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PubMed2003

Predicting postnatal depression.

BACKGROUND: The contribution that recently identified risk factors for Postnatal Depression (PND) made to an existing prenatal screening tool ('Predictive Index' of PND; Cooper et al., 1996) was assessed in an attempt to improve the performance of this measure. METHOD: The Predictive Index and measures of appraisal and coping were administered during the final trimester of pregnancy (n=306). The Edinburgh Postnatal Depression Scale (EPDS) and Childcare Stress Inventory were completed at 6-weeks postpartum (n=223). RESULTS: The predictive index identified 23% of PND cases. The addition of specific appraisal and coping factors increased predictive performance by 26%. Inclusion of maternal reports of childcare stress in the early postpartum period resulted in a further 15% of PND cases being identified. LIMITATIONS: Diagnostic criteria were not used to assess the incidence of PND; instead PND case status was assessed using an established cut-off criterion on the EPDS. In addition, the contribution that women's prenatal appraisal and coping processes made to improving the predictive index was not assessed on a second independent sample. CONCLUSIONS: The inclusion of prenatal appraisal, coping and maternal reports of childcare stress in a screening tool for PND substantially increased predictive performance, resulting in 64% of PND cases being identified. These findings highlight the importance of negative prenatal appraisal and coping processes in the development of PND and have important implications for the prevention and treatment of this disorder.

Adaptation, Psychological↗
PubMed2000

Paternal and maternal depressed mood during the transition to parenthood.

BACKGROUND: The course of postnatal depression was examined in first-time mothers and fathers with emphasis on the role of personality and parental relationships as risk factors. METHOD: 157 couples were assessed at four points: antenatally and at 6, 12 and 52 weeks postnatally. Various measures of mood and personality were administered at each of these assessment points. RESULTS: Examination of the factors associated with depressed mood suggested that a woman's relationship with her own mother was important in the early postpartum stage, and also her level of interpersonal sensitivity and neuroticism. For the father, his relationship with either his mother or father and his level of neuroticism were associated with his mood level early on. By the end of the first year couple morbidity increased, with rates of distress being at their highest for both parents, and factors associated with depressed mood being linked to partner relationship variables, at least for mothers. At most time points, antenatal mood and partner relationship were significant predictor variables for the postnatal mood of both mothers and fathers. LIMITATIONS: The sample had a relatively high level of education and this should be taken into account when considering the generalisation of findings to less educated populations. At the time of conducting this study, the Edinburgh Postnatal Depression Scale (EPDS) had only been validated for use in the first few months postpartum, and thus we used another scale to measure the mother's mood at the other assessment points (the Beck Depression Inventory). Current research would suggest that the EPDS is valid both antenatally and at other times in the first year postpartum. CONCLUSION: Whilst there was some consistency for mothers and fathers in the variables that predict their postpartum adjustment, these being antenatal mood and partner relationship, there is also evidence that adjustment to parenthood was related to different variables at different times. Early adjustment was related to the couple's relationship with their own parents, as well as their own personality. Later adjustment was related to the couple's functioning and relationship.

Adult↗
PubMed1994

A study on the effects of low haemoglobin on postnatal women.

OBJECTIVE: to assess the effect of low haemoglobin (Hb) on the mental and physical health of postnatal women. DESIGN: survey conducted between May 1991 and February 1992. SETTING: maternity unit in district general hospital in the UK. PARTICIPANTS: 1010 postnatal women who had delivered a live baby, did not stay in hospital for seven or more days postnatally, whose baby was not admitted to the neonatal unit and who did not have a current psychiatric disorder. MEASUREMENTS: Hb levels at 'booking', 34 weeks gestation, three days and six weeks post delivery; the Edinburgh Postnatal Depression Scale (EPDS) and a self-completion questionnaire at ten days, four weeks and six weeks post delivery. FINDINGS: women with a low Hb are more likely to be under 25 years of age, primiparous, be anaemic at 34 weeks gestation, not to have had a normal delivery, have had a blood loss greater than 250 ml and to have had heavy lochia postnatally. Low Hb levels were not associated with high EPDS scores. Low Hb levels were related to reports of low energy, breathlessness, faintness/dizziness, painful perineal sutures and tingling in fingers and toes at ten days post delivery. Whilst tiredness persisted to six weeks post delivery the other symptoms disappeared. IMPLICATIONS FOR PRACTICE: in order to reduce the incidence of postnatal anaemia a review of policies for testing is recommended so that the incidence of physical problems in the first six weeks can be reduced. There is a need for further research into the causes and potential alleviation of tiredness.

