positive anal cytology, anal high-risk HPV, and anal intraepithelial neoplasia. Anal cancer screening should be considered for these high-risk women. II.

  12. Early Discharge in Low-Risk Patients Hospitalized for Acute Coronary Syndromes: Feasibility, Safety and Reasons for Prolonged Length of Stay.

    Directory of Open Access Journals (Sweden)

    Marie-Eva Laurencet

    Full Text Available Length of hospital stay (LHS is an indicator of clinical effectiveness. Early hospital discharge (≤72 hours is recommended in patients with acute coronary syndromes (ACS at low risk of complications, but reasons for prolonged LHS poorly reported.We collected data of ACS patients hospitalized at the Geneva University Hospitals from 1st July 2013 to 30th June 2015 and used the Zwolle index score to identify patients at low risk (≤ 3 points. We assessed the proportion of eligible patients who were successfully discharged within 72 hours and the reasons for prolonged LHS. Outcomes were defined as adherence to recommended therapies, major adverse events at 30 days and patients' satisfaction using a Likert-scale patient-reported questionnaire.Among 370 patients with ACS, 255 (68.9% were at low-risk of complications but only 128 (50.2%were eligible for early discharge, because of other clinical reasons for prolonged LHS (e.g. staged coronary revascularization, cardiac monitoring in 127 patients (49.8%. Of the latter, only 45 (35.2% benefitted from an early discharge. Reasons for delay in discharge in the remaining 83 patients (51.2% were mainly due to delays in additional investigations, titration of medical therapy, admission or discharge during weekends. In the early discharge group, at 30 days, only one patient (2.2% had an adverse event (minor bleeding, 97% of patients were satisfied by the medical care.Early discharge was successfully achieved in one third of eligible ACS patients at low risk of complications and appeared sufficiently safe while being overall appreciated by the patients.

  13. Early Discharge in Low-Risk Patients Hospitalized for Acute Coronary Syndromes: Feasibility, Safety and Reasons for Prolonged Length of Stay.

    Science.gov (United States)

    Laurencet, Marie-Eva; Girardin, François; Rigamonti, Fabio; Bevand, Anne; Meyer, Philippe; Carballo, David; Roffi, Marco; Noble, Stéphane; Mach, François; Gencer, Baris

    2016-01-01

    Length of hospital stay (LHS) is an indicator of clinical effectiveness. Early hospital discharge (≤72 hours) is recommended in patients with acute coronary syndromes (ACS) at low risk of complications, but reasons for prolonged LHS poorly reported. We collected data of ACS patients hospitalized at the Geneva University Hospitals from 1st July 2013 to 30th June 2015 and used the Zwolle index score to identify patients at low risk (≤ 3 points). We assessed the proportion of eligible patients who were successfully discharged within 72 hours and the reasons for prolonged LHS. Outcomes were defined as adherence to recommended therapies, major adverse events at 30 days and patients' satisfaction using a Likert-scale patient-reported questionnaire. Among 370 patients with ACS, 255 (68.9%) were at low-risk of complications but only 128 (50.2%)were eligible for early discharge, because of other clinical reasons for prolonged LHS (e.g. staged coronary revascularization, cardiac monitoring) in 127 patients (49.8%). Of the latter, only 45 (35.2%) benefitted from an early discharge. Reasons for delay in discharge in the remaining 83 patients (51.2%) were mainly due to delays in additional investigations, titration of medical therapy, admission or discharge during weekends. In the early discharge group, at 30 days, only one patient (2.2%) had an adverse event (minor bleeding), 97% of patients were satisfied by the medical care. Early discharge was successfully achieved in one third of eligible ACS patients at low risk of complications and appeared sufficiently safe while being overall appreciated by the patients.

  14. Systematic review with meta-analysis: the incidence of advanced neoplasia after polypectomy in patients with and without low-risk adenomas.

    Science.gov (United States)

    Hassan, C; Gimeno-García, A; Kalager, M; Spada, C; Zullo, A; Costamagna, G; Senore, C; Rex, D K; Quintero, E

    2014-05-01

    Patients with one to two tubular adenomas advanced neoplasia as those with no neoplasia at baseline colonoscopy. To compare incidence of metachronous advanced neoplasia between patients in the low-risk adenoma group and those without neoplasia at index colonoscopy. Relevant publications were identified by MEDLINE/EMBASE and other databases for the period 1992-2013. Studies comparing the incidence of post-polypectomy advanced neoplasia (adenomas ≥10 mm/high-grade dysplasia/villous or cancer) between the low-risk group and patients without colorectal neoplasia at the first colonoscopy were included. Detection rates for advanced neoplasia at endoscopic surveillance were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random-effect models. Inter-study heterogeneity was assessed using the I(2) statistic. Seven studies provided data on 11 387 patients. Mean surveillance periods ranged between 2 and 5 years. Altogether, 267 patients with post-polypectomy advanced neoplasia were detected in the two groups. The incidence of advanced neoplasia was 1.6% (119/7308) in those without neoplasia and 3.6% (148/4079) in those with low-risk adenoma, respectively, corresponding to a relative risk of 1.8 (95% CI: 1.3-2.6). Inter-study heterogeneity was only moderate (I(2) : 37%). No publication bias was present. Patients with low-risk adenomas at baseline had a higher risk of metachronous advanced neoplasia than the group with no adenomas at baseline, though the absolute risk was low in both groups. © 2014 John Wiley & Sons Ltd.

  15. Management of low-risk early-stage cervical cancer: Should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care?

    Science.gov (United States)

    Ramirez, Pedro T.; Pareja, Rene; Rendón, Gabriel J.; Millan, Carlos; Frumovitz, Michael; Schmeler, Kathleen M.

    2014-01-01

    The standard treatment for women with early-stage cervical cancer (IA2-IB1) remains radical hysterectomy with pelvic lymphadenectomy. In select patients interested in future fertility, the option of radical trachelectomy with pelvic lymphadenectomy is also considered a viable option. The possibility of less radical surgery may be appropriate not only for patients desiring to preserve fertility but also for all patients with low-risk early-stage cervical cancer. Recently, a number of studies have explored less radical surgical options for early-stage cervical cancer, including simple hysterectomy, simple trachelectomy, and cervical conization with or without sentinel lymph node biopsy and pelvic lymph node dissection. Such options may be available for patients with low-risk early-stage cervical cancer. Criteria that define this low-risk group include: squamous carcinoma, adenocarcinoma, or adenosquamous carcinoma, tumor size <2 cm, stromal invasion <10mm, and no lymph-vascular space invasion. In this report, we provide a review of the existing literature on the conservative management of cervical cancer and describe ongoing multi-institutional trials evaluating the role of conservative surgery in selected patients with early-stage cervical cancer. PMID:24041877

  16. KIT Mutation and Loss of 14q May Be Sufficient for the Development of Clinically Symptomatic Very Low-Risk GIST.

    Directory of Open Access Journals (Sweden)

    Olaf Karl Klinke

    Full Text Available The aim of this study was to determine the minimal set of genetic alterations required for the development of a very low risk clinically symptomatic gastro-intestinal stromal tumour within the stomach wall. We studied the genome of a very low-risk gastric gastro-intestinal stromal tumour by whole-genome sequencing, comparative genomic hybridisation and methylation profiling. The studied tumour harboured two typical genomic lesions: loss of the long arm of chromosome 14 and an activating mutation in exon 11 of KIT. Besides these genetic lesions, only two point mutations that may affect tumour progression were identified: A frame-shift deletion in RNF146 and a missense mutation in a zinc finger of ZNF407. Whilst the frameshift deletion in RNF146 seemed to be restricted to this particular tumour, a similar yet germline mutation in ZNF407 was found in a panel of 52 gastro-intestinal stromal tumours from different anatomical sites and different categories. Germline polymorphisms in the mitotic checkpoint proteins Aurora kinase A and BUB1 kinase B may have furthered tumour growth. The epigenetic profile of the tumour matches that of other KIT-mutant tumours. We have identified mutations in three genes and loss of the long arm of chromosome 14 as the so far minimal set of genetic abnormalities sufficient for the development of a very low risk clinically symptomatic gastric stromal tumour.

  17. Is {sup 131}I ablation necessary for patients with low-risk papillary thyroid carcinoma and slightly elevated stimulated thyroglobulin after thyroidectomy?

    Energy Technology Data Exchange (ETDEWEB)

    Rosario, Pedro Weslley; Mourao, Gabriela Franco, E-mail: pedrowsrosario@gmail.com [Santa Casa de Belo Horizonte, MG (Brazil). Instituto de Ensino e Pesquisa

    2016-02-15

    Objective: This prospective study evaluated the recurrence rate in low-risk patients with papillary thyroid cancer (PTC) who presented slightly elevated thyroglobulin (Tg) after thyroidectomy and who did not undergo ablation with {sup 131}I. Subjects and methods: The study included 53 low-risk patients (non aggressive histology; pT1b-3, cN0pNx, M0) with slightly elevated Tg after thyroidectomy (> 1 ng/mL, but ≤ 5 ng/mL after levothyroxine withdrawal or ≤ 2 ng/mL after recombinant human TSH). Results: The time of follow-up ranged from 36 to 96 months. Lymph node metastases were detected in only one patient (1.9%). Fifty-two patients continued to present negative neck ultrasound. None of these patients without apparent disease presented an increase in Tg. Conclusions: Low-risk patients with PTC who present slightly elevated Tg after thyroidectomy do not require ablation with {sup 131}I. (author)

  18. Gateway Effects: Why the Cited Evidence Does Not Support Their Existence for Low-Risk Tobacco Products (and What Evidence Would

    Directory of Open Access Journals (Sweden)

    Carl V. Phillips

    2015-05-01

    Full Text Available It is often claimed that low-risk drugs still create harm because of “gateway effects”, in which they cause the use of a high-risk alternative. Such claims are popular among opponents of tobacco harm reduction, claiming that low-risk tobacco products (e.g., e-cigarettes, smokeless tobacco cause people to start smoking, sometimes backed by empirical studies that ostensibly support the claim. However, these studies consistently ignore the obvious alternative causal pathways, particularly that observed associations might represent causation in the opposite direction (smoking causes people to seek low-risk alternatives or confounding (the same individual characteristics increase the chance of using any tobacco product. Due to these complications, any useful analysis must deal with simultaneity and confounding by common cause. In practice, existing analyses seem almost as if they were designed to provide teaching examples about drawing simplistic and unsupported causal conclusions from observed associations. The present analysis examines what evidence and research strategies would be needed to empirically detect such a gateway effect, if there were one, explaining key methodological concepts including causation and confounding, examining the logic of the claim, identifying potentially useful data, and debunking common fallacies on both sides of the argument, as well as presenting an extended example of proper empirical testing. The analysis demonstrates that none of the empirical studies to date that are purported to show a gateway effect from tobacco harm reduction products actually does so. The observations and approaches can be generalized to other cases where observed association of individual characteristics in cross-sectional data could result from any of several causal relationships.

  19. Written Informed Consent for Computed Tomography of the Abdomen/Pelvis is Associated with Decreased CT Utilization in Low-Risk Emergency Department Patients

    Directory of Open Access Journals (Sweden)

    Lisa H. Merck

    2015-12-01

    Full Text Available Introduction: The increasing rate of patient exposure to radiation from computerized tomography (CT raises questions about appropriateness of utilization. There is no current standard to employ informed consent for CT (ICCT. Our study assessed the relationship between informed consent and CT utilization in emergency department (ED patients. Methods: An observational multiphase before-after cohort study was completed from 4/2010-5/2011. We assessed CT utilization before and after (Time I/ Time II the implementation of an informed consent protocol. Adult patients were included if they presented with symptoms of abdominal/pelvic pathology or completed ED CT. We excluded patients with pregnancy, trauma, or altered mental status. Data on history, exam, diagnostics, and disposition were collected via standard abstraction tool. We generated a multivariate logistic model via stepwise regression, to assess CT utilization across risk groups. Logistic models, stratified by risk, were generated to include study phase and a propensity score that controlled for potential confounders of CT utilization. Results: 7,684 patients met inclusion criteria. In PHASE 2, there was a 24% (95% CI [10-36%] reduction in CT utilization in the low-risk patient group (p<0.002. ICCT did not affect CT utilization in the high-risk group (p=0.16. In low-risk patients, the propensity score was significant (p<0.001. There were no adverse events reported during the study period. Conclusion: The implementation of ICCT was associated with reduced CT utilization in low-risk ED patients. ICCT has the potential to increase informed, shared decision making with patients, as well as to reduce the risks and cost associated with CT.

  20. Comparison of seed brachytherapy or external beam radiotherapy (70 Gy or 74 Gy) in 919 low-risk prostate cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Goldner, G.; Poetter, R.; Schmid, M.P.; Kirisits, C. [University Hospital of Vienna (Austria). Dept. of Radiotherapy and Radiobiology; Battermann, J.J.; Sljivic, S.; Vulpen, M. van [University Medical Center Utrecht (Netherlands). Dept. of Radiation Oncology

    2012-04-15

    The aim of this analysis was to compare the biochemical no evidence of disease (bNED) rates in low-risk prostate cancer patients treated at two centers of excellence using different approaches: seed brachytherapy (BT) and external beam radiotherapy (EBRT). Materials and methods: A total of 919 low-risk prostate cancer patients, treated from 1998-2008, were identified in the two databases. In Utrecht, 667 patients received I-125 BT applying a dose of 144 Gy. In Vienna, 252 patients were treated with EBRT, applying a local dose of 70 Gy in 82 patients and 74 Gy in 170 patients. bNED rates (Phoenix definition) were assessed. Results: The median follow-up was 46 months (range 1-148 months). The 5-year actuarial bNED rates were 94% for BT patients and 88% for EBRT patients (p = 0.002) - 84% for patients receiving 70 Gy and 91% for patients receiving 74 Gy, respectively. In the univariate analysis, patients receiving 70 Gy showed significantly worse outcome compared to BT (p = 0.001) and a difference close to significance compared to 74 Gy (p = 0.06). In the multivariate analysis including tumor stage, Gleason score, initial PSA, hormonal therapy, and dose, patients receiving 70 Gy EBRT showed significantly worse bNED rates compared to BT patients. Conclusion: Low-risk prostate cancer patients receiving 74 Gy by EBRT show comparable biochemical control rates to patients receiving seed brachytherapy, whereas patients receiving 70 Gy show significantly worse outcome. (orig.)

  1. No survival difference after successful {sup 131}I ablation between patients with initially low-risk and high-risk differentiated thyroid cancer

    Energy Technology Data Exchange (ETDEWEB)

    Verburg, Frederik Anton [University of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); University Medical Center Utrecht, Department of Radiology and Nuclear Medicine, Utrecht (Netherlands); Stokkel, Marcel P.M.; Verkooijen, Robbert B.T. [Leiden University Medical Center, Department of Radiology, Division of Nuclear Medicine, Leiden (Netherlands); Dueren, Christian; Reiners, Christoph [University of Wuerzburg, Department of Nuclear Medicine, Wuerzburg (Germany); Maeder, Uwe [University of Wuerzburg, Comprehensive Cancer Center, Wuerzburg (Germany); Isselt, Johannes W. van [University Medical Center Utrecht, Department of Radiology and Nuclear Medicine, Utrecht (Netherlands); Marlowe, Robert J. [Spencer-Fontayne Corporation, Jersey City, NJ (United States); Smit, Johannes W. [Leiden University Medical Center, Department of Endocrinology, Leiden (Netherlands); Luster, Markus [University of Ulm, Department of Nuclear Medicine, Ulm (Germany)

    2010-02-15

    To compare disease-specific survival and recurrence-free survival (RFS) after successful {sup 131}I ablation in patients with differentiated thyroid carcinoma (DTC) between those defined before ablation as low-risk and those defined as high-risk according to the European Thyroid Association 2006 consensus statement. Retrospective data from three university hospitals were pooled. Of 2009 consecutive patients receiving ablation, 509 were identified as successfully ablated based on both undetectable stimulated serum thyroglobulin in the absence of antithyroglobulin antibodies and a negative diagnostic whole-body scan in a follow-up examination conducted 8.1{+-}4.6 months after ablation. Of these 509 patients, 169 were defined as high-risk. After a mean follow-up of 81{+-}64 months (range 4-306 months), only three patients had died of DTC, rendering assessment of disease-specific survival differences impossible. Of the 509 patients, 12 (2.4%) developed a recurrence a mean 35 months (range 12-59 months) after ablation. RFS for the duration of follow-up was 96.6% according to the Kaplan-Meier method. RFS did not differ between high-risk and low-risk patients (p=0.68). RFS differed slightly but significantly between those with papillary and those with follicular thyroid carcinoma (p=0.03) and between those aged {<=}45 years those aged >45 years at diagnosis (p=0.018). After (near) total thyroidectomy and successful {sup 131}I ablation, RFS does not differ between patients classified as high-risk and those classified as low-risk based on TNM stage at diagnosis. Consequently, the follow-up protocol should be determined on the basis of the result of initial treatment rather than on the initial tumour classification. (orig.)

  2. Outpatient thyroid remnant ablation using repeated low 131-iodine activities (740 MBq/20 mCix2) in patients with low-risk differentiated thyroid cancer.

    Science.gov (United States)

    Clerc, Jérôme; Bienvenu-Perrard, Marie; de Malleray, Caroline Pichard; Dagousset, Françoise; Delbot, Thierry; Dreyfuss, Marc; Groussin, Lionel; Marlowe, Robert J; Leger, Françoise Aubène; Chevalier, Alain

    2012-03-01

    In low-risk differentiated thyroid cancer (DTC), postoperative (131)I remnant ablation should employ a minimum effective activity; reports increasingly suggest efficacy of low activities, e.g. 1110 MBq/30 mCi. OBJECTIVES, DESIGN, PATIENTS, AND INTERVENTIONS: We retrospectively studied the ablation capability and diagnostic utility of the Minidose protocol, two 740-MBq/20 mCi outpatient administrations, 6-18 months apart, plus related diagnostic procedures, in 160 consecutive (near-) totally thyroidectomized low-risk DTC (pT1/N0-Nx) patients. Successful ablation comprised negative 740-MBq whole-body scintigraphy with cervical uptake below 0.1%, negative stimulated thyroglobulin (STg) (<1 ng/ml, negative thyroglobulin antibodies), and negative Doppler ultrasonography (performed around Minidose 2). The study took place at a referral center. Minidose imaging found unsuspected nodal or distant metastases in nine of 160 patients (5.6%). Ablation success rates after one (two) 740-MBq activity (activites) were 75.9% (90.2%) in 145 (132) evaluable imaging-negative patients. Compared with thyroid hormone withdrawal, recombinant human TSH stimulation was associated with higher urinary iodine excretion/creatinine, lower cervical uptake, and more frequent ablation success after the first 740 MBq; success rates no longer differed significantly after both administrations. Patients with STg below 10 ng/ml at Minidose 1 were oftener ablated at Minidose 2 (odds ratio=13.9, 95% confidence interval=2.5-76.4, P<0.003), attaining 92.0% final ablation success after recombinant human TSH preparation, suggesting that one 740-MBq activity should suffice in this subgroup. All 81 evaluable patients with prolonged follow-up (mean 41.8±21.9 months after Minidose 1) had no evidence of disease at the last visit. The Minidose outpatient ablation protocol is effective and diagnostically useful in low-risk DTC.

  3. Body mass index was associated with upstaging and upgrading in patients with low-risk prostate cancer who met the inclusion criteria for active surveillance.

    Science.gov (United States)

    de Cobelli, Ottavio; Terracciano, Daniela; Tagliabue, Elena; Raimondi, Sara; Galasso, Giacomo; Cioffi, Antonio; Cordima, Giovanni; Musi, Gennaro; Damiano, Rocco; Cantiello, Francesco; Detti, Serena; Victor Matei, Deliu; Bottero, Danilo; Renne, Giuseppe; Ferro, Matteo

    2015-05-01

    Obesity is associated with an increased risk of high-grade prostate cancer (PCa). The effect of body mass index (BMI) as a predictor of progression in men with low-risk PCa has been only poorly assessed. In this study, we evaluated the association of BMI with progression in patients with low-risk PCa who met the inclusion criteria for the active surveillance (AS) protocol. We assessed 311 patients who underwent radical prostatectomy and were eligible for AS according to the following criteria: clinical stage T2a or less, prostate-specific antigen level pT2) and upgraded (Gleason score ≥ 7; primary Gleason pattern 4) disease. Seminal vesicle invasion, positive lymph nodes, and tumor volume ≥ 0.5 ml were also recorded. We found that high BMI was significantly associated with upgrading, upstaging, and seminal vesicle invasion, whereas it was not associated with positive lymph nodes or large tumor volume. At multivariate analysis, 1 unit increase of BMI significantly increased the risk of upgrading, upstaging, seminal vesicle invasion, and any outcome by 21%, 23%, 27%, and 20%, respectively. The differences between areas under the receiver operating characteristics curves comparing models with and without BMI were statistically significant for upgrading (P = 0.0002), upstaging (P = 0.0007), and any outcome (P = 0.0001). BMI should be a selection criterion for inclusion of patients with low-risk PCa in AS programs. Our results support the idea that obesity is associated with worse prognosis and suggest that a close AS program is an appropriate treatment option for obese subjects. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. The effects of standing, lifting and noise exposure on preterm birth, growth restriction, and perinatal death in healthy low-risk working military women.

