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PubMed1990

Contraceptive social marketing in Nepal: consumer and retailer knowledge, needs and experience.

In 1986, a survey was conducted to assess knowledge, health concerns and experience with marketing (retailers) and use (consumers) of Gulaf and Nilocon pills and Kamal vaginal tablets distributed by the Nepal Contraceptive Retail Sales Company (CRS). A sample of 763 consumers of Gulaf, Nilocon and Indian pills and Kamal vaginal tablets, and 361 retailers from a stratified sample of urban medical shops were interviewed. The CRS marketing programme is reaching people who have previously never used family planning; most of the users were practising contraception to limit, not space, births; a high proportion of pill users over 35 smoked; only about a third of CRS pill users had prescriptions or consulted a physician prior to use; CRS training of retailers was found to have increased their knowledge. Recommendations are made for improving communication, education and marketing of CRS contraceptives to ensure their safe and effective use and increase the acceptability of this mode of service delivery.

Contraception↗
PubMed2000

Infection and preterm birth.

Preterm birth complicates 11% of all pregnancies in the United States and remains a leading cause of infant mortality and long-term neurological handicap. The majority of this morbidity and mortality is concentrated among the small subset of infants born before 32 weeks' gestational age and that have birth weights < 1500 g. Although the survival of these preterm infants has improved over the last 20 years, the rate of long-term handicap has not. Despite widespread use of preventive strategies, the rate of preterm birth is increasing. Therefore, the prevalence of long-term handicap attributed to preterm birth also is increasing. Considerable data implicate a clinically silent upper genital tract infection as a key component of the pathophysiology of a majority of early spontaneous preterm births, but a minority of preterm births that occur near term. This report reviews the current status of our understanding of the relationship between genital tract microbial infection and spontaneous preterm birth, the availability and usefulness of markers to identify women with such infections, and the results of recent prospective randomized clinical trials of antibiotic therapy to prevent preterm birth. Strengths and limitations of the trials are reviewed in relationship to their value for guidance in clinical management strategies and directions for future research are discussed.

Female↗
PubMed2004

Birthweight differences among infants of North African immigrants and Belgians in Belgium.

BACKGROUND: Infants of North African immigrants are reported to have higher birthweights than their Belgian counterparts. It is unclear what mechanism contributes to this difference. METHODS: Analyses were based on a hospital-based cohort of 1,162 women. RESULTS: Infants of North African immigrants were less likely to be born preterm, compared to infants of Belgian women. After adjusting for sociodemographic and maternal factors, the estimated difference in mean birthweight was 74 g (p=0.05). When limited to term births, this difference was 28 g (p=0.42). CONCLUSION: The difference in mean birthweight between North African and Belgian infants was explained by differences in preterm birth and other risk factors.

Adult↗
PubMed2000

Biophysical properties and molecular characterization of amiloride-sensitive sodium channels in A549 cells.

Amiloride-sensitive Na(+) channels, present in fetal and adult alveolar epithelial type II (ATII) cells, play a critical role in the reabsorption of fetal fluid shortly after birth and in limiting the extent of alveolar edema across the adult lung. Because of the difficulty in isolating and culturing ATII cells, there is considerable interest in characterizing the properties of ion channels and their response to injury of ATII cell-like cell lines such as A549 that derive from a human alveolar cell carcinoma. A549 cells were shown to contain alpha-, beta-, and gamma-epithelial Na(+) channel mRNAs. In the whole cell mode of the patch-clamp technique (bath, 145 mM Na(+); pipette, 145 mM K(+)), A549 cells exhibited inward Na(+) currents reversibly inhibited by amiloride, with an inhibition constant of 0.83 microM. Ion substitution studies showed that these channels were moderately selective for Na(+) (Na(+)-to-K(+) permeability ratio = 6:1). Inward Na(+) currents were activated by forskolin (10 microM) and inhibited by nitric oxide (300 nM) and cGMP. Recordings in cell-attached mode revealed the presence of an amiloride-sensitive Na(+) channel with a unitary conductance of 8.6 +/- 0.04 (SE) pS. Channel activity was increased by forskolin and decreased by nitric oxide and the cGMP analog 8-bromo-cGMP. These data demonstrate that A549 cells contain amiloride-sensitive Na(+) channels with biophysical properties similar to those of ATII cells.

