Stress during gestation alters postpartum maternal care and the development of the offspring in a rodent model.

BACKGROUND: Epidemiological studies suggest that environmental adversity can alter parental care and thus influence child development. We addressed the question of whether stressors can directly affect parental behavior using a rodent model of stable, individual differences in maternal behavior. METHODS: Lactating rat mothers were characterized as high or low in pup-directed licking/grooming (LG) behavior, rebred, and subjected to 7 days of intermittent stress or control conditions during gestation. Female rats were mated a third time without any subsequent intervention. Maternal behavior, oxytocin receptor (OTR) binding, and offspring behavior were examined. RESULTS: Stress reduced OTR levels and pup LG of high LG mothers to levels comparable with those of low LG mothers. The adult offspring of the gestational stress/high LG mothers resembled those of low LG mothers on behavioral measures of anxiety and maternal behavior, as well as OTR levels. The results of the third mating revealed an enduring effect of gestational stress on both mother and offspring maternal LG. CONCLUSIONS: These findings suggest that stress can directly alter maternal care through the neuroendocrine systems that normally regulate this behavior. Thus, the effects of environmental adversity can be transmitted across generations through a nongenomic mechanism involving maternal care.     

Improving emergency obstetric care in Mozambique: the story of Sofala.

OBJECTIVE: The 5-year project in the province of Sofala was designed to improve access, quality and utilization of emergency obstetric care (EmOC) by strengthening rural hospitals and health centers and ultimately the health system's capacity to respond to emergencies more quickly and effectively. METHODS: Implementation consisted of attention to infrastructure, human resource development, transportation and communication systems, and management. Specific management aspects that were targeted for improvement included: supportive supervision, logistics for supplies, equipment and drugs, record keeping, monitoring and evaluation, and quality improvement techniques such as maternal death audits. RESULTS: Access to EmOC improved with an increase in the number of fully functional EmOC facilities from 4 to 18. The number of women with obstetric complications who were admitted for treatment in participating facilities tripled, and the proportion of those women dying declined by half. CONCLUSIONS: Close collaboration and partnership with the provincial health directorate make the sustainability of many results likely while the replication of much of the Sofala model to other provinces is promising for the national strategy to reduce maternal mortality.     

踝关节骨折并下胫腓联合分离的手术治疗

自1998年8月-2005年8月共收治踝关节骨折患者117例，其中合并下胫腓联合分离者39例，均采用手术治疗并取得了满意的疗效。 1临床资料 本组39例，男18例，女21例；年龄19—71岁，平均27．8岁；左侧22例，右侧17例；双踝骨折34例，合并后踝骨折5例。     

The role of professional associations in reducing maternal mortality worldwide.

The death of hundreds of thousands of women due to pregnancy-related complications casts a shadow over the modern obstetrical world. This paper examines the potential roles and responsibilities of professional obstetrical and midwifery associations in addressing this tolerated tragedy of maternal deaths. We examine the successes and challenges of obstetrical and midwifery associations and encourage the growth and development of active associations to address maternal mortality within their own borders. Professional associations can play a vital role in the reduction of maternal mortality worldwide. Their roles include lobbying for women's health and rights, setting standards of practice, raising awareness and team building. Associations from developed countries can influence and strengthen their colleagues within developing countries; for example, the FIGO Save the Mothers initiative. Professional associations should be encouraged to play an active role in reducing maternal mortality within their own country and abroad.     

Septic separation of the symphysis pubis

Summary Symphysial osteomyelitis has been distinguished from osteitis pubis because of the more serious nature of the disease. We report a case in which there was a pelvic separation similar to that seen after trauma or pregnancy. The previously undescribed complications of bladder perforation and pelvic instability are also noted. There was no predisposing cause in this case, in contrast to the 40 previously reported. The causative organism was staphylococcus aureus, but pseudomonas aeruginosa and escherichia coli have also been found in other cases.

---

Résume L'ostéomyélite de la symphyse pubienne a pu être distinguée de l'ostéite pubienne en raison de sa plus grande gravité. Nous en rapportons un cas dans lequel existait une disjonction symphysaire semblable à celles que l'on observe après traumatisme ou grossesse. On a également noté des complications jamais décrites, à savoir une perforation vésicale et une instabilité pelvienne. Il n'y avait pas de cause prédisposante dans ce cas, contrairement aux 40 observations précédemment rapportées dans la littérature. La bactérie causale était un staphylocoque doré, mais le pyocyanique et le colibacille ont également été retrouvés dans d'autres cas.