    Science.gov (United States)

    Magann, Everett F; Evans, Sharon F; Chauhan, Suneet P; Nolan, Thomas E; Henderson, Jenni; Klausen, Jack H; Newnham, John P; Morrison, John C

    2005-09-01

    The effects of standing, lifting and noise in low-risk, healthy pregnant women are uncertain. In the past, the heterogeneity of the populations studied, the limitations of the designs of the retrospective and case control studies, and a failure of some of the larger investigations to evaluate all the potential confounding variables has hampered many studies. The purpose of this investigation was to evaluate, throughout pregnancy, the effects of standing, repetitive lifting, and noise in the workplace compared with no standing, lifting or noise exposure, on maternal and perinatal outcomes in a large prospective study of a low-risk healthy population of working women cared for by a single group of health providers. This prospective observational study used an extensive questionnaire to collect antepartum, intrapartum, and postpartum information. Information was collected on the initial visit, each subsequent visit, and immediately after delivery. The participating women were divided into groups based on the amount of time spent standing, the amount and extent of repetitive lifting, and noise exposure in the workplace. Eight hundred and fourteen low-risk active duty women participated in this investigation over a 4-year period. Multivariate analysis with non-exposure compared with exposure reinforced the effect of standing on preterm labor (OR 1.80, 95% CI 1.05, 3.16) and preterm birth (OR 1.69, 95% CI 1.03, 2.80) and showed a trend toward an effect of noise exposure on preterm labor (OR 1.76, 95% CI 0.78, 3.39) after controlling for other exposures. This investigation suggests an association of occupational standing with preterm labor and preterm birth.

  5. Predictive value of general movements' quality in low-risk infants for minor neurological dysfunction and behavioural problems at preschool age.

    Science.gov (United States)

    Bennema, Anne N; Schendelaar, Pamela; Seggers, Jorien; Haadsma, Maaike L; Heineman, Maas Jan; Hadders-Algra, Mijna

    2016-03-01

    General movement (GM) assessment is a well-established tool to predict cerebral palsy in high-risk infants. Little is known on the predictive value of GM assessment in low-risk populations. To assess the predictive value of GM quality in early infancy for the development of the clinically relevant form of minor neurological dysfunction (complex MND) and behavioral problems at preschool age. Prospective cohort study. A total of 216 members of the prospective Groningen Assisted Reproductive Techniques (ART) cohort study were included in this study. ART did not affect neurodevelopmental outcome of these relatively low-risk infants born to subfertile parents. GM quality was determined at 2 weeks and 3 months. At 18 months and 4 years, the Hempel neurological examination was used to assess MND. At 4 years, parents completed the Child Behavior Checklist; this resulted in the total problem score (TPS), internalizing problem score (IPS), and externalizing problem score (EPS). Predictive values of definitely (DA) and mildly (MA) abnormal GMs were calculated. DA GMs at 2 weeks were associated with complex MND at 18 months and atypical TPS and IPS at 4 years (all ppredictive value of DA GMs at 2 weeks were rather low (13%-60%); specificity and negative predictive value were excellent (92%-99%). DA GMs at 3 months occurred too infrequently to calculate prediction. MA GMs were not associated with outcome. GM quality as a single predictor for complex MND and behavioral problems at preschool age has limited clinical value in children at low risk for developmental disorders. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Outpatient rapid 4-step desensitization for gynecologic oncology patients with mild to low-risk, moderate hypersensitivity reactions to carboplatin/cisplatin.

    Science.gov (United States)

    Li, Quan; Cohn, David; Waller, Allyson; Backes, Floor; Copeland, Larry; Fowler, Jeffrey; Salani, Ritu; O'Malley, David

    2014-10-01

    The primary objective of this study is to assess the efficacy and safety of an outpatient, 4-step, one-solution desensitization protocol in gynecologic oncology patients with history of mild to low-risk, moderate hypersensitivity reactions (HSRs) to platinums (carboplatin and cisplatin). This was a single institutional retrospective review. Gynecologic oncology patients with a documented history of mild or low-risk, moderate immediate HSRs to carboplatin/cisplatin and continued treatment with 4-step, one-solution desensitization protocols in the outpatient infusion center were included. Patients with delayed HSRs or immediate high-risk, moderate or severe HSRs were excluded. The primary end point was the rate of successful administrations of each course of platinums. From January 2011 to June 2013, eighteen eligible patients were evaluated for outpatient 4-step, one-solution desensitization. Thirteen patients had a history of HSRs to carboplatin and 5 with HSRs to cisplatin. All of 18 patients successfully completed 94 (98.9%) of 95 desensitization courses in the outpatient infusion center. Eight of 8 (100%) patients with initial mild HSRs completed 29/29 (100%) desensitization courses, and 9 of 10 (90%) of patients with initial moderate HSRs completed 65/66 (94%) desensitization courses. In total, 65/95 (68%) desensitizations resulted in no breakthrough reactions, and mild, moderate and severe breakthrough reactions were seen in 19%, 12% and 1% desensitizations, respectively. No patients were hospitalized during desensitization. The outpatient rapid, 4-step, one-solution desensitization protocol was effective and appeared safe among gynecologic oncology patients who experienced mild to low-risk, moderate HSRs to carboplatin/cisplatin. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. Restrictions on Oral and Parenteral Intake for Low-risk Labouring Women in Hospitals Across Canada: A Cross-Sectional Study.

    Science.gov (United States)

    Chackowicz, Ariel; Spence, Andrea R; Abenhaim, Haim A

    2016-11-01

    The dietary intake allowed during the latent and active phases of labour varies between Canadian hospitals. Our objective was to document current restrictions on oral and parenteral intake for low-risk labouring women in hospitals across Canada. We carried out a cross-sectional study of 118 Canadian hospitals that have specialized birthing centres. Information on dietary protocols for low-risk women in labour was obtained from each hospital via a brief telephone interview with the head nurse of each birthing centre. Data were presented by stage of labour, both with and without epidural anaesthesia, and also by dextrose supplementation of intravenous fluids. If epidural anaesthesia was not used during the active phase of labour, oral intake was restricted to clear fluids and/or ice chips in 50.9% of surveyed hospitals and oral intake could include solid food in 38.1%. However, when epidural anaesthesia was used during the active phase of labour, oral intake was restricted to clear fluids and ice chips in 82.8% of surveyed hospitals, while oral intake could include solid food in 7.2%. Furthermore, in 77.5% of hospitals, not only was oral intake during active labour with epidural anaesthesia limited to clear fluids and/or ice chips, but in addition this restrictive diet was not supplemented with parenteral dextrose. The majority of low-risk pregnant women in Canadian hospitals are subjected to caloric restriction during the active phase of labour, especially when epidural anaesthesia is administered. Further studies on this subject are warranted because such pervasive practices may have important population effects on labouring women. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  8. Eficácia de dinoprostone e misoprostol para indução do trabalho de parto em nulíparas Efficacy of dinoprostone and misoprostol for labor induction in nulliparous women

    Directory of Open Access Journals (Sweden)

    Tenilson Amaral Oliveira

    2011-03-01

    Full Text Available OBJETIVO: verificar a eficácia e a segurança de dinoprostone e misoprostol para indução do parto vaginal, com ou sem o uso de ocitocina em nulíparas. MÉTODOS: realizou-se estudo retrospectivo, observacional, envolvendo 238 pacientes que foram submetidas à indução do parto de janeiro de 2008 a fevereiro de 2010 com uso de misoprostol 25 mcg via vaginal ou pessário contendo 10 mg de dinoprostone. Desse grupo, foram selecionadas 184 pacientes, que apresentavam as seguintes características: nulíparas, gestação entre 37 e 42 semanas, feto único, apresentação cefálica, membranas íntegras e índice de Bishop PURPOSE: to determine the efficacy and safety of dinoprostone and misoprostol for the induction of vaginal childbirth, with or without the use of oxytocin in nulliparous women. METHODS: in this retrospective observational study, 238 patients were subjected to the induction of delivery from January 2008 to February 2010 with the use of misoprostol 25 mcg by the vaginal route or a pessary containing 10 mg of dinoprostone. A total of 184 patients were selected, with the following characteristics: nulliparous, gestational age of 37-42 weeks, singleton pregnancies, cephalic presentation, intact membranes, and Bishop score < 3. Obstetric and neonatal data were analyzed and compared between groups. The Student t-test, chi-square test and Fisher's exact test were used for statistical analysis, with the level of significance set at p<0.05. RESULTS: the rate of vaginal childbirth did not differ significantly in patients who used misoprostol and dinoprostone (43.2% versus 50%; p = 0.35, respectively. The ripening of cervix was higher in the group treated with misoprostol (87.3% versus 75.6%, p=0.04. The use of oxytocin was necessary in 58.8% of the misoprostol group and 57.3% in the dinoprostone group after the ripening of cervix. Failed induction was the primary indication of caesarean section delivery in both groups, with no significant

  9. Randomized phase II trial of urethral sparing intensity modulated radiation therapy in low-risk prostate cancer: implications for focal therapy

    International Nuclear Information System (INIS)

    Vainshtein, Jeffrey; Hamstra, Daniel A; Abu-Isa, Eyad; Olson, Karin B; Ray, Michael E; Sandler, Howard M; Normolle, Dan; Litzenberg, Dale W; Masi, Kathryn; Pan, Charlie

    2012-01-01

    Low-risk prostate cancer (PCa) patients have excellent outcomes, with treatment modality often selected by perceived effects on quality of life. Acute urinary symptoms are common during external beam radiotherapy (EBRT), while chronic symptoms have been linked to urethral dose. Since most low-risk PCa occurs in the peripheral zone (PZ), we hypothesized that EBRT using urethral sparing intensity modulated radiation therapy (US-IMRT) could improve urinary health-related quality of life (HRQOL) while maintaining high rates of PCa control. Patients with National Comprehensive Cancer Network (NCCN) defined low-risk PCa with no visible lesion within 5 mm of the prostatic urethra on MRI were randomized to US-IMRT or standard (S-) IMRT. Prescription dose was 75.6 Gy in 41 fractions to the PZ + 3–5 mm for US-IMRT and to the prostate + 3 mm for S-IMRT. For US-IMRT, mean proximal and distal urethral doses were limited to 65 Gy and 74 Gy, respectively. HRQOL was assessed using the Expanded Prostate Cancer Index (EPIC) Quality of Life questionnaire. The primary endpoint was change in urinary HRQOL at 3 months. From June 2004 to November 2006, 16 patients were randomized, after which a futility analysis concluded that continued accrual was unlikely to demonstrate a difference in the primary endpoint. Mean change in EPIC urinary HRQOL at 3 months was −0.5 ± 11.2 in the US-IMRT arm and +3.9 ± 15.3 in the S-IMRT arm (p = 0.52). Median PSA nadir was higher in the US-IMRT arm (1.46 vs. 0.78, p = 0.05). At 4.7 years median follow-up, three US-IMRT and no S-IMRT patients experienced PSA failure (p = 0.06; HR 8.8, 95% CI 0.9–86). Two out of 3 patients with PSA failure had biopsy-proven local failure, both located contralateral to the original site of disease. Compared with S-IMRT, US-IMRT failed to improve urinary HRQOL and resulted in higher PSA nadir and inferior biochemical control. The high rate of PSA failure and contralateral local failures in US-IMRT patients, despite

  10. Randomized phase II trial of urethral sparing intensity modulated radiation therapy in low-risk prostate cancer: implications for focal therapy

    Directory of Open Access Journals (Sweden)

    Vainshtein Jeffrey

    2012-06-01

    Full Text Available Abstract Background Low-risk prostate cancer (PCa patients have excellent outcomes, with treatment modality often selected by perceived effects on quality of life. Acute urinary symptoms are common during external beam radiotherapy (EBRT, while chronic symptoms have been linked to urethral dose. Since most low-risk PCa occurs in the peripheral zone (PZ, we hypothesized that EBRT using urethral sparing intensity modulated radiation therapy (US-IMRT could improve urinary health-related quality of life (HRQOL while maintaining high rates of PCa control. Methods Patients with National Comprehensive Cancer Network (NCCN defined low-risk PCa with no visible lesion within 5 mm of the prostatic urethra on MRI were randomized to US-IMRT or standard (S- IMRT. Prescription dose was 75.6 Gy in 41 fractions to the PZ + 3–5 mm for US-IMRT and to the prostate + 3 mm for S-IMRT. For US-IMRT, mean proximal and distal urethral doses were limited to 65 Gy and 74 Gy, respectively. HRQOL was assessed using the Expanded Prostate Cancer Index (EPIC Quality of Life questionnaire. The primary endpoint was change in urinary HRQOL at 3 months. Results From June 2004 to November 2006, 16 patients were randomized, after which a futility analysis concluded that continued accrual was unlikely to demonstrate a difference in the primary endpoint. Mean change in EPIC urinary HRQOL at 3 months was −0.5 ± 11.2 in the US-IMRT arm and +3.9 ± 15.3 in the S-IMRT arm (p = 0.52. Median PSA nadir was higher in the US-IMRT arm (1.46 vs. 0.78, p = 0.05. At 4.7 years median follow-up, three US-IMRT and no S-IMRT patients experienced PSA failure (p = 0.06; HR 8.8, 95% CI 0.9–86. Two out of 3 patients with PSA failure had biopsy-proven local failure, both located contralateral to the original site of disease. Conclusions Compared with S-IMRT, US-IMRT failed to improve urinary HRQOL and resulted in higher PSA nadir and inferior biochemical

  11. Effects of angiotensin-converting enzyme inhibition in low-risk patients early after coronary artery bypass surgery

    NARCIS (Netherlands)

    Rouleau, Jean L.; Warnica, Wayne J.; Baillot, Richard; Block, Pierre J.; Chocron, Sidney; Johnstone, David; Myers, Martin G.; Calciu, Cristina-Dana; Dalle-Ave, Sonia; Martineau, Pierre; Mormont, Christine; van Gilst, Wiek H.

    2008-01-01

    Background-Early after coronary artery bypass surgery (CABG), activation of numerous neurohumoral and endogenous vasodilator systems occurs that could be influenced favorably by angiotensin-converting enzyme inhibitors. Methods and Results-The Ischemia Management with Accupril post -bypass Graft via

  12. The effect of prophylactic intravenous tranexamic acid on blood loss after vaginal delivery in women at low risk of postpartum haemorrhage: a double-blind randomised controlled trial.

    Science.gov (United States)

    Mirghafourvand, Mojgan; Mohammad-Alizadeh, Sakineh; Abbasalizadeh, Fatemeh; Shirdel, Mina

    2015-02-01

    To determine the effect of prophylactic tranexamic acid (TA) on calculated and measured blood loss after vaginal delivery in women at low risk of postpartum haemorrhage. In this double-blind randomised controlled trial, 120 women with a singleton pregnancy were randomly allocated to receive either one gram intravenous TA or placebo in addition to 10 IU oxytocin after delivery of the fetus. Calculated blood loss was determined based on haematocrit before delivery and 12-24 h postdelivery. The quantity of blood loss was measured during two time periods: from delivery of the fetus to placental expulsion and from placental expulsion to the end of the second hour after childbirth. The mean (SD) calculated total blood loss (519 (320) vs 659 (402) mL, P = 0.036) and measured blood loss from placental delivery to 2 h postpartum (69 (39) vs 108 (53) mL, P  1000 mL was lower in the TA group (7% vs 18%, P = 0.048). Prophylactic TA reduces blood loss after vaginal delivery in women with a low risk of postpartum haemorrhage. The prophylactic use of TA may reduce blood loss complications and enhance maternal health. © 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

  13. Performance of Interleukin-6 and Interleukin-8 serum levels in pediatric oncology patients with neutropenia and fever for the assessment of low-risk

    Directory of Open Access Journals (Sweden)

    Kontny Udo

    2008-03-01

    Full Text Available Abstract Background Patients with chemotherapy-related neutropenia and fever are usually hospitalized and treated on empirical intravenous broad-spectrum antibiotic regimens. Early diagnosis of sepsis in children with febrile neutropenia remains difficult due to non-specific clinical and laboratory signs of infection. We aimed to analyze whether IL-6 and IL-8 could define a group of patients at low risk of septicemia. Methods A prospective study was performed to assess the potential value of IL-6, IL-8 and C-reactive protein serum levels to predict severe bacterial infection or bacteremia in febrile neutropenic children with cancer during chemotherapy. Statistical test used: Friedman test, Wilcoxon-Test, Kruskal-Wallis H test, Mann-Whitney U-Test and Receiver Operating Characteristics. Results The analysis of cytokine levels measured at the onset of fever indicated that IL-6 and IL-8 are useful to define a possible group of patients with low risk of sepsis. In predicting bacteremia or severe bacterial infection, IL-6 was the best predictor with the optimum IL-6 cut-off level of 42 pg/ml showing a high sensitivity (90% and specificity (85%. Conclusion These findings may have clinical implications for risk-based antimicrobial treatment strategies.

  14. Gender- and parity-specific reference charts for fetal size in low risk singleton pregnancies at the onset of the third trimester.

    Science.gov (United States)

    De Reu, Paul; Smits, Luc J; Oosterbaan, Herman P; Snijders, Rosalinde J; De Reu-Cuppens, Marga J; Nijhuis, Jan G

    2007-01-01

    To determine fetal growth in low risk pregnancies at the beginning of the third trimester and to assess the relative importance of fetal gender and maternal parity. Dutch primary care midwifery practice. Retrospective cohort study on 3641 singleton pregnancies seen at a primary care midwifery center in the Netherlands. Parameters used for analysis were fetal abdominal circumference (AC), fetal head circumference (HC), gestational age, fetal gender and maternal parity. Regression analysis was applied to describe variation in AC and HC with gestational age. Means and standard deviations in the present population were compared with commonly used reference charts. Multiple regression analysis was applied to examine whether gender and parity should be taken into account. The fetal AC and HC increased significantly between the 27th and the 33rd week of pregnancy (AC r2=0.3652, Pgender was a significant determinant for both AC (PParity contributed significantly to AC only but the difference was small (beta=0.00464). At the beginning of the third trimester, fetal size is associated with fetal gender and, to a lesser extent, with parity. Some fetal growth charts (e.g., Chitty et al.) are more suitable for the low-risk population in the Netherlands than others.

  15. Intelligent Structured Intermittent Auscultation (ISIA): evaluation of a decision-making framework for fetal heart monitoring of low-risk women

    Science.gov (United States)

    2014-01-01

    Background Research-informed fetal monitoring guidelines recommend intermittent auscultation (IA) for fetal heart monitoring for low-risk women. However, the use of cardiotocography (CTG) continues to dominate many institutional maternity settings. Methods A mixed methods intervention study with before and after measurement was undertaken in one secondary level health service to facilitate the implementation of an initiative to encourage the use of IA. The intervention initiative was a decision-making framework called Intelligent Structured Intermittent Auscultation (ISIA) introduced through an education session. Results Following the intervention, medical records review revealed an increase in the use of IA during labour represented by a relative change of 12%, with improved documentation of clinical findings from assessments, and a significant reduction in the risk of receiving an admission CTG (RR 0.75, 95% CI, 0.60 – 0.95, p = 0.016). Conclusion The ISIA informed decision-making framework transformed the practice of IA and provided a mechanism for knowledge translation that enabled midwives to implement evidence-based fetal heart monitoring for low risk women. PMID:24884597

  16. Outcome of planned home and hospital births among low-risk women in Iceland in 2005-2009: a retrospective cohort study.

    Science.gov (United States)

    Halfdansdottir, Berglind; Smarason, Alexander Kr; Olafsdottir, Olof A; Hildingsson, Ingegerd; Sveinsdottir, Herdis

    2015-03-01

    At 2.2 percent in 2012, the home birth rate in Iceland is the highest in the Nordic countries and has been rising rapidly in the new millennium. The objective of this study was to compare the outcomes of planned home births and planned hospital births in comparable low-risk groups in Iceland. The study is a retrospective cohort study comparing the total population of 307 planned home births in Iceland in 2005-2009 to a matched 1:3 sample of 921 planned hospital births. Regression analysis, adjusted for confounding variables, was performed for the primary outcome variables. The rate of oxytocin augmentation, epidural analgesia, and postpartum hemorrhage was significantly lower when labor started as a planned home birth. Differences in the rates of other primary outcome variables were not significant. The home birth group had lower rates of operative birth and obstetric anal sphincter injury. The rate of 5-minute Apgar score home and hospital birth groups, but the home birth group had a higher rate of neonatal intensive care unit admission. Intervention and adverse outcome rates in both study groups, including transfer rates, were higher among primiparas than multiparas. Oxytocin augmentation, epidural analgesia, and postpartum hemorrhage rates were significantly interrelated. This study adds to the growing body of evidence that suggests that planned home birth for low-risk women is as safe as planned hospital birth. © 2015 Wiley Periodicals, Inc.

  17. The impact of umbilical and uterine artery Doppler indices on antenatal course, labor and delivery in a low-risk primigravid population.

    LENUS (Irish Health Repository)

    Cooley, Sharon M

    2012-02-01

    AIMS: To evaluate the impact of umbilical and uterine artery Doppler in the second and third trimester on antenatal course, labor and delivery in a low-risk primigravid population. METHODS: Prospective recruitment of 1011 low-risk primigravidas with uterine and umbilical artery Doppler assessment at 22-24 weeks and 36 weeks. All mothers and infants were reviewed postnatally with a retrospective analysis of ultrasound and clinical outcome data. RESULTS: Elevated uterine artery indices were associated with increased rates of threatened miscarriage, higher rates of pre-eclampsia (PET) and a higher incidence of fetal birth weight <2nd and 9th centile for gestation. Uterine artery pulsatility index (PI) >95th centile for gestation was associated with statistically higher rates of small-for-gestational age (SGA) infants. Elevated umbilical artery indices were associated with higher rates of induction of labor and a higher incidence of fetal birth weight infants <2nd and 9th centile for gestation. Umbilical artery PI >95th centile for gestation was associated with statistically higher rates of SGA infants. CONCLUSION: Elevated uterine and umbilical artery indices are associated with higher rates of maternal and fetal disease.

