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PubMed2001

[Do not minimize signs of postpartum depression! Early intervention essential to prevent negative consequences for the child].

Recent clinical research reveals that postnatal depression is associated with disturbances in the mother-infant relationship. These disturbances have in turn an adverse impact on the child's cognitive and emotional development. Postnatal depression affects 8-15 percent of women in the first months after delivery. The use of the Edinburgh Postnatal Depression Scale (EPDS) has proven useful in Swedish child health care to help nurses identify mothers with symptoms of depression. Weekly counselling visits by trained nurses are effective as the first treatment of choice for most women with postnatal depression.

Child↗
PubMed2003

Postnatal morbidity after childbirth and severe obstetric morbidity.

OBJECTIVE: To identify the impact of pregnancy and childbirth, and severe obstetric morbidity on outcome 6 to 12 months postpartum. DESIGN: Questionnaire assessment of postnatal outcome in a cohort study. SETTING: South East Thames, UK. POPULATION: All women resident in South East Thames and delivering between 1st March 1997 and 28th February 1998. METHODS: Questionnaire study of a cohort of women who experienced a severe obstetric morbidity during pregnancy or labour (cases), compared with a cohort of women who did not (controls). MAIN OUTCOME MEASURES: Assessment of postnatal depression risk [Edinburgh Postnatal Depression Scale (EPDS)], general health [Short Form 36 (SF-36)], sexual activity and use of health services between 6 and 12 months postpartum. RESULTS: There were 331 cases and 1339 controls out of 48,262 deliveries. Six to 12 months after delivery, 77 (23.3%) of cases and 272 (20.5%) of the controls were at risk of postnatal depression (P = 0.25; 95% CI for difference -2.2% to 7.9%), 43.1% of cases were having problems with sexual relations compared with 18.7% of controls (P < 0.001; 95% CI for difference 8.9% to 21.9%). There was evidence of poorer general health in cases. Some 31.5% of cases attended outpatients in the first six months and 9.4% required emergency admission to hospital compared with 17.0% (P < 0.001; 95% CI for difference 9.1% to 19.9%) and 3.7% (P < 0.001; 95% CI for difference 2.4% to 9.0%), respectively, in controls. CONCLUSION: Both control pregnancy and childbirth and severe obstetric morbidity are associated with significant postnatal morbidity. A severe obstetric morbid event significantly influences women's sexual health and wellbeing and increases health services utilisation. Prevention and appropriate management of severe obstetric morbid events may reduce these outcomes.

Case-Control Studies↗
PubMed2001

Understanding factors influencing request for a repeat termination of pregnancy.

OBJECTIVE: To assess factors influencing request for a termination of pregnancy (TOP). DESIGN: A questionnaire based, prospective study of 150 women requesting a TOP. This questionnaire contained a modified version of the Edinburgh Postnatal Depression Scale (EPDS). SUBJECTS: Of the 150 women requesting a TOP, 100 were seeking a TOP for the first time and the remaining 50 had at least one TOP in the past. RESULTS: Forty-five percent of women requesting termination of the first pregnancy were under the age of 20, 62% earned less than 10,000 Pounds per year and 12% did not use any form of contraception. Ninety-eight percent knew about emergency contraception but only 3% used it. The repeat termination group were older (only 24% under the age of 20). Fifty-five percent earned less than 10,000 Pounds per year, 15% did not use any contraception, 92% knew about emergency contraception but only 10% used it. Both groups were highly satisfied with the counselling, explanation about the procedure and future contraception advice. However, about 60% of women in both groups had suffered from mild to moderate depression as a consequence of termination. CONCLUSION: This study confirms the need for easy availability of emergency contraception and emphasises the importance of education about contraception in general.

Abortion, Induced↗
PubMed2003

[Perinatal psychiatry for mother-infant mental health--perinatal care for untreated patient].

