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Biomedical subjects

G G Essed

Publications and source records attributed to G G Essed.

At least 19 recordsLinked to original sources
PubMed1998

Aspects of food and fluid intake during labour. Policies of midwives and obstetricians in The Netherlands.

OBJECTIVE: This study outlines the current policies on food and fluid intake during labour in The Netherlands and discusses the pro's and con's of food-restriction. STUDY DESIGN: 50 midwives and 30 obstetricians were asked about their actual policy on food and fluid-intake during labour. RESULTS: A restrictive policy during normal labour is followed by 20% of the midwives and 14% of the obstetricians. About 75% leaves the decision on food and fluid-intake to the women themselves. CONCLUSIONS: Despite the non-restrictive policy in The Netherlands, the mortality due to the Mendelson-syndrome is not higher than in countries where a restrictive policy is followed. During normal labour there are no conclusive reasons for food or fluid-restriction. From a metabolic point of view it is hypothesized that the intake of energy-rich substrates may have a positive influence on labour progression. Further study on the subject seems indicated.

Drinking↗
PubMed1997

[Optimal world-wide obstetrical care; a WHO report].

'Safe motherhood; care in normal birth: a practical guide' is a document produced by an international technical working group of the World Health Organization. This report addresses issues of care during normal birth irrespective of country or region. Routine interventions and non-interventions in the physiological processes of pregnancy and labour are analysed and assessed for their scientific validity. Scientific foundation of obstetric practice is considered an important step towards worldwide demystification of obstetric practice, which now often relies on authority, culture and habit. For risk assessment, the cornerstone of the Dutch system of obstetric care, an evidence-based strategy is imperative. This requires scientific training in schools of midwifery.

Delivery of Health Care↗
PubMed1996

Smoking in Dutch pregnant women and birth weight.

In this study 796 ambulatory singular pregnant women were questioned about their smoking habits both before and during pregnancy (ambispective). Important covariates such as parity, blood pressure, maternal weight gain, salt- and alcohol consumption and length of gestation were taken into account. At the beginning of pregnancy 52% of the questioned women smoked; 36% smoked in the seventh/eighth month of pregnancy. A dose-response relationship was found between the number of cigarettes smoked per day and birth weight. For those pregnant women who still smoked after 7 months of pregnancy an average birth weight loss of 24 g was found per cigarette per day. Even after controlling for covariates, there still remains an independent influence of smoking on birth weight loss on the average of 19 g for each cigarette smoked per day.

Adult↗
PubMed1995

Long-term effect of feedback and peer comparison on the sampling quality of cervical smears--a randomized controlled trial.

In a randomized controlled trial the effect of feedback and peer review directed at the sample-taking doctor (n = 179) on the sampling quality of cervical smears (n = 21,240) was studied. This paper reports the impact 6 and 12 months after the end of the intervention. Monthly feedback with peer comparison was related to a net improvement in the proportion of cervical smears without endocervical cells during the intervention period, as well as during a follow-up period lasting until 15 months after the end of the intervention. This improvement seemed to be related to a minimum of 50 or even 100 smears performed each year and was therefore not confirmed on clustered data analysis. There is a strong suggestion that the intervention also related to an increase of the number of smears showing cytological pathology, although this study lacked sufficient power to test this hypothesis.

Cluster Analysis↗
PubMed1995

Blues and depression during early puerperium: home versus hospital deliveries.

