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71.
A questionnaire was sent to 2000 members of two of the largest national infertility support organizations as part of the National Infertility Awareness Campaign (NIAC), 1997. A total of 980 questionnaires was completed and returned to the market research company, Ballington Hall. Some 69% of the respondents were aged between 30 and 39 years. One-third of the couples had been trying for a baby for more than 3 years, including one-tenth who had been trying to conceive for more than 10 years. Some 40% of respondents were successful in conceiving, although a significant proportion of these took more than 6 years. About 75% of those surveyed had been forced to pay for some or all of their infertility treatments and investigations, whereas 18% had their treatments funded fully by the National Health Service (NHS). Funding sources for the remaining 7% were unknown. Just over one-third of respondents felt that their GP provided sufficient information about the causes of infertility investigations and treatment, while the majority said that their specialists had been helpful. One in three said that they did not fully understand the medical nature of their own or their partner's infertility. A wide range of negative emotions was experienced by respondents. One in five said they experienced suicidal feelings; one in three said that infertility had strained their relationship; and just over one-quarter found that their relationship improved as a result of the treatment. Some 71% said that they would request counselling if it were offered free, but only 12% had been provided with free counselling on the NHS. 相似文献
72.
Marije S. Holstege Monique A.A. Caljouw Ineke G. Zekveld Romke van Balen Aafke J. de Groot Jolanda C.M. van Haastregt Jos M.G.A. Schols Cees M.P.M. Hertogh Jacobijn Gussekloo Wilco P. Achterberg 《Journal of the American Medical Directors Association》2017,18(5):383-387
Objective
To determine whether the implementation of a national program to improve quality of care in geriatric rehabilitation (GR) in the Netherlands improves successful GR in terms of independence in activities of daily living (ADL), discharge destination, and length of stay.Design
Prospective longitudinal study, comparing 2 consecutive cohorts: at the start of implementation (n = 386) and at 1 year after implementation (n = 357) of this program.Setting/Participants
Included were 16 skilled nursing facilities, 743 patients (median age 80 years, interquartile range 72–85; 64.5% females) indicated for GR and their health care professionals (elderly care physicians, physiotherapists, and nursing staff).Intervention
National program to stimulate self-organizing capacity to develop integrated care to improve GR service delivery in 4 domains: alignment with patients’ (care) needs, care coordination, team cooperation, and quality of care.Measurements
Data on patients’ characteristics, functional outcomes at admission and discharge, length of stay, and discharge destination were collected via an online questionnaire sent to health care professionals. The primary outcome measure was successful rehabilitation defined as independence in ADL (Barthel Index ≥15), discharge home, and a short length of stay (lowest 25% per diagnostic group). Generalized estimating equation analysis was used to adjust for age, gender, and clustering effects in the total population and for the 2 largest diagnostic subgroups, traumatic injuries and stroke.Results
In the total population, at 1 year postimplementation there was 12% more ADL independence [odds ratio (OR) 1.59, 95% confidence interval (CI) 1.00–2.54]. Although successful rehabilitation (independence in ADL, discharge home, short length of stay) was similar in the 2 cohorts, patients with traumatic injuries were more successful 1 year postimplementation (OR 1.61, 95% CI 1.01–2.54). In stroke patients, successful rehabilitation was similar between the cohorts, but with more independence in ADL in the follow-up cohort (OR 1.99, 95% CI 1.09–3.63).Conclusions
This study shows that 1-year after the implementation of the Dutch national program to improve quality of care there was more independence in ADL at discharge, but the combined outcome of successful GR (independence in ADL, discharge home, short length of stay) was only significantly improved in patients with traumatic injuries. 相似文献73.
