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PubMed2005

Relationships among infant sleep patterns, maternal fatigue, and development of depressive symptomatology.

BACKGROUND: Postpartum depression is a serious condition for women after childbirth. Although its etiology is unclear, one potentially important predictive variable that has received little attention is maternal sleep deprivation. The objective of this study was to examine relationships among infant sleep patterns, maternal fatigue, and the development of postpartum depression in women with no major depressive symptomatology at 1 week postpartum. METHODS: As part of a population-based postpartum depression study, 505 women who had an Edinburgh Postnatal Depression Scale (EPDS) score < 13 at 1 week postpartum completed questionnaires at 4 and 8 weeks postpartum. RESULTS: Mothers exhibiting major depressive symptomatology (EPDS > 12) at 4 and 8 weeks were significantly more likely to report that their baby cried often, be woken up 3 times or more between 10 pm and 6 am, have received less than 6 hours of sleep in a 24-hour period over the past week, indicate that their baby did not sleep well, and think that their baby's sleep pattern did not allow them to get a reasonable amount of sleep. Consistent with these findings, mothers with an EPDS score > 12 were significantly more likely to respond that they often felt tired. CONCLUSIONS: These results suggest that infant sleep patterns and maternal fatigue are strongly associated with a new onset of depressive symptoms in the postpartum period, and provide support for the development of postpartum depression preventive interventions designed to reduce sleep deprivation in the early weeks postpartum.

Adolescent↗
PubMed1997

Risk factors for postpartum depression in Japan.

We conducted a longitudinal study to identify risk factors for postpartum depression. At the late phase of pregnancy, 627 pregnant women agreed to take the State-Trait Anxiety Inventory Trait (STAIT) test and to remain in the study until 4 months postpartum. At 1, 3 and 4 months postpartum, they took the Edinburgh Postnatal Depression Scale (EPDS) test and the State-Trait Anxiety Inventory State (STAIS) test. At 3 months postpartum, they were asked about socio-psychological and obstetric factors. High scores in the EPDS and STAIS tests were correlated with primiparity, premature delivery, difficult labor, experience of life events and worries about baby care. Furthermore, high scores in the STAIT test in late pregnancy were strongly correlated with high scores in the EPDS and STAIS tests in the postpartum period.

Adolescent↗
PubMed2002

A two-centred pragmatic randomised controlled trial of two interventions of postnatal support.

OBJECTIVES: To establish whether providing additional postnatal support during the early postnatal months influences women's physical and psychological health and to identify health service benefits. DESIGN: Pragmatic randomised controlled trial with a 2 x 2 factorial design with two interventions. SETTING: Community centres, Ayrshire and Grampian, Scotland. POPULATION: One thousand and four primiparous women, 83% completed the baseline questionnaire, 71% at six months. METHODS: (1) An invitation to a local postnatal support group run weekly with a facilitator, starting two weeks postpartum. (2) A postnatal support manual, posted two weeks postpartum. MAIN OUTCOME MEASURES: Data regarding primary outcome postnatal depression (Edinburgh Postnatal Depression Scale, EPDS), secondary outcomes, general health measures (SF-36), social support (SSQ6), use of health services and women's views of interventions were collected at two weeks postpartum and at three and six months. RESULTS: There were no significant differences in EPDS scores between the control and trial arms at three and six months, nor were there differences in the SF-36 and the SSQ6 scores. The 95% CI for the difference in EPDS effectively excluded a change in mean score of more than 10% with either intervention. There were no differences in health service attendances in primary or secondary care between the control and trial arms. Of those women who attended the groups, 40% attended six or more. Women reported favourably on the 'pack' with the majority reading it a few times and feeling that it was aimed at them. CONCLUSIONS: Wide-scale provision by the National Health Service of either support groups or self-help manuals is not appropriate if the aim is to improve measurable health outcomes.

Adult↗
PubMed1994

Postnatal depression: a South Australian prospective survey.