  18. Quality of antenatal care provided by nurse midwives in an Urban health centre with regard to low-risk antenatal mothers

    Directory of Open Access Journals (Sweden)

    Ruby Angeline Pricilla

    2017-01-01

    Full Text Available Background:India contributes to 19% of the global maternal deaths. Good quality antenatal care can prevent maternal deaths by early detection of complications and maintaining maternal health. There are few studies documenting quality of antenatal care in India. This study aimed to document the antenatal services provided by nurse midwives to low-risk pregnant mothers from an urban population. Aims: The primary objective was to describe the quality of the antenatal care provided by nurse midwives of an urban health centre with regard to low-risk mothers. The secondary objective was to document the maternal and early neonatal outcomes of the enrolled mothers during the period of study. Methods: This prospective cohort study was done on 200 pregnant women who had antenatal care by nurse midwives between April 2014 and November 2014. The quality of care was assessed by a checklist adapted from World Health Organization (WHO. Results: We report that the quality of antenatal care for all domains was above 90% except for the health education domain, which was poor with regard to breastfeeding and family planning in the enrolled 200 pregnant women. Conclusion: Our study concluded that trained nurse midwives when regularly monitored, audited and linked with reliable referral facilities can deliver good quality antenatal care.

  19. Survival benefit associated with adjuvant androgen deprivation therapy combined with radiotherapy for high- and low-risk patients with nonmetastatic prostate cancer

    International Nuclear Information System (INIS)

    Zeliadt, Steven B.; Potosky, Arnold L.; Penson, David F.; Etzioni, Ruth

    2006-01-01

    Background: The use of adjuvant androgen deprivation therapy (ADT) combined with radiotherapy has become common in low-risk patients, although clinical trials have focused primarily on high-risk patients. This study examines the effectiveness of adjuvant ADT combined with radiotherapy for a wide range of patients treated in the 1990s. Methods and Materials: Prostate cancer survival was examined in a population based cohort of 31,643 patients aged 65 to 85 years who were diagnosed with nonmetastatic prostate cancer and treated with external beam radiotherapy and/or brachytherapy. Instrumental variable analysis methods were used to control for selection bias. Results: Patients with stage T3/T4 disease who received adjuvant ADT experienced improved 5-year and 8-year survival. No survival advantage was observed for men with T1/T2 disease during this interval. Conclusion: High-risk patients who receive primary radiotherapy have benefited from adjuvant ADT, whereas low-risk patients with disease confined to the prostate have not yet benefited from adjuvant therapy within the first 8 years after treatment. These findings are consistent with practice guidelines, which recommend adjuvant ADT for patients with high-risk disease

  20. Limiting overdiagnosis of low-risk prostate cancer through an evaluation of the predictive value of transrectal and power Doppler ultrasonography.

    Science.gov (United States)

    Sauvain, Jean Luc; Sauvain, Elise; Papavero, Roger; Louis, Didier; Rohmer, Paul

    2016-12-01

    Overdiagnosis induced by prostate cancer screening makes necessary a better selection of candidate patients for prostate biopsy. The objective of our study is to assess the probability of having a high- or low-risk lesion that could require active surveillance (AS) after biopsies and a normal or abnormal examination, including transrectal and power Doppler ultrasonography (TRUS-PDS). Four hundred and twenty-nine consecutive patients with a PSA level risk of a biological recurrence and Dall'Era's criteria to assess possible AS. The TRUS-PDS was considered positive if one biopsy was positive in the same sextant as the suspect image. One hundred and seventy-seven out of 429 (41 %) T1c cancers were diagnosed; 131 out of 177 (74 %) could be qualified as low risk, and 119 out of 177 (67 %) could require AS. The TRUS-PDS was normal in 285 of 429 patients (66 %). With a normal TRUS-PDS, the probability of not having cancer with a high or intermediate risk was 96 % (negative predictive value). With an abnormal TRUS-PDS, the probability of having a positive biopsy was 59 %, and the probability of having a significant cancer was 30 %, according to the Dall'Era criteria. When TRUS-PDS was normal, these probabilities significantly decreased to 32 and 5 %, respectively ( p  risk of high- or intermediate-risk cancer.

  1. Maternal and neonatal outcomes in birth centers versus hospitals among women with low-risk pregnancies in Japan: A retrospective cohort study.

    Science.gov (United States)

    Kataoka, Yaeko; Masuzawa, Yuko; Kato, Chiho; Eto, Hiromi

    2018-01-01

    In order for low-risk pregnant women to base birth decisions on the risks and benefits, they need evidence of birth outcomes from birth centers. The purpose of this study was to describe and compare the maternal and neonatal outcomes of low-risk women who gave birth in birth centers and hospitals in Japan. The participants were 9588 women who had a singleton vaginal birth at 19 birth centers and two hospitals in Tokyo. The data were collected from their medical records, including their age, parity, mode of delivery, maternal position at delivery, duration of labor, intrapartum blood loss, perineal trauma, gestational weeks at birth, birth weight, Apgar score, and stillbirths. For the comparison of birth centers with hospitals, adjusted odds ratios for the birth outcomes were estimated by using a logistic regression analysis. The number of women who had a total blood loss of >1 L was higher in the midwife-led birth centers than in the hospitals but the incidence of perineal lacerations was lower. There were fewer infants who were born at the midwife-led birth centers with Apgar scores of birth centers and hospitals. Additional research, using matched baseline characteristics, could clarify the comparisons for maternal and neonatal outcomes. © 2017 Japan Academy of Nursing Science.

  2. Financial impact of outpatient clinic radioiodine therapy with sodium iodide I-131 for the treatment of patients with differentiated low-risk thyroid carcinoma in relation to hospital doses; Impacto financeiro da radioiodoterapia ambulatorial com iodeto de sódio I-131 para tratamento de pacientes com carcinoma diferenciado da tireóide de baixo risco em relação às doses hospitalares

    Energy Technology Data Exchange (ETDEWEB)

    Berenguer, P.F.; Chang, T.M.C.; Silva, R.A.M.; Neto, A.H.D.; Belo, I.B., E-mail: pricilaberenguer@gmail.com [Instituto de Medicina Integral Professor Fernando Figueira, Recife, PE (Brazil). Serviço de Medicina Nuclear; Santos, M.A.P. [Centro Regional de Ciências Nucleares do Nordeste (CRCN-NE/CNEN-PE), Recife (Brazil). Coordenação de Radioproteção

    2017-07-01

    Differential thyroid carcinoma (CDT) is the most prevalent endocrine malignancy in the world, with an excellent prognosis and a 10-year survival rate of over 95%. By 2013, the lowest activity of I-131 authorized by the Brazilian Unified Health System (SUS) in the therapy of patients with low-risk CDT was 3,700 MBq, requiring hospitalization. Recent studies have shown similar effectiveness between low and high doses of I-131 in the treatment of low-risk CDT. In 2014, the Ministry of Health included in the list of SUS procedures the use of lower activities (1,110 MBq and 1,850 MBq) for this purpose. The Brazilian National Nuclear Energy Commission (CNEN) also authorized the outpatient use of activity up to 1,850 MBq of I-131. Objective: To evaluate the financial impact of the adoption of ambulatory radioiodine therapy in patients with CDT of low-risk when compared to the hospital dose. Methods: Analysis of patients with CDT low-risk who were treated with an outpatient dose of I-131 from August / 2014 to January / 2017 at a nuclear medicine service in Recife, PE, Brazil. The cost of outpatient versus hospital doses was calculated. Results: A total of 289 patients underwent low doses of iodine therapy were evaluated, resulting in a savings of R$227,793.80. Conclusion: Outpatient radioiodine therapy in the treatment of patients with CDT of low-risk resulted in a 61.10% reduction in SUS expense, in addition to enabling faster care.

  3. Milk intake is not associated with low risk of diabetes or overweight-obesity: a Mendelian randomization study in 97,811 Danish individuals.

    Science.gov (United States)

    Bergholdt, Helle K M; Nordestgaard, Børge G; Ellervik, Christina

    2015-08-01

    High dairy/milk intake has been associated with a low risk of type 2 diabetes observationally, but whether this represents a causal association is unknown. We tested the hypothesis that high milk intake is associated with a low risk of type 2 diabetes and of overweight-obesity, observationally and genetically. In 97,811 individuals from the Danish general population, we examined the risk of incident type 2 diabetes and of overweight-obesity by milk intake observationally and by LCT-13910 C/T genotype [polymorphism (rs4988235) upstream from the lactase (LCT) gene], where TT and TC genotypes are associated with lactase persistence and CC with nonpersistence. Observationally for any compared with no milk intake, the HR for type 2 diabetes was 1.10 (95% CI: 0.98, 1.24; P = 0.11), whereas the OR for overweight-obesity was 1.06 (1.02, 1.09; P = 0.002). Median milk intake was 5 glasses/wk (IQR: 0-10) for lactase TT/TC persistence and 3 (0-7) for CC nonpersistence. Genetically for lactase TT/TC persistence compared with CC nonpersistence, the OR was 0.96 (0.86, 1.08; P = 0.50) for type 2 diabetes and 1.06 (1.00, 1.12; P = 0.04) for overweight-obesity. In a stratified analysis for type 2 diabetes, corresponding values in those with and without milk intake were 0.88 (0.76, 1.03; P = 0.11) and 1.35 (1.07, 1.70; P = 0.01) (P-interaction: 0.002), whereas no gene-milk interaction on overweight-obesity was found. For a 1-glass/wk higher milk intake, the genetic risk ratio for type 2 diabetes was 0.99 (0.93, 1.06), and the corresponding observational risk was 1.01 (1.00, 1.01). For overweight-obesity, the corresponding values were 1.01 (1.00, 1.02) genetically and 1.00 (1.00, 1.01) observationally. High milk intake is not associated with a low risk of type 2 diabetes or overweight-obesity, observationally or genetically via lactase persistence. The higher risk of type 2 diabetes in lactase-persistent individuals without milk intake likely is explained by collider stratification

  4. An assessment of Prostate Cancer Research International: Active Surveillance (PRIAS) criteria for active surveillance of clinically low-risk prostate cancer patients

    Science.gov (United States)

    da Silva, Vitor; Cagiannos, Ilias; Lavallée, Luke T.; Mallick, Ranjeeta; Witiuk, Kelsey; Cnossen, Sonya; Eastham, James A.; Fergusson, Dean A.; Morash, Chris; Breau, Rodney H.

    2017-01-01

    Introduction Active surveillance is a strategy to delay or prevent treatment of indolent prostate cancer. The Prostate Cancer Research International: Active Surveillance (PRIAS) criteria were developed to select patients for prostate cancer active surveillance. The objective of this study was to compare pathological findings from PRIAS-eligible and PRIAS-ineligible clinically low-risk prostate cancer patients. Methods A D’Amico low-risk cohort of 1512 radical prostatectomy patients treated at The Ottawa Hospital or Memorial Sloan Kettering Cancer Centre between January 1995 and December 2007 was reviewed. Pathological outcomes (pT3 tumours, Gleason sum ≥7, lymph node metastases, or a composite) and clinical outcomes (prostate-specific antigen [PSA] recurrence, secondary cancer treatments, and death) were compared between PRIAS-eligible and PRIAS-ineligible cohorts. Results The PRIAS-eligible cohort (n=945) was less likely to have Gleason score ≥7 (odds ratio [OR] 0.61; 95% confidence interval [CI] 0.49–0.75), pT3 (OR 0.41; 95% CI 0.31–0.55), nodal metastases (OR 0.37; 95% CI 0.10–1.31), or any adverse feature (OR 0.56; 95% CI 0.45–0.69) compared to the PRIAS-ineligible cohort. The probability of any adverse pathology in the PRIAS-eligible cohort was 41% vs. 56% in the PRIAS-ineligible cohort. At median follow-up of 3.7 years, 72 (4.8%) patients had a PSA recurrence, 24 (1.6%) received pelvic radiation, and 13 (0.9%) received androgen deprivation. No difference was detected for recurrence-free and overall survival between groups (recurrence hazard ratio [HR] 0.71; 95% CI 0.46–1.09 and survival HR 0.72; 95% CI 0.36–1.47). Conclusions Low-risk prostate cancer patients who met PRIAS eligibility criteria are less likely to have higher-risk cancer compared to those who did not meet at least one of these criteria. PMID:28798822

  5. Incidence of ventricular tachyarrhythmias during permanent pacemaker therapy in low-risk patients results from the German multicentre EVENTS study.

    Science.gov (United States)

    Faber, Thomas S; Gradinger, Robert; Treusch, Sven; Morkel, Carsten; Brachmann, Johannes; Bode, Christoph; Zehender, Manfred

    2007-09-01

    Current studies found an incidence of 12-31% ventricular tachyarrhythmias and sudden cardiac death during cardiac pacing months or even years after pacemaker insertion. MADIT(12) and MUSTT(13) demonstrated that patients with poor LV function after Myocardial infarction (MI) showing non-sustained ventricular tachycardia (nsVT) and inducibility during electrophysiologic testing benefit from an ICD. The present study was dedicated to assess the global incidence of non-sustained ventricular arrhythmias in a general population of pacemaker patients. Special regard was on patients with a potential ICD indication, e.g. those matching the MADIT/MUSTT criteria. Two hundred and thirty-one patients (72 +/- 11 years; 134 men) with an indication for dual chamber pacing entered the study. In all patients pacemaker systems capable of automatic storing of intracardiac electrocardiograms were implanted (Pulsar, Discovery, Guidant). Follow-up time was 15 months after inclusion. In 54 (25.7%) of 210 patients with at least one follow-up, episodes of nsVT were documented by stored electrocardiograms (up to >30 beats, >200 b.p.m.). Multiple-up to nine-episodes of ventricular tachycardia were retrieved in 31 of these patients. Three out of 14 patients with an LVEF <40% after MI presented nsVT during the follow-up. One of these patients received an ICD. A significant number of pacemaker patients present with ventricular tachycardia. Intracardiac electrocardiograms and alert functions from pacemakers may enhance physicians' awareness of the patient's intrinsic arrhythmic profile and help uncover underlying mechanisms of arrhythmias by storing the initiation of the arrhythmia.

  6. Intermittent auscultation of fetal heart rate during labour - a widely accepted technique for low risk pregnancies: but are the current national guidelines robust and practical?

    Science.gov (United States)

    Sholapurkar, S L

    2010-01-01

    Intermittent auscultation of fetal heart rate is an accepted practice in low risk labours in many countries. National guidelines on intrapartum fetal monitoring were critically reviewed regarding timing and frequency of intermittent auscultation. Hypothetical but plausible examples are presented to illustrate that it may be possible to miss significant fetal distress with strict adherence to current guidelines. Opinion is forwarded that intermittent auscultation should be performed for 60 seconds before and after three contractions over about 10 min every half an hour in the first stage of labour. Reasons are put forward to show how this could be more practical and patient friendly and at the same time could improve detection of fetal distress. The current recommendation of intermittent auscultation every 15 min in the first stage is associated with poor compliance and leads to unnecessary burden, stress and medicolegal liability for birth attendants. Modification of current national guidelines would be desirable.

  7. Brain Derived Neurotrophic Factor (BDNF) levels as a possible predictor of psychopathology in healthy twins at high and low risk for affective disorder

    DEFF Research Database (Denmark)

    Vinberg, Maj; Miskowiak, Kamilla; Kessing, Lars Vedel

    2014-01-01

    and low risk twins, respectively). Participants were followed up longitudinally with questionnaires at 6-month intervals for mean seven years and then reassessed with a personal interview to obtain information about whether they had developed psychiatric illness. At follow-up 36 participants (15.4%) had...... developed psychiatric disorder. Cox regression analysis revealed that BDNF levels at baseline were not associated with onset of illness in this explorative study. Further, two-way interactions between BDNF levels and the Val66Met polymorphism or between familial risk and the Val66Met polymorphism did......Brain Derived Neurotrophic Factor (BDNF) is a potential biomarker of affective disorder. However, longitudinal studies evaluating a potential predictive role of BDNF on subsequent psychopathology are lacking. The aim of this study was to investigate whether BDNF alone or in interaction...

  8. The HEART score is useful to predict cardiovascular risks and reduces unnecessary cardiac imaging in low-risk patients with acute chest pain.

    Science.gov (United States)

    Dai, Siping; Huang, Bo; Zou, Yunliang; Guo, Jianbin; Liu, Ziyong; Pi, Dangyu; Qiu, Yunhong; Xiao, Chun

    2018-06-01

    The present study was to investigate whether the HEART score can be used to evaluate cardiovascular risks and reduce unnecessary cardiac imaging in China.Acute coronary syndrome patients with the thrombosis in myocardial infarction risk score risk HEART score group and 2 patients (1.5%) in the high risk HEART score group had cardiovascular events. The sensitivity of HEART score to predict cardiovascular events was 100% and the specificity was 46.7%. The potential unnecessary cardiac testing was 46.3%. Cox proportional hazards regression analysis showed that per one category increase of the HEART score was associated with nearly 1.3-fold risk of cardiovascular events.In the low-risk acute chest pain patients, the HEART score is useful to physicians in evaluating the risk of cardiovascular events within the first 30 days. In addition, the HEART score is also useful in reducing the unnecessary cardiac imaging.

  9. The AFFORD clinical decision aid to identify emergency department patients with atrial fibrillation at low risk for 30-day adverse events.

    Science.gov (United States)

    Barrett, Tyler W; Storrow, Alan B; Jenkins, Cathy A; Abraham, Robert L; Liu, Dandan; Miller, Karen F; Moser, Kelly M; Russ, Stephan; Roden, Dan M; Harrell, Frank E; Darbar, Dawood

    2015-03-15

    There is wide variation in the management of patients with atrial fibrillation (AF) in the emergency department (ED). We aimed to derive and internally validate the first prospective, ED-based clinical decision aid to identify patients with AF at low risk for 30-day adverse events. We performed a prospective cohort study at a university-affiliated tertiary-care ED. Patients were enrolled from June 9, 2010, to February 28, 2013, and followed for 30 days. We enrolled a convenience sample of patients in ED presenting with symptomatic AF. Candidate predictors were based on ED data available in the first 2 hours. The decision aid was derived using model approximation (preconditioning) followed by strong bootstrap internal validation. We used an ordinal outcome hierarchy defined as the incidence of the most severe adverse event within 30 days of the ED evaluation. Of 497 patients enrolled, stroke and AF-related death occurred in 13 (3%) and 4 (aid included the following: age, triage vitals (systolic blood pressure, temperature, respiratory rate, oxygen saturation, supplemental oxygen requirement), medical history (heart failure, home sotalol use, previous percutaneous coronary intervention, electrical cardioversion, cardiac ablation, frequency of AF symptoms), and ED data (2 hours heart rate, chest radiograph results, hemoglobin, creatinine, and brain natriuretic peptide). The decision aid's c-statistic in predicting any 30-day adverse event was 0.7 (95% confidence interval 0.65, 0.76). In conclusion, in patients with AF in the ED, Atrial Fibrillation and Flutter Outcome Risk Determination provides the first evidence-based decision aid for identifying patients who are at low risk for 30-day adverse events and candidates for safe discharge. Copyright © 2015 Elsevier Inc. All rights reserved.

  10. Accelerated fetal growth in early pregnancy and risk of severe large-for-gestational-age and macrosomic infant: a cohort study in a low-risk population.

    Science.gov (United States)

    Simic, Marija; Wikström, Anna-Karin; Stephansson, Olof

    2017-10-01

    Our objective was to examine the association between fetal growth in early pregnancy and risk of severe large-for-gestational-age (LGA) and macrosomia at birth in a low-risk population. Cohort study that included 68 771 women with non-anomalous singleton pregnancies, without history of diabetes or hypertension, based on an electronic database on pregnancies and deliveries in Stockholm-Gotland Region, Sweden, 2008-2014. We performed multivariable logistic regression to estimate the association between accelerated fetal growth occurring in the first through early second trimester as measured by ultrasound and LGA and macrosomia at birth. Restricted analyses were performed in the groups without gestational diabetes and with normal body mass index (18.5-24.9 kg/m 2 ). When adjusting for confounders, the odds of having a severely LGA or macrosomic infant were elevated in mothers with fetuses that were at least 7 days larger than expected as compared with mothers without age discrepancy at the second-trimester scan (adjusted odds ratio 1.80; 95% CI 1.23-2.64 and adjusted odds ratio 2.15; 95% CI 1.55-2.98, respectively). Additionally, mothers without gestational diabetes and mothers with normal weight had an elevated risk of having a severely LGA or macrosomic infant when the age discrepancy by second-trimester ultrasound was at least 7 days. In a low-risk population, ultrasound-estimated accelerated fetal growth in early pregnancy was associated with an increased risk of having a severely LGA or macrosomic infant. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  11. Radical parametrectomy after 'cut-through' hysterectomy in low-risk early-stage cervical cancer: Time to consider this procedure obsolete.

    Science.gov (United States)

    Pareja, Rene; Echeverri, Lina; Rendon, Gabriel; Munsell, Mark; Gonzalez-Comadran, Mireia; Sanabria, Daniel; Isla, David; Frumovitz, Michael; Ramirez, Pedro T

    2018-03-01

    The goal of this study is to identify predictive factors in patients with a diagnosis of early-stage cervical cancer after simple hysterectomy in order to avoid a radical parametrectomy. A retrospective review was performed of all patients who underwent radical parametrectomy and bilateral pelvic lymphadenectomy at MD Anderson Cancer Center and at the Instituto de Cancerologia Las Americas in Medellin, Colombia from December 1999 to September 2017. We sought to determine the outcomes in patients diagnosed with low-risk factors (squamous, adenocarcinoma or adenosquamous lesions<2cm in size, and invading<10mm) undergoing radical parametrectomy and pelvic lymphadenectomy. A total of 30 patients were included in the study. The median age was 40.4years (range; 26-60) and median body mass index (BMI) was 26.4kg/m 2 (range; 17.7-40.0). A total 22 patients had tumors<1cm and 8 had tumors between 1 and 2cm. A total of 6 (33%) of 18 patients had evidence of lymph-vascular invasion (LVSI). No radical parametrectomy specimen had residual tumor, involvement of the parametrium, vaginal margin positivity, or lymph node metastasis. None of the patients received adjuvant therapy. After a median follow-up of 99months (range; 6-160) only one patient recurred. Radical parametrectomy may be avoided in patients with low-risk early-stage cervical cancer detected after a simple hysterectomy. Rates of residual disease (parametrial or vaginal) and the need for adjuvant treatments or recurrences are very low. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. Development of fine motor skills is associated with expressive language outcomes in infants at high and low risk for autism spectrum disorder.

