Patient disclosure of the use of complementary and alternative medicine to their obstetrician/gynaecologist.

The objective of the study was to determine the extent of complementary and alternative medicine use and the disclosure of that use by patients seeing an obstetrician/gynaecologist. Data from the National Health Interview Survey of the USA 2007 were reviewed. Of the 2,673 women seeing an obstetrician/gynaecologist 956 (35.8%) used at least one form of CAM. However, only 51.8% of the women using CAM disclosed that use to their physician.

Vibration exercise for treatment of osteoporosis: a theoretical model.

Orthopaedic rehabilitation of osteoporosis by muscle vibration exercise is investigated theoretically using Wolff's theory of strain-induced bone 'remodelling'. The remodelling equation for finite amplitude vibration to be transmitted to the bone via muscle corresponds to a slowly time-varying non-linear dynamic system. This slowly time-varying system is governed by a Riccatti equation with rapidly varying coefficients that oscillate with the frequency of the applied vibration. An averaging technique is used to determine the effective force transmitted to the bone. This force is expressed in terms of the stiffness and damping parameters of the connected muscle. The analytical result predicts that, in order to obtain bone reinforcement, the frequency and amplitude of vibration should not exceed specified levels. Furthermore, low-frequency vibration does not stimulate the bone sufficiently to cause significant remodelling. The theoretical model herein confirms the clinical recommendations regarding vibration exercise and its effects on rehabilitation. In a numerical example, the model predicts that a femur with reduced bone mass as a result of bed rest will be healed completely by vibration consisting of an acceleration of 2g applied at a frequency of 30 Hz over a period of 250 days.

The Werner syndrome protein is required for recruitment of chromatin assembly factor 1 following DNA damage.

The Werner syndrome protein (WRN) and chromatin assembly factor 1 (CAF-1) are both involved in the maintenance of genome stability. In response to DNA-damaging signals, both of these proteins relocate to sites where DNA synthesis occurs. However, the interaction between WRN and CAF-1 has not yet been investigated. In this report, we show that WRN interacts physically with the largest subunit of CAF-1, hp150, in vitro and in vivo. Although hp150 does not alter WRN catalytic activities in vitro, and the chromatin assembly activity of CAF-1 is not affected in the absence of WRN in vivo, this interaction may have an important role during the cellular response to DNA replication fork blockage and/or DNA damage signals. In hp150 RNA-mediated interference (RNAi) knockdown cells, WRN partially formed foci following hydroxyurea (HU) treatment. However, in the absence of WRN, hp150 did not relocate to form foci following exposure to HU and ultraviolet light. Thus, our results demonstrate that WRN responds to DNA damage before CAF-1 and suggest that WRN may recruit CAF-1, via interaction with hp150, to DNA damage sites during DNA synthesis.

Maternal age and risk of fetal death in singleton gestations: USA, 1995-2000.

OBJECTIVE: To determine the magnitude of risk for fetal death among singleton pregnancies in relation to maternal age, and to compare the risks with other common indications for fetal testing. STUDY DESIGN: We performed a retrospective cohort analysis of singleton births delivered between 1995 and 2000 using the US linked birth/infant death data. Gestational age at < 24 weeks and fetuses with anomalies were excluded. Fetal death rates at > or = 24 and > or = 32 weeks were calculated among women aged 15-19, 20-24, 25-29, 30-34, 35-39, 40-44 and 45-49 years, as well as for other common indications for testing: chronic and pregnancy-induced hypertension, diabetes and small-for-gestational age (SGA). The association between maternal age and fetal deaths was derived after adjusting for potential confounders through multivariable logistic regression models. Relative risks (RR) and 95% confidence intervals (CI) were derived from these models after adjusting for the effects of gravidity, race, marital status, prenatal care, education, smoking and placental abruption. RESULTS: Among the 21,610,873 singleton births delivered at > or = 24 weeks, fetal deaths occurred in 58,580 (2.7 per 1000). Births to young (15-19 years) and older (> or = 35 years) women comprised 12.6% and 11.4%, respectively. Compared with women aged 20-24 years, young women did not experience an increased risk of fetal death. However, increasing rates of fetal death at > or = 24 and at > or = 32 weeks were seen with increasing maternal age. The RR for fetal death at > or = 24 and at > or = 32 weeks among women 35-39 years were 1.21 and 1.31, respectively, while the RRs were 1.62 and 1.67 among women aged 40-44 years. Women 45-49 years were 2.40-fold (95% CI 1.77, 3.27) and 2.38-fold (95% CI 1.64, 3.46) as likely to deliver a stillborn fetus at > or = 24 weeks and > or = 32 weeks, respectively. RRs for fetal death at > or = 24 and > or = 32 weeks for hypertensive disease, diabetes, and SGA ranged between 1.46 and 4.95. CONCLUSION: Fetal deaths are increased among older women (> or = 35 years). Fetal testing in women of advanced maternal age may be beneficial.