OBJECTIVE: To investigate whether women who give birth at home are less prone to mood disturbances during the early puerperium than those who give birth in hospital. DESIGN: A prospective study of 303 pregnant women who registered for antenatal care. SETTING: The antenatal clinic at St Joseph's Hospital, Veldhoven, The Netherlands, and five antenatal consultation programmes of local midwives working in the surrounding region. SUBJECTS: Three hundred and eighty-two consecutive caucasian women registering for antenatal care were approached. Of these, 303 consented to participate and 293 completed the study. MAIN OUTCOME MEASURE: The predictor variable was the way in which the women gave birth: spontaneous vaginal parturition at home or in hospital as follows: spontaneously; vaginal parturition after stimulation with medication; vaginal parturition with forceps/vacuum extraction; or caesarean section. The outcome variables were blues and depression. The occurrence of blues was assessed at 4 weeks postpartum, using Pitt's criteria. The occurrence of depression was assessed at 4 weeks postpartum using the Research Diagnostic Criteria. The possible confounding effects of a set of obstetrical and psycho-social variables relating to the early puerperium were investigated using logistic regression analysis. RESULTS: Of the 293 women who completed the study, 52% gave birth at home. Significantly more nullipara gave birth in hospital. Parturition occurred where it had been planned in 77% of women; referral occurred later on in pregnancy in 11% and during labour in 12%. Nullipara had to be referred significantly more often than multipara. In general, there was no difference in the incidence of blues and depression between women who gave birth at home and those who gave birth in hospital. Obstetric factors were not related to the occurrence of blues or depression in the early puerperium. CONCLUSIONS: Women who gave birth in hospital are no more prone to postpartum mood disturbances, such as blues and depression, than women who give birth at home.

Affective Disorders, Psychotic↗
PubMed1995

Composition of cervical smears in patients with and without a cervical ectropion.

AIMS: To test the hypothesis that absence of squamous cells in cervical smears obtained by an endocervical sampling technique is more prominent in patients with a cervical ectropion. METHODS: Prospective study exploring the relation between the composition of cervical smears obtained using an endocervical cotton swab in patients with (n = 188) and without (n = 341) a cervical ectropion. Subjects were 529 consecutive patients from whom a cervical smear was prepared at a university gynaecological clinic. RESULTS: In 7% of the endocervical samples no squamous cells were found. There was no correlation, however, between the presence or the size of an ectropion and the absence of squamous cells in those samples. CONCLUSIONS: It was confirmed that endocervical sampling alone is insufficient to obtain good quality cervical smears. The presence of an ectropion proved to be an unreliable predictor of the absence of squamous cells.

Cervix Uteri↗
PubMed1994

The effect of different sampling devices on the presence of endocervical cells in cervical smears. A systematic literature review.

A literature search examined 39 reports on the relationship between the absence of endocervical cells in a cervical smear and the sampling technique used. Using (pooled) ratios we compared the results for different pairs of sampling devices, thereby controlling for the design of each study when appropriate. The Cytobrush appears the most efficient sampling method with regard to the presence of endocervical cells. Combining the results of this review with the results of a previous meta-analysis on the effect of the sampling technique on the detection of pathology, the combined spatula and Cytobrush technique seems to be the best sampling method.

Cervix Uteri↗
PubMed1993

Role of the baroreflex in beta 2-sympathomimetic induced tachycardia in male rats.

The aim of the study was to determine whether tachycardia which is associated with the use of beta 2-sympathomimetic tocolytic agents is caused by baroreflex activation or by direct stimulation of cardiac beta-adrenoceptors. In conscious male rats, tachycardiac responses following intravenous injection of hexoprenaline, ritodrine and fenoterol were compared following (i) bilateral sinoaortic denervation (SAD) or (ii) sham-operation, and (iii) ganglionic-blockade using hexamethonium. Dose-ranges were chosen to result in similar reductions in diastolic blood pressure (DAP). Furthermore, following ganglionic blockade, the relative contribution of beta 1-adrenoceptor stimulation was assessed using the selective beta 2-receptor antagonist ICI 118,551. In intact rats, increases in HR induced by all beta-adrenoceptor agonist were comparable. In SAD and ganglion-blocked rats, DAP fell more pronounced at even lower doses. The corresponding increases in HR were approximately 3 times smaller than in intact rats but not different between agents. During ganglionic blockade ICI 118,551 significantly inhibited HR responses to fenoterol and hexoprenaline but not ritodrine. The conclusion is that in intact male rats, baroreflex activation is the major determinant of tachycardia following injection of ritodrine, fenoterol or hexoprenaline. Increasing the beta 2-selectivity of these drugs will not limit the tachycardic effects.