Adolescent↗
PubMed1998

What influences the uptake and early cessation of breast feeding?

OBJECTIVE: To examine obstetric, maternal and social factors associated with the uptake and early cessation of breast feeding and women's reasons for altering from breast to bottle feeding. DESIGN: Women who responded to a postal questionnaire on long-term postpartum health were contacted and asked to participate in a home-based interview. In addition to health problems, the interview obtained information on baby feeding and a number of social factors. Women were also asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Obstetric and maternal data were obtained from maternity records. SETTING: Deliveries from a large maternity hospital in Birmingham. PARTICIPANTS: 906 women were interviewed at a mean of 45 weeks after delivery. FINDINGS: 63% of the women said they had breast fed, but 40% of these stopped within three months of delivery. Many of the women gave physical problems with lactation as reasons for stopping. The factors found to be predictors of early cessation were: return to work within three months of birth; regular childcare support from other female relatives, and a high EPDS score. Non-initiation of breast feeding was predicted by a different set of factors: multiparity; general anaesthetic (GA); and unmarried status. DISCUSSION AND CONCLUSION: Despite evidence of the benefits of breast feeding, this remains an unacceptable long-term option for many women, and for over one-third it is never attempted. Factors within the woman's social environment were found to influence early cessation. Women who had a GA during or immediately following labour and delivery were less likely to initiate breast feeding. IMPLICATIONS FOR PRACTICE: If breast-feeding incidence and duration are to increase, more attention should be paid to establishing early, successful breast feeding and countering the negative influences of factors within the social environment.

Adult↗
PubMed1999

Migration and motherhood: a response to Barclay and Kent (1998)

A recent paper by Barclay and Kent (1998) raised various issues with regards to motherhood and recent immigration. They expressed reservations with conceptualizing extreme misery in new mothers as depression, and with screening for postnatal distress in women from non-English-speaking backgrounds (NESB). They argued that a common self-report measure for postnatal distress screening, the Edinburgh Postnatal Depression Scale (EPDS), was flawed. They also argued that the concept of postnatal depression implies a medical aetiology and, thus, fails to recognise the socio-cultural aspects experienced by NESB women. We address these issues, by demonstrating that the EPDS is not flawed, and by arguing that screening for postpartum distress results in more NESB women being identified and, consequently, offered a service, than if such screening does not occur. We also disagree with the view that the term 'postnatal depression' necessarily implies any aetiology, and that work by our unit, as well as others around the world, indicates that the psychosocial and cultural aspects related to distress in new immigrant mothers is being recognised and acted upon.

Attitude to Health↗
PubMed1998

Investigation of the relationship between farrowing environment, sex steroid concentrations and maternal aggression in gilts.

Maternal oestrogen and progesterone have been shown to be important in the initiation of maternal behaviour. Thirty-three Large White x Landrace gilts, housed in groups during pregnancy, were observed and aggressive interactions recorded. Individuals had jugular catheters implanted 14.5 (s.e. 0.34) days before their expected parturition date (EPD). Five days before EPD gilts were randomly allocated and moved to either a conventional farrowing crate (C; without straw, 16 gilts) or a pen (P; 2.1 x 3.1 m2; with straw bedding, 17 gilts). Blood samples were taken at frequencies determined by the proximity to farrowing onset. Piglets were removed at birth and returned 2 h after placental expulsion. The reaction of each gilt to her piglets was monitored. Gilts savaging piglets were sedated with azaperone (n = 8). There was no overall effect of farrowing environment on oestradiol and progesterone concentrations. The pre-farrowing ratio of progesterone to oestradiol was higher for (P) gilts (0.45 vs. 0.25, (P) vs. (C); S.E.D. 0.085, P < 0.05) as was their overall maximum oestradiol level (3.39 vs. 2.29 ng/ml, (P) vs. (C); S.E.D. 0.39, P < 0.01). In contrast to progesterone, oestradiol patterns varied considerably between individuals. Dominance rank value during pregnancy, but not levels of aggression, correlated positively to pre-farrowing oestradiol concentrations. Treatment with azaperone was not related to farrowing environment, piglet weight or litter size. Azaperone treated gilts showed a higher pre-farrowing oestradiol to progesterone ratio (0.55 vs. 0.29, +/- azaperone; S.E.D. 0.10, P < 0.05), significantly higher levels of oestradiol post-partum (0.7 vs. 0.19 ng/ml, +/- azaperone; S.E.D. 0.20, P < 0.001) and significantly lower levels of aggression during pregnancy (1.68 vs. 2.23 aggressive interactions/h, +/- azaperone; S.E.D. 0.15, P < 0.001). The results indicate that there are no major effects of farrowing environment on sex steroid concentrations. Maternal aggression under these conditions appears to be negatively related to aggression during pregnancy, but this is not reflected in plasma concentrations of sex steroids around parturition.

