Psychosocial risk factors for emergency cesarean section.

OBJECTIVE: To compare the effects of childbirth fear and trait anxiety on the risk of emergency cesarean section; to analyze whether emergency cesarean section is associated with low mastery and maternal self-esteem; to examine whether stress and low social support in pregnancy may be considered risk factors for emergency cesarean section. DESIGN: Original study. SETTING: Department of Psychology, Faculty of Arts, Charles University, Prague. METHODS: The study sample consisted of 447 women who gave birth at a maternity hospital in Vysočina Region (Havlíčkův Brod, Jihlava, Pelhřimov, Třebíč, Nové Město na Moravě) between October 2013 and September 2014. In the last trimester of pregnancy, the women completed validated questionnaires designed to assess fear of childbirth, general anxiety, maternal self-esteem, mastery, perceived stress and social support. Data regarding the course of labor were extracted from medical records. The association between the psychosocial factors and the risk of delivery via emergency cesarean section was analyzed using multiple logistic regression adjusted for marital status, parity, childs sex and epidural anesthesia. RESULTS: A total of 73 women (16.3%) delivered by emergency cesarean section. The only statistically significant psychosocial predictor of emergency cesarean section was fear of childbirth (the women with strong fear had a twice higher risk; OR = 2.01; p = 0.021), whereas low maternal self-esteem was marginally significant (OR = 1.68; p = 0.082) in the adjusted analysis. No association between emergency cesarean section and general anxiety, mastery, stress or social support in pregnancy was found. The risk of cesarean section was higher for primiparous women and lower for women who gave birth to a girl. CONCLUSION: Fear of childbirth but not general anxiety is associated with a higher risk of emergency cesarean section. The women who experience strong fear of childbirth during pregnancy should be recommended to attend antenatal classes or, in case of extremely severe childbirth fear, to seek psychological counseling.

[Are womens attitudes towards pregnancy, childbirth and motherhood associated with length of labour?] / Souvisí postoje zen k tehotenství, porodu a materství s délkou porodu?

OBJECTIVE: To examine the association between length of labour and womens attitudes towards pregnancy, childbirth and motherhood, while controlling for biomedical and maternal psychosocial characteristics. DESIGN: Original study. SETTING: Department of Psychology, Faculty of Arts and Philosophy, Charles University, Prague. METHODS: The sample consisted of 362 women who gave birth in one of the five maternity hospitals in Vysocina region (Havlíckuv Brod, Jihlava, Pelhrimov, Trebíc, Nové Mesto na Morave) between October 2013 and September 2014. The data were collected at two points in time. In the third trimester of pregnancy, womens attitudes towards pregnancy, childbirth and motherhood and other psychosocial characteristics were surveyed using the range of validated tools. Within one week of delivery, women were asked about social support they received during labour. Data concerning the course of labour were extracted from medical records. The dependent variable was the active phase of the first stage of labour (time from 3 cm to full dilatation). The differences among women with prolonged/rapid labour (duration above 90th percentile/less than 10th percentile) with respect to their attitudes towards pregnancy, childbirth and motherhood and other characteristics were assessed using the Students t test and the χ2 test. Factors associated with length of labour were analysed using logistic regression. The results were adjusted for maternal age, marital status and newborn weight. RESULTS: In labours without oxytocin administration, the median of the duration of active phase of the first stage was 180 minutes for primiparas and 144 minutes for multiparas. Women with prolonged labour reported more frequently low maternal self-esteem compared to women with normal labour duration (34.0% vs. 19.1%; p = 0,021), but maternal self-esteem was not a significant predictor of prolonged labour in regression analysis. No other differences were found with respect to psychosocial and personality characteristics in women with prolonged and normal labour. Women with rapid labour did not differ from women with normal labour as for their attitudes towards pregnancy, labour and motherhood. Nevertheless, they reported clinically relevant scores for trait anxiety more frequently, a difference that approached statistical significance (52.6% vs. 38.3%; p = 0,090). Multiple regression analysis showed a trend towards trait anxiety being associated with rapid labour (p = 0,098). No significant predictor of labour duration was identified except newborn weight which predicted both prolonged and rapid labour. CONCLUSION: Our data indicate that the association between length of labour and womens attitudes towards pregnancy, childbirth and motherhood is rather weak and clinically less relevant. Our results portray the newborn weight as a key factor affecting labour duration.