    Science.gov (United States)

    Choi, Boin; Leech, Kathryn A; Tager-Flusberg, Helen; Nelson, Charles A

    2018-04-12

    A growing body of research suggests that fine motor abilities are associated with skills in a variety of domains in both typical and atypical development. In this study, we investigated developmental trajectories of fine motor skills between 6 and 24 months in relation to expressive language outcomes at 36 months in infants at high and low familial risk for autism spectrum disorder (ASD). Participants included 71 high-risk infants without ASD diagnoses, 30 high-risk infants later diagnosed with ASD, and 69 low-risk infants without ASD diagnoses. As part of a prospective, longitudinal study, fine motor skills were assessed at 6, 12, 18, and 24 months of age and expressive language outcomes at 36 months using the Mullen Scales of Early Learning. Diagnosis of ASD was determined at the infant's last visit to the lab (18, 24, or 36 months) using the Autism Diagnostic Observation Schedule. Hierarchical linear modeling revealed that high-risk infants who later developed ASD showed significantly slower growth in fine motor skills between 6 and 24 months, compared to their typically developing peers. In contrast to group differences in growth from age 6 months, cross-sectional group differences emerged only in the second year of life. Also, fine motor skills at 6 months predicted expressive language outcomes at 3 years of age. These results highlight the importance of utilizing longitudinal approaches in measuring early fine motor skills to reveal subtle group differences in infancy between ASD high-risk and low-risk infant populations and to predict their subsequent language outcomes.

  13. Frequency of CDH1 germline mutations in gastric carcinoma coming from high- and low-risk areas: metanalysis and systematic review of the literature

    International Nuclear Information System (INIS)

    Corso, Giovanni; Marrelli, Daniele; Pascale, Valeria; Vindigni, Carla; Roviello, Franco

    2012-01-01

    The frequency of E-cadherin germline mutations in countries with different incidence rates for gastric carcinoma has not been well established. The goal of this study was to assess the worldwide frequency of CDH1 germline mutations in gastric cancers coming from low- and high-risk areas. English articles using MEDLINE access (from 1998 to 2011). Search terms included CDH1, E-cadherin, germline mutation, gastric cancer, hereditary, familial and diffuse histotype. The study included all E-cadherin germline mutations identified in gastric cancer patients; somatic mutations and germline mutations reported in other tumors were excluded. The method of this study was scheduled in accordance with the 'PRISMA statement for reporting systematic reviews and meta-analyses'. Countries were classified as low- or middle/high risk-areas for gastric carcinoma incidence. Statistical analysis was performed to correlate the CDH1 mutation frequency with gastric cancer incidence areas. A total of 122 E-cadherin germline mutations have been identified; the majority (87.5%) occurred in gastric cancers coming from low-risk areas. In high-risk areas, we identified 16 mutations in which missense mutations were predominant. (68.8%). We verified a significant association between the mutation frequency and the gastric cancer risk area (p < 0.001: overall identified mutations in low- vs. middle/high-risk areas). E-cadherin genetic screenings performed in low-risk areas for gastric cancer identified a higher frequency of CDH1 germline mutations. This data could open new approaches in the gastric cancer prevention test; before proposing a proband candidate for the CDH1 genetic screening, geographic variability, alongside the family history should be considered

  14. Home treatment of patients with low-risk pulmonary embolism with the oral factor Xa inhibitor rivaroxaban. Rationale and design of the HoT-PE Trial.

    Science.gov (United States)

    Barco, Stefano; Lankeit, Mareike; Binder, Harald; Schellong, Sebastian; Christ, Michael; Beyer-Westendorf, Jan; Duerschmied, Daniel; Bauersachs, Rupert; Empen, Klaus; Held, Matthias; Schwaiblmair, Martin; Fonseca, Cândida; Jiménez, David; Becattini, Cecilia; Quitzau, Kurt; Konstantinides, Stavros

    2016-07-04

    Pulmonary embolism (PE) is a potentially life-threatening acute cardiovascular syndrome. However, more than 95 % of patients are haemodynamically stable at presentation, and among them are patients at truly low risk who may qualify for immediate or early discharge. The Home Treatment of Pulmonary Embolism (HoT-PE) study is a prospective international multicentre single-arm phase 4 management (cohort) trial aiming to determine whether home treatment of acute low-risk PE with the oral factor Xa inhibitor rivaroxaban is feasible, effective, and safe. Patients with confirmed PE, who have no right ventricular dysfunction or free floating thrombi in the right atrium or ventricle, are eligible if they meet none of the exclusion criteria indicating haemodynamic instability, serious comorbidity or any condition mandating hospitalisation, or a familial/social environment unable to support home treatment. The first dose of rivaroxaban is given in hospital, and patients are discharged within 48 hours of presentation. Rivaroxaban is taken for at least three months. The primary outcome is symptomatic recurrent venous thromboembolism or PE-related death within three months of enrolment. Secondary outcomes include quality of life and patient satisfaction, and health care resource utilisation compared to existing data on standard-duration hospital treatment. HoT-PE is planned to analyse 1,050 enrolled patients, providing 80 % power to reject the null hypothesis that the recurrence rate of venous thromboembolism is >3 % with α≤0.05. If the hypothesis of HoT-PE is confirmed, early discharge and out-of-hospital treatment may become an attractive, potentially cost-saving option for a significant proportion of patients with acute PE.

  15. Sentinel lymph node biopsy is unsuitable for routine practice in younger female patients with unilateral low-risk papillary thyroid carcinoma

    International Nuclear Information System (INIS)

    Huang, Ou; Xiang, YouQun; Yang, Kai; Zhou, ShuMei; Chen, XueMin; Pan, YiFei; Guo, GuiLong; Zhang, XiaoHua; Wu, WeiLi; Wang, OuChen; You, Jie; Li, Quan; Huang, DuPing; Hu, XiaoQu; Qu, JinMiao; Jin, Cun

    2011-01-01

    Sentinel lymph node (SLN) biopsy has been used to assess patients with papillary thyroid carcinoma (PTC). To achieve its full potential the rate of SLN identification must be as close to 100 percent as possible. In the present study we compared the combination of preoperative lymphoscintigraphy scanning by sulfur colloid labeled with 99 m Technetium, gamma-probe guided surgery, and methylene blue with methylene blue, alone, for sentinel node identification in younger women with unilateral low-risk PTC. From January 2004 to January 2007, 90 female patients, ages 23 to 44 (mean = 35), with unilateral low-risk PTC (T 1-2 N 0 M 0 ) were prospectively studied. Mean tumor size was 1.3 cm (range, 0.8-3.7 cm). All patients underwent unilateral modified neck dissection. Prior to surgery, patients had, by random assignment, identification and biopsy of SLNs by methylene blue, alone (Group 1), or by sulfur colloid labeled with 99 m Technetium, gamma-probe guided surgery and methylene blue (Group 2). In the methylene blue group, SLNs were identified in 39 of 45 patients (86.7%). Of the 39 patients, 28 (71.8%) had positive cervical lymph nodes (pN+), and 21 patients (53.8%) had pSLN+. In 7 of the 28 pN+ patients (25%), metastases were also detected in non-SLN, thus giving a false-negative rate (FNR of 38.9% (7/18), a negative predictive value (NPV) of 61.1% (11/18), and an accuracy of 82.1% (32/39). In the combined technique group, the identification rate (IR) of SLN was 100% (45/45). Of the 45 patients, 27 (60.0%) had pN+, 24 (53.3%) had pSLN+. There was a FNR of 14.3% (3/21), a NPV of 85.7% (18/21), and an accuracy of 93.3% (42/45). The combined techniques group was significantly superior to the methylene blue group in IR (p = 0.035). There were no significant differences between two groups in sensitivity, specificity, NPV, or accuracy. Location of pN+ (55 patients) in 84 patients was: level I and V, no patients; level II, 1 patient (1.2%); level III, 6 patients (7.2%); level

  16. Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): a randomised controlled trial.

    Science.gov (United States)

    Vora, Ajay; Goulden, Nick; Wade, Rachel; Mitchell, Chris; Hancock, Jeremy; Hough, Rachael; Rowntree, Clare; Richards, Sue

    2013-03-01

    Minimal residual disease (MRD) is the most sensitive and specific predictor of relapse risk in children with acute lymphoblastic leukaemia (ALL) during remission. We assessed whether treatment intensity could be adjusted for children and young adults according to MRD risk stratification. Between Oct 1, 2003 and June 30, 2011, consecutive children and young adults (aged 1-25 years) with ALL from the UK and Ireland were recruited. Eligible patients were categorised into clinical standard, intermediate, and high risk groups on the basis of a combination of National Cancer Institute (NCI) criteria, cytogenetics, and early response to induction therapy, which was assessed by bone marrow blast counts taken at days 8 (NCI high-risk patients) and 15 (NCI standard-risk patients) after induction began. Clinical standard-risk and intermediate-risk patients were assessed for MRD. Those classified as MRD low risk (undetectable MRD at the end of induction [day 29] or detectable MRD at day 29 that became undetectable by week 11) were randomly assigned to receive one or two delayed intensification courses. Patients had received induction, consolidation, and interim maintenance therapy before they began delayed intensification. Delayed intensification consisted of pegylated asparaginase on day 4; vincristine, dexamethasone (alternate weeks), and doxorubicin for 3 weeks; and 4 weeks of cyclophosphamide and cytarabine. Computer randomisation was done with stratification by MRD result and balancing for sex, age, and white blood cell count at diagnosis by method of minimisation. Patients, clinicians, and data analysts were not masked to treatment allocation. The primary outcome was event-free survival (EFS), which was defined as time to relapse, secondary tumour, or death. Our aim was to rule out a 7% reduction in EFS in the group given one delayed intensification course relative to that given two delayed intensification courses. Analyses were by intention to treat. This trial is

  17. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial.

    Science.gov (United States)

    Freund, Yonathan; Cachanado, Marine; Aubry, Adeline; Orsini, Charlotte; Raynal, Pierre-Alexis; Féral-Pierssens, Anne-Laure; Charpentier, Sandrine; Dumas, Florence; Baarir, Nacera; Truchot, Jennifer; Desmettre, Thibaut; Tazarourte, Karim; Beaune, Sebastien; Leleu, Agathe; Khellaf, Mehdi; Wargon, Mathias; Bloom, Ben; Rousseau, Alexandra; Simon, Tabassome; Riou, Bruno

    2018-02-13

    The safety of the pulmonary embolism rule-out criteria (PERC), an 8-item block of clinical criteria aimed at ruling out pulmonary embolism (PE), has not been assessed in a randomized clinical trial. To prospectively validate the safety of a PERC-based strategy to rule out PE. A crossover cluster-randomized clinical noninferiority trial in 14 emergency departments in France. Patients with a low gestalt clinical probability of PE were included from August 2015 to September 2016, and followed up until December 2016. Each center was randomized for the sequence of intervention periods. In the PERC period, the diagnosis of PE was excluded with no further testing if all 8 items of the PERC rule were negative. The primary end point was the occurrence of a thromboembolic event during the 3-month follow-up period that was not initially diagnosed. The noninferiority margin was set at 1.5%. Secondary end points included the rate of computed tomographic pulmonary angiography (CTPA), median length of stay in the emergency department, and rate of hospital admission. Among 1916 patients who were cluster-randomized (mean age 44 years, 980 [51%] women), 962 were assigned to the PERC group and 954 were assigned to the control group. A total of 1749 patients completed the trial. A PE was diagnosed at initial presentation in 26 patients in the control group (2.7%) vs 14 (1.5%) in the PERC group (difference, 1.3% [95% CI, -0.1% to 2.7%]; P = .052). One PE (0.1%) was diagnosed during follow-up in the PERC group vs none in the control group (difference, 0.1% [95% CI, -∞ to 0.8%]). The proportion of patients undergoing CTPA in the PERC group vs control group was 13% vs 23% (difference, -10% [95% CI, -13% to -6%]; P < .001). In the PERC group, rates were significantly reduced for the median length of emergency department stay (mean reduction, 36 minutes [95% CI, 4 to 68]) and hospital admission (difference, 3.3% [95% CI, 0.1% to 6.6%]). Among very low-risk patients with suspected

  18. OBSTETRIC AND PERINATAL OUTCOME OF LOW-RISK PREGNANCIES WITH TERM LABOUR AND MECONIUM-STAINED AMNIOTIC FLUID AT ST. PHILOMENA’S HOSPITAL

    Directory of Open Access Journals (Sweden)

    Roopashree D

    2016-12-01

    Full Text Available BACKGROUND Meconium-stained amniotic fluid has been considered as sign of foetal distress in presentations other than breech and is associated with poor foetal outcome, but others consider meconium passage by foetus as physiological phenomenon and procedures of environmental hazards to foetus before birth. MATERIALS AND METHODS 200 women with meconium-stained amniotic fluid in labour, all low-risk pregnancies were included in our study from September 2010 to August 2012 admitted in our department. For uniformity of results, cases with obstetric and medical complications were excluded. The cases were divided into three groups depending upon grades of meconium staining as thin, moderate and thick. Foetal monitoring, uterine contractions and Apgar score, birth weight, resuscitation of baby noted. All babies were followed up to first week of neonatal life. RESULTS Of 200 cases, 147 had caesarean delivery 73.5% and 53 had vaginal delivery 26.5%. The incidence of LSCS was found to be maximum in the thick MSAF group 54.5%, 14% in moderate and 5% in this MSAF group. In moderate MSAF group, 2.17% had <7, 1 minute Apgar. In thick MSAF group, 3.33% had <7 Apgar; in thin MSAF group, 11.76% had <7 Apgar at 1 minute. The p value was 0.094 in all grades of MSAF, the 5 min. Apgar’s were more than 7. The occurrence of complications in the baby did not depend on the mode of delivery. The p value was 0.58, which was insignificant. The ‘p value of association of CTG abnormality and foetal morbidity was significant <0.001. The association of grades of meconium and foetal morbidity, the p value was 0.337, which was insignificant. There was no perinatal mortality in our study. CONCLUSION The incidence of low-risk pregnancies with MSAF in our study was 4.5%. There was increased tendency for LSCS in the MSAF. The foetal morbidity depends on the reactivity to CTG not on grades of MSAF. Therefore, close intrapartum monitoring has to be done in such cases and LSCS done

  19. Utilizing time-driven activity-based costing to understand the short- and long-term costs of treating localized, low-risk prostate cancer.

    Science.gov (United States)

    Laviana, Aaron A; Ilg, Annette M; Veruttipong, Darlene; Tan, Hung-Jui; Burke, Michael A; Niedzwiecki, Douglas R; Kupelian, Patrick A; King, Chris R; Steinberg, Michael L; Kundavaram, Chandan R; Kamrava, Mitchell; Kaplan, Alan L; Moriarity, Andrew K; Hsu, William; Margolis, Daniel J A; Hu, Jim C; Saigal, Christopher S

    2016-02-01

    Given the costs of delivering care for men with prostate cancer remain poorly described, this article reports the results of time-driven activity-based costing (TDABC) for competing treatments of low-risk prostate cancer. Process maps were developed for each phase of care from the initial urologic visit through 12 years of follow-up for robotic-assisted laparoscopic prostatectomy (RALP), cryotherapy, high-dose rate (HDR) and low-dose rate (LDR) brachytherapy, intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and active surveillance (AS). The last modality incorporated both traditional transrectal ultrasound (TRUS) biopsy and multiparametric-MRI/TRUS fusion biopsy. The costs of materials, equipment, personnel, and space were calculated per unit of time and based on the relative proportion of capacity used. TDABC for each treatment was defined as the sum of its resources. Substantial cost variation was observed at 5 years, with costs ranging from $7,298 for AS to $23,565 for IMRT, and they remained consistent through 12 years of follow-up. LDR brachytherapy ($8,978) was notably cheaper than HDR brachytherapy ($11,448), and SBRT ($11,665) was notably cheaper than IMRT, with the cost savings attributable to shorter procedure times and fewer visits required for treatment. Both equipment costs and an inpatient stay ($2,306) contributed to the high cost of RALP ($16,946). Cryotherapy ($11,215) was more costly than LDR brachytherapy, largely because of increased single-use equipment costs ($6,292 vs $1,921). AS reached cost equivalence with LDR brachytherapy after 7 years of follow-up. The use of TDABC is feasible for analyzing cancer services and provides insights into cost-reduction tactics in an era focused on emphasizing value. By detailing all steps from diagnosis and treatment through 12 years of follow-up for low-risk prostate cancer, this study has demonstrated significant cost variation between competing treatments. © 2015

  20. Performance of highly sensitive cardiac troponin T assay to detect ischaemia at PET-CT in low-risk patients with acute coronary syndrome: a prospective observational study.

    Science.gov (United States)

    Morawiec, Beata; Fournier, Stephane; Tapponnier, Maxime; Prior, John O; Monney, Pierre; Dunet, Vincent; Lauriers, Nathalie; Recordon, Frederique; Trana, Catalina; Iglesias, Juan-Fernando; Kawecki, Damian; Boulat, Olivier; Bardy, Daniel; Lamsidri, Sabine; Eeckhout, Eric; Hugli, Olivier; Muller, Olivier

    2017-07-10

    Highly sensitive troponin T (hs-TnT) assay has improved clinical decision-making for patients admitted with chest pain. However, this assay's performance in detecting myocardial ischaemia in a lowrisk population has been poorly documented. To assess hs-TnT assay's performance to detect myocardial ischaemia at positron emission tomography/CT (PET-CT) in low-risk patients admitted with chest pain. Patients admitted for chest pain with a nonconclusive ECG and negative standard cardiac troponin T results at admission and after 6 hours were prospectively enrolled. Their hs-TnT samples were at T0, T2 and T6. Physicians were blinded to hs-TnT results. All patients underwent a PET-CT at rest and during adenosine-induced stress. All patients with a positive PET-CT result underwent a coronary angiography. Forty-eight patients were included. Six had ischaemia at PET-CT. All of them had ≥1 significant stenosis at coronary angiography. Areas under the curve (95% CI) for predicting significant ischaemia at PET-CT using hs-TnT were 0.764 (0.515 to 1.000) at T0, 0.812(0.616 to 1.000) at T2 and 0.813(0.638 to 0.989) at T6. The receiver operating characteristicbased optimal cut-off value for hs-TnT at T0, T2 and T6 needed to exclude significant ischaemia at PET-CT was <4 ng/L. Using this value, sensitivity, specificity, positive and negative predictive values of hs-TnT to predict significant ischaemia were 83%/38%/16%/94% at T0, 100%/40%/19%/100% at T2 and 100%/43%/20%/100% at T6, respectively. Our findings suggest that in low-risk patients, using the hs-TnT assay with a cut-off value of 4 ng/L demonstrates excellent negative predictive value to exclude myocardial ischaemia detection at PET-CT, at the expense of weak specificity and positive predictive value. ClinicalTrials.gov Identifier: NCT01374607. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly

  1. CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison.

    Science.gov (United States)

    Bailitz, John; Starr, Frederic; Beecroft, Matthew; Bankoff, Jon; Roberts, Roxanne; Bokhari, Faran; Joseph, Kimberly; Wiley, Dorian; Dennis, Andrew; Gilkey, Susan; Erickson, Paul; Raksin, Patricia; Nagy, Kimberly

    2009-06-01

    An estimated 10,000 Americans suffer cervical spine injuries each year. More than 800,000 cervical spine radiographs (CSR) are ordered annually. The human and healthcare costs associated with these injuries are enormous especially when diagnosis is delayed. Controversy exists in the literature concerning the diagnostic accuracy of CSR, with reported sensitivity ranging from 32% to 89%. We sought to compare prospectively the sensitivity of cervical CT (CCT) to CSR in the initial diagnosis of blunt cervical spine injury for patients meeting one or more of the NEXUS criteria. The study prospectively compared the diagnostic accuracy of CSR to CCT in consecutive patients evaluated for blunt trauma during 23 months at an urban, public teaching hospital and Level I Trauma Center. Inclusion criteria were adult patient, evaluated for blunt cervical spine injury, meeting one or more of the NEXUS criteria. All patients received both three-view CSR and CCT as part of a standard diagnostic protocol. Each CSR and CCT study was interpreted independently by a different radiology attending who was blinded to the results of the other study. Clinically significant injuries were defined as those requiring one or more of the following interventions: operative procedure, halo application, and/or rigid cervical collar. Of 1,583 consecutive patients evaluated for blunt cervical spine trauma, 78 (4.9%) patients received only CCT or CSR and were excluded from the study. Of the remaining 1,505 patients, 78 (4.9%) had evidence of a radiographic injury by CSR or CCT. Of these 78 patients with radiographic injury, 50 (3.3%) patients had clinically significant injuries. CCT detected all patients with clinically significant injuries (100% sensitive), whereas CSR detected only 18 (36% sensitive). Of the 50 patients, 15 were at high risk, 19 at moderate risk, and 16 at low risk for cervical spine injury according to previously published risk stratification. CSR detected clinically significant

  2. Performance of motor sequences in children at heightened vs. low risk for ASD: A longitudinal study from 18 to 36 months of age

    Directory of Open Access Journals (Sweden)

    VALENTINA eFOCAROLI

    2016-05-01

    Full Text Available Recent research shows that motor difficulties are a prominent component of the behavioral profile of autism spectrum disorder (ASD and are also apparent from early in development in infants who have an older sibling with ASD (High Risk; HR. Delays have been reported for HR infants who do and who do not receive an eventual diagnosis of ASD. A growing body of prospective studies has focused on the emergence of early motor skills primarily during the first year of life. To date, however, relatively little work has examined motor skills in the second and third years. Thus, the present research was designed to investigate motor performance in object transport tasks longitudinally in HR and LR (Low Risk children between the ages of 18 and 36 months. Participants (15 HR children and 14 LR children were observed at 18, 24, and 36 months. Children completed two motor tasks, the Ball Task and the Block Task, each of which included two conditions that varied in terms of the precision demands of the goal action. Kinematic data were acquired via two magneto inertial sensors worn on each wrist. In the Block Task, HR children reached more slowly (i.e., mean acceleration was lower compared to LR children. This finding is in line with growing evidence of early delays in fine motor skills in HR children and suggests that vulnerabilities in motor performance may persist into the preschool years in children at risk for ASD.