The purpose of this study was to determine the prevalence of postnatal depression (PND) and to assess self-esteem in the early postnatal period and at 6 weeks postpartum and PND at 6 months postpartum. Women giving birth to term babies over a 6-month period, completed an Edinburgh postnatal depression scale (EPDS) and a Rosenberg self-esteem scale in hospital, at 6 weeks postpartum and an EPDS only at 6 months postpartum. A total of 235 women participated in the study of which 222 (95%) returned their questionnaire at 6 weeks postpartum and 192 (82%) at 6 months postpartum. Characteristics of the women and their pregnancy outcome are presented. The EPDS identified a depressed mood in 9% of women in hospital and at 6 weeks postpartum (95% CI 5.3%-12.8%). At 6 months this had increased to 10% (95% CI 7.8%-12.2%).

Adolescent↗
PubMed1996

Predicting postnatal depression among pregnant women.

BACKGROUND: Depression after the birth of a baby is a common cause of maternal morbidity, and its prevalence in Australia is 10 to 15 percent at 6 to 9 months postpartum. This study assesses the prediction of postnatal depression at 6 weeks postpartum. METHOD: Women at 24 weeks' gestation or less were invited to complete a Modified Antenatal Screening Questionnaire (MASQ) that identified women more vulnerable to becoming depressed after childbirth. Of these 249 women, 144 (58%) screened more vulnerable, and were randomly allocated to receive either a supportive intervention to reduce postnatal depression or to receive no intervention. At 6 weeks postpartum the women completed the Edinburgh Postnatal Depression Scale (EPDS) to assess their mood after the birth. RESULTS: No difference occurred at 6 weeks postpartum between the MASQ vulnerable group (return rate 64/68) and the MASQ less vulnerable group (return rate 44/51) in the frequency of those who screened as potential candidates for major depression using the EPDS. For major depression the MASQ's sensitivity was 73 percent, specificity 43 percent, positive predictive value 17 percent, and negative predictive value 91 percent; for minor depression its sensitivity was 81, 48, 34, and 89 percent, respectively. The MASQ was able to predict minor depression. More women in the vulnerable group scored at increased risk of minor depression on the EPDS at 6 weeks postpartum. CONCLUSION: Further studies are needed to extend this work and develop a screening test with higher specificity and greater positive predictive value.

Adult↗
PubMed2001

Cerebral protection systems for distal emboli during carotid artery interventions.

Carotid angioplasty and stenting is associated with liberation of cerebral emboli that can cause periprocedural stroke. There are currently three classes of emboli protection devices (EPDs) that are undergoing feasibility studies and one randomized clinical trial. Preliminary data from a small series appear to be promising, and there appears to be attenuation of embolic signals on a cerebral Doppler exam with EPD use. However, rare strokes and patient intolerance due to imposed ischemia have been observed. The advantages and disadvantages of each EPD class and the issues involving clinical trials and surrogate end points in this area of study are discussed.

Angioplasty↗
PubMed2006

Mothers' postpartum psychological adjustment and infantile colic.

BACKGROUND: Infantile colic is a common problem of early infancy. There is limited data on the relation between postpartum maternal psychological problems and colic. AIM: : To investigate whether infantile colic is associated with postpartum mood disorders or insecure adult attachment style of the mother. METHODS: Seventy eight mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened with Edinburgh Postpartum Depression Score (EPDS) and maternal anxiety was assessed with State-Trait Anxiety Inventory (STAI). The Adult Attachment Scale was used to determine the attachment style of the mother. Infantile colic was defined according to Wessel criteria. RESULTS: Infantile colic was present in 17 infants (21.7%); 12.9% of the mothers had an EPDS > or =13. The mean EPDS of the mothers whose infants had infantile colic (10.2+/-6.0) was significantly higher than that of the mothers of infants without colic (6.3+/-4.0). Among infants with infantile colic, 62.5% had mothers who had insecure attachment style, whereas only 31.1% of mothers had insecure attachment when the infant did not have infantile colic. CONCLUSION: Postpartum maternal depressive symptoms and insecure attachment style are associated with infantile colic. Screening and early intervention of postpartum depression might promote the health of both the mother and infant.