Aggression↗
PubMed1998

The effect of environment on plasma cortisol and beta-endorphin in the parturient pig and the involvement of endogenous opioids.

Previous work has indicated that plasma cortisol increases during farrowing in the pig suggesting increasing physiological stress. The aim of this study was to determine changes in plasma cortisol and beta-endorphin over farrowing in the pig to obtain a more detailed profile of pituitary and adrenal release at this time and also to investigate the involvement of endogenous opioids in the mediation of the HPA axis. Indwelling jugular catheters were implanted, under general anaesthesia, in 31 Large White x Landrace gilts approximately 15 days before the expected parturition day (EPD). Gilts were moved into either a farrowing crate, without straw (n = 15), or a straw-bedded pen (n = 16) 5 days before the EPD. Samples were taken during the pre-farrowing period and then during farrowing itself. At 7.5 min after the birth of the first piglet (BFP), gilts either received naloxone, an opioid antagonist, (1 mg kg(-1) body weight, i.v.) or a control dose of saline. Plasma beta-endorphin increased following the BFP but remained fairly constant over the third and fourth hour of farrowing. Plasma cortisol continued to increase over the 4 h following the BFP. Changes seen in these hormones were generally insensitive to the environment and there was little evidence of opioid mediation of the HPA axis at parturition. From these results it is suggested that certain aspect(s) of parturition itself stimulate the HPA axis. However it is unknown if the rise in plasma cortisol is a result of some stress-inducing factor of the parturition process or whether it reflects a metabolic function. The study also demonstrates the lack of any inhibitory mediation of the HPA axis by endogenous opioids at parturition.

Animals↗
PubMed1986

Early onset Parkinson's disease in Saskatchewan--environmental considerations for etiology.

The cause of idiopathic Parkinson's Disease (PD) is not known but it is believed to be related to some environmental agent(s). Given a long preclinical interval and onset of symptomatology around age 60 years, it becomes impossible to identify and analyze all prior environmental factors satisfactorily. To circumvent these difficulties we evaluated the childhood environment in those PD patients whose symptoms began at age 40 years or earlier. Twenty-one such cases were born and raised in the province of Saskatchewan. Nineteen of these 21 patients spent the first 15 years of life exclusively in rural Saskatchewan. Detailed population analysis indicates a strong predisposition to early onset idiopathic Parkinson's Disease (EPD) in those raised in rural areas (p = 0.0154). All but one case utilized exclusively well water for the first 15 years of life--a trait significantly different from that expected in the provincial population. It is concluded that rural Saskatchewan environments contribute to EPD and that well water used in childhood should be considered as a potential vehicle for the etiological agent.

Age Factors↗
PubMed2005

Multidimensional scaling of schematically represented faces based on dissimilarity estimates and evoked potentials of differences amplitudes.