Van Balen F 《Prenatal diagnosis》2006,26(7):614-618
It appears that in most Western countries, son preference is somewhat stronger than daughter preference. However, when one considers the preference of women it looks as though the opposite pattern is emerging. There is a considerable social acceptance of 'light' methods of sex selection (such as diets), even though these methods are not proven to be effective. The inclination to use sperm separation methods appears to be greater in the United States than in some European countries. There are indications that a preference for boys or for girls is associated with attitudes towards technology, child-rearing style and the stereotyping of boys or girls. 相似文献
74.
Society for Endocrinology UK guidance on the initial evaluation of an infant or an adolescent with a suspected disorder of sex development (Revised 2015)
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S. Faisal Ahmed John C. Achermann Wiebke Arlt Adam Balen Gerry Conway Zoe Edwards Sue Elford Ieuan A. Hughes Louise Izatt Nils Krone Harriet Miles Stuart O'Toole Les Perry Caroline Sanders Margaret Simmonds Andrew Watt Debbie Willis 《Clinical endocrinology》2016,84(5):771-788
It is paramount that any child or adolescent with a suspected disorder of sex development (DSD) is assessed by an experienced clinician with adequate knowledge about the range of conditions associated with DSD. If there is any doubt, the case should be discussed with the regional DSD team. In most cases, particularly in the case of the newborn, the paediatric endocrinologist within the regional team acts commonly as the first point of contact. This clinician should be part of a multidisciplinary team experienced in management of DSD and should ensure that the affected person and parents have access to specialist psychological support and that their information needs are comprehensively addressed. The underlying pathophysiology of DSD and the strengths and weaknesses of the tests that can be performed should be discussed with the parents and affected young person and tests undertaken in a timely fashion. Finally, in the field of rare conditions, it is imperative that the clinician shares the experience with others through national and international clinical and research collaboration. 相似文献
75.
Frank van Balen 《Journal of psychosomatic obstetrics and gynaecology》2013,34(4):229-230
The aim of this study was to describe security associated with pregnancy and childbirth. Security was described as a human need and as a human value. Data were collected in semi-structured interviews in two maternity health care clinics. Data interpretation was based on the method of content analysis. A convenience sample of 20 volunteer Finnish women was interviewed during pregnancy. The elements creating security associated with pregnancy and childbirth were maternity health care, social support, sense of control, and attitudes. The feeling of security was manifested in different resources, feelings and behavior. If the feeling of security associated with pregnancy and childbirth was impaired, the participants would resort to their network of social support, contact health care or social welfare services, or try to achieve a sense of security by their own resources. Feeling secure during pregnancy influences the pregnant woman's resources, feelings and behavior. It is important that professionals in maternity health care talk with the client about issues that influence her individually-experienced security associated with pregnancy and childbirth. These include examination of the client's network of social support and informing the client about the health care and social welfare services available. 相似文献
76.
Pierre Genton †Jürgen Bauer ‡Susan Duncan §Ann E. Taylor Adam H. Balen ¶Andrea Eberle Birthe Pedersen ††Xavier Salas-Puig §§Mark V. Sauer 《Epilepsia》2001,42(3):295-304
Summary: Recent studies by Isojärvi et al. have raised the issue of an increased incidence of polycystic ovary syndrome (PCOS) in women with epilepsy treated with valproate (VPA) and have proposed replacement with lamotrigine (LTG). Polycystic ovaries (PCO) are a common finding, with a prevalence >20% in the general population, and are easily detected by pelvic or vaginal ultrasonography, whereas PCOS is comparatively rare: few women with PCO have fully developed PCOS, which includes hirsutism, acne, obesity, hypofertility, hyperandrogenemia, and menstrual disorders. From an extensive review of the current literature, it appears that there are no reliable data on the actual prevalence of PCOS in normal women and in women with epilepsy. The pathogenesis of PCO is multifactorial, including genetic predisposition and the intervention of environmental factors, among which weight gain and hyperinsulinism with insulin resistance may play a part. The roles of central (hypothalamic/pituitary), peripheral, and local ovarian factors are still debated. PCO and PCOS appear to be more frequent in women with epilepsy, but there are no reliable data showing a greater prevalence after VPA. The recent studies by Isojärvi et al. may have been biased by the retrospective selection of patients. To date, there is no reason to contraindicate the use of VPA in women with epilepsy. However, patients should be informed about the risk of weight gain and its consequences. 相似文献
77.