Adaptation, Psychological↗
PubMed2002

An uncontrolled pilot study of HT7 for 'stress'.

Bilateral acupuncture needling at HT7 was an effective method for reducing the rating of 'psychological stress' in 16 out of of a group of 17 volunteers (94%), recruited from staff in a hospice. Ratings were made using the Edinburgh Postnatal Depression Scale (EPDS), which was felt to be the most useful scale of those considered, despite not being validated in this population. Four brief acupuncture sessions were performed at weekly intervals. The greatest fall in the EPDS scores was observed within the first two treatments. At the end of the study, there was an average reduction of 44% in the EPDS scores. Further research is needed, including a suitable control group, to determine whether the effect observed in this study was a specific effect of needling at HT7.

Acupuncture Therapy↗
PubMed2005

Erosive pustular dermatosis of the scalp: a case report and review of the literature.

Erosive pustular dermatosis of the scalp (EPDS) is a rare entity characterized by pustular, erosive and crusted lesions of the scalp with progressive scarring alopecia. The aetiology is unknown, but predisposing factors have been reported such as trauma, skin grafting, prolonged exposure to UV light of a bald scalp as well as co-existence of auto-immune diseases. Laboratory data, bacteriological and mycological investigations and histopathology are generally not diagnostic. A 45-year-old Caucasian man with 1-year-old pustular, erosive and crusted lesions on his bald scalp was seen. Laboratory data, including auto-immunity, bacteriological and mycological investigations were negative. Histopathology was not diagnostic showing a diffuse polymorphous infiltrate involving the dermis. A diagnosis of EPDS was made. The patient was treated with topical and systemic antibiotics and steroids as well as oral nimesulide with no or partial response. Consequently, isotretinoin (0.75 mg/kg/day) was started obtaining complete resolution in few months. No relapse after 1 year of follow-up was seen. EPDS represents a distinct disease with a history of relapsing and unsatisfactory response to common treatments. Systemic retinoids may be considered as a potentially resolutive choice.

Administration, Topical↗
PubMed1997

Erosive pustular dermatosis of the scalp in skin grafts: report of three cases.

Three patients developed erosive pustular dermatosis of the scalp (EPDS). Two of them, both males, had previously undergone surgical excision for squamous cell carcinoma and basal cell carcinoma, and a female experienced avulsive trauma of the scalp. The erosive lesions and crusts were located at the site of a skin graft; microbiological cultures were negative for bacterial and fungal growth. Histological examination ruled out pustular bullous disorders. Topical therapy with corticosteroids and antibiotics resulted in clinical remission in only 2 cases. The third case showed a tendency to recur despite numerous therapeutic attempts with oral dapsone and isotretinoin. We conclude that surgical trauma is a possible cause of EPDS. Our patients seem to be the first reported cases of EPDS in skin grafts following plastic surgical procedures.

Administration, Cutaneous↗
PubMed1981

Localization of the origin of systolic clicks using echo-pulsed Doppler technique.

Echo-pulsed doppler (EPD) studies were performed in 2 surgically controlled patients with systolic clicks. The recorded blood samples documented the click to be originated in the right atrium, at the site of the prolapsed anterior tricuspid leaflet in 1 case of heroin-induced tricuspid acute endocarditis. In the second patient suffering from aortic valve disease, an ejection click was recorded, and could be demonstrated by using EPD, to originate from the aortic leaflet at its time of maximal excursion. EPD apears to be a safe, noninvasive method to solve the problem of the origin of systolic clicks.

Adult↗
PubMedDate not supplied

The early detection of postpartum depression: midwives and nurses trial a checklist.