This study researches the input of the cerebral occipital and temporal cortex in the analysis of facial configuration and expressive characteristics. Analysis is based on the construction of a spherical model for the differentiation of schematically presented faces with quantitatively altering curvature of the mouth and brows. The model is designed using the method of multidimensional scaling of the dissimilarity judgments between stimuli (faces) and the amplitude of evoked potentials of differences (EPD) between abrupt stimulus changes recorded from the occipital and posterior temporal cortex. Analysis of the structure of the spherical model of facial differentiation depending on the electrode site and the latency of the EPD component within the duration of 120-240 ms has demonstrated that the activity of the occipital and posterior temporal cortex of the right hemisphere is associated with the emotional characteristics of the presented face, whereas facial configuration is reflected in the activation of both posterior temporal cortex and the occipital cortex of the left hemisphere. At all electrode sites maximum information of the emotional expression and configuration is represented in inter-peak amplitude P120-N180. With increasing latency there is increased distortion of the structure of differences in the spherical model of schematically presented faces, which is interpreted as an attenuation of electrical activity associated with the analysis of the emotional expression, which occurs more rapidly than configuration analysis.

Brain Mapping↗
PubMed1994

Mapping staphylococcal nuclease conformation using an EDTA-Fe derivative attached to genetically engineered cysteine residues.

Six single cysteine variants of staphylococcal nuclease were reacted with the iron complex of (EDTA-2-aminoethyl) 2-pyridyl disulfide (EPD-Fe) [Ermácora, M. R., Delfino, J. M., Cuenoud, B., Schepartz, A., & Fox, R. O. (1992) Proc. Natl. Acad. Sci. U.S.A. 89, 6383-6387] and used to assess the ability of this cleavage reagent to faithfully report on the structure of nonnative protein states. The act of mutation and modification did not significantly alter the protein's global structure, as measured by CD and enzymatic activity, and only modestly affected its stability. The reaction was conformation dependent and generated specific cleavage products that mapped tertiary interactions present in the folded state. Several parameters relevant to the cleavage reaction and its use as a conformational probe were analyzed. Proximity and solvent accessibility are the most important parameters in determining the cleavage pattern and can be used to predict cleavage sites in the native protein. The cleavage reaction can be performed in the presence of high denaturant concentration, in the presence of SDS, and under a wide range of pH values; thus it can readily be applied to the study of equilibrium folding intermediates. Mass spectrometric analysis combined with N-terminal sequencing identified cleavage products consistent with a single cleavage event per protein molecule and revealed one cleavage mechanism which was not previously considered for protein oxidative degradation, although it was reported for hydroxyl radical induced cleavage of small peptides. Identification of the cleavage sites obtained from each variant allowed a nearest-neighbor mapping of the secondary structural elements of nuclease. Quantitation of specific cleavage products was used to monitor the disruption of the interaction between helices H2 and H3 in equilibrium unfolding experiments. The resulting unfolding curve revealed a local conformational heterogeneity at low denaturant concentration which was not observed when the same transition was monitored by the change in fluorescence of a single nuclease tryptophan. Interestingly, the midpoint of the transition and the second half of the unfolding curve were the same, as monitored by the two probes. This indicates that the lifetime of the reactive oxygen species generated by the cleavage reagent is short compared to the unfolding equilibrium rate constants and that the cleavage technique identifies a native-like folding intermediate not detected by fluorescence. The experiments presented herein demonstrate that EPD-Fe-mediated protein cleavage is an appropriate technique for the study of nonnative protein structure.(ABSTRACT TRUNCATED AT 400 WORDS)

Computer Graphics↗
PubMed1999

Involvement of proteins in cloud instability of shamouti orange [Citrus sinensis (L.) Osbeck] juice.

The present study provides evidence for the involvement of protein in cloud instability of natural orange juice. No heat-coagulable proteins were found in the serum. Insoluble cloud matter (ICM) was heat-flocculated following enzymatic pectin degradation (EPD). The degree of flocculation depended on temperature (from approximately 50 to 75 degrees C) and was highest at pH 3.5. The fresh juice contained about 6.5 and 1.8 mg mL(-1) of ICM and alcohol-insoluble solids of the serum (AISS), respectively. The ICM and the AISS contained, respectively, proteins (182+/-14 and 119+/-3 microg mg(-1)), galacturonic acid (37+/-6.6 and 175+/-1 microg mg(-1)), and neutral sugars (350+/-44 and 338+/-22 microg mg(-1)). EPD resulted in removal of a marked portion of the pectin and was accompanied by partial removal of neutral sugars (mainly glucose and galactose) and some proteins from the pectic polymer in both AISS and ICM. Under electrophoresis, proteins of the AISS included bands in the range of 20-52 kDa and 10-14 kDa and those of the ICM at 22 and 50 kDa.