I have presented to our support system, which mainly utilizes the Edinburgh Postnatal Depression Scale (EPDS) at 4 days and 1 month for mothers in the perinatal period and newborn babies, who have been under the care of the Morioka Red Cross Hospital. The perinatal system for mothers and babies, which has evolved over the past 9 years at the Morioka Red Cross Hospital. I explained the case of a 25-year-old woman who had already been suffering from depression before her pregnancy, and the course of improvement she experienced under this support system. In particular, I have shown a means of support, which can be provided by the obstetrics staff and is available to patient and families without making them feel hesitant. We take care of childbirth, and after baby care has started, we encourage depressive mothers to visit the Psychiatric Department. As a result, depression is no longer problematic, and the mothers recover sufficiently to be able to take good care of their babies. Even now, we are keeping track of these mothers and babies, while working together with the public health centers in communities. In the future, we will place emphasis on the implementation of SCID and on the careful observations of mothers and especially, babies, under the room-in system. We are also planning to begin lactation guidance at an earlier stage than before.

Adult↗
PubMed2003

[Treatment strategy for women with puerperal psychiatric disorders--psychopharmaco-therapy and its impact on fetus and breast-fed infants].

Women have the most possibility of suffering from mental disorders during pregnancy and postpartum periods in their whole life time. Especially, postnatal depression is not uncommon with an incidence of 10-20%, fortunately a screening system has been developed, and in Japan the Edinburgh Postnatal Depression Scale (EPDS) is now practically used in both hospitals and community health service centers. Additionally most mental disorders during this period are not severely disturbed, so they do not have to be necessarily treated by psychiatrists. Severely disturbed cases, however, which include postnatal depression with self or infant harm thought or puerperal psychosis are to be treated by psychiatrists and tend to have psychopharmaco-therapy. In using psychotropic drugs attention must be paid for both women and their babies. Impact on breast-fed babies while mothers take psychotropic drugs have been reported, mostly as case reports. We have reported the controlled studies, (1) The 25 mothers with postnatal depression were treated by tricyclic antidepressants, of which 10 breast-fed and 15 did not. The drugs were amitriptyline, imipramine, clomipramine, dothiepine, (2) The 30 mothers with puerperal psychosis were treated by antipsychotic drugs, of which 12 breast-fed and 18 did not. The drugs were chlorpromazine, trifluoperazine, perphenazine and haloperidol. Both antidepressants and neuroleptics were transferred through breast-milk and a few % of maternal dose per kilogram were injected to their babies by calculating drug concentration ratios of in breast-milk/in serum. None of the breast-fed infants had adverse effects, and no developmental difference was found compared to bottle-fed infants using the Bayley Development Scale during infancy. Furthermore, the breast-fed infants were followed up as long as possible up to 30 months and no significant developmental delay was found. In addition, we reported a case study on four breast-fed babies whose mothers took fluoxetine. The infants had no adverse effects. Pregnant women and their fetuses need to be more carefully monitored. Three preliminary cases were reported here; the pregnant women took clomipramine, sulpiride, haloperidol and chlorpromazine. Drug concentrations in maternal plasma in late pregnancy and postnatally and in umbilical cords were almost the same, which meant they were freely transferred from mothers to babies. Regarding the neonate's outcome, all were full turn born with normal birth weight with good Apgar scores. Weight gain in one month was normal which meant all babies had normal sucking without hypotonic muscle. Psychiatrists must accumulate these date and contribute as one of specialists in perinatal mental health in multi-disciplinary team.

Adult↗
PubMed2003

[Characteristic of affective disorders of the first week of puerperium].