  3. Prevalence, incidence and correlates of low risk HPV infection and anogenital warts in a cohort of women living with HIV in Burkina Faso and South Africa.

    Science.gov (United States)

    Chikandiwa, Admire; Kelly, Helen; Sawadogo, Bernard; Ngou, Jean; Pisa, Pedro T; Gibson, Lorna; Didelot, Marie-Noelle; Meda, Nicolas; Weiss, Helen A; Segondy, Michel; Mayaud, Philippe; Delany-Moretlwe, Sinead

    2018-01-01

    To report the prevalence and incidence of low-risk human papillomavirus infection (LR-HPV) and anogenital warts (AGW) among women living with HIV (WLHIV) in Burkina Faso (BF) and South Africa (SA), and to explore HIV-related factors associated with these outcomes. We enrolled 1238 WLHIV (BF = 615; SA = 623) aged 25-50 years and followed them at three time points (6, 12 and 16 months) after enrolment. Presence of AGW was assessed during gynaecological examination. Cervico-vaginal swabs for enrolment and month 16 follow-up visits were tested for HPV infection by Inno-LiPA® genotyping. Logistic regression was used to assess risk factors for prevalent infection or AGW. Cox regression was used to assess risk factors for incident AGW. Women in SA were more likely than those in BF to have prevalent LR-HPV infection (BF: 27.1% vs. SA: 40.9%; p500 cells/μL). Duration of ART and HIV plasma viral load were not associated with any LR-HPV infection or AGW outcomes. LR-HPV infection and AGW are common in WLHIV in sub-Saharan Africa. Type-specific HPV vaccines and effective ART with immunological reconstitution could reduce the burden of AGW in this population.

  4. High-risk versus low-risk football game weekends: differences in problem drinking and alcohol-related consequences on college campuses in the United States.

    Science.gov (United States)

    Champion, Heather; Blocker, Jill N; Buettner, Cynthia K; Martin, Barbara A; Parries, Maria; Mccoy, Thomas P; Mitra, Ananda; Andrews, David W; Rhodes, Scott D

    2009-01-01

    Collegiate football games provide multiple social opportunities for alcohol use by students over the course of the weekend. The goal of this study was to examine alcohol use and alcohol-related consequences on football game weekends to determine differences based on characteristics of the game. A random sample of students from two large, public universities in the United States completed a survey on the Sunday-Friday following a high-risk weekend (HRW, important, home game) and low-risk weekend (LRW, no home game or game of importance) (N = 3,238 total). The survey measured the number of days students drank (0-3) and got drunk (0-3) over the weekend and whether 1+ consequences were experienced due to one's own drinking (yes/no) and due to others' drinking (yes/no). Ordinal logistic regression analyses revealed greater odds of drinking alcohol (OR = 1.70, CI = 1.46-1.97) and getting drunk (OR = 1.49, CI = 1.27-1.76) on HRW versus LRW. Logistic regression analyses revealed greater odds of experiencing 1+ consequences as a result of one's own drinking (OR = 1.38, CI = 1.16-1.63) and experiencing 1+ consequences as a result of others' drinking (OR = 1.52, CI = 1.30-1.78) on HRW versus LRW. These findings suggest that additional prevention efforts aimed at reducing risky drinking are needed over HRW and have implications for campus administrators, law enforcement, and substance abuse program coordinators.

  5. Ponderal index (PI) vs birth weight centiles in the low-risk primigravid population: which is the better predictor of fetal wellbeing?

    LENUS (Irish Health Repository)

    Cooley, S M

    2012-07-01

    Our objective was to compare Ponderal index (PI) with birth weight centiles as predictors of perinatal morbidity and to determine which best reflects the presence of placental disease. We prospectively recruited 1,011 low-risk primigravidas and calculated PI and birth weight centiles following delivery. Perinatal morbidity was defined as: pre-term birth (PTB); fetal acidosis; an Apgar score <7 at 5 min or neonatal resuscitation. Placental disease was defined as chronic uteroplacental insufficiency (CUPI); villous dysmaturity; infection or vascular pathology. Ponderal index was statistically reduced (25.33 vs 27.79 p =0.001) and the incidence of infant birth weight <9th centile was statistically higher (11.1% vs 5.1%; p =0.004) in cases with PTB and in CUPI (26.23 vs 27.84; p =0.001 and 28.2.1% vs 10.4%; p =0.002). Both PI and infant birth weight centile <9th centile for gestational age correlate with PTB, however overall, both are poor predictors of neonatal and placental disease.

  6. Normal value of functional parameters in gated myocardial perfusion SPECT in patients with low risk of coronary artery disease: emory cardiac tool box program

    Energy Technology Data Exchange (ETDEWEB)

    Kang, D. Y.; Kim, M. H.; Kim, Y. D.; Kim, D. K. [Donga University College of Medicine, Busan (Korea, Republic of)

    2002-07-01

    Absolute value of the functional data of gated myocardial perfusion SPECT is necessary to determine that individual patient is normal or not. Tc-99m MIBI gated myocardial perfusion SPECT was performed using emory cardiac tool box program. All patients (M:F=15:36, age 64{+-}10 yrs) showed normal myocardial perfusion. The patients with following characteristics were excluded; previous angina or MI, ECG change with Q wave or ST-T change, diabetes mellitus, hypercholesterolemia, typical chest pain and hypertension. In all patients, myocardial mass is 117{+-}23 g in stress gated SPECT, 106{+-}22 g in stress ungated SPECT and 102{+-}21 g in rest ungated SPECT. EDV is 90{+-}28 ml, ESV 26{+-}20 ml, SV 66{+-}21 ml, EF 73{+-}10 % and TID 1.06{+-}0.14. Myocardial mass in rest ungated SPECT is significantly different between men and women (p=0.025). Myocardial mass is significantly different between stress gated SPECT and stress ungated SPECT (p=0.000), and between stress ungated SPECT and rest ungated SPECT (p=0.003). We provide normal value of functional parameters to determine the abnormality of individual patients in patients with low risk of coronary artery disease.

  7. The nuclear localization of low risk HPV11 E7 protein mediated by its zinc binding domain is independent of nuclear import receptors

    International Nuclear Information System (INIS)

    Piccioli, Zachary; McKee, Courtney H.; Leszczynski, Anna; Onder, Zeynep; Hannah, Erin C.; Mamoor, Shahan; Crosby, Lauren; Moroianu, Junona

    2010-01-01

    We investigated the nuclear import of low risk HPV11 E7 protein using 1) transfection assays in HeLa cells with EGFP fusion plasmids containing 11E7 and its domains and 2) nuclear import assays in digitonin-permeabilized HeLa cells with GST fusion proteins containing 11E7 and its domains. The EGFP-11E7 and EGFP-11cE7 39-98 localized mostly to the nucleus. The GST-11E7 and GST-11cE7 39-98 were imported into the nuclei in the presence of either Ran-GDP or RanG19V-GTP mutant and in the absence of nuclear import receptors. This suggests that 11E7 enters the nucleus via a Ran-dependent pathway, independent of nuclear import receptors, mediated by a nuclear localization signal located in its C-terminal domain (cNLS). This cNLS contains the zinc binding domain consisting of two copies of Cys-X-X-Cys motif. Mutagenesis of Cys residues in these motifs changed the localization of the EGFP-11cE7/-11E7 mutants to cytoplasmic, suggesting that the zinc binding domain is essential for nuclear localization of 11E7.

  8. Active surveillance for low-risk prostate cancer in Austria: the online registry of the Qualitätspartnerschaft Urologie (QuapU).

    Science.gov (United States)

    Eredics, Klaus; Dorfinger, Karl; Kramer, Gero; Ponholzer, Anton; Madersbacher, Stephan

    2017-06-01

    Active surveillance (AS) is a well-recognized strategy to reduce the risk of overtreatment in men with low-risk prostate cancer. No data on this approach are available from Austria. The Qualitätspartnerschaft Urologie (QuapU) developed an online database for patients managed with AS in Austria. Principal inclusion/exclusion criteria corresponded to those of the S3 prostate cancer guideline of German urologists: prostate-specific antigen (PSA) 4-10 ng/ml: 85%). The prostate volume averaged 39 ml. The mean time under AS was 17.5 months (12 months: 40%). The AS adherence at 12 months was 85% and at 24 months 76%. To date, a total of 23 patients (17.6%) stopped AS. The most frequent reasons for discontinuing AS were patient wish for active treatment (43.5%) and PSA progression (30.4%). A histological progression was rarely seen (6.1%) and the control biopsy rate was low (19.8%). This study is the first description of AS in Austria and documents the feasibility of an online registry for AS. The data confirm the international experience with this approach with acceptable adherence rates.

  9. The role of a personalized dietary intervention in managing gestational weight gain: a prospective, controlled study in a low-risk antenatal population.

    Science.gov (United States)

    Di Carlo, Costantino; Iannotti, Giuseppina; Sparice, Stefania; Chiacchio, Maria Pia; Greco, Elena; Tommaselli, Giovanni Antonio; Nappi, Carmine

    2014-04-01

    To compare the efficacy of a personal dietary intervention on gestational weight gain control with a general intervention promoting healthy eating. Prospective, controlled study including 154 low-risk pregnant women randomly allocated to two groups: 77 receiving a personalized diet plan and a close follow-up by a dietician (intervention group), 77 receiving standard dietary care by means of a brochure on healthy eating during pregnancy (control group). Pre-pregnancy weight, gestational age, height, weight and BMI at baseline, weight at term, gestational age at delivery and newborn weight were recorded for all participants. The primary end-point was the difference in body weight between baseline and term. Secondary end-points were the difference in body weight between pre-pregnancy and term and in newborn weights. Maternal weight gain at term was significantly lower both as compared to pre-pregnancy weight (8.2 ± 4.0 vs. 13.4 ± 4.2 kg; p weight at baseline (7.7 ± 3.8 vs. 13.7 ± 4.3 kg; p weight between baseline and term and newborn weight was observed in both groups, but stronger in patients from the intervention group (intervention group R = 0.76, p weight gain in pregnant women.

  10. Detection of serous precursor lesions in resected fallopian tubes from patients with benign diseases and a relatively low risk for ovarian cancer.

    Science.gov (United States)

    Nishida, Naoyo; Murakami, Fumihiro; Higaki, Koichi

    2016-06-01

    The frequency of ovarian cancers in Japan has increased; however, doubts have been raised concerning the mechanism by which high-grade serous adenocarcinomas (HGSCs) arise. Conventionally, HGSC is thought to originate from the ovarian surface epithelium or epithelial inclusion cyst. However, recent data indicate that HGSCs may in fact develop from precursor lesions in the fallopian tube, including epithelia with a p53 signature, serous tubal intraepithelial carcinomas (STICs), secretory cell outgrowths (SCOUTs), and tubal intraepithelial lesions in transition (TILT). Here, we determined the frequency of these fallopian tube precursors in surgically excised samples from 123 patients with benign pelvic diseases. We identified 12 cases with a p53 signature (9.7%), 26 with observable SCOUTs (21.1%), and 4 with TILT (3.2%), but no STIC cases. Although the lifetime risk for developing ovarian cancer is only around 1.4% for women without germ-line mutations, it is important to evaluate the presence of precursor lesions to understand HGSC pathogenesis better. Taken together, salpingectomy appears to be an option for women who are past their childbearing age and plan to undergo elective pelvic surgery. To our knowledge, this is the first study to investigate the presence of these specific precursors post-salpingectomy in low-risk patients. © 2016 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd.

  11. A national standard for psychosocial safety climate (PSC): PSC 41 as the benchmark for low risk of job strain and depressive symptoms.

    Science.gov (United States)

    Bailey, Tessa S; Dollard, Maureen F; Richards, Penny A M

    2015-01-01

    Despite decades of research from around the world now permeating occupational health and safety (OHS) legislation and guidelines, there remains a lack of tools to guide practice. Our main goal was to establish benchmark levels of psychosocial safety climate (PSC) that would signify risk of job strain (jobs with high demands and low control) and depression in organizations. First, to justify our focus on PSC, using interview data from Australian employees matched at 2 time points 12 months apart (n = 1081), we verified PSC as a significant leading predictor of job strain and in turn depression. Next, using 2 additional data sets (n = 2097 and n = 1043) we determined benchmarks of organizational PSC (range 12-60) for low-risk (PSC at 41 or above) and high-risk (PSC at 37 or below) of employee job strain and depressive symptoms. Finally, using the newly created benchmarks we estimated the population attributable risk (PAR) and found that improving PSC in organizations to above 37 could reduce 14% of job strain and 16% of depressive symptoms in the working population. The results provide national standards that organizations and regulatory agencies can utilize to promote safer working environments and lower the risk of harm to employee mental health. PsycINFO Database Record (c) 2014 APA, all rights reserved.

  12. Prevalence, incidence and correlates of low risk HPV infection and anogenital warts in a cohort of women living with HIV in Burkina Faso and South Africa.

    Directory of Open Access Journals (Sweden)

    Admire Chikandiwa

    Full Text Available To report the prevalence and incidence of low-risk human papillomavirus infection (LR-HPV and anogenital warts (AGW among women living with HIV (WLHIV in Burkina Faso (BF and South Africa (SA, and to explore HIV-related factors associated with these outcomes.We enrolled 1238 WLHIV (BF = 615; SA = 623 aged 25-50 years and followed them at three time points (6, 12 and 16 months after enrolment. Presence of AGW was assessed during gynaecological examination. Cervico-vaginal swabs for enrolment and month 16 follow-up visits were tested for HPV infection by Inno-LiPA® genotyping. Logistic regression was used to assess risk factors for prevalent infection or AGW. Cox regression was used to assess risk factors for incident AGW.Women in SA were more likely than those in BF to have prevalent LR-HPV infection (BF: 27.1% vs. SA: 40.9%; p500 cells/μL. Duration of ART and HIV plasma viral load were not associated with any LR-HPV infection or AGW outcomes.LR-HPV infection and AGW are common in WLHIV in sub-Saharan Africa. Type-specific HPV vaccines and effective ART with immunological reconstitution could reduce the burden of AGW in this population.

  13. Late acute humoral rejection in low-risk renal transplant recipients induced with an interleukin-2 receptor antagonist and maintained with standard therapy: preliminary communication.

    Science.gov (United States)

    Morales, J; Contreras, L; Zehnder, C; Pinto, V; Elberg, M; Araneda, S; Herzog, C; Calabran, L; Aguiló, J; Ferrario, M; Buckel, E; Fierro, J A

    2011-01-01

    Low-risk renal transplant recipients treated with standard immunosuppressive therapy including interleukin-2 receptor (IL-2R) antagonist show a low incidence of early rejection episodes but few reports have examined the incidence and severity of late rejection processes. This study evaluated retrospectively cellular and antibody-mediated rejection (AMR) among 42 recipients selected because they showed low panel-reactive-antibodies, short cold ischemia time, no delayed graft function, and therapy including basiliximab (Simulect) induction. The mean observation time was 6.6 years. Sixty-seven percent of donors were deceased. Ten-year patient and death-censored graft survivals were 81% and 78%, respectively. Seven patients lost their kidneys due to nonimmunologic events. The seven recipients who experienced cellular rejection episodes during the first posttransplant year had them reversed with steroids. Five patients displayed late acute AMR causing functional deterioration in four cases including 1 graft loss. De novo sensitization occurred in 48% of recipients including patients without clinical rejection. In conclusion, long-term follow-up of kidney transplant recipients selected by a low immunologic risk showed a persistent risk of de novo sensitization evolving to acute AMR in 11% of cases. Although immunologic events were related to late immunosuppressive reduction, most graft losses were due to nonimmunologic factors. Copyright © 2011 Elsevier Inc. All rights reserved.

  14. Predictors of vaginal delivery in nulliparous mothers

    African Journals Online (AJOL)

    physical characteristics such as height and weight, events in labor and mode of ... maternal BMI, fetal head engagement and normal range of fetal birth weight were .... gestational age at booking, height, weight, fetal ... study due to: Hypertensive disorders of pregnancy ... vaginal delivery compared with overweight or obese.

  15. Primary caesarean section in nulliparous and grandmultiparous ...

    African Journals Online (AJOL)

    ... hemoglobine post-opératoire, et poids de naissance ont été comparés p 0,05. L'indication la plus fréquente pour la chirurgie dans les deux groupes des patientes était la douleur foetale (NPG = 28%, ...

  16. Is there any association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer?

    Science.gov (United States)

    Doluoglu, Omer Gokhan; Ceylan, Cavit; Kilinc, Fatih; Gazel, Eymen; Resorlu, Berkan; Odabas, Oner

    2016-01-01

    We investigated the association between National Institute of Health category IV prostatitis and prostate-specific antigen levels in patients with low-risk localized prostate cancer. The data of 440 patients who had undergone prostate biopsies due to high PSA levels and suspicious digital rectal examination findings were reviewed retrospectively. The patients were divided into two groups based on the presence of accompanying NIH IV prostatitis. The exclusion criteria were as follows: Gleason score>6, PSA level>20ng/mL, >2 positive cores, >50% cancerous tissue per biopsy, urinary tract infection, urological interventions at least 1 week previously (cystoscopy, urethral catheterization, or similar procedure), history of prostate biopsy, and history of androgen or 5-alpha reductase use. All patient's age, total PSA and free PSA levels, ratio of free to total PSA, PSA density and prostate volume were recorded. In total, 101 patients were included in the study. Histopathological examination revealed only PCa in 78 (77.2%) patients and PCa+NIH IV prostatitis in 23 (22.7%) patients. The median total PSA level was 7.4 (3.5-20.0) ng/mL in the PCa+NIH IV prostatitis group and 6.5 (0.6-20.0) ng/mL in the PCa group (p=0.67). The PSA level was≤10ng/mL in 60 (76.9%) patients in the PCa group and in 16 (69.6%) patients in the PCa+NIH IV prostatitis group (p=0.32). Our study showed no statistically significant difference in PSA levels between patients with and without NIH IV prostatitis accompanying PCa.

  17. Patient Perceptions of Breast Cancer Risk in Imaging-Detected Low-Risk Scenarios and Thresholds for Desired Intervention: A Multi-Institution Survey.

    Science.gov (United States)

    Grimm, Lars J; Shelby, Rebecca A; Knippa, Emily E; Langman, Eun L; Miller, Lauren S; Whiteside, Beth E; Soo, Mary Scott C

    2018-06-01

    To determine women's perceptions of breast cancer risk and thresholds for desiring biopsy when considering BI-RADS 3 and 4A scenarios and recommendations, respectively. Women presenting for screening mammography from five geographically diverse medical centers were surveyed. Demographic information and baseline anxiety were queried. Participants were presented with scenarios of short-term imaging follow-up recommendations (ie, BI-RADS 3) and biopsy recommendations (ie, BI-RADS 4A) for low-risk mammographic abnormalities and asked to estimate their breast cancer risk for each scenario. Participants reported the threshold (ie, likelihood of cancer) where they would feel comfortable undergoing short-term imaging follow-up and biopsy and their anticipated regret for choosing short-term follow-up versus biopsy. Analysis of 2,747 surveys showed that participants estimated breast cancer risk of 32.8% for a BI-RADS 3 and 41.1% for a BI-RADS 4A scenarios are significantly greater rates than clinically established rates (<2% [P < .001] and 2%-10% [P < .001], respectively). Over one-half (55.4%) of participants reported they would never want imaging follow-up if there was any chance of cancer; two-thirds (66.2%) reported they would desire biopsy if there was any chance of cancer. Participants reported greater anticipated regret (P < .001) and less relief and confidence (P < .001) with the decision to undergo follow-up imaging versus biopsy. Women overestimate breast cancer risk associated with both BI-RADS 3 and 4A scenarios and desire very low biopsy thresholds. Greater anticipated regret and less relief and confidence was reported with the choice to undergo short-term imaging follow-up compared with biopsy. Copyright © 2018 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  18. [Comparison of 64 MDCT coronary CTA and coronary angiography in the detection of coronary artery stenosis in low risk patients with stable angina and acute coronary syndrome].