Beverages↗
PubMed2005

Preferential solvation stabilization for hydrophobic polymeric nanoparticle fabrication.

Preferential solvation of polymer molecules and strong EPD-EPA (EPD, electron pair donor; EPA, electron pair acceptor) interaction between solvent and nonsolvent molecules were found to be of great significance in the fabrication of two kinds of aromatic polyimide (AP) nanoparticles. Surfactant free yet stable AP nanoparticles were prepared using a liquid-liquid phase separation method. The stability of the AP nanoparticles can be achieved by the solvation multilayer resulting from a solvation stabilization chain in the form of nonsolvent --> solvent --> AP (a --> b denotes that component b is solvated by component a). The significance of this stabilization chain was identified by many comparative experiments using different types of molecular probes. On the other hand, the formation of AP nanoparticles was found to be governed by a nucleation process and therefore the particle size is controlled by the nucleation rate. A very high level of supersaturation can be attained under the intensive local motions induced by ultrasound, resulting in a very high nucleation rate. This effect was found to be extremely useful in the fabrication of sub-50 nm AP nanoparticles.

Journal Article↗
PubMed1999

Interfacial bond strength of electrophoretically deposited hydroxyapatite coatings on metals.

Hydroxyapatite (HAp) coatings were deposited onto substrates of metal biomaterials (Ti, Ti6Al4V, and 316L stainless steel) by electrophoretic deposition (EPD). Only ultra-high surface area HAp powder, prepared by the metathesis method 10Ca(NO3)2 + 6(NH4)2HPO4 + 8NH4OH), could produce dense coatings when sintered at 875-1000degreesC. Single EPD coatings cracked during sintering owing to the 15-18% sintering shrinkage, but the HAp did not decompose. The use of dual coatings (coat, sinter, coat, sinter) resolved the cracking problem. Scanning electron microscopy/energy dispersive spectroscopy (SEM/EDS) inspection revealed that the second coating filled in the "valleys" in the cracks of the first coating. The interfacial shear strength of the dual coatings was found, by ASTM F1044-87, to be approximately 12 MPa on a titanium substrate and approximately 22 MPa on 316L stainless steel, comparing quite favorably with the 34 MPa benchmark (the shear strength of bovine cortical bone was found to be 34 MPa). Stainless steel gave the better result since -316L (20.5 microm mK(-1)) > alpha-HAp (approximately 14 microm mK(-1)), resulting in residual compressive stresses in the coating, whereas alpha-titanium (approximately 10.3 microm mK(-1)) < alpha-HAp, resulting in residual tensile stresses in the coating.

Journal Article↗
PubMed1992

Pharmacokinetic analysis of the structural requirements for forming "stable" analogues of valpromide.

The following valpromide (VPD) analogues were synthesized and their structure-pharmacokinetic relationships explored: 3-ethyl pentanamide (EPD), methylneopentylacetamide (MND), 1-methyl cyclohexanecarboxamide (MCD), cycloheptanecarboxamide (CHD), and t-butylacetamide (TBD). Two aliphatic (EPD and MND) and two cyclic amides (MCD and CHD) underwent complete or partial conversion to their corresponding acids. The only amide found in this study to be "stable" to the amide-acid biotransformation was TBD. It also had the lowest clearance and the longest half-life and mean residence time. Unlike the other investigated amides, TBD contained two substitutions of two methyl moieties at the beta position of its chemical structure. A "stable" valpromide analogue must have either two substitutions at the beta position, such as in the case of TBD, or a substitution in the alpha and beta positions, such as in the case of the VPD isomer valnoctamide (VCD). This paper discusses the antiepileptic potential of stable VPD analogues which may be more potent and less teratogenic than their biotransformed isomers.

Animals↗
PubMed1999

["A small piece of normal life". A qualitative study on health care for chronically ill children in home care].

This qualitative study deals with the subjective experiences of families with chronically-ill children and with experiences of the External Care Services (EPD) in Berlin, who exclusively conduct home-care for children. Learning to cope with chronic illness is a process that often demands professional help that extends beyond the time spent in hospital. Essential for the analysis performed here are the systemic positions put forward by v. Uexküll, Wesiack (psychosomatic medicine) and Friedemann (nursing science) who stress the connection between health and relationship. The parents' positive experiences reflect the patient-oriented understanding of health-care developed by the takes in the families in many respects. Without the care offered by the EPD some children would have been torn out of their family environment due to hospitalizations. This would have resulted in the damaging of the family health.

