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At least 19 recordsLinked to original sources
PubMed1975

Impact of expanded-duty assistants on cost and productivity in dental care delivery.

Data from an experimental dental program are used to develop a linear programming model of dental care delivery that the authors use to examine the economic implications of introducing expanded-duty dental assistants (EDDA's) in three types of dental practices. The authors examine the changes in productivity and profitability that result from hiring one or more EDDAs and conclude that a dentist in solo practice can more than double his net revenue by hiring one EDDA but will not increase his productivity further by hiring additional EDDAs. Two- and three-dentist groups also can increase revenue by hiring EDDAs, but, beyond a certain point, an inverse relationship exists between the number of auxiliaries hired and net revenue generated.

Cost-Benefit Analysis↗
PubMed1988

Evaluating the risks of cesarean section: low Apgar score in repeat C-section and vaginal deliveries.

Data from Washington State birth certificates from 1980-83 were used to estimate excess risk to the infant delivered via repeat cesarean section independently of any risk associated with the indication for the procedure. Using a case-control design, we compared the method of delivery of all infants with low (0-6) five-minute Apgar scores born to multiparous mothers after uncomplicated pregnancies and births to that of similar infants with a high score (7-10), frequency matched by birthweight. Of the 1,030 infants with low Apgar score, 127 (12.3 per cent) were delivered via repeat cesarean section, in contrast to 98 (9.8 per cent) of 998 controls with high Apgar score. In a regression model controlling for birthweight, gestational length, maternal age, and income the relative risk was 1.29 (95% confidence interval 0.97, 1.72). Excess risk was highest among babies of normal (2500-4000 grams) birthweight. While a number of limitations inherent in the source of data require cautious interpretation of these results, we conclude that some excess risk of low Apgar score may be associated with repeat cesarean section procedures.

Apgar Score↗
PubMed1988

A longterm follow-up study of children born to women with contagious diseases at delivery.

Data are presented from a long-term follow-up study of 308 live born children to women admitted post partum to the Department of Infectious Diseases (DID), Danderyd Hospital, Sweden, during a 10-year period (1975-1984) for avoiding nosocomial transmission of infections in the obstetrical wards. The rate of stillbirths (1/309 deliveries) was not higher than reported for all births in Stockholm. 20% of the live born children were transferred within 24 h after birth to the pediatric department for observation, but half of them could return to their mothers at the DID within 6 days (generally 3 days). Four newborns were treated at an intensive care unit. Only 3 fatalities occurred, all of them among newborns to mothers with an overt infection at delivery. The fatality rate (1.8%) was significantly higher among the newborns of these mothers than normally (0.3%) noted among all children born in Stockholm county during the period studied. Two of the 3 newborns, who all died within 3 days of life, had a low birth weight (600 and 1,000 g). The total number of newborns with low birth weights (less than 2,500 g) was, however, not higher in the above-mentioned group of newborns than for all children born in Stockholm county 1980. None of the 3 fatalities was caused by infection transmitted from the mother. No further deaths occurred. Infections in pregnancy at term, at birth or post partum were transmitted from the women to 41 (13%) of their newborns.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗
PubMed1990

Infant feeding practice in mothers at risk of low birth weight delivery.

Data relating to infant feeding practices were obtained by a 6 week postnatal questionnaire from 459 women who participated in a randomised controlled trial of social support in pregnancy. They represented a 90% response rate from 507 women with a past history of a low birth weight baby before the index pregnancy. Thirty-nine per cent of the babies weighing more than 2500 g were breast fed completely. Women who experienced a delay of more than half an hour between birth and first suckling, and those who were given pethidine during labour breast fed for a shorter period, as did those who gave complementary bottle feeds. By considering the women's reasons for discontinuing or not initiating breast feeding, this paper suggests that improved social support from health professionals and others in the postnatal period can increase breast feeding success rates.

Attitude↗
PubMed1991

The relationship of maternal exercise on labor, delivery and health of the newborn.