Amiloride↗
PubMed2001

A population-based prescription study of asthma drugs during pregnancy: changing the intensity of asthma therapy and perinatal outcomes.

BACKGROUND: Among the goals of gestational asthma, therapy is optimisation of pulmonary function. According to the US Food and Drug Administration, no asthma drugs can be considered 'safe' during pregnancy. Fear of adverse fetal effects may thus lead to restrictive use of asthma drugs during pregnancy, and no population-based studies concerning gestational asthma therapy exist. OBJECTIVES: To examine whether asthma drugs or changing intensity of asthma therapy during pregnancy was associated with deviations from expected values of gestational age, birth weight, length at birth, or malformations. METHODS: The Birth Registry was used to identify all 15,756 primiparous women who gave birth in the County of North Jutland between 1991 and 1996. According to the North Jutland Prescription Database, 303 of these women received prescriptions for asthma drugs during pregnancy. Women who did not purchase any prescription drugs during pregnancy constituted the reference group. CONCLUSION: Women who received prescriptions for asthma drugs during pregnancy gave birth to infants with birth weight and length at birth within the expected limits. Reducing intensity of asthma treatment during pregnancy was associated with lower birth weight and length at birth. This may indicate that pregnant women chose to discontinue therapy although their disease severity justifies continuation of treatment. However, analyses did not take into account important clinical variables, and results could also be due to confounding factors or chance.

Adult↗
PubMed2005

Estradiol modulation of kainic acid-induced calcium elevation in neonatal hippocampal neurons.

The developing hippocampus of both males and females is exposed to high levels of the gonadal steroid estradiol. The impact of this estradiol exposure on developing hippocampal neurons is essentially unknown. In the rat, the newborn hippocampus is relatively insensitive to excitotoxic brain injury, which in adults is associated with the release of amino acids, in particular glutamate, resulting in a significant increase in intracellular calcium and eventual cell death. We have shown previously in the rat that administration of the glutamate agonist, kainic acid (KA), on the day of birth results in limited hippocampal damage, which is ameliorated by treatment with the gonadal steroid, estradiol. We now show that KA induces an increase in intracellular calcium through L-type voltage-sensitive calcium channels early in development and, later in development, through polyamine-sensitive alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors with a modest increase through N-methyl-D-aspartate receptors. Pretreatment with the gonadal steroid, estradiol, decreases the percentage of neurons responding to KA and decreases the peak amplitude of the calcium transient early in development but has no effect later in development. Taken together, these data suggest that there is a developmental shift in the route of KA-induced intracellular calcium and estradiol modulates KA-induced intracellular calcium to a time restricted to early development, but whether this is the basis of the neuroprotective effect of estradiol remains to be determined.

Animals↗
PubMed1993

Effect of premature birth and survival on hepatic thyroxine 5'-monodeiodinase activity in baboons.

Plasma thyroid hormones and hepatic 5'-monodeiodinase type I (5'-MDI) activity were measured in a primate model of premature birth and survival. When prematurely delivered at 140 days (term gestation is 184 days), infant baboons developed hyaline membrane disease, had no surge in T3 and T4, temporarily developed hypothyroxinemia, and had extremely low T3 concentrations during the first 40 h of life. After 4 days, both plasma T4 and T3 levels progressively increased, but were still considerably lower at 16 days compared to those in normal term infants. Hepatic 5'-MDI activity was measured in the presence of dithiothreitol in fetal, premature, and infant baboons. Fetal baboons at 140 and 161 days gestation had 80% less 5'-MDI activity than term infants, but at 178-180 days gestation, near term, fetal hepatic 5'-MDI activity increased to levels similar to those in young adults. Interruption of in utero development by premature birth resulted in no change in hepatic 5'-MDI activity after 24 h, but within 6 days after delivery, hepatic 5'-MDI had significantly increased to levels observed in fetal baboons near term. Kinetic analysis revealed that fetal and premature 5'-MDI had different maximum velocities and similar apparent Km values. There was no significant difference in hepatic total, protein, or nonprotein sulfhydryl groups between 1- and 10-day-old premature (140 days gestation) baboons. These results suggest that premature birth does not limit the postnatal maturation of hepatic 5'-MDI activity.