Adrenergic beta-Agonists↗
PubMed1993

Interobserver variation in the assessment of the sampling quality of cervical smears.

In order to assess the interobserver variation among cytological assistants in evaluating the sampling quality of cervical smears, all four laboratory assistants from one cytological department examined the same set of 71 smears. They assessed the presence of endocervical cells, the quality of fixation, the number of cells and the undesirable presence of clumps of cells. The interobserver agreement, uncorrected for chance, varied from 73 to 93% for the presence of endocervical cells and from 86 to 100% for the three other criteria. For the presence of endocervical cells, the kappa values, a measure for the interobserver agreement corrected for chance, varied from 42 to 84%. This is a reasonable outcome. For the three other criteria many kappa values were zero or uncalculable. The interobserver agreement in evaluating the sampling quality of cervical smears is reasonable to good, but not perfect. Prudence in the interpretation of quality data is warranted.

Female↗
PubMed1993

Prevalence of post partum depression--or is it post-puerperium depression?

In a longitudinal study, the prevalence of post partum depression was investigated in 293 women. They were assessed during gestation at 32 weeks, and consecutively after parturition with an interval of six weeks from four weeks until 34 weeks' post partum. The prevalence of post partum depression (RDC) varied between seven and 14%, with a peak at ten weeks' post partum. It was found that women were depressed significantly more often at ten weeks' post partum compared with pregnancy, the first post partum weeks and the later post partum period. This finding suggests that it is not directly after parturition that women are more prone to depression. The relationship between variables such as blues, parity, PMS and depression showed that at different assessments in the post partum period different women are depressed, women who do not necessarily share the same characteristics. This finding may explain why in some studies a relationship was found between certain kinds of variables and post partum depression while in others not. PMS was found to be significantly related to post partum depression only at the time of the women resumed menstruation. It is suggested that screening on post partum depression partly involves screening on depressive symptoms related to PMS.

Adult↗
PubMed1993

Does feedback improve the quality of cervical smears? A randomized controlled trial.

In a randomized controlled trial three methods of feedback of increasing intensity, directed at 183 doctors taking cervical smears, were compared with respect to their effects on the sampling quality of smears. Overall, feedback was found to have no influence on quality criteria in the crude data analysis. However, a significantly larger decrease in the percentage of smears lacking endocervical cells was found in the groups receiving monthly overviews of their results with peer comparison, when compared with the groups not receiving this type of feedback (odds ratio 0.75). Moreover, feedback appeared to have a clear effect on the presence of endocervical cells among doctors submitting a substantial number of smears in the intervention period, as opposed to those who submitted fewer smears. A positive correlation was also observed between the increase in the group mean of the proportions of smears containing pathological cells and the intensity of the feedback. However, this increase did not reach statistical significance. This study suggests that monthly feedback with peer comparison may have a positive relationship with some aspects of quality improvement in cervical screening.

Adult↗
PubMed1992

[Incidence of postpartum thyroid function disorders in The Netherlands].

In a longitudinal study the incidence of postpartum thyroid dysfunction in the Netherlands was investigated in an unselected open population. There were 293 women who were screened by repeated assessments of thyroid function until 34 weeks postpartum at 6-week intervals. Thyroid dysfunction was defined as abnormal TSH values accompanied by abnormal FT4 and (or) FT3 values. The frequency of postpartum thyroid dysfunction was 7.2% (n = 21). Most of the thyroid dysfunction occurred between 16 and 28 weeks postpartum. There were five women with subclinical thyroid dysfunction: abnormal TSH values with complementary FT4 and (or) FT3 changes within normal limits. Four of them showed (marked) increase in antimicrosomal antibody titres. With the inclusion of the five women the frequency rose to 8.9%. These data appear representative for the Netherlands as a whole, suggesting that every year 14,000 women suffer from (transient) postpartum thyroid dysfunction.

Adult↗