    Science.gov (United States)

    Cazalas, G; Sarran, A; Amabile, N; Chaumoitre, K; Marciano-Chagnaud, S; Jacquier, A; Paganelli, F; Panuel, M

    2009-09-01

    To determine the accuracy of 64 MDCT coronary CTA (CCTA) compared to coronary angiography in low risk patients with stable angina and acute coronary syndrome and determine the number of significant coronary artery stenoses ( 50%) in these patients. Materials and methods. Fifty-five patients underwent CCTA using a 32 MDCT unit with z flying focus allowing the acquisition of 64 slices of 0.6 mm thickness as well as coronary angiography (gold standard). Nine patients were excluded due to prior coronary artery bypass surgery (n=4), insufficient breath hold (n=3), calcium scoring>1000 (n=1) and delay between both examinations over 4 months (n=1). Forty-six patients: 27 males and 19 females were included. CCTA results were compared to coronary angiography per segment and artery with threshold detection of stenoses 50%. The degree of correlation between both examinations was performed using a regression analysis with a Pearson correlation coefficient<0.05 considered significant. The overall accuracy of CCTA was 90%; limitations related to the presence of calcifications, motion artifacts or insufficient vessel opacification. The correlation for all analyzed segments was 96.4%. Thirty-eight of 50 significant stenoses seen on coronary angiography were correctly detected on CCTA. Sensitivity, specificity, PPVC and NPV for detection of stenoses 50% were 76%, 98.3%, 80.3% and 97.7% respectively. Evaluation per segment had a NPV of 96.8% (interventricular and diagonal segments) to 100% (main trunk). Our results for specificity and NPV are similar to reports from the literature. This suggests that CCTA in this clinical setting may replace coronary angiography.

  19. Risk of spontaneous preterm delivery in a low-risk population: the impact of maternal febrile episodes, urinary tract infection, pneumonia and ear-nose-throat infections.

    Science.gov (United States)

    Morken, Nils-Halvdan; Gunnes, Nina; Magnus, Per; Jacobsson, Bo

    2011-12-01

    To assess the associations between maternal infections during pregnancy (i.e. ear-nose-throat infection, pneumonia, urinary tract infection, febrile episodes and influenza-like infection) and spontaneous preterm delivery (SPTD). Prospective questionnaire data from the Norwegian Mother and Child Cohort (MoBa) study, including more than 100000 pregnancies and, collected during 1999-2008, were used. Linked data from the Medical Birth Registry of Norway were added. SPTD occurring between gestational weeks 22+0 days and 36+6 days was the main outcome. Data were analysed in two steps because questionnaires (including information about occurrence of the various infections so far) were completed at different stages of pregnancy. Hazard ratios (HR) were obtained using Cox regression. The SPTD proportion was low in this cohort: 2.9% and 2.7% at the two analysis steps, respectively. After exclusions, 67310 and 60689 pregnancies, respectively, remained for the analyses. Ear-nose-throat infections occurring before week 17 were associated with an increased risk of SPTD in the first (HR: 1.27, 95% CI: 1.08-1.50) and second (HR: 1.26, 95% CI: 1.04-1.52) step of the analysis, but not if occurring later in pregnancy. None of the other maternal infections were associated with an increased risk of SPTD. In this low-risk population, ear-nose-throat infection in early pregnancy was associated with an increased risk of SPTD. However, infectious morbidity in later pregnancy was not. Thus, the link between maternal infection and preterm delivery may vary in different populations and health care settings. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  20. Contrast-enhanced spectral mammography as work-up tool in patients recalled from breast cancer screening has low risks and might hold clinical benefits.

    Science.gov (United States)

    Houben, I P L; Van de Voorde, P; Jeukens, C R L P N; Wildberger, J E; Kooreman, L F; Smidt, M L; Lobbes, M B I

    2017-09-01

    Contrast-enhanced spectral mammography (CESM) is a reliable problem solving tool in the work-up of women recalled from breast cancer screening. We evaluated additional findings caused by CESM alone and outweighed them against the disadvantages of this technique. From December 2012 to December 2015, all women recalled from screening who underwent CESM were considered for this study. Radiation exposure and number of adverse contrast reactions were analysed. An experienced breast radiologist reviewed all exams and identified cases with lesions detected by CESM alone and scored their conspicuity. From these cases, data on breast density and final diagnosis were collected. For malignant cases, tumour grade and receptor characteristics were also collected. During this study, 839 women underwent CESM after a screening recall, in which five minor adverse contrast reactions were observed. Median radiation dose per exam was 6.0mGy (0.9-23.4mGy). Seventy CESM-only lesions were detected in 65 patients. Of these 70 lesions, 54.3% proved to be malignant, most commonly invasive ductal carcinomas. The remaining CESM-only lesions were benign, predominantly fibroadenomas. No complications were observed during biopsy of these lesions. Retrospectively, the majority of the lesions were either occult or a 'minimal sign' on low-energy CESM images or the screening mammogram. Using CESM as a work-up tool for women recalled from screening carries low risk for the patient, while additionally detected tumour foci might hold important clinical implications which need to be further studied in large, randomized controlled trials. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. Application of National Emergency X-Ray Utilizations Study low-risk c-spine criteria in high-risk geriatric falls.

    Science.gov (United States)

    Evans, Daniel; Vera, Luis; Jeanmonod, Donald; Pester, Jonathan; Jeanmonod, Rebecca

    2015-09-01

    We sought to validate National Emergency X-Radiography Utilizations Study low-risk cervical spine (C spine) criteria in a geriatric trauma population. We sought to determine whether patients' own baseline mental status (MS) could substitute for Glasgow Coma Scale (GCS) to meet the criteria "normal alertness." We further sought to refine the definition of "distracting injury." This is a retrospective review of geriatric fall patients presenting to a level 1 trauma center and triaged to the trauma bay. We queried our database from 2008 to 2013. Abstractors recorded GCS, deviation from baseline MS, midline neck tenderness, intoxication, focal deficit, signs of trauma, and presence of other injury. Patients were considered at baseline MS if specific documentation was present on the chart, or if their GCS was 15. Six hundred sixty elderly fall patients were trauma alerts during the study period. Seventeen were excluded for incomplete records/death before imaging, leaving 647. The median age was 81 (interquartile range, 74-87). Fifty patients (8.0%) had C spine or cord injury. Two hundred ninety-four (44.5%) had baseline MS (including GCS 13-15), no spine tenderness, no intoxication, and no focal neurologic deficit. Of these, 18 had C-spine injury. Using physical findings of head trauma as the only "distracting injury," no injury would have been missed (sensitivity, 100% [confidence interval, 91.1-100]; specificity, 14.2%). Our study suggests that National Emergency X-Radiography Utilizations Study can be safely applied in elderly fall patients who are at their personal baseline MS. Furthermore, our data support a more narrow definition of distracting injury to include only patients with signs of trauma to the head. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. The comparison of birth outcomes and birth experiences of low-risk women in different sized midwifery practices in the Netherlands.

    Science.gov (United States)

    Fontein, Yvonne

    2010-09-01

    To examine maternal birth outcomes and birth experiences of low-risk women in the Netherlands in different sized midwifery practices. Descriptive study using postal questionnaires six weeks after the estimated due date. Women were recruited from urban, semi-rural and rural areas from small-sized practices (1-2 midwives), medium-sized practices (3-4 midwives) or large-sized practices (5 or more). 718 Dutch speaking women with uncomplicated pregnancies, a representative sample of women in 143 midwifery practices in the Netherlands who had given birth in the period between 20 April and 20 May 2007. Distribution of place of birth categories and intervention categories, birth experience, woman-midwife relationship and presence of own midwife after referral. Data were analyzed with Statistical Package for Social Sciences (SPSS). Women in practices with a maximum of two midwives were significantly more likely to experience lower rates of referral, interventions in general and specifically pain relief by means of pethidine, CTG registration and unplanned caesarean sections. Women with a maximum of two midwives were significantly more likely to know their midwife or midwives and were more frequently supported by their own midwife after referral in comparison to women in practices with more than two midwives. The presence of the woman's own midwife added value to the birth experience. Women with a maximum of two midwives had higher levels of a positive birth experience than women in practices with more than two midwives. Midwifery practices with a maximum of two midwives contribute to non-interventionist birth and a positive birth experience. Awareness of the study results and further study is recommended to discuss reorganization of care in order to achieve significant reductions on referral and interventions during childbirth and positive maternal birth experiences. Copyright (c) 2010 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  3. Outcomes of planned home births and planned hospital births in low-risk women in Norway between 1990 and 2007: a retrospective cohort study.

    Science.gov (United States)

    Blix, Ellen; Huitfeldt, Anette Schaumburg; Øian, Pål; Straume, Bjørn; Kumle, Merethe

    2012-12-01

    The safety of planned home births remains controversial in Western countries. The aim of the present study was to compare outcomes in women who planned, and were selected to, home birth at the onset of labor with women who planned for a hospital birth. Data from 1631 planned home births between 1990 and 2007 were compared with a random sample of 16,310 low-risk women with planned hospital births. The primary outcomes were intrapartum intervention rates and complications. Secondary outcomes were perinatal and neonatal death rates. Primiparas who planned home births had reduced risks for assisted vaginal delivery (OR 0.32; 95% CI 0.20-0.48), epidural analgesia (OR 0.21; CI 0.14-0.33) and dystocia (OR 0.40; CI 0.27-0.59). Multiparas who planned home births had reduced risks for operative vaginal delivery (OR 0.26; CI 0.12-0.56), epidural analgesia (OR 0.08; CI 0.04-0.16), episiotomy (OR 0.48; CI 0.31-0.75), anal sphincter tears (OR 0.29; CI 0.12-0.70), dystocia (OR 0.10; CI 0.06-0.17) and postpartum hemorrhage (OR 0.27; CI 0.17-0.41). We found no differences in cesarean section rate. Perinatal mortality rate was 0.6/1000 (CI 0-3.4) and neonatal mortality rate 0.6/1000 (CI 0-3.4) in the home birth cohort. In the hospital birth cohort, the rates were 0.6/1000 (CI 0.3-1.1) and 0.9/1000 (CI 0.5-1.5) respectively. Planning for home births was associated with reduced risk of interventions and complications. The study is too small to make statistical comparisons of perinatal and neonatal mortality. Copyright © 2012 Elsevier B.V. All rights reserved.

  4. Effects of maternal absence due to employment on the quality of infant-mother attachment in a low-risk sample.

    Science.gov (United States)

    Barglow, P; Vaughn, B E; Molitor, N

    1987-08-01

    Recent reports have suggested that day-care experience initiated prior to 12 months of age is associated with increased proportions of infants whose attachment to mother is classified as "insecure-avoidant." However, reviewers have questioned the generality of these findings, noting that samples in which associations between early day-care experience and avoidant attachment patterns have been reported come from high-risk populations, and/or that the infants' day-care settings may not have been of high quality. In the present study, effects of maternal absences on infant-mother attachment quality were assessed in a low-risk, middle-class sample (N = 110). In all instances, substitute care had been initiated at least 4 months prior to the infant's first birthday and was provided in the infant's home by a person unrelated to the baby. Infants were assessed using the Ainsworth Strange Situation when they were 12-13 months of age. Analyses indicated that a significantly greater proportion of infants whose mothers worked outside the home (N = 54) were assigned to the category "insecure-avoidant" as compared to infants whose mothers remained in the home (N = 56) throughout the first year of life. Analyses of demographic and psychological data available for the sample indicated that this relation is dependent upon maternal parity (primi- vs. multiparous mother). The association between attachment quality and work status was significant only for firstborn children of full-time working mothers. The results are interpreted as evidence that the repeated daily separations experienced by infants whose mothers are working full-time constitute a "risk" factor for the development of "insecure-avoidant" infant-mother attachments.

  5. Outcomes of Incidental Fallopian Tube High-Grade Serous Carcinoma and Serous Tubal Intraepithelial Carcinoma in Women at Low Risk of Hereditary Breast and Ovarian Cancer.

    Science.gov (United States)

    Chay, Wen Yee; McCluggage, W Glenn; Lee, Cheng-Han; Köbel, Martin; Irving, Julie; Millar, Joanne; Gilks, C Blake; Tinker, Anna V

    2016-03-01

    The natural history and optimal management of serous tubal intraepithelial carcinoma (STIC), regardless of BRCA status, is unknown. We report the follow-up findings of a series of incidental fallopian tube high-grade serous carcinomas (HGSCs) and STICs identified in women at low risk for hereditary breast and ovarian cancer (HBOC), undergoing surgery for other indications. Cases of incidental STIC and HGSC were identified from 2008. Patients with known BRCA1 or BRCA2 mutations, or a family history of ovarian or breast cancer before the diagnosis of STIC or HGSC were excluded. A retrospective chart review was conducted to obtain clinical data. Eighteen cases were identified with a median follow-up of 25 months (range, 4-88 months). Twelve of 18 patients had a diagnosis of STIC with no associated invasive HGSC and 6 had STIC associated with other invasive malignancies. Completion staging surgery was performed on 7 of the 18 patients, including 5 of 12 in which there was STIC only identified on primary surgery; 3 cases were upstaged from STIC only to HGSC based on the staging surgery. Recurrence of HGSC occurred in 2 of the 18 patients. BRCA testing was performed on 3 patients, 1 of whom tested positive for a pathogenic BRCA1 mutation. Our study suggests that completion staging surgery for incidental STICs in non-BRCA patients may be considered. These patients should be offered hereditary testing. The Pelvic-Ovarian cancer INTerception (POINT) Project is an international registry set up to add to our understanding of STICs.

  6. Alcohol consumption and low-risk drinking guidelines among adults: a cross-sectional analysis from Alberta’s Tomorrow Project

    Science.gov (United States)

    Darren R., Brenner; Tiffany R., Haig; Abbey E, Poirier; Alianu, Akawung; Christine M., Friedenreich; Paula J., Robson

    2017-01-01

    strategies to promote low-risk drinking among those who choose to drink could impact future chronic disease risk in this population. PMID:29236379

  7. High-risk and low-risk human papilloma virus in association to spontaneous preterm labor: a case-control study in a tertiary center, Egypt.

    Science.gov (United States)

    Mosbah, Alaa; Barakat, Rafik; Nabiel, Yasmin; Barakat, Ghada

    2018-03-01

    This study aimed to detect the correlation between human papillomavirus (HPV) and spontaneous preterm labor in Egyptian women and its association to the human papilloma viral load and MPP2 gene expression. We performed an observational comparative case-control study in Department of Obstetric and Gynecology, Mansoura University Hospitals over women presented with spontaneous preterm labor, besides females admitted for giving birth at full term to detect conserved sequence in HPV-L1 gene (GP5/GP6) followed by genotype detection of high- and low-risk HPVs with quantification of the viral load and the MMP2 gene expression using real-time polymerase chain reaction (PCR). The prevalence of HPV was 18.1% in preterm females, but only 4% in full-term women (p value = 0.019*). Twenty percent were PCR positive for HPV 16 and 40% for HPV 18 whereas none of the control was positive for any of the studied high-risk genotypes. Thirty percent were PCR positive for HPV 6 and 10% were positive for HPV 11. MMP2 gene expression was significantly higher in preterm than full term. Human papilloma viral load was found to be positively correlated to the rate of MMP2 expression and the gestational age was significantly related to the viral load and the rate of expression of MMP2 gene. Human pabilloma virus especially high-risk genotypes was correlated to spontaneous preterm labor in Egyptian females through increasing early expression of MMP2 gene. The time of occurrence of preterm labor was affected by the viral load and so the rate of expression of MMP2 gene.

  8. Age-related changes of healthy bone marrow cell signaling in response to growth factors provide insight into low risk MDS.

    Science.gov (United States)

    Kornblau, Steven M; Cohen, Aileen C; Soper, David; Huang, Ying-Wen; Cesano, Alessandra

    2014-11-01

    Single Cell Network Profiling (SCNP) is a multiparametric flow cytometry-based assay that quantifiably and simultaneously measures changes in intracellular signaling proteins in response to in vitro extracellular modulators at the single cell level. Myelodysplastic syndrome (MDS) is a heterogeneous clonal disorder of hematopoietic stem cells that occurs in elderly subjects and is characterized by dysplasia and ineffective hematopoiesis. The functional responsiveness of MDS bone marrow (BM) hematopoietic cells, including functionally distinct myeloid and erythroid precursor subsets, to hematopoietic growth factors (HGF) and the relationship of modulated signaling to disease characteristics is poorly understood. SCNP was used first to examine the effects of age on erythropoietin (EPO) and granulocyte colony stimulating factor (GCSF)-induced signaling in myeloid, nucleated red blood cells (nRBC), and CD34 expressing cell subsets in healthy BM (n = 15). SCNP was then used to map functional signaling profiles in low risk (LR) MDS (n = 7) for comparison to signaling in samples from healthy donors and to probe signaling associations within clinically defined subgroups. In healthy BM samples, signaling responses to HGF were quite homogeneous (i.e., tightly regulated) with age-dependent effects observed in response to EPO but not to GCSF. Despite the relatively small number of samples assayed in the study, LR MDS could be classified into distinct subgroups based on both cell subset frequency and signaling profiles. As a correlate of underlying genetic abnormalities, signal transduction analyses may provide a functional and potentially clinically relevant classification of MDS. Further evaluation in a larger cohort is warranted. © 2013 Clinical Cytometry Society.

  9. Multiparametric Magnetic-Resonance to Confirm Eligibility to an Active Surveillance Program for Low-Risk Prostate Cancer: Intermediate Time Results of a Third Referral High Volume Centre Active Surveillance Protocol.

    Science.gov (United States)

    Luzzago, Stefano; Musi, Gennaro; Catellani, Michele; Russo, Andrea; Di Trapani, Ettore; Mistretta, Francesco Alessandro; Bianchi, Roberto; Cozzi, Gabriele; Conti, Andrea; Pricolo, Paola; Ferro, Matteo; Matei, Deliu-Victor; Mirone, Vincenzo; Petralia, Giuseppe; de Cobelli, Ottavio

    2018-05-07

    To evaluate the role of confirmatory multiparametric magnetic resonance imaging (mpMRI) of the prostate at the time of Active Surveillance (AS) enrollment to reduce disease misclassification. From 2012 to 2016, 383 patients with low-risk disease respecting Prostate Cancer Research International AS criteria underwent confirmatory 1.5-T mpMRI. AS was proposed to patients with Prostate Imaging and Report and Data System (PI-RADS) score ≤3 and no extraprostatic extension (EPE), whereas patients with PI-RADS score ≥4 and/or EPE were treated actively. Kaplan-Meier analyses quantified progression-free survival (PFS) in patients enrolled in the AS program. Logistic regression analyses tested the association between confirmatory mpMRI and clinically significant prostate cancer (csPCa) at radical prostatectomy (RP). Diagnostic performance of mpMRI was calculated in patients submitted to immediate RP. PFS rate was 99, 90 and 86% at 1, 2 and 3 years respectively. At multivariable analysis, PI-RADS 3, PI-RADS 4, PI-RADS 5 and EPE increased the probability of having csPCa at immediate RP (PI-RADS 3 [OR] 1.2, p = 0.26; PI-RADS 4 [OR] 5.1, p = 0.02; PI-RADS 5 [OR] 6.7; p = 0.009; EPE [OR] 11.8, p < 0.001). Confirmatory mpMRI showed sensibility, specificity, positive predictive value and negative predictive value of 85, 55, 68 and 76% respectively. MpMRI at the time of AS enrollment reduces the misclassification rate of csPCa. We suggest to perform target biopsies in patients with PI-RADS score 3 and 4 lesions. © 2018 S. Karger AG, Basel.

  10. Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases

    NARCIS (Netherlands)

    de Jonge, A.; Geerts, C.C.; van der Goes, B.Y.; Mol, B.W.; Buitendijk, S.E.; Nijhuis, J.G.

    2015-01-01

    Objective To compare rates of adverse perinatal outcomes between planned home births versus planned hospital births. Design A nationwide cohort study. Setting The Netherlands. Population Low-risk women in midwife-led care at the onset of labour. Methods Analysis of national registration data. Main

  11. Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases

    NARCIS (Netherlands)

    de jonge, A.; Geerts, C. C.; van der Goes, B. Y.; Mol, B. W.; Buitendijk, S. E.; Nijhuis, J. G.