Animals↗
PubMed1981

Birth control practice in Khartoum.

The results presented here are based on a fertility survey carried out in Khartoum in 1978. It was shown that the knowledge of family planning is widespread in the city and that the level of ever-use of birth control is becoming significant. The popularity of the different methods of birth control is investigated, revealing that the pill is used by nearly all ever-users. IUDs, rhythm, and withdrawal are also relatively popular. A great degree of consistency was found to exist between reports given by husbands and their wives in this respect. The purpose of using birth control is not yet clear. The significant ever-use, noted before the 3rd live birth, indicates that these methods are used for the purpose of spacing births rather than limiting the number of children.

Africa↗
PubMed1977

[2 cases of arthrogryposis].

The authors report two cases of arthrogryposis in two children of 7 1/2 and 13 years; the diagnostic criteria were those of Fisher, combining the joint limitations present since birth in at least two different regions, the absence of progressive neurological involvement, and evident amyotrophy. The different etiopathogenic theories are then discussed: review of the literature concerning cases of myopathic arthrogryposis is not very useful; the twelve cases mentioned in the literature are not homogenous, the histopathological findings were very variable, and the histoenzymological studies have been insufficient. The combination of neurological anomalies with arthrogryposis is undeniable (cerebral atrophy, depopulation of the anterior cornu, anterior radicular changes). They are not always present, however, and are insufficient to explain the symptoms. Consideration should be given to the question of whether the importance of the changes in the connective tissue are not underestimated: the proliferation of the connective tissue is, in fact, most of the time, the essential feature to be seen in a histological section. In connection with this "connective theory" it is important to recall the work of Ionasescu et al. (1970) who demonstrated in vitro the excessive synthesis of connective proteins in the muscles of patients with arthrogryposis.

Adenosine Triphosphatases↗
PubMed2006

Post-Perruche: what responsibilities for professionals?

Damage compensation relating to handicapped new-borns, the wrongful life law, was put in place after a great controversy in France by the Perruche ruling of November 13th 2000. The French parliaments have voted a special law against wrongful life action. But questions about medical liability are not answered by the new law. For wrongful life, what are now the medical errors likely to directly provoke a handicap or aggravate it or obstruct measures to alleviate it? For a wrongful birth claim it limits parental damages to psychological damages only, due to a lack of mental preparation, whilst denying economic losses, thus preventing complete compensation arising from medical malpractice for all the other types of difficulty suffered by the parents. Why does it give a new definition of medical malpractice as a "characterized fault" and insist upon the qualification 'blatant" in the field of medical liability? For health professionals, it is a question of knowing and being acquainted with the errors that fall under their liability with regard to handicapped persons and a "characterized fault" with regard to parents. It is through a review of past and present case law that we will try to answer these medical questions. All court rulings that awarded monetary damages to the child were reviewed. We include only three decisions after the new law, which do not allow damage compensation in respect of a handicapped new-born. The rulings incorporate decisions taken by the French Supreme Court, of the council of state as well as by courts of appeal. Failure of voluntary termination of pregnancy, missing rubella immune antibody, omission of mandatory tests during pregnancy, typical medical fetal malpractice, were and are professional faults.

Compensation and Redress↗
PubMedDate not supplied

Marked preference for female sterilization in a semirural squatter settlement.

The following article analyzes the reasons very poor semirural women in South India choose sterilization as a means of birth control. The women, who work for minimal wages in a narrowing job market and whose children have little hope for jobs or land marriages, are choosing to be sterilized after two or three births. Among their limited range of contraceptive choices, female sterilization in the nearby hospital where women go for deliveries and abortion is perceived by them to be the most advantageous in terms of the cost of medicines and transportation and time away from jobs. The article illustrates the centrality of economic factors in low-income women's family planning decisions.

Adult↗
PubMed1980

The value of the micromethod erythrocyte sedimentation rate in the diagnosis of infections in newborns.