[Postpartum blues - a Czech adaptation of the Maternity Blues Questionnaire]. / Poporodní blues - ceská adaptace dotazníku "Maternity Blues Questionnaire".

OBJECTIVE: To validate the Kennerley and Gaths Maternity Blues Questionnaire (MBQ) for the Czech postpartum population, to present the psychometric properties of the Czech version of that screening method, and to assess its predictive power for the risk of postpartum depression. DESIGN: Original study. SETTING: Department of Psychology, Faculty of Arts and Philosophy, Charles University, Prague. METHODS: The Czech version of the MBQ was validated on a sample of 1093 women. The data were collected from October 2013 to September 2014 at all maternity hospitals in Vysocina region. The MBQ was administered on a one-time basis during womens postpartal stay at maternity hospital. After six weeks post partum, a screening for postpartum depression was performed using the Edinburgh Postnatal Depression Scale (EPDS). The cut-off point was set at 10/11 for MBQ and 12/13 for EPDS as such were the respective levels achieved by the 90th percentile in the MBQ and EPDS scores. The sociodemografic data were collected at the time of completing the MBQ. A logistic regression was performed to identify the predictors of severe blues. Cronbachs alpha was calculated to assess the internal consistency of the MBQ as a whole and its component scales. In order to assess the validity of the MBQ, a logistic regression was used to analyze the association between the MBQ and EPDS scores. The norms for the Czech version of MBQ are presented as percentiles. RESULTS: The MBQ scores showed a gradual rise over the days following the delivery (day 0 to day 4). The percentage of women with severe blues (MBQ score > 10) increased from 7.3% to 14.55% between day 0 and day 4. The most frequent feelings and mood states experienced by women in the first postpartum days included tiredness (61%), decreased self-confidence (30%), over-sensitivity (26%) and tension (19%), while 6,5% of women felt low spirited and 7% felt depressed. The women suffering from severe blues reported most frequently the same states of mood as did the women in the whole sample, but the rates of those states were higher: 83% for tiredness, 81% for decreased self-confidence, 79% for over-sensitivity, 71% for tension, while 46% of women with severe blues felt low spirited and 51% felt depressed. The significant risk factors for severe blues included parity (multipara, OR = 0.42; p < 0,001), mode of delivery (reference category unassisted vaginal delivery: emergency sectio caesarea, OR = 2.188, p = 0.004; planned sectio caesarea, OR = 1.843, p = 0.03; assisted vaginal delivery, OR = 6.136; p < 0.001), and previous depression (OR = 4.71, p = 0.003). Cronbachs alpha of the individual scales ranged from 0.34 to 0.76, Cronbachs alpha for the MBQ as a whole was 0.88. The severe blues were found to be a predictive factor for postpartum depression as assessed with EPDS (OR = 5.90; p < 0.001). CONCLUSION: With its high reliability and validity, the MBQ appears to be a useful tool for clinical practice and research. The MBQ can be used to identify the women with severe blues and with an increased risk of postpartum depression.

A comparison of secondary prevention practice in poststroke and coronary heart disease patients.

OBJECTIVES: It is evident that patients with atherosclerotic vascular disease (AVD) benefit from appropriate secondary prevention. In clinical reality, the secondary prevention in AVD patients other than those with coronary heart disease (CHD) is often overlooked. Therefore, we compared the adherence to secondary prevention principles between poststroke and CHD patients. STUDY DESIGN: Descriptive (cross-sectional) study with prospective mortality follow-up. METHODS: We examined 1729 chronic patients with AVD (mean age 65.9 (±SD 9.6) years), 964 with CHD, and 765 poststroke (pooled data of Czech samples of EUROASPIRE III, IV, and the ESH stroke survey). The interview was performed 6-36 months after the coronary event/revascularization or the first ischemic stroke, while the mortality follow-up 5 years after this interview. RESULTS: Poststroke patients had a significantly higher risk of persistent smoking, blood pressure ≥140/90 mmHg and LDL ≥2.5 mmol/L than CHD patients [odds ratios adjusted for age, gender and survey were 1.63 (95% CI: 1.13-2.33), 1.38 (95% CI: 1.13-1.69) and 2.26 (95% CI: 1.84-2.78), respectively]. In contrast, poststroke patients showed a lower risk of inappropriate glucose control and hypertriglyceridemia [0.66 (95%CI: 0.54-0.82) and 0.74 (95%CI: 0.61-0.91), respectively]. The prescription rates of antiplatelets/anticoagulants, antihypertensives and statins were also significantly lower in poststroke than in CHD patients (89.4 vs 93.7, 85.9 vs 97.5, and 57.7 vs 89.8, respectively). Mortality analysis was performed in a subsample of 815 subjects interviewed in 2006/07. The 5-year all-cause mortality rates were 25.8% and 13.3% in poststroke and coronary patients, respectively (P = 0.0023); the hazard ratio for stroke adjusted for major risk factors was 1.85 (95% CI: 1.31-2.63). CONCLUSIONS: Compared to CHD patients, poststroke patients are strongly handicapped in terms of poor adherence to secondary prevention target, prescription of basic pharmacotherapies and mortality risk.