L Morley T Tang E Yasmin R Hamzeh AJ Rutherford AH Balen 《Human fertility (Cambridge, England)》2012,15(3):134-139
This randomized controlled trial investigated whether delaying human chorionic gonadotrophin hormone (hCG) administration within an IVF cycle impacts upon clinical outcomes. Participants included 125 women undergoing IVF/ICSI cycles at Leeds Centre for Reproductive Medicine. Subjects were aged 20-36 years, body mass index (BMI) 20-30?kg/m(2) with a normal FSH level (<8 IU/l). Administration of hCG took place 35-36?h prior to oocyte retrieval when there were ≥3 follicles ≥17?mm in diameter (Group A), delayed by 1 day (Group B) or 2 days (Group C). Outcomes included the number of oocytes retrieved per cycle, fertilization rate and live birth rate. On the day of oocyte retrieval, women in Groups B and C had significantly more mature follicles than Group A, although the number of oocytes retrieved did not differ (median = 12 in each group). Fertilization rates and embryo quality were comparable between groups. Pregnancies and live births per cycle were higher in Groups B and C (A = 30.8%, B = 54.1%, C = 38.7%; A = 17.9%, B = 27.0%, C = 25.8%), but did not reach statistical significance. Delaying hCG administration had no significant negative impact upon morphological quality of embryos, availability of surplus embryos for freezing or pregnancy outcomes. Postponing hCG may enable increased flexibility of cycle scheduling to avoid weekend procedures. 相似文献
78.
79.
The relation between women's age and fertility, and the factors that
influence the age at which couples desire to have their first child, were
analysed in a national sample of women aged 25-49 years. A random sample of
8050 households in the Netherlands was approached. In these households,
3295 women between the ages of 25 and 49 years answered a short
questionnaire about planning their first pregnancy and about fertility.
Furthermore, sociodemographic data were gathered. There appeared to be
almost no variation in cumulative pregnancy rate between age 20 and 28:
between 65 and 70% at 6 months, just below 90% at 12 months and
approximately 93% at 24 months. After the age of 33 years, the cumulative
pregnancy rate at 6 months decreased. From the age of 28 years the
cumulative pregnancy rate at 12 months and at 24 months decreased
gradually, reaching 75 and 80% respectively, by the age of 35 years. The
year of birth of the woman (the 'time' factor) was the most important
factor influencing the age at which couples desired to have their first
child. In addition, demographic factors, particularly a high level of
education, a high professional level and a high level of family income,
were associated with the desire to have the first child at a relatively
late age.
相似文献
80.
D. B. van Dorp A. W. Eriksson J. W. Delleman A. G. M. van Vliet H. Collewijn A. Th. M. van Balen H. R. Forsius 《Clinical genetics》1985,28(6):526-531
Electrophysiological studies showed that a patient with Åland eye disease had no misrouting of the optic pathways which is always found in all forms of albinism as a consequence of the retinogeniculate anomaly. Also the spontaneous and optokinetic nystagmus did not resemble that of the large majority of human albinos. The marked asymmetry found in this patient seems to be typical for humans with a defective development of foveal binocular vision. These findings are in agreement with clinical, nystagmographic and EM findings that Åland eye disease is distinct from the Nettleship-Falls type of X–linked ocular albinism. Furthermore, Åland eye disease is different from X-chromosomal congenital stationary night blindness with myopia by the fact that the scotopic functions are only moderately affected and there is no restriction of the peripheral photopic visual fields. In addition, there is latent nystagmus of extraocular type that appears also in female carriers. There is no ophthalmoplegia, there is a progression of the myopia and the dyschromatopsia is of secondary type. 相似文献