200 newborns, gestational age between 27 and 43 weeks (mean 39 weeks) and a birth weight between 900 and 4600 g (mean 2600 g) were studied. 18 patients had severe infections, 20 topical infections, 11 had signs of infection but negative microbiological cultures, 26 had positive cultures but no clinical signs of infection, and 125 patients had no sign of infection at all. In the group without infection (125 patients), the micromethod erythrocyte sedimentation rate (MESR) raised slowly from 2 mm/h at birth (95% upper limit 8 mm/h) to 4 mm/h 8 days after delivery. The MESR of the patients with respiratory distress, asphyxia, intubated children and patients with umbilical catheter, who had no infection, did not differ from other patients in this group. In patients with focal and general infections, rapidly rising MESR within wide limits was observed. Thus, in the individual newborn a high MESR supports the diagnosis of severe infection, whereas a low MESR does not exclude this diagnosis.

Bacterial Infections↗
PubMed1978

Serum lipid concentration in newborns from various ethnic groups in Israel.

Serum cholesterol was determined in the cord blood of 438 newborns and repeated on venous samples from the same infants at the ages of 6 and 18 months. Of 36 infants who were originally defined as hypercholesterolemic, 28 had normal values by the age of six months. The prevalence of hypercholesterolemia at birth was 8%. No differences were noted among the five ethnic groups examined. The results suggest that serum cholesterol level at birth is of limited value for the early detection of familial hypercholesterolemia.

Cholesterol↗
PubMed1995

Neonatal tetanus mortality in Veracruz, Mexico, 1989.

This article describes a survey conducted in the State of Veracruz, Mexico, to estimate neonatal tetanus (NNT) mortality. The survey, which entailed visits to 72,720 households, collected data on 8,401 live births and 209 infant deaths occurring between April 1988 and May 1989. Twenty-six of the 209 fatalities conformed to a WHO standard case definition of death from neonatal tetanus. The estimated neonatal tetanus mortality was thus 3.1 deaths per 1,000 live births (95% confidence limits = 1.7, 4.5). Comparison of this rate to reported figures suggests that for every NNT death recorded in Veracruz during the study period, as many as 50 others went unreported. A case-control study nested within the survey was conducted to assess preventable NNT risk factors. Limited information on 13 NNT deaths and 217 controls showed an increased risk for neonates who were delivered at home and whose parents' ethnic background was Mexican Indian. Five of the 13 fatalities had their umbilical cords cut with a domestic or traditional cutting tool such as a reed cane, as compared to none of the 217 controls. The observed vaccine efficacy of 2+ doses of tetanus toxoid was 70% (95% confidence limits = 52, 100). Both the mothers of neonates who died of NNT and their controls missed an average of five opportunities to receive tetanus toxoid. These findings underscore the need to launch a perinatal health program serving Mexico's high-risk populations.

Case-Control Studies↗
PubMed1994

Differential expression of two different homeobox gene families during mouse tegument morphogenesis.

The expression of six genes belonging to two different homeobox gene families was studied during the embryonic and postnatal morphogenesis of head and body regions of the mouse integument. The first family included the Otx1 and Otx2 genes, both related to the orthodenticle Drosophila gene and the second was represented by four members of the Antennapedia class HOX genes: Hoxc8 and three Hoxd genes, d9, d11 and d13. In situ hybridizations with 35S labeled antisense RNA probes were performed on head serial frontonasal sections, as well as entire embryo and postnatal tail longitudinal sections. The expression of these genes shows a differential spatiotemporal pattern along the cephalo-caudal axis. In 12.5-day and 15.5-day embryos, the Otx2 gene expression is restricted to the nasal epithelium and its associated glands, while the Otx1 transcripts are present in both nasal and facial integuments, including nasal glands and hair vibrissa follicles. The Hoxc8 expression first appears in skin at 14.5 days of gestation in the sternal region and is extended at 16.5 days to the thoracic ventral and lumbar dorsal regions. The Hoxd9 and Hoxd11 genes are only expressed in the caudal skin from 14.5 days of gestation. The Hoxd13 transcripts are the last to appear, 2 days after birth, and are limited to the last epidermal cells to differentiate, i.e. those of the hair matrix of the caudal pelage hair follicles. Taken together, these observations strengthen the hypothesis that different homeobox gene families specify the regional identity of the skin in the cephalic and body regions.

Animals↗
PubMed1993

[Ultramicroscopic aspects of the lungs in copper-deficient newborn rats].