Prospective studies ware carried in 200 lying-ins. To diagnose affective disorders medical interview and anonymous questionnaire BDI and EPDS were used. During interview 31% showed baby-blues. Signs of postpartum depression occurred in 18.5% women. No case of psychosis as well as critical incident of stress debriefing were stated. Recapitulating postpartum affective disorders occurred in 49.5% of examined group. Among negative psycho-socioeconomic factors pathological course of pregnancy in 14%, incorrect relationship with parents in 9%, low material status in 7%, unemployment in 32% and unwanted pregnancy in 3% of women were observed. Affective disorders in lying-ins women with postpartum depression are correlated with occurring of least 3 of above-mentioned factors. Baby-blues was found in 31%, while signs of depression were found in 17-20% of women during first week of puerperium. Existence of at least 3 negative psycho-socioeconomic factors during pregnancy or labour correlates with appearance of postpartum depression.

Adult↗
PubMed2004

Prediction of cis-regulatory elements of coregulated genes.

We present a computational pipeline to predict cis-regulatory elements composing results based on different algorithms: Clover, Cluster-Buster, an own implementation of human/rat/mouse sequence identity and our ITB algorithm. The procedure uses information from the human genome sequence, NCBI gene annotations, verified eukaryotic promoters (EPD), experimentally proven binding sites (Transfac) and homologies to mouse and rat (HomGL/HomoloGene). We test the approach on 18 upstream regions of experimentally verified AP-1 target genes. About a half of the known sites belong to high-scoring candidates. Three top-scoring elements are confirmed by Cluster-Buster and high homologies. The same analysis we applied to genes found to be up- or downregulated due to mutated RAS. We performed a detailed literature and computational search for promoter regions. Indications of overrepresented Elk-1 and AP-1 motifs are found via a comparison with shuffled sequences. In some promoters consistent predictions of clustered binding sites were obtained.

Animals↗
PubMed2005

[Regional differences in viscosity, elasticity and wall buffering function in systemic arteries: pulse wave analysis of the arterial pressure-diameter relationship].

INTRODUCTION AND OBJECTIVES: Regional variations in the incidence of vascular diseases have been related to regional differences in arterial viscoelasticity. The aim of this study was to characterize the differences in the elastic and viscous modulus and in wall buffering function between central and peripheral systemic arteries, through a time-series analysis of the pressure-diameter relationship. MATERIAL AND METHOD: Pressure and diameter were measured in seven arterial segments (carotid, brachiocephalic trunk, ascending aorta, proximal, middle and distal descending thoracic aorta, and femoral artery) from six sheep. Each segment was mounted on an in vitro mock circulatory system and perfused with Tyrode solution, with a pulse frequency of 1.8 Hz and systemic pressure levels. We used the Kelvin-Voigt model to calculate the pressure-diameter elastic (Epd, mmHg/mm) and viscous (Vpd, mmHg.s/mm) modulus, and to quantify the local wall buffering function (Vpd/Epd). We also calculated the incremental Young's and pressure-strain elastic modulus and pulse wave velocity for each segment. RESULTS: The elastic and viscous modulus increased from proximal to distal segments. The wall buffering function did not differ significantly between arteries. The lower rigidity of the central arteries compared to the distal ones may indicate that the systolic arterial compliance function is concentrated in the central arterial segments. On the other hand, the greater viscosity in the distal segments may indicate that viscous energy loss is concentrated in these segments. CONCLUSIONS: Arterial elasticity and viscosity can be interpreted as properties that are dependent on the region of the vessel, whereas wall buffering function can be considered region-independent.

Animals↗
PubMed2005

Does carotid artery stenting work on the long run: 5-year results in high-volume centers (ELOCAS Registry).