Thirty women were interviewed and divided into active and sedentary groups. Pre-delivery data, information regarding labor and delivery, Apgar scores of the newborn and perceived exertion during labor were recorded and statistically analyzed. Neonates of active women showed slightly higher one-minute Apgars and no difference in fetal weight or five-minute Apgars. Active women indicated lower perceived exertion during labor, longer delivery times and no differences in gestational length, maternal weight gain and time during the first stage of labor. Maternal weight gain in both groups correlated positively with fetal weight. A higher fetal weight indicated a slightly higher five-minute Apgar. Primaparas showed no difference in the first stage of labor although longer delivery time was noted. No differences in levels of medication during labor were revealed although the youngest and oldest subjects required cesarean delivery. Obese women labored longer, indicated higher perceived exertion and higher fetal weights.

Adolescent↗
PubMed1982

High risk antenatal hospitalization.

High risk, antenatal units have been established to provide highly sophisticated obstetric care for women with complications of pregnancy. In an effort to more precisely define the patients requiring this care, and to begin to document the benefits of antenatal hospitalization, a 2-year prospective evaluation of the Antenatal Unit (AU) at the Brigham and Women's Hospital was performed. Between July 1, 1978 and June 30, 1980, 1488 consecutive patients were admitted to the AU. Demographic data, antenatal hospitalization time, hospitalization outcome, and delivery data were determined for these patients. Diabetes mellitus, premature labor, hypertensive disorders, premature rupture of the membranes, and late pregnancy bleeding disorders resulted in over 60% of the admissions. Follow-up data demonstrated that among these 1488 patients admitted to the AU, there occurred 32 stillbirths (21.5/1000), 50 neonatal deaths (33.6/1000), and no maternal deaths. This study demonstrated that a broad spectrum of medical, surgical, and obstetric complications necessitate antenatal hospitalization, resulting in an overall perinatal survival rate of 95%.

Boston↗
PubMed1989

Immunoliposomes with different acid sensitivities as probes for the cellular endocytic pathway.

By combining dioleoylphosphatidylethanolamine (DOPE) with oleic acid (OA), palmitoylhomocysteine (PHC) or dipalmitoylsuccinylglycerol (DPSG) we have prepared pH-sensitive liposomes with different acid sensitivities. DOPE/OA liposomes are the most acid sensitive, while DOPE/DPSG liposomes are the least acid sensitive. Incubation of DOPE/OA liposomes with mouse L929 cells reduces the pH-sensitivity of these liposomes by altering the lipid composition. Using diphtheria toxin fragment A as a marker for cytoplasmic delivery, we find that the delivery kinetics of pH-sensitive immunoliposomes closely correlates with the modified acid sensitivities of the liposomes. Immunoliposomes encounter pH 6-6.2 with a t1/2 of 5-15 min after internalization. By contrast, acidification of the endosomes to pH 5.0 takes longer (t1/2 approximately 25 min). We also used a whole cell null point technique (Yamishiro and Maxfield (1987) J. Cell Biol. 105, 2713-2721) to directly determine the average pH encountered by the endocytosed immunoliposomes. We find that acidification determined by the null point method proceeds less rapidly than that estimated from DTA delivery data. This is likely due to the fact that the measured DTA delivery is done by those liposomes which first arrive at the endosomes with sufficient acidity. Our data suggests that DOPE/PHC immunoliposomes deliver at the early endosome while DOPE/DPSG immunoliposomes deliver at the late endosomes. The DOPE/OA immunoliposomes, with the altered composition and acid sensitivity, deliver with a kinetics intermediate between the other two immunoliposomes. Thus, pH-sensitive liposomes represent useful probes for studying the kinetics of endosome acidification.

Animals↗
PubMedDate not supplied

Recovery from childbirth: looking back 6 months after delivery.

Women's perceptions of their recovery from childbirth were investigated by open-ended interviews of 96 mothers of health, full-term infants 6 months after delivery. Data included factors affecting physical, mental, and emotional recovery; sources of help and hindrance; ideas of what each women would do differently after the delivery of another child; and overall evaluation of how the months after delivery compared with expectations. Content analysis of the data revealed that 25% of the women did not feel physically recovered from childbirth at 6 months postpartum. Husbands and other family members were major sources of help. Prolonged labor and cesarean delivery were the major hindrances to recovery. More household and child-care help was desired after delivery of another child. Almost half of the women found the first 6 months after delivery more difficult than anticipated. The findings suggest that pregnant women need more information about lifestyle adjustments after childbirth.