    2015-01-01

    To compare rates of adverse perinatal outcomes between planned home births versus planned hospital births. A nationwide cohort study. The Netherlands. Low-risk women in midwife-led care at the onset of labour. Analysis of national registration data. Intrapartum and neonatal death, Apgar scores, and

  12. Management of low-risk patients with thyroid carcinoma and detectable thyroglobulin on T4 after thyroidectomy and ablation with iodine-131

    Energy Technology Data Exchange (ETDEWEB)

    Rosario, Pedro Weslley Souza [Clinica de Endocrinologia e Metabologia (CEPCEM), Belo Horizonte, MG (Brazil). Centro de Estudos e Pesquisa]. E-mail: pedrorosario@globo.com; Borges, Michelle A.R.; Costa, Graciela B.C.; Resende, Leonardo L.; Padrao, Eduardo L.; Barroso, Alvaro L.; Purish, Saulo [Santa Casa de Belo Horizonte, MG (Brazil). Dept. de Tireoide. Servico de Endocrinologia; Santa Casa de Belo Horizonte, MG (Brazil). Servico de Medicina Nuclear

    2007-01-15

    Objective: To evaluate the positive predictive value of detectable Tg during T4 therapy (Tg on T4) in patients with thyroid cancer after total thyroidectomy and remnant ablation, discussing the work-up in this situation and the empirical indication of {sup 131}I. Patients and methods: Initially, 234 low-risk patients [tumor {<=} 5 cm, completely resected, no extensive extrathyroid invasion (pT4)] submitted to total thyroidectomy and ablation with {sup 131}I (3.7-5.5 GBq) who presented no ectopic uptake on RxWBS were studied. Of these, 23 patients with detectable Tg on T4 (> 1 ng/ml) during the first year after initial therapy were selected. Results: Metastases were detected by neck US in 7 patients, by chest CT in 2 and by US and CT in 3. Four of five patients with lung metastases upon CT had a positive RxWBS. Eleven patients with negative US and CT received a new {sup 131}I dose (without DxWBS), and RxWBS showed ectopic uptake in 3 patients. Among the patients with negative RxWBS, 7 remained free of apparent disease and Tg was declining (5 with undetectable Tg on T4 at the end of the study). One patient presented an increase in Tg and FDG-PET was positive for lymph node and bone metastases. Conclusions: All patients with Tg on T4 > 5 ng/ml presented apparent disease. In these cases, even when US and CT are negative, the administration of a therapeutic dose of {sup 131}I (without DxWBS) and FDG-PET are recommended. Among patients with detectable Tg on T4 {<=} 5 ng/ml and negative US and CT, only 12% presented ectopic uptake on RxWBS. These cases could be followed up by monitoring Tg on T4, and RxWBS and FDG-PET should only be performed if this marker does not decrease after 1-2 years. (author)

  13. A prospective study of effects of psychological factors and sleep on obstetric interventions, mode of birth, and neonatal outcomes among low-risk British Columbian women

    Directory of Open Access Journals (Sweden)

    Hall Wendy A

    2012-08-01

    Full Text Available Abstract Background Obstetrical interventions, including caesarean sections, are increasing in Canada. Canadian women’s psychological states, fatigue, and sleep have not been examined prospectively for contributions to obstetric interventions and adverse neonatal outcomes. Context and purpose of the study: The prospective study was conducted in British Columbia (BC, Canada with 650 low-risk pregnant women. Of those women, 624 were included in this study. Women were recruited through providers’ offices, media, posters, and pregnancy fairs. We examined associations between pregnant women’s fatigue, sleep deprivation, and psychological states (anxiety and childbirth fear and women’s exposure to obstetrical interventions and adverse neonatal outcomes (preterm, admission to NICU, low APGARS, and low birth weight. Methods Data from our cross-sectional survey were linked, using women’s personal health numbers, to birth outcomes from the Perinatal Services BC database. After stratifying for parity, we used Pearson’s Chi-square to examine associations between psychological states, fatigue, sleep deprivation and maternal characteristics. We used hierarchical logistic regression modeling to test 9 hypotheses comparing women with high and low childbirth fear and anxiety on likelihood of having epidural anaesthetic, a caesarean section (stratified for parity, assisted vaginal delivery, and adverse neonatal outcomes and women with and without sleep deprivation and high levels of fatigue on likelihood of giving birth by caesarean section, while controlling for maternal, obstetrical (e.g., infant macrosomia, and psychological variables. Results Significantly higher proportions of multiparas, reporting difficult and upsetting labours and births, expectations of childbirth interventions, and health stressors, reported high levels of childbirth fear. Women who reported antenatal relationship, housing, financial, and health stressors and multiparas

  14. Neutropenia febril: convertir el bajo riesgo en cero riesgo To convert the low risk in zero risk in patients with febrile neutropenia

    Directory of Open Access Journals (Sweden)

    Alberto Arencibia Núñez

    2009-08-01

    Full Text Available La neutropenia febril constituye una de las principales causas de morbiletalidad en los pacientes con hemopatías malignas; sin embargo, la presentación clínica y evolución de esta complicación varía considerablemente de un paciente a otro. El primer modelo de estratificación de riesgo fue desarrollado por Talcot a partir de elementos clínicos y diferenciaba a los pacientes según el riesgo de presentar complicaciones letales. No obstante, cerca del 10 % de los pacientes catalogados como de bajo riesgo de complicaciones graves requieren tratamiento intrahospitalario. La determinación de algunos reactantes de fase aguda como la proteína C reactiva, las interleucinas 6 y 8 y la procalcitonina, aumentan notablemente la sensibilidad y especificidad de los modelos pronósticos. Las nuevas técnicas imagenológicas y de biología molecular facilitarán el diagnóstico precoz y certero de las infecciones en un futuro cercano. Sin embargo, es necesario desarrollar modelos pronósticos que combinen elementos clínicos y humorales adaptados a las condiciones epidemiológicas de cada centro, para optimizar el tratamiento diferenciado de los enfermos con neutropenia febril.Febrile neutropenia is one of the main causes of mortality in patients presenting with malignant hemopathic disorders; however the clinical and course presentation of this condition differ notably between patients. The first risk stratification model was developed by Talcot from clinical elements and differentiated the patients according the risk of lethal complications. However, around the 10% of patients classed as low risk of severe complications required intrahospital treatment. The determination of some acute phase reactants e.g. reactive C protein, 6 and 8 interleukins, and procalcitonin, increases remarkably the sensitivity and specificity of prognostic model. The new imaging techniques and of molecular biology allow an early and accurate diagnosis of infections in a near

  15. Attitudes and beliefs among high- and low-risk population groups towards β-thalassemia prevention: a cross-sectional descriptive study from India.

    Science.gov (United States)

    Chawla, Swati; Singh, Rajnish Kumar; Lakkakula, Bhaskar V K S; Vadlamudi, Raghavendra Rao

    2017-07-01

    β-thalassemia is an autosomal recessive blood disorder caused by gene mutations that affect all aspects of β-globin production. In majority of Asian countries including India, the frequency of β-thalassemia is closely intertwined with social, cultural, and religious issues of the respective country. Several national level screening programs imparted education regarding β-thalassemia, but follow-up evaluation revealed that education was not effective. It has been hypothesized that the beliefs and attitudes, carrier screening, and education among "high risk communities" will have far-reaching implications towards β-thalassemia prevention in the country. The present study is aimed to investigate attitudes, intention, and behavior of β-thalassemia high- and low-risk ethnic groups towards carrier screening and education. A structured questionnaire on knowledge, attitude, and practice regarding β-thalassemia was administered on 926 individuals belong to Arora, a high-risk ethnic group for β-thalassemia (347 rural (AR) and 202 urban (AU)) and 377 cosmopolitan commoners (CC) aged above 18 years of both sexes. To understand the relationship between various questions, Pearson's correlation test and factor analysis was performed. The responses were further categorized into the theory of planned behavior (TPB) constructs with the measures of the main constructs reported as a mean. Various dimensions of knowledge, attitude, and practice reveal that the urban groups (AU and CC) are better aware of the disease "β-thalassemia" than the rural group (AR) who witness suffering at close quarters. The AR group is more positive for preventive measures than the urban groups. Significant correlations and factor analysis show "intentions" for premarital and prenatal screening highly loaded as outcome behaviors. The Ajzen's "Theory of planned behavior" support that the "intention" and "perceived behavior control" are better predictors of "outcome behavior" compared to "attitude

  16. Low risk HLA-DQ and increased body mass index in newly diagnosed type 1 diabetes children in the Better Diabetes Diagnosis study in Sweden.

    Science.gov (United States)

    Carlsson, A; Kockum, I; Lindblad, B; Engleson, L; Nilsson, A; Forsander, G; Karlsson, A-K; Kernell, A; Ludvigsson, J; Marcus, C; Zachrisson, I; Ivarsson, S-A; Lernmark, A

    2012-05-01

    Type 1 diabetes and obesity has increased in childhood. We therefore tested the hypothesis that type 1 diabetes human leukocyte antigen DQ (HLA-DQ) risk genotypes may be associated with increased body mass index (BMI). The type 1 diabetes high-risk HLA-DQ A1*05:01-B1*02:01/A1*03:01-B1*03:02 genotype along with lower risk DQ genotypes were determined at the time of clinical onset by PCR and hybridization with allele-specific probes. BMI was determined after diabetes was stabilized. A total of 2403 incident type 1 diabetes children below 18 years of age were ascertained in the Swedish national Better Diabetes Diagnosis (BDD) study between May 2005 to September 2009. All children classified with type 1 diabetes, including positivity for at least one islet autoantibody, were investigated. Overall, type 1 diabetes HLA-DQ risk was negatively associated with BMI (P1-B1*02:01/A1*03:01-B1)03:02 genotype decreased with increasing BMI (Ptype 1 diabetes DQ genotypes were associated with an increased proportion of patients who were overweight or obese (P1). Indeed, the proportion of patients with the low-risk A1*05:01-B1*02:01/A1*05:01-B1*02:01 genotype increased with increasing BMI (P1-B1*02:01/A1*05:01-B1*02:01 genotype and increased BMI was significant (Pobese was 1.80 (95% confidence interval 1.21-2.61; Ptype 1 diabetes children with the A1*05:01-B1*02:01 haplotype was most pronounced in children diagnosed between 5 and 9 years of age. Susceptibility for childhood type 1 diabetes was unexpectedly found to be associated with the A1*05:01-B1*02:01/A1*05:01-B1*02:01 genotype and an increased BMI. These results support the hypothesis that overweight may contribute to the risk of type 1 diabetes in children positive for HLA-DQ A1*05:01-B1*02:01.

  17. Management of low-risk patients with thyroid carcinoma and detectable thyroglobulin on T4 after thyroidectomy and ablation with iodine-131

    International Nuclear Information System (INIS)

    Rosario, Pedro Weslley Souza; Borges, Michelle A.R.; Costa, Graciela B.C.; Resende, Leonardo L.; Padrao, Eduardo L.; Barroso, Alvaro L.; Purish, Saulo; Santa Casa de Belo Horizonte, MG

    2007-01-01

    Objective: To evaluate the positive predictive value of detectable Tg during T4 therapy (Tg on T4) in patients with thyroid cancer after total thyroidectomy and remnant ablation, discussing the work-up in this situation and the empirical indication of 131 I. Patients and methods: Initially, 234 low-risk patients [tumor ≤ 5 cm, completely resected, no extensive extrathyroid invasion (pT4)] submitted to total thyroidectomy and ablation with 131 I (3.7-5.5 GBq) who presented no ectopic uptake on RxWBS were studied. Of these, 23 patients with detectable Tg on T4 (> 1 ng/ml) during the first year after initial therapy were selected. Results: Metastases were detected by neck US in 7 patients, by chest CT in 2 and by US and CT in 3. Four of five patients with lung metastases upon CT had a positive RxWBS. Eleven patients with negative US and CT received a new 131 I dose (without DxWBS), and RxWBS showed ectopic uptake in 3 patients. Among the patients with negative RxWBS, 7 remained free of apparent disease and Tg was declining (5 with undetectable Tg on T4 at the end of the study). One patient presented an increase in Tg and FDG-PET was positive for lymph node and bone metastases. Conclusions: All patients with Tg on T4 > 5 ng/ml presented apparent disease. In these cases, even when US and CT are negative, the administration of a therapeutic dose of 131 I (without DxWBS) and FDG-PET are recommended. Among patients with detectable Tg on T4 ≤ 5 ng/ml and negative US and CT, only 12% presented ectopic uptake on RxWBS. These cases could be followed up by monitoring Tg on T4, and RxWBS and FDG-PET should only be performed if this marker does not decrease after 1-2 years. (author)

  18. Persistent Low-Risk and High-Risk Human Papillomavirus Infections of the Uterine Cervix in HIV-Negative and HIV-Positive Women

    Directory of Open Access Journals (Sweden)

    Sally N. Adebamowo

    2017-07-01

    Full Text Available BackgroundThe prevalence, persistence, and multiplicity of human papillomavirus (HPV infection appears different comparing HIV-positive to HIV-negative women. In this study, we examined prevalent, persistent, and multiple low- and high-risk cervical HPV infections in HIV-negative and HIV-positive women.MethodsWe studied 1,020 women involved in a study of HPV infection using SPF25/LiPA10. Two study visits were scheduled, at enrollment and 6 months afterward. At each study visit, research nurses used a cervical brush to collect samples of exfoliated cervical cells from the cervical os, from all the study participants. Exact logistic regression models were used to estimate associations between HIV and HPV infections.ResultsThe mean (SD age of the study participants was 38 (8 years, 56% were HIV-negative and 44% were HIV-positive. Among HIV-negative women at baseline, single low-risk HPV (lrHPV infections occurred in 12%; multiple lrHPV in 2%; single high-risk human papillomavirus (hrHPV infections in 9%, and multiple hrHPV infections in 2%. Single lrHPV infections were persistent in 6%, but there was no persistent multiple lrHPV infections. Single hrHPV infections were persistent in 4% while multiple hrHPV infections were persistent in 0.3%. Among HIV-positive women at baseline, single lrHPV infections occurred in 19%, multiple lrHPV in 6%, single hrHPV infections in 17%, and multiple hrHPV infections occurred in 12%. Single lrHPV infections were persistent in 9%, multiple lrHPV infections in 0.6%, single hrHPV infections in 13%, while multiple hrHPV were persistent in 3%. Prevalent, persistent, and multiple infections were more common in HIV-positive women, compared to HIV-negative women. In multivariate models adjusted for age, marital status, socioeconomic status, age at sexual initiation, and douching, the odds ratios comparing HIV-positive to HIV-negative women, were 2.09 (95% CI 1.47–2.97, p < 0.001 for prevalent lrHPV, 1.26 (95% CI

  19. Local recurrences and distant metastases after breast-conservative treatments in a population at very low risk of recurrence are very dependent events

    International Nuclear Information System (INIS)

    Cowen, Didier; Jacquemier, Jocelyne; Houvenaeghel, Gilles; Viens, Patrice; Maraninchi, Dominique; Puig, Brigitte; Bardou, Valerie-Jeanne; Resbeut, Michel

    1997-01-01

    PURPOSE: Assessment of the relative merits of individual factors influencing the risks of loco-regional failure (LRF) and metastases (M) after breast-preserving treatments is made difficult by the marked inhomogeneities within the published series: short follow-up, use of chemotherapy, nodal status, margins of resection. We therefore selected a very homogenous population with an expected low-risk of recurrence to identify high-risk subgroups which may need more aggressive treatments. MATERIALS AND METHODS: Between 1980 and 1995, 3697 women with breast cancer were referred to Paoli-Calmettes Cancer Center, Marseille. Patients included in the study had undergone axillary dissection and were node negative (n=1840), were treated with conservative surgery (usually lumpectomy) and standard radiotherapy (n=1241), had histological tumor sizes ≤ 50 mm, received no chemotherapy (n=1024), and had negative margins of resection (n=756). Hormonal therapy was given to 238 women (31.5%): castration for premenopausal women (n=92), tamoxifen for postmenopausal women (n=146). The following factors were entered in the univariate analysis: age (≤ 40 yrs. vs > 40 yrs.), menopausal status, hormonal treatment, peritumoral vessel invasion (PVI), histologic multifocality (HM), extensive intraductal component (EIC), estrogen receptor (ER) and progesterone receptor (PR) status, SBR grade (I vs II vs III) and histological size (≤20 mm vs >20 mm). Factors statistically significant (p + and 72.1% PR + tumors. PVI was found in 184 tumors and EIC only in 30 tumors whereas HM was found in 106 cases. There were 53 local recurrences, 8 locoregional failures and 65 metastases as first event. The yearly conditional event probability for LRF and M was 1.8% and 1.6% respectively, constant over the years. Five and ten-year freedom from recurrence rates were 92.7% [90.4%-94.9%] and 81.6% [76.2%-86.9%] respectively for LRFs, and 91.6% [89.2%-94%] and 83.6% [79%-88.1%] respectively for M. Patients with

  20. Modeling of live-birth rates and cost-effectiveness of oocyte cryopreservation for cancer patients prior to high- and low-risk gonadotoxic chemotherapy.

    Science.gov (United States)

    Lyttle Schumacher, B; Grover, N; Mesen, T; Steiner, A; Mersereau, J

    2017-10-01

    What is the live-birth rate (LBR) and cost-effectiveness of fertility preservation with oocyte cryopreservation (FP-OC) compared to expectant management in cancer patients age 25-40 based on estimated gonadotoxicity of treatments 5 years after cancer diagnosis? Oocyte cryopreservation prior to cancer treatment is more costly, yet more effective (producing more live births), than not undergoing oocyte cryopreservation but it is most beneficial for patients undergoing high-risk chemotherapy (HRC). The decision to undergo FP prior to treatment is multifactorial and can be costly and delay treatment. Not all treatments carry the same gonadotoxicity and patients may choose to undergo FP-OC based on the probability of premature ovarian insufficiency, predicted outcomes and cost. A comprehensive model that incorporates age at diagnosis and toxicity of treatment to help guide patients in the decision to undergo FP-OC does not yet exist. This study used a Decision Analysis Model to estimate effectiveness and cost of FP for cancer patients. Age-based estimates of LBR and cost per live birth were calculated for ages 25-40 years based on gonadotoxicity of treatment. A decision analysis model was constructed using Treeage Pro 2015 with case base probabilities derived from national registries, practice guidelines and medical records from a national network of infertility practices (IntegraMed). Compared to no FP-OC, FP-OC improved LBRs for women of all ages undergoing either low-risk chemotherapy (LRC) or HRC; however, it was most cost effective for women undergoing LRC at older ages or HRC at younger ages. Although FP-OC results in higher LBRs, it was always more costly. Using donor oocyte IVF can be a successful alternative to autologous FP-OC. Decision tree results reflect probabilities of certain events and are compiled from multiple reputable sources but are not directly derived from a recruited cohort of patients. Outcomes are based on United States estimates and should be

  1. Função sexual e qualidade de vida em gestantes de baixo risco Sexual function and quality of life of low-risk pregnant women

    Directory of Open Access Journals (Sweden)

    Denise Queiroz Ferreira

    2012-09-01

    Full Text Available OBJETIVO: Avaliar em gestantes saudáveis no segundo trimestre a associação entre função sexual e qualidade de vida, e função sexual e satisfação sexual. MÉTODOS: Estudo transversal com 51 gestantes em acompanhamento em ambulatório de pré-natal de baixo risco. A função sexual foi aferida por meio do Quociente Sexual - Versão Feminina (QS-F. A qualidade de vida e a satisfação sexual foram avaliadas pelo Instrumento Abreviado de Avaliação de Qualidade de Vida da Organização Mundial da Saúde (WHOQOL-bref. Os critérios de inclusão foram idade gestacional entre a 15ª e a 26ª semana, idade materna igual ou superior a 20 anos, mínimo de 5 anos de educação escolar, ter parceiro fixo há pelo menos 6 meses, ter tido relação sexual com penetração vaginal nos últimos 15 dias. Foram excluídas mulheres vítimas de violência sexual, com história pregressa ou atual de depressão, antecedente de aborto habitual ou complicações na gestação atual (amniorrexe prematura, trabalho de parto prematuro ou hemorragia. Para a análise dos dados foram utilizados os testes do χ² e exato de Fisher e pPURPOSE: To evaluate, in healthy women in the second trimester of pregnancy, a possible association between sexual function and quality of life, and between sexual function and sexual satisfaction. METHODS: This cross-sectional study involved 51 pregnant women managed at a low-risk antenatal care clinic. Sexual function was evaluated through the Sexual Quotient - Female Version (QS-F questionnaire. Quality of life and sexual satisfaction were evaluated though the brief version of the World Health Organization Quality of Life questionnaire (WHOQOL-bref. Inclusion criteria were pregnancy between 15-26 weeks, maternal age 20 or more years, at least five years of scholling, in a relationship with a single partner for the last 6 months, having sexual intercourse with vaginal penetration in the last 15 days. We excluded women with a history

  2. Is negative self-referent bias an endophenotype for depression? An fMRI study of emotional self-referent words in twins at high vs. low risk of depression.

    Science.gov (United States)

    Miskowiak, K W; Larsen, J E; Harmer, C J; Siebner, H R; Kessing, L V; Macoveanu, J; Vinberg, M

    2018-01-15

    Negative cognitive bias and aberrant neural processing of self-referent emotional words seem to be trait-marks of depression. However, it is unclear whether these neurocognitive changes are present in unaffected first-degree relatives and constitute an illness endophenotype. Fifty-three healthy, never-depressed monozygotic or dizygotic twins with a co-twin history of depression (high-risk group: n = 26) or no first-degree family history of depression (low-risk group: n = 27) underwent neurocognitive testing and functional magnetic imaging (fMRI) as part of a follow-up cohort study. Participants performed a self-referent emotional word categorisation task and free word recall task followed by a recognition task during fMRI. Participants also completed questionnaires assessing mood, personality traits and coping strategies. High-risk and low-risk twins (age, mean ± SD: 40 ± 11) were well-balanced for demographic variables, mood, coping and neuroticism. High-risk twins showed lower accuracy during self-referent categorisation of emotional words independent of valence and more false recollections of negative words than low-risk twins during free recall. Functional MRI yielded no differences between high-risk and low-risk twins in retrieval-specific neural activity for positive or negative words or during the recognition of negative versus positive words within the hippocampus or prefrontal cortex. The subtle display of negative recall bias is consistent with the hypothesis that self-referent negative memory bias is an endophenotype for depression. High-risk twins' lower categorisation accuracy adds to the evidence for valence-independent cognitive deficits in individuals at familial risk for depression. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Time to Detection in Culture Supports Prediction of Low Transmissibility of Tuberculosis and Discontinuation of Isolation for Low-Risk Patients With A Single AFB-Negative and NAAT-Negative Respiratory Specimen.

    Science.gov (United States)

    Khan, Saahir; Nakasone, Audrey; Ghajar, Minoo; Zhowandai, Mariam; Prabhu, Sunita; Alexander, Rick; Low, Julie; Peterson, Ellena; Thrupp, Lauri

    2018-05-01

    For 94 patients with culture-positive pulmonary tuberculosis, time-to-detection (TTD), acid-fast bacilli (AFB) smear, and nucleic acid amplification test (NAAT) results were reviewed. All 12 patients whose first specimen was negative by AFB smear and NAAT had prolonged TTD, indicating low transmissibility and supporting discontinuing isolation for low-risk patients.Infect Control Hosp Epidemiol 2018;39:619-621.

  4. Feasibility of the Less Is More Approach in Treating Low-Risk Ductal Carcinoma In Situ Diagnosed on Core Needle Biopsy: Ten-Year Review of Ductal Carcinoma In Situ Upgraded to Invasion at Surgery.