AIM: Although the first long-term results of Carotid Artery Stenting (CAS) became available only recently, CAS has become an accepted treatment for carotid artery disease. We report CAS data up to 5 years, both late stroke rate and patency rates as observed in 4 high-volume European centers. METHODS: Between February 1, 1993 and December 31, 2004, 2 172 patients were selected over the 4 participating centres, with intention to treat endovascularly. Conscientious follow-up was done according to the in-hospital stipulations of each centre and was entered into a database both retrospectively and prospectively. Long-term restenosis and stroke-death rates were investigated and statistically analysed and stratified using the Kaplan-Meier method. RESULTS: Of the 2 172 patients with intention to treat 2 165 (99.7%) were technically successful. Of these 306 (14.1%) were performed without and 1 859 (85.9%) with embolic protection device (EPD); 96 patients (4.4%) received balloon dilation only and stenting was performed in 2 069 (95.6%) cases. Kaplan-Meier analysis of major stroke/all death and of significant restenosis (>50%) for the total population showed stroke/death rates of 4.1% (nar=1 356), 10.1% (nar=476) and 15.5% (nar=138); and restenosis rates of 1% (nar=1 363), 2% (nar=480) and 3.4% (nar=139), after 1, 3 and 5 years respectively. CONCLUSIONS: The patency and stroke/death rates resulting from our database analysis are pleasing and indicate that CAS also on longer term is a valuable treatment method for carotid artery disease. Due to the fact that our dataset contains prospective as well as retrospective data, it may have its limitations. Until this moment, data indicating that certain patient subgroups are at increased risk for neurological complications and in-stent restenosis during and after CAS are sparse. Further multivariant analysis on this unique dataset is mandatory in order to identify any potential links in between plaque morphology, preprocedural neurological complications, risk factor distribution, procedural steps and clinical outcome.

Adult↗
PubMed2006

Postnatal depression and socio-cultural practices among postnatal mothers in Kota Bahru, Kelantan, Malaysia.

This is a cross sectional study to determine the relationship of postnatal depression (PND) and socio-cultural practices post-delivery among women in Kota Bharu, Kelantan. Four hundred and twenty one pregnant women were screened for depression between 36 - 42 weeks of pregnancy, 1 week and 4 - 6 weeks postpartum using Edinburgh Postnatal Depression Scale (EPDS). The women also completed questionnaires on socio-demography, psychosocial support and traditional postnatal care. The prevalence of PND at 4-6 weeks postpartum was 20.7%. Depressive symptoms at the end of pregnancy (p<0.05) and one week postpartum (p<0.05), worry about the baby (p<0.05), use of traditional medication (p<0.05) and traditional massage (p<0.05) were significantly associated with PND.

Adult↗
PubMed2006

[Viscoelastic and functional similarities between native femoral arteries and fresh or cryopreserved arterial and venous homografts].

INTRODUCTION AND OBJECTIVES: It is not yet known whether cryopreservation enables vessels to retain their viscoelastic properties or whether cryopreserved homografts are biomechanically more like native arteries than currently used vascular prostheses. The study objectives were: a) to determine whether our cryopreservation methodology enables arterial and venous homografts to retain their viscoelastic and functional properties; and b) to assess similarities between patients' femoral arteries, homografts, and other vascular prostheses in common use. METHODS: The pressure and the diameter and parietal thickness of 15 muscular (femoral) arteries were measured in patients using tonometry and echography, both noninvasive techniques. In addition, the pressure in and diameter and parietal thickness of 15 fresh and 15 cryopreserved human muscular (femoral) artery segments, saphenous veins, and 15 expanded polytetrafluoroethylene (ePTFE) vascular prostheses were measured in vitro under hemodynamic conditions similar to those in patients. A Kelvin-Voigt model of the segment wall was used to derive elastic (Epd, mm Hg/mm) and viscous (Vpd, mm Hg x s/mm) pressure-diameter indices, the buffering function (Vpd/Epd), and the conduit function (1/Zc, where Zc is the characteristic impedance). The incremental Young modulus, the pressure-strain elastic modulus, and pulse wave velocity were also calculated. RESULTS: No difference was observed between either the viscoelastic or functional properties of fresh and cryopreserved homografts. Arterial homografts were the most similar to the patient's arteries. CONCLUSIONS: Cryopreservation enabled venous and arterial homografts to retain their viscoelastic and functional properties. Of all the grafts investigated, arterial homografts were most similar, both biomechanically and functionally, to the patient's femoral arteries.