Human diseases deficient in RecQ helicases.

RecQ helicases are conserved from bacteria to man. Mutations in three of the human RecQ family members give rise to genetic disorders characterized by genomic instability and a predisposition to cancer. RecQ helicases are therefore caretakers of the genome, and although they do not directly regulate tumorigenesis, they influence stability and the rate of accumulation of genetic alterations, which in turn, result in tumorigenesis. Maintenance of genome stability by RecQ helicases likely involves their participation in DNA replication, recombination, and repair pathways.

Assessing genetic risk: comparison between the referring obstetrician and genetic counselor.

OBJECTIVE: To compare the genetic risk assessment of the referring obstetrician to the risk assessment of the genetic counselor. STUDY DESIGN: All patients evaluated between January 1, 1999, and March 31, 1999, and who required genetic counseling were retrospectively reviewed. The genetic risk assessment of the referring obstetrician was compared to the genetic risk assessment following counseling by a genetic counselor who used a questionnaire and a three-generation pedigree. The number of patients with additional genetic risk factors identified by the genetic counselor were recorded and compared by using the McNemar chi-square test. Group demographics and characteristics were evaluated. RESULTS: Among the 145 patients evaluated, 38% (n = 55) had additional genetic risk factors detected by the genetic counselor (P =.01). The maternal demographics and characteristics did not differ between the two groups. CONCLUSION: The practice of referring high-risk obstetric patients for genetic counseling improves the detection of identifiable genetic risk factors.

Changing trends in patient decisions concerning genetic amniocentesis.

OBJECTIVE: This study was undertaken to determine whether there was a change in patient decisions concerning genetic amniocentesis during the period 1995-1998. STUDY DESIGN: All patients referred for genetic counseling because of advanced maternal age, abnormal serum triple-screen results, or ultrasonographic abnormalities between January and March 1995 and between January and March 1998 were evaluated through a retrospective chart review. Patient characteristics included age, race, and gestational age. Group 1 consisted of patients from 1995. Group 2 consisted of patients from 1998. Data on patient decisions concerning amniocentesis before and after genetic counseling and ultrasonographic examination were compared in each group. Groups 1 and 2 were then compared with respect to decisions before and after genetic counseling and ultrasonographic evaluation. RESULTS: A total of 112 patients were studied. Group 1 consisted of 53 patients and group 2 consisted of 59 patients. When the groups were compared, no differences in age, race, or gestational age were noted. In group 1, before counseling, 18 of 53 patients desired genetic testing, compared with 44 of 53 after counseling (P =.02). In group 2, before counseling, 4 of 59 patients desired genetic testing, compared with 15 of 59 after counseling (P =.01). A significantly greater number of patients in group 1 than in group 2 desired genetic testing both before counseling (n = 18/53 vs n = 4/59; P =.01) and after counseling (n = 44/53 vs n = 15/59; P =.01). CONCLUSION: Fewer patients at risk for Down syndrome in 1998 than in 1995 desired amniocentesis both before and after genetic counseling and ultrasonographic examination.

Domestic abuse in pregnancy: A comparison of a self-completed domestic abuse questionnaire with a directed interview.