Desphospho-uncarboxylated matrix Gla protein is associated with increased aortic stiffness in a general population.

Matrix Gla protein (MGP), a natural inhibitor of calcification, strongly correlates with the extent of coronary calcification. Vitamin K is the essential cofactor for the activation of MGP. The nonphosphorylated-uncarboxylated isoform of MGP (dp-ucMGP) reflects the status of this vitamin. We investigated whether there is an association between dp-ucMGP and stiffness of elastic and muscular-type large arteries in a random sample from the general population. In a cross-sectional design, we analyzed 1087 subjects from the Czech post-MONICA study. Aortic and femoro-popliteal pulse wave velocities (PWVs) were measured using a Sphygmocor device. Dp-ucMGP concentrations were assessed in freshly frozen samples by enzyme-linked immunosorbent assay methods using the InaKtif MGP iSYS pre-commercial kit developed by IDS and VitaK. Aortic PWV significantly (P<0.0001) increased across the dp-ucMGP quartiles. After adjustment for all potential confounders, aortic PWV independently correlated with dp-ucMGP (with beta coefficient (s.d.) 11.61 (5.38) and P-value=0.031). In a categorized manner, subjects in the top quartile of dp-ucMGP (⩾ 671 pmol l(-1)) had a higher risk of elevated aortic PWV, with corresponding adjusted odds ratio (95% confidence interval) 1.73 (1.17-2.5). In contrast, no relation between dp-ucMGP and femoro-popliteal PWV was found. In conclusion, increased dp-ucMGP, which is a circulating biomarker of vitamin K status and vascular calcification, is independently associated with aortic stiffness, but not with stiffness of distal muscular-type arteries.

[Satisfaction with perinatal care in Vysocina region in the period between October 2013 and September 2014]. / Spokojenost zen s perinatální pécí v Kraji Vysocina za období ríjen 2013 az zárí 2014.

OBJECTIVE: To assess women's satisfaction with perinatal care provided in maternity hospitals in Vysocina region, to identify the areas with high satisfaction scores as well as those requiring improvement, and to describe the factors influencing women's satisfaction, i. e. dissatisfaction with the care provided during labor and birth and the early postpartal period. DESIGN: Original study. SETTING: Department of Psychology, Faculty of Philo-sophy, Charles University, Prague. METHODS: The satisfaction survey was conducted in all maternity hospitals in Vysocina region (Jihlava, Havlíckuv Brod, Trebíc, Pelhrimov, Nové mesto na Morave) during the period between October 2013 and September 2014. All women who had given birth in those hospitals during the period were approached and asked to participate in this survey. The women evaluated the perinatal care not before 58 days after birth, so that the evaluation of perinatal care did not take place directly during their stay at maternity hospital. In total, 1366 women took part in the study. The original Czech questionnaire KLI-P was used for the data collection. The KLI-P measures psychosocial climate of maternity hospitals on the following six scales: helpfulness and empathy of caregivers; control and involvement in decision-making; communication of information and availability of caregivers; dismissive attitude and lack of interest; physical comfort and services. The satisfaction rates with component dimensions of intrapartal and postpartal care at the maternity hospitals in Vysocina region were compared to the satisfaction rates for the Czech Republic as a whole as obtained in our previous study. We used the Kruskal-Wallis test for this comparison. The ordinal logistical regression (cumulative logit model) was used to identify predictors of women's satisfaction with intrapartum and postpartum care in Vysocina region. RESULTS: The women who delivered at maternity hospitals in Vysocina region were significantly more satisfied with all dimensions of care received both at delivery (DU) and after-birth unit (ABU) as compared to the average parturient's satisfaction in the Czech Republic as specified in our previous study. The best rated scale at DU in Vysocina region was Physical comfort and services (93% vs. 85% for the whole country; P < 0,0001), while the worst evaluation score received the scale Control and involvement in decision-making (75% vs. 58% for the whole country; P < 0,0001). At ABU, the best rated scale was Control and involvement in decision-making (95% vs. 89% for the whole country; P < 0,0001), while the lowest evaluation score was found for the scale Physical comfort and services (85% vs. 76% for the whole Republic; P < 0,0001). The women perceived generally the caregivers as helpful and kind but they often missed sufficient emotional support. They considered the information received easy to understand, but they would welcome more information in general. Among the most important determinants of parturients satisfaction with care at DU were kind and helpful attitude of midwives (P < 0,0001), confidence in physicians (P < 0,0001), sufficient provision of information (P = 0,0016), pleasant appearance of the delivery room (P = 0,0010), kind and helpful attitude of physicians (P = 0,018). Among the most important determinants of satisfaction with care at ABU were sufficient provision of information (P = 0,0007), equipment of the room (P = 0,0014), informations regarding the care for the newborn (P = 0,0013), emotional support (P = 0,0039) and confidence in staff employed in newborn care (P = 0,025). CONCLUSION: Satisfaction with care received at maternity hospitals in Vysocina region was rated very high. However, despite its high quality, the perinatal care in Vysocina region suffers from several shortcomings. Regarding the significance of the individual determinants of parturient's satisfaction, improving the quality of care requires first of all better provision of information both during the labor and postpartal period. It would be beneficial to provide the health care professionals with the opportunities of attending a training in breastfeeding support and communication and of taking part in clinical supervision.

