Randomised trial comparing the upright and supine positions for the second stage of labour

Objective To assess the maternal and neonatal effects of upright compared with recumbent positions during delivery, in terms of defined outcome variables.
Design A randomised controlled trial.
Setting St Monica's Nursing Home, a midwife based maternity unit in Cape Town, South Africa.
Participants Five hundred and seventeen women of low obstetrical risk assigned to deliver at the nursing home.
Results The trial showed that women who adopted the upright posture for delivery experienced less pain, perineal trauma and fewer episiotomies than those who delivered in the supine position.
Conclusion The data suggest that in women of low obstetrical risk, choice of posture during delivery may be encouraged.     

Urogenital ageing and its effect on sexual health in older British women

Objective To provide information on the extent of problems of urogenital ageing in older British women.
Design A MORI survey of a representative population sample of older British women.
Setting Home interviews.
Participants Two thousand and forty-five women aged 55–85+.
Results Urogenital symptoms had affected 48.8% of the women at some time, but no more than 11% were currently affected by individual symptoms; however, these were often of long duration. The majority (73%) were not sexually active, with lack of a partner being a factor for many. There was also a decreasing prevalence of sexual activity with increasing age. Those sexually active in the 65–74 year old age group (   n = 148  ) tended to have a similar sexual frequency (at least once per month) compared with the younger women studied. Approximately 12% of those who reported dyspareunia and/or vaginal dryness claimed a severe problem; 33% did not seek professional advice and 36% resorted to an over the counter remedy. Use of hormone replacement therapy was generally of relatively short duration. There was a declining gradient of ever-use with age.
Conclusions The extent of significant urogenital symptoms is relatively low, but some women are seriously affected and use self-help as well as professional assistance. The extent of sexual activity in older women and factors affecting this have been defined, and the effect of urogenital symptoms on sexual activity demonstrated.     

Prevalence of faecal incontinence among women with urinary incontinence

Four hundred and sixty-five women attending a urodynamic clinic were interviewed, and completed a detailed bowel questionnaire, about their urinary and bowel symptoms. All the women underwent video-cystourethrography with pressure and flow studies. The reported incidence of faecal incontinence was 15.3% (   n = 71  ) on direct questioning and 26% 0(  n = 121  ) on the postal questionnaire. Faecal incontinence was more common in women with a urodynamic diagnosis of detrusor instability (30'%1 (   n = 26  )) than among women diagnosed as having genuine stress incontinence (21% (   n = 38  )). Denervation and myogenic injuries sustained during childbirth have been suggested as a common cause for genuine stress and faecal incontinence, but there may be an alternative mechanism to explain why women with detrusor instability suffer from faecal incontinence.     

Plasma from pre-eclamptic women and functional change in myometrial resistance arteries

This study assesses the ability of plasma from women with pre-eclampsia to induce altered endothelial function in myometrial resistance vessels from normotensive women. Vessels from normotensive pregnant women (n= 7) were incubated with plasma from other pregnant women who were normotensive (n= 6)or had pre-eclampsia (n= 7). A wire myograph was used to test the endothelium-dependent relaxatory response to bradykinin of preconstricted vessels. The relaxation in vessels incubated with plasma from women with pre-eclampsia was markedly less than in vessels incubated with plasma from normotensive pregnant women (  P = 0.039  ). This supports the theory that a plasma-borne factor contributes to the endothelial changes seen in pre-eclampsia.     

人感染高致病性禽流感中医药诊治指导方案(天津)

自我国部分地区出现高致病性禽流感疫情以来，党和国家领导人高度关注。胡锦涛总书记、温家宝总理强调：要切实做好高致病性禽流感防治工作。1月29日，温家宝总理主持召开国务院第37次常务会议，对高致病性禽流感防治工作提出了8项重点措施。在市政府的统一部署下，天津市卫生局成立了“天津市卫生局防控人感染高致病性禽流感工作领导小组”，认真按照全国防控高致病性禽流感指挥部和卫生部有关工作部署和要求，多次召开会议，会同天津中医学院组织全市知名中医药专家制定了中医药诊治人感染高致病性禽流感指导方案，以确保在发生高致病性禽流感疫情时，能够及时、高效、有序地进行应急处理，最大限度地减轻疫情造成的危害，保障人体健康和养殖业持续发展。该方案根据《全国高致病性禽流感应急预案》和《天津市重大动物疫情应急预案》之精神，结合天津地域、时令及气候变化实际，结合历次治疗突发疫情特别是非典的宝贵经验，突出中医药在防治传染病中的优势，以期为防治人感染高致病性禽流感以及今冬明春可能出现的流感作出应有的贡献。现将方案公布，以备需用，也希望同道在实践中提出真知灼见，使之更趋完善。[编者按]     

Book Review

Performance Breakthroughs for Adolescents With Learning Disabilities or ADD. G. Markel & J. Greenbaum.