Blood Vessels↗
PubMed2006

Is it possible to predict postnatal depression? Research into the origin of blues and depression. The role of the gynaecologist.

PURPOSE OF INVESTIGATION: the authors investigated the role of the gynaecologist in trying to predict postnatal depression. Women suffering from postnatal depression (PND) are the expression of a failure to adapt to the unjust demands that society makes on them. Isolation and the lack of social support during and after the pregnancy are very strong factors of risk for postpartum depression. The problem is serious and it develops rapidly, within two weeks of childbirth. It requires immediate and continuous treatment. There is also some risk of infanticide or suicide. METHODS: submission of a questionnaire based on the EPDS (Edinburgh Postnatal Depression Scale) to 222 pregnant women between 28 and 40 weeks of gestation. RESULTS: 28.4% of the patients resulted positive to the test (score > 12 points) and the hypothesis would seem to be that there is a continuum between depression suffered pre- and postpartum, and that the depression begins during pregnancy and then becomes more acute or less latent at the time of confinement. CONCLUSIONS: the gynaecologist must have a role in helping to achieve an early diagnosis of the depression, because the earlier the problem is recognised the greater are the possibilities of therapy and preventing any consequences for the entire family group.

Adult↗
PubMed1991

Health visitor intervention in postnatal depression.

Using the Edinburgh postnatal depression scale (EPDS) Ruth Cullinan undertook a study to identify postnatal depression among new mothers in North West Hertfordshire. Following health visitor intervention--which involved six to eight weekly counselling visits--87 per cent of those mothers who had been identified as postnatally depressed had improved.

Community Health Nursing↗
PubMedDate not supplied

[Differences in electrical potentials of different areas of human skin as a characteristic of the functional state of the body].

Constant electric field (CEF) of an organism in various physiological states has been studied by two complementing methods. The states "healthy" and "sick" are described in terms of electrical potential difference (EPD) between two skin regions of man. It is shown that at the state "sick" equipotentiality of CEF is disturbed in the plane perpendicular to the principal axis of the body symmetry. It enables to outline further development of differential diagnistics of this state.

Diagnosis, Differential↗
PubMed1995

Health visitor identification of postnatal depression.

Evaluation of a health visitor project in Sevenoaks demonstrated both the value of the Edinburgh postnatal depression scale (EPDS) in the identification of postnatal depression, and the positive benefit of health visitor intervention in its early stages. But, as Angela Painter reports, the project also underlined the need for a ten-week home visit and the obstacles presented by large caseloads, poor liaison with other services and purchaser reluctance.

Community Health Nursing↗
PubMed1996

Transitions from home to nursing home in a capitated long-term care program: the role of individual support systems.

OBJECTIVE: This study calculated the risk of nursing home admission for clients receiving home- and community-based (HCB) care in a capitated long-term care system. DATA SOURCES: Program administrative data for non-institutionalized elderly and physically disabled (EPD) clients who had an HCB long-term care placement in the Arizona Long-Term Care System (ALTCS) during the period from January 1989 through December 1991. STUDY DESIGN: The program experience of clients who were initially placed in HCB care (N = 2,923) was tracked from the date on which they entered the program until the end of December 1992. DATA EXTRACTION METHODS: Program administrative data were used to create spans of program experience for each client. Cox proportional hazards regression models were then used to assess the individual factors associated with the risk of nursing home entry during the study period. PRINCIPAL FINDINGS: The greatest risk of nursing home entry was observed for those who were older or white, and for those clients with Alzheimer's disease. Little significant effect was observed for support system variables. CONCLUSIONS: Study results suggest that efforts to prevent nursing home entry may be most productive if they focus on the point at which clients are first assessed for placement into the ALTCS program. Once in HCB care, subsequent risk of nursing home placement may be more related to the client's health and frailty than to support system factors.

Activities of Daily Living↗
PubMed1997

Molecular analysis of Rh transcripts and polypeptides from individuals expressing the DVI variant phenotype: an RHD gene deletion event does not generate All DVIccEe phenotypes.