The association of factor V Leiden with various clinical patterns of venous thromboembolism-the factor V Leiden paradox.

BACKGROUND: Factor V Leiden (FVL) supposedly carries relatively higher risk of deep vein thrombosis (DVT), compared to the risk of pulmonary embolism (PE). AIM: To prove this paradox in a group of patients with various clinical presentation of venous thromboembolism (VTE). MATERIALS AND METHODS: We retrospectively evaluated clinical pattern of VTE in patients who had been referred to vascular clinic shortly after an acute VTE event. In FVL positive and FVL negative groups we compared the prevalence of isolated symptomatic DVT (proximal or distal) and symptomatic PE with/without DVT, and, moreover, asymptomatic DVT or PE. RESULTS: Of 575 patients (mean age 57 years, 50.1% women), 120 were FVL positive and those had significantly higher prevalence of isolated symptomatic DVT, compared to symptomatic PE with/without DVT. Proximal DVT location was significantly more frequent in FVL carriers. The prevalence of asymptomatic PE did not differ between the two groups. The rate of asymptomatic DVT tended to be higher in FVL negative group. In a multivariate analysis, we confirmed FVL to be positively associated with isolated DVT presentation (odds ratio OR 1.757; 95% confidence interval (CI) 1.148-2.690). On the contrary, increasing age and unprovoked nature of VTE event carried a higher risk of symptomatic PE. CONCLUSIONS: We confirmed FVL to be significantly associated with isolated symptomatic DVT despite higher prevalence of proximal DVT in FVL carriers. The fact of relatively lower risk of PE in FVL positive patients might have clinical implication. However, mechanisms of FVL paradox remain to be elucidated.

Deep vein thrombosis and/or pulmonary embolism concurrent with superficial vein thrombosis of the legs: cross-sectional single center study of prevalence and risk factors.

AIM: The aim of this paper was to assess the prevalence of concurrent deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in the patients with superficial vein thrombosis (SVT) of the legs and to find factors significantly and independently associated with coincident DVT/PE. METHODS: In the setting of a tertiary referral hospital, patients with SVT, attending vascular clinic, underwent physical examination, laboratory testing and leg vein ultrasound (in the case of clinically suspected PE also perfusion/ventilation lung scan or/and helical CT pulmonary angiography). In statistical analysis, we used unpaired t-test, non-parametric Wilcoxon rank sum test, stepwise logistic regression and multivariable logistic regression model. RESULTS: We examined 138 patients (age 61.4 ± 13.9 years, 36.2% men), with ST mostly on varicose veins (89.9%). The prevalence of concurrent DVT/PE was 34.1%. Neither the clinical manifestation nor SVT localization differed significantly between the group with isolated SVT and that with coincident DVT/PE. Of all the assessed patients characteristics (age and sex, BMI, history of SVT, DVT or PE, hypercoagulable states, cardiovascular risk factors) only two factors were significantly and independently associated with the presence of concurrent DVT/PE. Log BMI was significantly higher in the patients with isolated SVT. Factor V Leiden (FVL) was proved as an independent risk factor for concomitant DVT/PE with odds ratio 2,531 (95% CI 1,064-6,016). CONCLUSION: The prevalence of concurrent DVT/PE in patients with SVT, referred to hospital vascular clinic was 34.1%. Lower BMI (log BMI, respectively) and the presence of FVL were significantly and independently associated with concurrent DVT/PE. Our results should be further investigated in a larger prospective study.