Adaptation, Psychological↗
PubMed1990

The use of nifedipine during the postpartum period in patients with severe preeclampsia.

Nifedipine is a calcium channel blocker that reduces blood pressure and increases renal blood flow. This double-blind investigation evaluated the effect of nifedipine in postpartum patients with severe preeclampsia. Thirty-one patients were randomized to receive either nifedipine (10 mg) or placebo every 4 hours beginning immediately after delivery. Data analysis revealed a significantly higher urine output in the nifedipine group during the first 24 hours after delivery (3834 versus 2057 ml; p less than 0.05). A significant reduction in mean arterial pressure was also noted in the nifedipine group between 18 and 24 hours postpartum (93.9 versus 100.2 mm Hg; p less than 0.05). There were no significant differences in the systolic or diastolic blood pressures, pulse, laboratory study results, or the need to administer hydralazine to control blood pressure. Nifedipine appears to have a beneficial effect on urinary output and mean arterial pressure during the first 24 hours post partum in patients with severe preeclampsia.

Blood Pressure↗
PubMed1991

[Development of an electronic calculator for gestational age in prenatal care].

The development of a portable electronic gestation calculator enables the obstetrician for the first time to recall all relevant data for his daily routine work from an electronic memory. This is useful not only for the calculation of the duration of pregnancies or the determination of delivery data, but also includes all relevant information from ultrasound biometry of the fetus. This paper presents the experience with this new electronic device, 'Babycomp', and comments on its design, technical features, functions and performance. The device has been thoroughly tested especially with respect to its suitability for practical purposes. Compared with the widely used disk for pregnancy calculations, the 'Babycomp' has a wide range of advantages for all users working in the field of obstetrics and reproductive medicine.

Computers↗
PubMed1989

Improvement in airway responsiveness and asthma severity during pregnancy. A prospective study.

In the myometrium and gut, smooth muscle becomes less contractile during pregnancy, probably because of the effect of progesterone and estrogen. It is not known whether these hormones cause similar changes in airway smooth muscle, and therefore, this study examined airway responsiveness during the large hormonal changes of pregnancy and evaluated whether changes in responsiveness are associated with changes in (1) progesterone and estrogen and (2) the clinical severity of asthma. Twenty nonpregnant asthmatic women were assessed every 3 months until conception. In the 16 who conceived, assessments were repeated once during the second and third trimesters and 1 month after delivery. Data collected preconception and from those who did not conceive within 1 yr were used for control subjects. There was a 2-fold improvement in airway responsiveness during pregnancy from a preconception mean PC20 0.35 to 0.72 mg/ml during the second trimester and 0.58 mg/ml during the third (p = 0.03). Post-delivery responsiveness (0.48 mg/ml) was not significantly different from preconception. The improvements during pregnancy were greater than the 3 monthly fluctuations when not pregnant (p = 0.04) and were greatest in those who were most hyperresponsive initially (p = 0.01). There was an associated improvement in clinical asthma severity as indicated by a reduction in minimum medication requirements (p = 0.03) and this was not at the expense of good symptoms control; both symptoms and spirometry remained unchanged during pregnancy. Changes in responsiveness were not closely related to progesterone or estriol, suggesting that other nonhormonal factors may also contribute to the improvement during pregnancy and that the control of asthmatic airway smooth muscle may not be exactly the same as that of the myometrium and gut.

Adult↗
PubMed1988

[Pneumothorax in pregnancy. Apropos of 3 cases].

We report 3 cases of pneumothorax developed during pregnancy and we compare them with the 16 cases previously published. We insist on the late occurrence of pneumothorax during pregnancy and on the possibility of vaginal delivery. Data from literature and our own experience incline us to believe that pneumothorax is not rare during pregnancy but is often misdiagnosed or unreported.

Adult↗
PubMed1986

Assessment of an on-line computerized perinatal data collection and information system.