OBJECTIVE: To evaluate the use of a standard pen-and-paper test versus the use of a checklist for the early identification of women at risk of postpartum depression and to investigate the experiences of nurses in using the checklist. DESIGN: A prospective cohort design using repeated measures. SETTING: The booking-in prenatal clinic at a regional hospital in Victoria, Australia, and the community-based postpartum maternal and child health service. PARTICIPANTS: 107 pregnant women over 20 years of age. MAIN MEASURES: Postpartum Depression Prediction Inventory (PDPI), Postpartum Depression Screening Scale (PDSS), Edinburgh Postnatal Depression Scale (EPDS), demographic questionnaire, and data on the outcome from the midwives and nurses. RESULTS: The PDPI identified 45% of the women at risk of depression during pregnancy and 30% postpartum. The PDSS and EPDS both identified the same 8 women (10%), who scored highly for depression at the 8-week postpartum health visit. Nurses provided 80% of the women with anticipatory guidance on postpartum depression in the prenatal period and 46% of women at the 8-week postpartum health visit. Nurse counseling or anticipatory guidance was provided for 60% of the women in the prenatal period. CONCLUSION: The PDPI was found to be a valuable checklist by many nurses involved in this research, particularly as a way of initiating open discussion with women about postpartum depression. It correlated strongly with both the PDSS and the EPDS, suggesting that it is useful as an inventory to identify women at risk of postpartum depression.

Adult↗
PubMed1987

Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale.

The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.

Adult↗
PubMed1996

Demographic and obstetric risk factors for postnatal psychiatric morbidity.

BACKGROUND: Postnatal depression follows 10% of live births but there is little consensus on the risk factors associated with its development. Previous smaller studies have been unable to quantify the impact of independent risk factors as relative and attributable risks. METHOD: The Edinburgh Postnatal Depression Scale (EPDS) was used to screen a systematic sample of 2375 women, six to eight weeks after delivery. Information on socio-demographic and obstetric variables was collected at the screening interview. The risk factors associated with high EPDS scores (> 12) were determined and entered stepwise into a regression model. RESULTS: Four independent variables were found to be associated with an EPDS score above this threshold. These were an unplanned pregnancy (OR 1.44); not breast-feeding (OR 1.52), and unemployment in either the mother, i.e. no job to return to following maternity leave (OR 1.56), or the head of household (OR 1.50). These four variables appeared to explain the risk associated with other risk factors. CONCLUSIONS: Although a direct aetiological role for these risk factors is not certain, they may indicate strategies for the prevention of affective morbidity in postnatal women. These may include reducing unwanted pregnancy and employment for women after childbirth.

Adolescent↗
PubMed1996

Comparative incidence of depression in women and men, during pregnancy and after childbirth. Validation of the Edinburgh Postnatal Depression Scale in Portuguese mothers.

BACKGROUND: Comparing women's and men's emotional reactions to childbirth can clarify the impact on mental health of childbirth as a life event. METHOD: Fifty-four first-time mothers attending obstetric services in Oporto, Portugal, and 42 of their husbands or partners participated in a longitudinal study of their mental health. All subjects were given a semi-structured clinical interview (SADS) at 6 months antenatally and at 12 months postnatally and sub-samples were interviewed at 3 months postnatally. At all these times all the mothers and fathers also completed a translated version of a self-rating scale for depression, the Edinburgh Postnatal Depression Scale (EPDS). RESULTS: More women than men had past histories of depression but their rates of depression did not differ significantly during pregnancy. In the first 3 months postnatally, nearly a quarter of the women at risk were found to have become depressed (major, minor and intermittent) in contrast with less than 5% of the men. In the next nine months men were more prone to become depressed than previously and their conditions tended to follow an earlier onset of depression in their spouses. CONCLUSION: Comparisons of EPDS and SADS ratings showed that the translated EPDS was a valid instrument for women but it was less satisfactory when applied to men.

Adolescent↗
PubMed2001

Comparison of deposition images obtained by use of an ultrafine 99m-technetium-labeled carbon dry aerosol with ventilation images obtained by use of 81m-krypton gas for evaluation of pulmonary dysfunction in calves.