The D antigen is a mosaic comprising at least 30 epitopes. Partial Rh D phenotypes occur when there is absence of one or more of these epitopes, with the remainder expressed. The DVI phenotype is the most common of the partial D phenotypes, lacking most D antigen epitopes (ep D) (epD1, 2, 5-8 using the 9-epitope model or epD 1-4, 7-22, 26-29 using the 30-epitope model). DVI mothers may become immunized by transfusion with D-positive blood (if typed as D-positive using polyclonal typing reagents) or by fetuses which have all of the D antigen. This situation can give rise to severe hemolytic disease of the newborn (HDN). The molecular basis of the DVI phenotype has previously been proposed to occur by two different genetic mechanisms, one (in individuals of DVICcee phenotype) where a gene conversion event generates a hybrid RHD-RHCE-RHD gene; the second (in individuals of DVIccEe phenotype) was proposed to be caused by a partial RHD gene deletion. We present evidence that in four DVICcee phenotypes studied, this phenotype is not generated by a partial RHD gene deletion, but occurs by a similar mechanism to the DVICcee phenotypes. In two individuals we have found hybrid RHD-RHCE-RHD transcripts in both DVICe and DVIcE haplotypes. These differ in that the DVICe transcripts are derived from an RHD gene where exons 4-6 have been replaced with RHCE equivalents (encoding Ala226); the DVIcE transcripts are derived from an RHD gene where exons 4 and 5 are replaced by RHCE equivalents (encoding Pro226). We provide direct evidence that Rh DVI polypeptides are expressed at the erythrocyte surface as full-length polypeptide products. We have used immunoprecipitation experiments using anti-D reactive with DVI erythrocytes followed by immunoblotting the immune complexes with rabbit sera immunoreactive to the fourth external and C-terminal domains of all Rh polypeptides. Our results illustrate that these domains are present on all Rh DVI proteins studied, and suggest that Rh DVI polypeptide species studied here exist as full-length Rh proteins.

Amino Acid Sequence↗
PubMed1997

Influence of sex steroids on development of cultured fetal rat metatarsal bones.

The effects of 17 beta-estradiol (E), dihydrotestosterone (D, a non aromatisable androgen), and progesterone (P) on osteogenesis were studied on fetal rat cartilaginous anlagues cultivated in vitro. The three medial metatarsal rudiments were harvested at day 19 of gestation and grown in 1% BSA MEM medium (MO 643, Sigma) without serum nor antibiotics. After a 18h preincubation period, hormones were added for 8 days. Paired controls were incubated in the same volume of medium. The length, the metacarpal thickness and the size of the mineralized zone were measured every day, using a calibrated eyepiece (magnification X 40). DNA and protein synthesis, cartilage metabolism and mineralization were evaluated by monitoring the incorporation of 3H-Thymidine, 3H-Proline, 35S and 45Ca into anlagues for the last three hours of incubation, respectively. The dose/response effect of each steroid was studied at the concentrations of 10(-4) M, 10(-6) M, 10(-7) M and 10(-9) M. No difference was observed between male and female fetuses. A significant positive effect on total length (% of length measured at harvesting day) was observed with the 10(-7) M dose of E (163% +/- 2 vs 148% +/- 4 in controls) or D (158% +/- 3). Endochondral growth was not modified by P treatment. The effect of the three steroids (given at a dose of 10(-7) M) alone or as combinations (E, D, P, EP, ED, PD, EPD) confirmed the positive effect of E on endochondral growth and, to a lesser extend, of D and the association ED. Nevertheless, D had a better effect than E on endomembranous growth. On the contrary, P did not affect growth neither administrated alone nor in combination with E or D, while a positive effect of P on mineralization was demonstrated. The treatment associating the three steroids slowed down all the parameters concerning growth but strongly stimulated calcification.

Androgens↗