[Psychosocial climate in maternity hospitals from the perspective of parturients II. Predictors of womens satisfaction with perinatal care in the Czech Republic]. / Psychosociální klima porodnice ocima rodicek II. Prediktory spokojenosti s perinatální pécí v Ceské republice.

OBJECTIVE: To identify the key determinants of parturients satisfaction with care provided in the Czech maternity hospitals and to draw up recommendation for good practice. DESIGN: Original study. SETTING: Department of Psychology, Faculty of Philosophy, Charles University, Prague. METHODS: Statistical analysis of data from the representative sample of Czech parturients (n = 1195) who gave birth from 2005 to 2012 in Czech maternity hospitals was conducted. Ordinal logistical regression (cumulative logit model) was used to identify predictors of womens satisfaction with intrapartum and postpartum care and their willingness to return and give birth in the same hospital as well as to recommend the hospital to others. The independent variables were the individual items of the KLI-P questionnaire measuring psychosocial climate in maternity hospitals and socio-demographic and anamnestic characteristics of parturients. RESULTS: Among the most important determinants of parturients satisfaction with care at delivery unit were well-timed provision of information concerning a treatment plan (OR = 2,79; p < 0,0001), privacy during the first stage of labour (OR = 2,81; p < 0,0001), kind and helpful attitude of physicians (OR = 2,67; p < 0,0001) and confidence in physicians (OR = 2,68; p = 0,0001). Among the most important determinants of satisfaction with care at after-birth unit were well-timed provision of information concerning a treatment plan (OR = 2,25; p < 0,0001), active breastfeeding support (OR = 2,19;p < 0,0001), availability of caregivers (OR = 2,16;p < 0,0001), multiparity (OR = 1,52; p = 0,0001), respect shownby staff employed in mother care (OR = 2,02; p = 0,0004) and kind and helpful attitude of staff employed in newborn care (OR = 1,86; p = 0,0005). When considering the future place of birth and recommendation of the hospital to others, women predominantly take into account the care provided at delivery unit. Intrapartal care evaluation was affected to a lesser degree by satisfaction with midwives as compared to satisfaction with physicians. CONCLUSION: Analyses of the most important predictors of satisfaction with perinatal care indicate the need for practice to focus on enhancing psychosocial competences (particularly communication skills) of health care providers, more active breastfeeding support and communication of consistent information (especially concerning newborn care) by caregivers at after-birth unit.

[Distribution of lipoprotein associated phospholipase A2 in Czech population and its interaction with conventional cardiovascular risk]. / Distribuce s lipoproteiny asociované fosfolipázy A2 v ceské populaci a její interakce s konvencním kardiovaskulárním rizikem.

INTRODUCTION: Lipoprotein associated phospholipase A2 (Lp PLA2) represent new cardiovascular risk factor and potential treatment target. We aimed to analyze the epidemiological situation of this factor in Czech population. METHODS AND RESULTS: The study population consisted from 1 962 subjects, a random samples of general population (postMONICA study), and from patients with manifest coronary or cerebrovascular disease (Czech samples of EUROASPIRE III survey). Lp PLA2 activity was estimated using commercial kits by diaDexus Inc. in frozen samples. Increased activity (by definition, i.e. > 195 nmol/ min/ ml) was observed in 21.1 % of sample, no apparent difference between subject with and without manifest vascular disease was found. Males showed higher Lp PLA2 activity, than females (179.6 vs 146, resp., p < 0.0001), while no substantial increase with age was observed. Taking Lp PLA2 activity > 195 as dependent variable, following independent variables entered the multiple logistic regression: male gender [with odds ratio 4.26 (3.26- 5.58)], low HDL cholesterol (i.e. < 1.0 mmol/ l in males or < 1.2 mmol/ l in females) [3.49 (2.62- 4.64)], LDLcholesterol > 2.5 mmol/ l [6.95 (4.79- 10.07)] and lipid  lowering treatment [0.59 (0.44- 0.79)]. In subject without manifest vascular disease, 6.3 % of them showed co incidence of markedly increased Lp PLA2 activity with high conventional risk (SCORE > 10 %). Expanding this group by intermediate risk subjects (ie. with Lp PLA2 activity 152- 194 and/ or SCORE 5- 9.9 %) leads to increase of this prevalence to 28.9 % of primary prevention subjects. CONCLUSION: Increased Lp PLA2 activity is in Czech population highly prevalent and with exception of lipid parameters, generally independent from conventional cardiovascular risk. However, up to 29 % of subject in primary prevention amalgamate increased Lp PLA2 activity with high conventional cardiovascular risk.