OBJECTIVE: To characterize the accuracy of an ultrafine 99m-technetium-labeled carbon dry aerosol for use in assessment of regional ventilation in calves with pulmonary dysfunction. ANIMALS: 7 Belgian White and Blue calves. PROCEDURE: The ultrafine aerosol was assessed by comparing deposition (D) images with ventilation (V) images obtained by use of 81 m-krypton (81mKr) gas via D-to-V ratio (D:V) image analysis in calves during spontaneous breathing (SB) and during experimentally induced pulmonary dysfunction (ePD). RESULTS: Mismatching index (LrTot) calculated on the D:V images revealed a good match (LrTot, 0.96 +/- 0.01) between D and V distribution patterns in calves during SB. Calculation of the ultrafine aerosol penetration index relative to 81mKr (PIRel) revealed preferential distribution of the ultrafine aerosol in lung parenchyma (PIRel, 1.13 +/- 0.11). In ePD, heterogeneity in the D:V distribution was observed (LrTot, 0.78 +/- 0.10) as a result of ultrafine aerosol particles impaction in airways as indicated by PIRel (0.66 +/- 0.16) and a proportion of pixels more radioactive in D images, compared with V images, that was located in the central part of the lung (475 +/- 77% in ePD vs 32.8 +/- 5.7% in SB). However, this central deposition did not prevent visual examination of the entire ventilated lung. CONCLUSIONS AND CLINICAL RELEVANCE: The ultrafine aerosol appears suitable for use in examination of ventilated parts of lungs of cattle, even those with impaired pulmonary function. However, airway impaction of ultrafine aerosol particles impedes the quantification of regional ventilation in cattle with abnormal lung function.

Aerosols↗
PubMed1991

Genetic improvement programs in livestock: swine testing and genetic evaluation system (stages).

Genetic evaluations for the U.S. swine industry are conducted by the eight purebred associations of the National Association of Swine Records. Within-herd evaluations of the growth traits (days to 105 kg [market] and backfat depth) were first reported in 1986. Analyses of the maternal traits (litter size at birth and weaning, and litter 21-d weight) were inaugurated in 1987. Expected progeny differences (EPD) are reported for all traits and for general, paternal, and maternal bioeconomic indexes. A sow productivity index combining only maternal traits is available. All records are adjusted according to National Swine Improvement Federation (NSIF) guidelines for effects such as number of pigs transferred at crossfostering and age at recorded observation prior to the BLUP evaluation. Within-herd analyses of individual contemporary groups are conducted immediately on receipt of performance records at each breed association office. All parents in the herd and the young pigs in the current group are evaluated. A report is returned to the breeder for use in herd selection and the EPD are placed in the pedigree file. The genetic base of each herd is defined as the first n tested pigs or litters, where n is the number of pigs registered annually within the herd. Change in mean EPD between groups is indicative of genetic trend. Periodic across-herd analyses are used to update interim within-herd analyses and a national sire summary is published.

Animals↗
PubMed1993

The effect of United States versus New Zealand Angus germplasm on characteristics of crossbred calves.

Blood selenium concentration at birth and growth from birth through finishing were analyzed on progeny from two birth years of Angus bulls of United States (US) or New Zealand (NZ) origin. Dams of the calves were Polled Hereford x Angus crossbreds whose sires had been selected divergently from the national sire summary to be superior (+) or inferior (-) for yearling weight EPD (G) and for total maternal effects (M) on weaning weight. There was no evidence of differences attributable to calf paternity or dam genetic group in concentration of blood selenium in calves at birth. For birth year 1988, progeny of US sires grew nonsignificantly more rapidly than progeny of NZ sires in most life-cycle phases. In 1989 calves, NZ-sired offspring grew nonsignificantly more rapidly than US-sired offspring through a year of age. Averaged across years, preweaning and postweaning growth rates were similar for calves of US and NZ paternity. Divergent selection of the calves' maternal grandsires for yearling weight EPD was successful; calves in +G groups had more rapid gains through 1 yr of age than did calves in -G groups. Also, growth rate through 4.5 mo of age was influenced by divergent selection of maternal grandsires on total maternal weaning weight EPD; calves from +M groups gained more rapidly than calves from -M groups.

Analysis of Variance↗