In order to investigate the possible morphological alterations in the lungs of copper-deficient neonatal rats, three groups of 10 female Sprague-Dawley rats were used. The copper-deficient group was fed with a copper-free diet beginning at 35 days before pregnancy and throughout the gestation period. The control group received a diet adequate in copper and the pair-fed group received a diet with adequate copper content, but in limited amounts. After birth, the ultrastructural study of the neonatal lungs showed a thickening of the air-blood barrier in the copper-deficient group. No other differences were observed in the rest of the pulmonary structures.

Animals↗
PubMed1993

Stromal cells from human long-term marrow cultures are mesenchymal cells that differentiate following a vascular smooth muscle differentiation pathway.

In human long-term marrow cultures connective tissue-forming stromal cells are an essential cellular component of the adherent layer where granulomonocytic progenitors are generated from week 2 onward. We have previously found that most stromal cells in confluent cultures were stained by monoclonal antibodies directed against smooth muscle-specific actin isoforms. The present study was carried out to evaluate the time course of alpha-SM-positive stromal cells and to search for other cytoskeletal proteins specific for smooth muscle cells. It was found that the expression of alpha-SM in stromal cells was time dependent. Most of the adherent spindle-shaped, vimentin-positive stromal cells observed during the first 2 weeks of culture were alpha-SM negative. On the contrary, from week 3 to week 7, most interdigitated stromal cells contained stress fibers whose backbone was made of alpha-SM-positive microfilaments. In addition, in confluent cultures, other proteins specific for smooth muscle were detected: metavinculin, h-caldesmon, smooth muscle myosin heavy chains, and calponin. This study confirms the similarity between stromal cells and smooth muscle cells. Moreover, our results reveal that cells in vivo with the phenotype closest to that of stromal cells are immature fetal smooth muscle cells and subendothelial intimal smooth muscle cells; a cell subset with limited development following birth but extensively recruited in atherosclerotic lesions. Stromal cells very probably derive from mesenchymal cells that differentiate along this distinctive vascular smooth muscle cell pathway. In humans, this differentiation seems crucial for the maintenance of granulomonopoiesis. These in vitro studies were completed by examination of trephine bone marrow biopsies from adults without hematologic abnormalities. These studies revealed the presence of alpha-SM-positive cells at diverse locations: vascular smooth muscle cells in the media of arteries and arterioles, pericytes lining capillaries, myoid cells lining sinuses at the abluminal side of endothelial cells or found within the hematopoietic logettes, and endosteal cells lining bone trabeculae. More or less mature cells of the granulocytic series were in intimate contact with the thin cytoplasmic extensions of myoid cells. Myoid cells may be the in vivo counterpart of stromal cells with the above-described vascular smooth muscle phenotype.

Actins↗
PubMed1996

Tissue blood flow distribution and the effect of chronic vascular catheterization in the hind limb of the fetal lamb.

In six chronically instrumented fetal lambs, hind-limb skin, bone, and muscle comprised 22.5 +/- 1.3, 35.3 +/- 1.6, and 42.3 +/- 1.1% of total limb weight, respectively. As estimated using radionuclide-labeled microspheres, blood flow to these tissues averaged 30.4 +/- 4.9, 30.1 +/- 3.3, and 14.0 +/- 3.1 mL.min-1.100 g-1, respectively, and they received 29.5 +/- 3.3, 45.3 +/- 3.6, and 25.2 +/- 4.5% of total limb blood flow. Thus, muscle has a lower blood flow in relation to its weight in comparison with the other tissues, while bone receives the largest fraction of hind-limb blood flow. The higher perfusion rate to bone may by due to a high rate of hematopoiesis in late gestation, whereas muscle flow may be lower than that reported immediately after birth because of limited limb movement and lack of shivering thermogenesis. There were no significant differences in tissue weights between the limb in which femoral arterial and lateral tarsal venous catheters were implanted (nonstudy limb) and the leg that had smaller diameter catheters placed in the pudendoepigastric artery and vein (study limb). However, nonstudy limb blood flow was 13.4 +/- 1.8% less than in the study limb, although the flow distribution to hind-limb tissues was not different between the two limbs. This suggests that the longer, larger diameter catheters inserted into the nonstudy limb had an adverse effect on hind-limb blood flow but not on overall limb growth or blood flow distribution. More attention should be paid to the effects of chronic fetal vascular catheterization on the tissues or organs normally perfused by the catheterized vessel.

Animals↗