An on-line maternity data collection system has been designed to provide the information required for perinatal audit and to allow many of the letters and forms required for effective communication in pregnancy to be produced automatically. The system meets the requirements of the Korner Committee on Health Services Information and has been approved by the Computer Policy Committee. Pregnancy is followed prospectively from the first antenatal clinic visit until the file is closed 28 days after delivery. Data are entered by midwives and secretaries onto a network of microcomputers placed at convenient points in the maternity unit. The system has been fully operational with no significant problems since the beginning of 1984 and has led to improved communication between hospital and the community. Analysis of 253 consecutive case notes showed a high level of accuracy of the data recorded on computer. Reports and clinical audit are readily available both from the system locally, from standard programmes on the regional mainframe computer and via a mainframe computer at London University.

Computer Systems↗
PubMed1991

The relationship of nasal septal deformity and palatal symmetry in neonates.

Results are reported of a study to evaluate possible associations between nasal septal deformity and palatal symmetry in neonates. Five hundred babies, born consecutively, were examined within three days of birth. Prenatal and delivery data were recorded for each baby and the nose was examined to determine airway patency and possible septal deformity. When a deviation of the septum was discovered an alginate impression of the palate was taken along with photographs of the nostrils. A matched control was then selected for each study group baby and similar records were obtained. Only 14 cases of septal deformity were found, an incidence of 2.8 per cent. No evidence of palatal asymmetry was found. The theory that moulding pressures during delivery may be a major cause of nasal septal deformity was not supported.

Delivery, Obstetric↗
PubMed1989

Semliki Forest virus capsid protein acts as a pleiotropic regulator of host cellular protein synthesis.

The Semliki Forest virus capsid (C) protein was introduced into various target cells by electroporation-, liposome-, and erythrocyte-ghost-mediated delivery. Data are presented which show that the incorporated C protein is biologically active and, at low concentrations (10(3) to 10(4) molecules per cell), markedly induces host cellular protein synthesis (average value, up to 90%). On the other hand, high concentrations (10(5) to 10(6) molecules per cell) led to a significant inhibition (average value, up to 60%). The cellular response to C protein was found to be identical in P3X63Ag8 suspension cells, CV-1 cells, and GpBind4 cells. Following electroporation-mediated delivery of C-protein molecules, both induction and repression of cellular protein synthesis were immediate, whereas with liposome-mediated delivery these events were delayed by about 1 h. Maximum stimulation and repression occurred between 0 and 1 h after delivery of C protein and decreased thereafter to reach control values at about 4 h. The analysis of the proteins synthesized suggests that low amounts of microinjected C protein are responsible for the induction of classes with specific Mrs, whereas high amounts lead to an inhibition of overall protein synthesis.

Animals↗
PubMed1991

[Fetomaternal transfusion in relation to mode of delivery. Comparison of data from the DFG multicenter study "Rhesus negative" (1965-70) with data from the Freiburg University Gynecologic Clinic (1989)].

Fetomaternal hemorrhage with transfusion of more than 10-25 ml fetal blood into the maternal circulation ("macrotransfusion") is one possible cause of the failure of combined pre- and postpartal anti-D prophylaxis. We analyzed the data from 391 patients who delivered at the UFK Freiburg in 1989. We evaluated the amount of fetomaternal bleeding in different modes of delivery. We observed fetomaternal hemorrhage of clinical relevance in 7.5% of spontaneous delivery, 11.1% of vacuum extraction, 17.7% of cesarean section (p less than 0.05). There was no difference concerning macrotransfusions in the above mentioned modes of delivery. Our data are compared with the data of the DFG multicenter trial "rhesus negative" (1965-79).

Cesarean Section↗
PubMed1987

Outpatient clinic therapist attitudes and beliefs relevant to client dropout.

One hundred and seventy-three psychotherapists from 43 Midwestern mental health clinics responded to a survey which addressed therapists' attitudes and beliefs on service delivery topics relevant to client premature therapy termination. Therapists' responses were contrasted with known client and service delivery data. Therapists preferred a treatment duration longer than that expected by clients, overestimated actual treatment length, underestimated actual dropout rates and cited dislike of therapy or the therapist less often than clients did as reasons for premature termination. Causes of therapists' overestimates of treatment length and continuance, and their relevance to the dropout problem, were discussed.

Attitude of Health Personnel↗