OBJECTIVE: The purpose of this study was to compare the results of a standardized self-completed domestic abuse questionnaire with those of a directed interview in the identification of domestic abuse in pregnant patients. STUDY DESIGN: All patients with a first prenatal visit between March 1 and September 30, 1997, were assessed for self-reported domestic abuse with a standardized domestic abuse questionnaire. This was followed by a directed interview that involved verbal review of the standardized domestic abuse questionnaire. Self-reported domestic abuse was defined as any positive response to the domestic abuse questionnaire or the directed interview. The number of patients with a positive response to either the standardized questionnaire or the directed interview, or both, were recorded. The 2 techniques were compared by the McNemar chi(2) test. The group demographics and characteristics were evaluated. RESULTS: Among the 224 patients evaluated, a total of 36% (n = 80) of the patients reported domestic abuse by either method. The standardized domestic abuse questionnaire identified 85% (n = 68) compared with 59% (n = 47) by a directed interview (P =.03). The use of the standardized domestic abuse questionnaire and the directed interview in parallel identified an additional 15% (n = 12) of patients with domestic abuse. CONCLUSION: A standardized domestic abuse questionnaire is superior to a directed interview in identifying self-reported domestic abuse in pregnancy. Utilizing both methods in parallel further increases the number of patients identified.

Detecting anxiety and defensiveness from visual and auditory cues.

Defensive individuals have been shown to differ from nondefensive individuals on a number of physiological and behavioral measures. We report two studies on observers' inferences of defensiveness, and the contribution of communication channels in the inference of defensiveness. Observers judged high and low state anxious segments of high and low trait anxious defensive and nondefensive individuals. Accurate assessments were made of (a) defensiveness, (b) state anxiety, and (c) trait anxiety: Individuals with higher levels of each variable were perceived as more anxious compared with the lower level. Effects for defensiveness and state anxiety were greater in audio-only segments, while effects for trait anxiety were greater in video-only segments. Inferences of defensiveness were greater at higher levels of state anxiety and trait anxiety. Low trait anxious defensive individuals were perceived as more anxious than the true low trait anxious. Results for defensiveness and trait anxiety were replicated in Study 2, and observers' perceptions of state anxiety matched individuals' self-reports: Defensive individuals with maximal differences between high and low state anxiety were seen as more anxious in high state anxiety, while defensive individuals with minimal differences between high and low state anxiety were regarded as less anxious in high state anxiety.

Nursing practice management: muscular dystrophy.

The Nursing Practice Management section displays a health care plan for a student with Duchenne Muscular Dystrophy. Following a brief overview of the pathophysiology of the disorder, a case study is presented from which a nursing process-based plan of care is derived.

Disclosure and anxiety: a test of the fever model.

According to the fever model of Disclosure, the relationship of Disclosure (utterances that reveal subjective information) to psychological distress is analogous to the relationship of fever to physical infection: Both are indicators of some underlying disturbance and part of a restorative process. High and moderate trait anxious university students (but not the low trait anxious students) used higher percentages of Disclosure when speaking about an anxiety-arousing topic than when speaking about a happy topic. With topic order counterbalanced, students tended to use more Disclosure during their 1st presentation than during their 2nd. These results support the fever model's suggestion that people tend to Disclose when they are distressed.

Perinatal outcome following improvement of abnormal umbilical artery velocimetry.