     

Risk factors and obstetric complications associated with macrosomia.

OBJECTIVE: Macrosomia is associated with adverse maternal outcomes. The objective of this study was to characterize the epidemiology of macrosomia and related maternal complications. METHOD: Live births (146,526) were identified between 1995 and 1999 in the Kaiser Permanente Medical Care Program's Northern California Region (KPMCP NCR) database. Bivariate and multivariate analyses were performed for risk factors and complications associated with macrosomia (birth weight >4500 g). RESULT: Male infant sex, multiparity, maternal age 30-40, white race, diabetes, and gestational age >41 weeks were associated with macrosomia (p<0.001). In bivariate and multivariate analyses, macrosomia was associated with higher rates of cesarean birth, chorioamnionitis, shoulder dystocia, fourth-degree perineal lacerations, postpartum hemorrhage, and prolonged hospital stay (p<0.01). CONCLUSION: Macrosomia was associated with adverse maternal outcomes in this cohort. More research is needed to determine how to prevent complications related to excessive birth weight.     

Skilled birth attendant competence: an initial assessment in four countries, and implications for the Safe Motherhood movement.

OBJECTIVES: Percentage of deliveries assisted by a skilled birth attendant (SBA) has become a proxy indicator for reducing maternal mortality in developing countries, but there is little data on SBA competence. Our objective was to evaluate the competence of health professionals who typically attend hospital and clinic-based births in Benin, Ecuador, Jamaica, and Rwanda. Methods: We measured competence against World Health Organization's (WHO) Integrated Management of Pregnancy and Childbirth guidelines. To evaluate knowledge, we used a 49-question multiple-choice test covering seven clinical areas. To evaluate skill, we had participants perform five different procedures on anatomical models. The 166 participants came from facilities at all levels of care in their respective countries. Results: On average, providers answered 55.8% of the knowledge questions correctly and performed 48.2% of the skills steps correctly. Scores differed somewhat by country, provider type, and subtopic. Conclusion: A wide gap exists between current evidence-based standards and current levels of provider competence.     

生脉散多糖的组成及其初级结构分析

目的：研究复方中药制剂中多糖与单方多糖之间的组成关系，以及生脉散多糖的初级结构分析。方法：提取和精制了生脉散（SMS）单方药材红参、麦冬、五味子中多糖成分；然后采用Sephadex G-75柱层析分离纯化SMS多糖，得一浅黄色SMS多糖纯品，经紫外光谱、Sephadex G－200凝胶柱层析和琼脂糖凝胶电泳检测证明为均一组分。同时采用Sephadex G-200凝胶柱层析，测得SMS多糖组成。运用TLC法和HPLC法测定了SMS多糖纯品的单糖组成；并采用IR，高碘酸氧化和Smith降解推知其初级结构。结果：SMS多糖由红参多糖，麦冬多糖和五味子多糖所组成，其中含有葡萄糖、L－鼠李糖、D－木糖、D－果糖、半乳糖和乳糖等多种单糖，主要糖苷键为α－构型；多糖糖苷键以1→4连接键为主，1→3为次。结论：首次报道了生脉散多糖的组成及其初级结构分析。     

医院门诊药房与医院分离的理性探讨

介绍了医药分业的定义、国外医药分业的目的和少数医院无门诊药房的原因。指出门诊药房从医院分离出去弊大于利,认为门诊药房从医院分离,难以达到预期目的,反而有损于医疗卫生事业的公益性;医药分离削弱、甚至取消了医院对医师不当处方和合理药物治疗等医疗行为的行政和技术监管与干预;医药分离不适合我国的国情,不符合我国卫生体制改革的精神,不利于医疗质量的提高,不利于病人安全、有效、经济用药,不利于调动医院广大药学技术人员的积极性,不利于医院药物治疗管理自动化的实现与信息的传递。建议医药结合的模式必须加强;保留门诊药房,加大监督力度;建立药品配送中心,完善社会化物流机制;加速非处方药药品的发展;在条件成熟后实施处方调剂费;高薪养廉,较大幅度提高医师职业的收入;解决当前医疗体系中分配不合理问题,适当提高挂号、手术、诊疗等收费标准,降低药品收入在医院总收入中所占的比例。