Adaptation, Psychological↗
PubMed2002

Obstetrical complications and the development of postpartum depressive symptoms: a prospective survey of the MATQUID cohort.

OBJECTIVE: To prospectively investigate in a cohort of pregnant women the association between obstetrical complications (OCs) and depressive symptomatology in the early postpartum period. METHOD: A total of 441 pregnant women attending the State Maternity Hospital in Bordeaux were interviewed during the third trimester of pregnancy, then at 3 days and 6 weeks after birth. Maternal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Data on a large range of pregnancy, delivery and neonatal somatic adverse events were collected by interviewing the mothers. Data on OCs were rated using the McNeil-Sjöström scale for OCs. A dimensional definition of postnatal depression (EPDS summary score 6 weeks after delivery) was used to explore the relationships between OCs and early postnatal depressive symptoms. RESULTS: Exposure to severe OCs during pregnancy was associated with more intense depressive symptoms in the early postnatal period, independently from demographic characteristics, marital adjustment, parity, and a history of depressive or anxiety disorder during pregnancy (adjusted B=0.16, 95% CI 0.007, 0.30, P=0.04). No association was found between the severity of postnatal depressive symptoms and labour/delivery or neonatal complications. CONCLUSION: Severe pregnancy complications may increase the severity of postnatal depressive symptoms by acting as acute or chronic stressors during pregnancy. The links between OCs, maternal psychopathology, and child development, need to be explored further.

Adult↗
PubMed2001

Immunohistochemical study of inducible nitric oxide synthase in skin cancers.

BACKGROUND: Nitric oxide (NO) is synthesized from the amino acid L-arginine by NO synthase (NOS). Experimental evidence suggests that increased express of inducible NOS (iNOS), which is an NOS isoform and calcium independent, is related to various pathological processes, such as inflammation and cancer. METHODS: In this study, we used immunohistochemistry to investigate iNOS expression in a series of basal cell carcinomas (BCC), Bowen's disease, squamous cell carcinomas (SCC), extramammary Paget's disease (EPD) and metastatic tumors of the skin. RESULTS: Only 1 of 16 BCC cases was positive for iNOS and the intensity of staining was weak. In most of the 10 cases of Bowen's disease, iNOS was weakly expressed and there was a wide range in the percentage of positive tumor cells. Twelve of the 16 cases of SCC were positive for iNOS and the extent of positivity was greater than in Bowen's disease. Two of the 7 cases of EPD were positive for iNOS, and 12 of the 15 cases of metastatic cancer were positive. Well-differentiated adenocarcinomas were diffusely positive, whereas poorly-differentiated ones showed strong and heterogeneous staining. CONCLUSIONS: These results indicated that the expression of iNOS may reflect the proliferation of tumor cells and that a heterogeneous distribution of iNOS may correlate with a wide variety of biological behavior of tumor cells.

Adenocarcinoma↗
PubMed2003

Risk of postnatal depression after emergency delivery.

AIM: To identify whether women having emergency delivery are at increased risk of developing postnatal depression (PND). METHODS: This is a retrospective comparative cohort study design. Two hundred and fifty Malaysian women were part of a previous study examining the prevalence of PND in a multiracial country and the effects of postnatal rituals. All women were at least 6 weeks post-partum when asked to complete the Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic and birth data were obtained. RESULTS: Data collected were divided into two groups: 55 emergency delivery and 191 non-emergency delivery. There were four missing data. There was no significant difference in the mean age, parity, gestational period, baby birthweight, 5 min baby Apgar score and EPDS scores of the two groups. However, the analysis of PND indicated that women with emergency delivery had a relative risk of 1.81 compared with women with non-emergency delivery. The comparison of the two groups using chi2 indicated a significant (chi2 = 3.94, d.f. = 1, P = 0.04) increase in the presence of PND in the emergency delivery. CONCLUSION: When compared with women having non-emergency delivery, women having emergency delivery had about twice the risk of developing PND. Special attention to this group appears warranted.

Adult↗