Umbilical artery velocimetry was investigated to determine whether abnormal flow patterns improved with bed rest and if the prognosis of the pregnancy was different in the improved groups. Abnormal flow waveform was defined as a systolic-diastolic ratio (S/D) above the 95th percentile of established normal values. One hundred twenty-eight women had abnormal waveforms. They were placed on bed rest in the left lateral position and monitored by biophysical profile and growth indices. Sixty-six subjects (51.5%) reverted to normal flow waveforms following bed rest, at a mean (+/- SD) interval of 4.5 +/- 1.5 weeks (range 3-10), and 62 (48.5%) exhibited persistent abnormal flow. None of the improved group exhibited fetal distress or perinatal mortality, whereas in the group with persistent abnormal flow, 15 (24%) experienced fetal distress and 13% experienced perinatal mortality. The diagnosis-to-delivery interval in the improved group was 63 +/- 14 days, versus 26 +/- 21 days in the unimproved group, and the mean gestational age at delivery was 37.3 +/- 2.0 versus 32.8 +/- 3.6 weeks, respectively (P less than .0001). We conclude that a subset of patients with abnormal Doppler velocimetry findings will improve on bed rest and have a better perinatal outcome, whereas persistence of abnormal flow defines a group of patients who are at risk for poor perinatal outcome and who require intensive monitoring and intervention.

Improving the outcome of cervical cerclage by sonographic follow-up.

A total of 39 patients with the diagnosis of cervical incompetence were followed up with cervical sonography after placement of prophylactic McDonald cerclage. During the first year of study, 3 out of 12 patients treated with prophylactic cerclage demonstrated funneling of the internal cervical os when examined with cervical sonography; all 3 had premature deliveries. During the last 3 years of the study, 8 of 27 patients treated with prophylactic cerclage demonstrated funneling. With active intervention, neonatal survival improved to 100%. Sonography aids in the management of patients with cervical incompetence and improves outcome even after placement of cervical cerclage.

Analysis of verbal behavior between physicians and geriatric patients.

This study was designed to analyze communication patterns between older patients and physicians by an in-depth examination of linguistic aspects of the interactions, including utterance form, process, and content variables. Sixteen family medicine residents were videotaped individually interviewing one of four simulated female patients. Verbal behavior was analyzed in detail using categories from linguistic studies. Residents were divided into High and Low Information groups. Significant differences in interviewing style were found between groups in categories of: Closed (High = 62.25, Low = 35.88), Compound (High = 11.63, Low = 2.00), and Reflective (High = 20.13, Low = 10.13) Questions; Direct (High = 33.50, Low = 25.00) and Positive (High = 9.25, Low = 3.88) Answers; Added Information (High = 15.75; Low = 9.38); Listener Responses (High = 57.38, Low = 41.50); and Appropriate Turn-Taking (High = 66.63, Low = 48.38). There seems to be a clear difference between what is taught in medical schools about interviewing and the interviewing techniques used by residents in the actual practice of medicine. High information doctors combined a style of closed and combined questions with considerable facilitation and respect for the patient.

It's how you say it: physicians' vocal behavior.

The present study was designed to assess evaluations of physicians interacting with patients via the telephone. Observers used ten adjective scales which resulted in three variables: empathic, dominant, and calm. Thirty doctor-patient interactions were presented in two different communication modes: audio-only and typed transcript-only. As predicted, female listeners rated doctors as more empathic, dominant, and calm, and communication modes were significantly different with audio segments rated as more empathic, dominant and calm. Middle phases of the conversation also were evaluated more positively than greeting phases. Significant interactions between temporal phase and mode indicated that audio segments were interpreted more positively during middle phases. Also, female listeners were more sensitive to audio segments. Physicians' amplitude and speech rate were positively correlated with dominance.

Sequential modification of membrane currents with classical conditioning.

Pavlovian conditioning of the nudibranch mollusc Hermissenda crassicornis was previously shown to produce long-lasting reduction of two K+ currents measured across the Type B photoreceptor soma membrane (Alkon et al., 1982a; Alkon et al., 1985). Pavlovian conditioning of the rabbit was also shown to be followed by persistent K+ current reduction (Disterhoft et al., 1986). Here we report the first evidence that Ca2+ currents can also be modified by conditioning. The amplitude of the currents rather than their voltage-dependence remains reduced at least 1-2 d after conditioning (but not control procedures). Conditioning-induced changes of both K+ and Ca2+ currents increased as a function of training, the Ca2+ currents only changing substantially with greater than or equal to 250 trials. The later changes of the Ca2+ current may function to limit the magnitude of excitability increases due to associative learning.