    Science.gov (United States)

    Podoll, Mirna B; Reisenbichler, Emily S; Roland, Lania; Bruner, Andrew; Mizuguchi, Sarah; Sanders, Mary Ann G

    2018-03-27

    - Ductal carcinoma in situ (DCIS) represents 20% of screen-detected breast cancers. The likelihood that certain types of DCIS are slow growing and may never progress to invasion suggests that our current standards of treating DCIS could result in overtreatment. The LORIS (LOw RISk DCIS) and LORD (LOw Risk DCIS) trials address these concerns by randomizing patients with low-risk DCIS to either active surveillance or conventional treatment. - To determine the upgrade rate of DCIS diagnosed on core needle biopsy to invasive carcinoma at surgery and to evaluate the safety of managing low-risk DCIS with surveillance alone, by characterizing the pathologic and clinical features of upgraded cases and applying criteria of the LORD and LORIS trials to these cases. - A 10-year retrospective analysis of DCIS on core needle biopsy with subsequent surgery. - We identified 1271 cases of DCIS on core needle biopsy: 200 (16%) low grade, 649 (51%) intermediate grade, and 422 (33%) high grade. Of the 1271 cases, we found an 8% upgrade rate to invasive carcinoma (n = 105). Nineteen of the 105 upgraded cases (18%) had positive lymph nodes. Low-grade DCIS was least likely to upgrade to invasion, comprising 10% (10 of 105) of upgraded cases. Three of the 105 upgraded cases (3%) met criteria for the LORD trial, and all were low-grade DCIS on core needle biopsy with favorable biology on follow-up. - There is a clear risk of upgrade to invasion on follow-up excision; however, applying strict criteria of the LORD trial effectively decreases the likelihood of a missed invasive component or missed aggressive pathologic features.

  5. Comparison of Oncotype DX® Recurrence Score® with other risk assessment tools including the Nottingham Prognostic Index in the identification of patients with low-risk invasive breast cancer.

    Science.gov (United States)

    Cotter, Maura Bríd; Dakin, Alex; Maguire, Aoife; Walshe, Janice M; Kennedy, M John; Dunne, Barbara; Riain, Ciarán Ó; Quinn, Cecily M

    2017-09-01

    Oncotype DX® is a gene expression assay that quantifies the risk of distant recurrence in patients with hormone receptor positive early breast cancer, publicly funded in Ireland since 2011. The aim of this study was to correlate Oncotype DX® risk groupings with traditional histopathological parameters and the results of other risk assessment tools including Recurrence Score-Pathology-Clinical (RSPC), Adjuvant Risk Index (Adj RI), Nottingham Prognostic Index (NPI) and the Adjuvant! Online 10-year score (AO). Patients were retrospectively identified from the histopathology databases of two Irish hospitals and patient and tumour characteristics collated. Associations between categorical variables were evaluated with Pearson's chi-square test. Correlations were calculated using Spearman's correlation coefficient and concordance using Lin's concordance correlation coefficient. Statistical analysis was performed using SPSS software, version 22.0.In our 300 patient cohort, Oncotype DX® classified 59.7% (n = 179) as low, 30% (n = 90) as intermediate, and 10.3% (n = 31) as high risk. Overall concordance between the RS and RSPC, Adj RI, NPI, and AO was 67.3% (n = 202), 56.3% (n = 169), 59% (n = 177), and 36.3% (n = 109), respectively. All risk assessment tools classified the majority of patients as low risk apart from the AO 10-year score, with RSPC classifying the highest number of patients as low risk. This study demonstrates that there is good correlation between the RS and scores obtained using alternative risk tools. Concordance with NPI is strong, particularly in the low-risk group. NPI, calculated from traditional clinicopathological characteristics, is a reliable alternative to Oncotype DX® in the identification of low-risk patients who may avoid adjuvant chemotherapy.

  6. Avaliação do ângulo ano-retal por meio de defecograma em voluntárias assintomáticas nulíparas e multíparas Measurement of the anorectal angle by defecography in asymptomatic nulliparous and multiparous volunteers

    Directory of Open Access Journals (Sweden)

    José Eduardo Mourão Santos

    2003-08-01

    Full Text Available OBJETIVO: Fizemos um protocolo para compararmos as medidas dos ângulos ano-retais em três situações diferentes, em voluntárias assintomáticas nulíparas e multíparas. CASUÍSTICA E MÉTODOS: Foram realizados defecogramas em 30 mulheres (15 nulíparas e 15 multíparas, de maio de 1997 a dezembro de 1998, e obtidas incidências radiográficas em perfil do reto após introdução de contraste baritado texturizado: em repouso, durante contração do músculo puborretal e durante a evacuação. Na análise estatística foi utilizada a análise de medidas repetidas. RESULTADOS: A média do ângulo não apresentou diferença significante entre as voluntárias nulíparas e multíparas. O ângulo mediu, nas nulíparas, 92,9° em repouso, 78,8° durante a contração do músculo puborretal e 117,9° durante a evacuação, e nas multíparas mediu 94,3° em repouso, 79,7° durante a contração do músculo puborretal e 121,4° durante a evacuação. Foi observada diferença significante entre os ângulos em repouso, durante a contração do músculo puborretal e durante a evacuação. CONCLUSÃO: Não houve diferença significante entre os dois grupos examinados.OBJECTIVE: We developed a protocol to compare the measurements of the anorectal angle in nulliparous and multiparous asymptomatic volunteers in three different situations. SUBJECTS AND METHODS: Defecograms were carried out in 30 women (15 nulliparous and 15 multiparous from May, 1997 to December, 1998. After rectal administration of texturized barium contrast media, lateral radiographic views of the rectum were obtained at rest, during contraction of the puborectal muscle and during defecation. A repeated measures model was used for the statistical analysis. RESULTS: There were no significant differences between the mean anorectal angles of nulliparous and multiparous volunteers. Measurements were as follows: 92.9° at rest, 78.8° during the contraction of the puborectal muscle and 117.9

  7. Excellent long-term survival and absence of vaginal recurrences in 332 patients with low-risk stage I endometrial adenocarcinoma treated with hysterectomy and vaginal brachytherapy without formal staging lymph node sampling: report of a prospective trial

    International Nuclear Information System (INIS)

    Eltabbakh, Gamal H.; Piver, M. Steven; Hempling, Ronald E.; Shin, Kyu H.

    1997-01-01

    Purpose: The value of adjuvant radiation therapy and staging pelvic lymphadenectomy in patients with low-risk, early-stage endometrial cancer is controversial. The aim of this study was to report the long-term survival, rate of recurrences, and complications in patients with Stage I endometrial cancer, Grade 1-2, with <50% myometrial invasion treated with hysterectomy (without formal staging pelvic and periaortic lymph node sampling or lymph-adenectomy) and postoperative vaginal brachytherapy. Methods and Materials: A total of 303 patients with pathologic Stage I endometrial cancer, Grade 1-2, with <50% myometrial invasion and nonmalignant peritoneal cytology, were treated with total abdominal hysterectomy, bilateral salpingo-oophorectomy, and postoperative vaginal brachytherapy (30 Gy to point 0.5 cm depth) in a prospective study extending from 1958 to 1994. In addition, 29 additional Stage I, Grade 1-2 patients with <50% myometrial invasion and malignant peritoneal cytology were treated with 1 year of progesterone therapy. Patients were followed for 1.2-32 years (median 8.1 y). Results: Six patients had recurrences and died secondary to disease. There were no vaginal recurrences. The 5-, 10-, 20-, and 30-year disease-free survivals of the 303 patients with nonmalignant peritoneal cytology were 98.9%, 97.8%, 96.7%, and 96.7%, respectively. Patients with malignant peritoneal cytology had a 5- and 10-year disease-free survival of 100%. Significant radiation complications occurred in 2.1% of the patients. Conclusion: In patients with low-risk, Stage I endometrial cancer, hysterectomy and adjuvant postoperative vaginal brachytherapy provide excellent long-term survival, eliminate vaginal recurrences, and are not associated with significant complications. The addition of 1 year of progesterone therapy to patients with malignant cytology provides 100% long-term survival. Based on these results, patients with low-risk, Stage I endometrial adenocarcinoma do not need

  8. Reference centiles for the middle cerebral artery and umbilical artery pulsatility index and cerebro-placental ratio from a low-risk population - a Generalised Additive Model for Location, Shape and Scale (GAMLSS) approach.

    Science.gov (United States)

    Flatley, Christopher; Kumar, Sailesh; Greer, Ristan M

    2018-02-06

    The primary aim of this study was to create reference ranges for the fetal Middle Cerebral artery Pulsatility Index (MCA PI), Umbilical Artery Pulsatility Index (UA PI) and the Cerebro-Placental Ratio (CPR) in a clearly defined low-risk cohort using the Generalised Additive Model for Location, Shape and Scale (GAMLSS) method. Prospectively collected cross-sectional biometry and Doppler data from low-risk women attending the Mater Mother's Hospital, Maternal and Fetal Medicine Department in Brisbane, Australia between January 2010 and April 2017 were used to derive gestation specific centiles for the MCA PI, UA PI and CPR. All ultrasound scans were performed between 18 + 0 and 41 + 6 weeks gestation with recorded data for the MCA PI and/or UA PI. The GAMLSS method was used for the calculation of gestational age-adjusted centiles. Distributions and additive terms were assessed and the final model was chosen on the basis of the Global Deviance, Akaike information criterion (AIC) and Schwartz bayesian criterion (SBC), along with the results of the model and residual diagnostics as well as visual assessment of the centiles themselves. Over the study period 6013 women met the inclusion criteria. The MCA PI was recorded in 4473 fetuses, the UA PI in 6008 fetuses and the CPR was able to be calculated in 4464 cases. The centiles for the MCA PI used a fractional polynomial additive term and Box-Cox t (BCT) distribution. Centiles for the UA PI used a cubic spline additive term with BCT distribution and the CPR used a fractional polynomial additive term and a BCT distribution. We have created gestational centile reference ranges for the MCA PI, UA PI and CPR from a large low-risk cohort that supports their applicability and generalisability.

  9. Pelvic Lymph Node Status Assessed by 18F-Fluorodeoxyglucose Positron Emission Tomography Predicts Low-Risk Group for Distant Recurrence in Locally Advanced Cervical Cancer: A Prospective Study

    International Nuclear Information System (INIS)

    Kang, Sokbom; Park, Jung-Yeol; Lim, Myung-Chul; Song, Yong-Joong; Park, Se-Hyun; Kim, Seok-Ki; Chung, Dae-Chul; Seo, Sang-Soo; Kim, Joo-Young; Park, Sang-Yoon

    2011-01-01

    Purpose: To develop a prediction model to identify a low-risk group for distant recurrence in patients with locally advanced cervical cancer treated by concurrent chemoradiation. Methods and Materials: Prospectively, 62 patients with locally advanced cervical cancer were recruited as a training cohort. Clinical variables and parameters obtained from positron emission tomography (PET) and magnetic resonance imaging were analyzed by logistic regression. For the test set, 54 patients were recruited independently. To identify the low-risk group, negative likelihood ratio (LR) less than 0.2 was set to be a cutoff. Results: Among the training cohort, multivariate logistic analysis revealed that advanced International Federation of Gynecology and Obstetrics (FIGO) stage and a high serum squamous cancer cell (SCC) antigen level were significant risk factors (p = 0.015 and 0.025, respectively). Using the two parameters, criteria to determine a low-risk subset for distant recurrence were postulated: (1) FIGO Stage IIB or less and (2) pretreatment SCC < 2.4 (Model A). Positive pelvic node on PET completely predicted all cases with distant recurrence and thus was considered as another prediction model (Model B). In the test cohort, although Model A did not showed diagnostic performance, Model B completely predicted all cases with distant recurrence and showed a sensitivity of 100% with negative LR of 0. Across the training and test cohort (n = 116), the false negative rate was 0 (95% confidence interval 0%-7.6%). Conclusions: Positive pelvic node on PET is a useful marker in prediction of distant recurrence in patients with locally advanced cervical cancer who are treated with concurrent chemoradiation.

  10. Is negative self-referent bias an endophenotype for depression? An fMRI study of emotional self-referent words in twins at high vs. low risk of depression

    DEFF Research Database (Denmark)

    Miskowiak, K W; Larsen, J E; Harmer, C J

    2018-01-01

    , mean ± SD: 40 ± 11) were well-balanced for demographic variables, mood, coping and neuroticism. High-risk twins showed lower accuracy during self-referent categorisation of emotional words independent of valence and more false recollections of negative words than low-risk twins during free recall...... is consistent with the hypothesis that self-referent negative memory bias is an endophenotype for depression. High-risk twins' lower categorisation accuracy adds to the evidence for valence-independent cognitive deficits in individuals at familial risk for depression....

  11. Quality of life, physical function and MRI T2* in elderly low-risk MDS patients treated to a haemoglobin level of ≥120 g/L with darbepoetin alfa ± filgrastim or erythrocyte transfusions

    DEFF Research Database (Denmark)

    Nilsson-Ehle, Herman; Birgegård, Gunnar; Samuelsson, Jan

    2011-01-01

    Anaemia in low-risk myelodysplastic syndromes (MDS) is associated with reduced quality of life (QoL). Response to treatment with erythropoietin ± granulocyte colony-stimulating factor (G-CSF) is associated with improved QoL, but whether transfusion therapy with higher haemoglobin (Hb) target levels...... has similar effects is unknown. The objective for this prospective phase II Nordic multicentre trial was to assess QoL, response rate and physical function in elderly anaemic MDS patients treated to a target Hb level of >120 g/L....

  12. The impact of an hematocrit of 20% during normothermic cardiopulmonary bypass for elective low risk coronary artery bypass graft surgery on oxygen delivery and clinical outcome – a randomized controlled study [ISRCTN35655335

    Science.gov (United States)

    von Heymann, Christian; Sander, Michael; Foer, Achim; Heinemann, Anja; Spiess, Bruce; Braun, Jan; Krämer, Michael; Grosse, Joachim; Dohmen, Pascal; Dushe, Simon; Halle, Jürgen; Konertz, Wolfgang F; Wernecke, Klaus-Dieter; Spies, Claudia

    2006-01-01

    Introduction Cardiopulmonary bypass (CPB) induces hemodilutional anemia, which frequently requires the transfusion of blood products. The objective of this study was to evaluate oxygen delivery and consumption and clinical outcome in low risk patients who were allocated to an hematocrit (Hct) of 20% versus 25% during normothermic CPB for elective coronary artery bypass graft (CABG) surgery. Methods This study was a prospective, randomized and controlled trial. Patients were subjected to normothermic CPB (35 to 36°C) and were observed until discharge from the intensive care unit (ICU). Outcome measures were calculated whole body oxygen delivery, oxygen consumption and clinical outcome. A nonparametric multivariate analysis of variance for repeated measurements and small sample sizes was performed. Results In a total of 54 patients (25% Hct, n = 28; 20% Hct, n = 26), calculated oxygen delivery (p = 0.11), oxygen consumption (p = 0.06) and blood lactate (p = 0.60) were not significantly different between groups. Clinical outcomes were not different between groups. Conclusion These data indicate that an Hct of 20% during normothermic CPB maintained calculated whole body oxygen delivery above a critical level after elective CABG surgery in low risk patients. The question of whether a transfusion trigger in excess of 20% Hct during normothermic CPB is still supported requires a larger prospective and randomized trial. PMID:16606474

  13. A Phase II Trial of SABR (Stereotactic Ablative Body Radiotherapy for Low-Risk Prostate Cancer Using a Non-Robotic Linear Accelerator and Real-Time Target Tracking: Report of Toxicity, Quality of Life and Disease Control Outcomes with 5-Year Minimum Followup

    Directory of Open Access Journals (Sweden)

    Constantine Anastasios Mantz

    2014-11-01

    Full Text Available Purpose/Objective(s: Herein, we report the results of an IRB-approved phase II trial of Varian Trilogy/TrueBeam-based SABR monotherapy for low-risk prostate cancer using the Calypso® System to provide real-time electromagnetic tracking of the prostate’s position during treatment delivery. Materials/Methods: A total of 102 low-risk patients completed protocol treatment between January 2007 and May 2009. A total dose of 40.0 Gy in 5 every-other-day fractions of 8.0 Gy was prescribed to the planning target volume. Target setup and tracking procedures were as follows: (1 the Calypso® System was used to achieve target setup prior to each fraction; (2 conebeam CT imaging was then used for correction of setup error and for assessment of target and Organs-at-Risk (OAR deformations; (3 after treatment delivery was initiated, the Calypso® System then provided real-time intrafractional target tracking. The NCI CTCAE v3.0 was used to assess urinary and rectal toxicity during treatment and at defined followup time points. Biochemical response and quality of life measurements were made at concurrent followup points.Results: Urinary toxicities were most common. At 6 months, 19.6%, 2.9% and 4.9% of patients reported grades 1 – 2 urinary frequency, dysuria and retention, respectively. Rectal toxicities were uncommon. By 12 months, 2.9% of patients reported painless rectal bleeding with subsequent symptom resolution without requiring invasive interventions. Quality of life measurements demonstrated a significant decline over baseline in urinary irritative/obstructive scores at 1 month following SABR but otherwise did not demonstrate any difference for bowel, bladder and sexual function scores at any other followup time point. One patient suffered biochemical recurrence at 6 years following SABR.Conclusions: At five years minimum followup for this favorable patient cohort, prostate SABR resulted in favorable toxicity, quality of life and biochemical

  14. Resultados neonatais no parto vaginal espontâneo comparados aos dos partos com fórcipe de Simpson-Braun em primíparas Neonatal outcome of spontaneous deliveries as compared to Simpson-Braun forceps deliveries in nulliparous women

    Directory of Open Access Journals (Sweden)

    Belmiro Gonçalves Pereira

    2004-02-01

    Full Text Available OBJETIVO: comparar os resultados neonatais dos partos vaginais espontâneos ou assistidos com fórcipe de Simpson-Braun em nulíparas. MÉTODO: em estudo de corte retrospectivo foram avaliados dois grupos de primíparas atendidas no Centro Obstétrico do CAISM/UNICAMP, que tiveram parto vaginal sob analgesia epidural. O grupo fórcipe foi formado por 119 pacientes que tiveram parto a fórcipe de Simpson-Braun, e o grupo normal por 114 casos de parto vaginal espontâneo. Foram estudadas as variáveis neonatais imediatas como o estado do líquido amniótico e os índices de Apgar, assim como a evolução neonatal nos primeiros dias de vida. Para análise estatística foram utilizados os testes c², exato de Fisher e t de Student para comparação de médias e considerada significativa a diferença correspondente a pPURPOSE: to compare maternal and neonatal outcomes between spontaneous vaginal and Simpson-Braun forceps deliveries in nulliparous women. METHOD: a retrospective study including two groups of nulliparous women, who had vaginal delivery under peridural anesthesia in the obstetric unit of the CAISM-UNICAMP: the forceps group included 119 women who had Simpson-Braun forceps delivery, and the normal group included 114 women who delivered spontaneously. Neonatal outcomes, such as Apgar score and the evolution in the first days of life, were studied. Data were compared in both groups and, for statistical analysis, c² test, Fisher exact, and Student t tests were used. The differences were considered significant when p<0.05. RESULTS: the indications for Simpson-Braun forceps delivery were maternal-fetal relief (90 cases and abbreviation of the expulsive period (29 cases. In the forceps group there were 8 cases (6.7% of vaginal injuries; a similar result was observed in the normal group. The number of hospitalization days for the parturient and the newborns was identical, 2.4 days. The newborns in the two groups had similar Apgar scores

  15. Time-driven activity-based costing of low-dose-rate and high-dose-rate brachytherapy for low-risk prostate cancer.

    Science.gov (United States)

    Ilg, Annette M; Laviana, Aaron A; Kamrava, Mitchell; Veruttipong, Darlene; Steinberg, Michael; Park, Sang-June; Burke, Michael A; Niedzwiecki, Douglas; Kupelian, Patrick A; Saigal, Christopher

    Cost estimates through traditional hospital accounting systems are often arbitrary and ambiguous. We used time-driven activity-based costing (TDABC) to determine the true cost of low-dose-rate (LDR) and high-dose-rate (HDR) brachytherapy for prostate cancer and demonstrate opportunities for cost containment at an academic referral center. We implemented TDABC for patients treated with I-125, preplanned LDR and computed tomography based HDR brachytherapy with two implants from initial consultation through 12-month followup. We constructed detailed process maps for provision of both HDR and LDR. Personnel, space, equipment, and material costs of each step were identified and used to derive capacity cost rates, defined as price per minute. Each capacity cost rate was then multiplied by the relevant process time and products were summed to determine total cost of care. The calculated cost to deliver HDR was greater than LDR by $2,668.86 ($9,538 vs. $6,869). The first and second HDR treatment day cost $3,999.67 and $3,955.67, whereas LDR was delivered on one treatment day and cost $3,887.55. The greatest overall cost driver for both LDR and HDR was personnel at 65.6% ($4,506.82) and 67.0% ($6,387.27) of the total cost. After personnel costs, disposable materials contributed the second most for LDR ($1,920.66, 28.0%) and for HDR ($2,295.94, 24.0%). With TDABC, the true costs to deliver LDR and HDR from the health system perspective were derived. Analysis by physicians and hospital administrators regarding the cost of care afforded redesign opportunities including delivering HDR as one implant. Our work underscores the need to assess clinical outcomes to understand the true difference in value between these modalities. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  16. Anesthesiologists’ and surgeons’ perceptions about routine pre-operative testing in low-risk patients: application of the Theoretical Domains Framework (TDF to identify factors that influence physicians’ decisions to order pre-operative tests