[Psychosocial climate in maternity hospitals from the perspective of parturients I. Results from a national survey on perinatal care satisfactionusing a representative sample of 1195 Czech parturients]. / Psychosociální klima porodnice ocima rodicek I. Výsledky celorepublikového pruzkumu spokojenosti s perinatální pécí v CR u reprezentativního souboru 1195 rodicek.

OBJECTIVE: To assess women's satisfaction with psychosocial aspects of perinatal care provided in Czech maternity hospitals, to identify areas that need improvement and to compare satisfaction with maternity care between selected subgroups of parturients. DESIGN: Original study. SETTING: Department of Psychology, Faculty of Philosophy, Charles University, Prague. METHODS: A survey on satisfaction with perinatal care was conducted with a sample of 1195 Czech parturients. The sample was representative of the Czech parturients population in terms of educational level, age, parity, and rate of vaginal and caesarean section delivery. The sample was proportionated as regards the number of births at small and large hospitals and at hospitals in different regions as well. All currently existing Czech maternity hospitals were included. For the data collection, the original Czech questionnaire KLI-P was used. The KLI-P measures psychosocial climate of maternity hospitals on following six scales: helpfulness and empathy of caregivers; control and involvement in decision-making; communication of information and availability of caregivers; dismissive attitude and lack of interest; physical comfort and services. In addition, differences in satisfaction rates between different subgroups of respondents were investigated: primiparas/multiparas, women with lower/higher educational status, women who gave birth at smaller/lager hospitals (< 800 / > 800 births per year), women who gave birth at university/other hospitals, women after vaginal delivery/caesarean section, women accommodated in high-standard rooms at after-birth unit, and women who filled the questionnaire within one year after/later than one year after delivery. RESULTS: The overall satisfaction with care provided at delivery unit (DU) and after-birth unit (ABU) was 70% and 61%, respectively. The best rated scale at DU was physical comfort and services (69%), the worst evaluation score received the scale control and involvement in decision-making (34%). At ABU, the best rated scale was control and involvement in decision-making (76%) while the lowest evaluation score was found for the scale dismissive attitude and lack of interest (48% - reverse-scored). The items with the best scores referred to the cleanliness at DU and mother-infant contact at ABU, the items with the lowest evaluation scores referred to emotional support provided by physicians at DU, involvement in decision-making concerning the position during the second stage of labour and quality of food. Significantly more satisfied with care provided at DU were multiparas, women who gave birth at non-university hospitals and women who gave birth vaginally. Significantly more satisfied with care at ABU were multiparas, women with lower educational status, women who gave birth at non-university and smaller hospitals (< 800 births per year) and women who evaluated a given hospital within one year after delivery. CONCLUSION: Despite its rather high quality, the Czech perinatal care suffers from several shortcomings as regards its psychosocial aspects. These shortcomings include lack of respect and empathy shown by caregivers, poor communication of information and low involvement of parturients in decision-making. Improving the quality of care at the Czech maternity hospitals requires empowerement of parturients in the system of perinatal care and development of psychological and psychosocial compteneces of health care providers.

[The psychosocial aspects of perinatal care and their relationship to selected medical interventions and health complications during parturition]. / Souvislost psychosociálních aspektu perinatální péce s nekterými zákroky a zdravotními komplikacemi v prubehu porodu.

OBJECTIVE: Find association between psychosocial factors of perinatal care and selected childbirth complications and interventions. DESIGN: Original study. SETTING: Department of Psychology, Faculty of Arts and Philosophy, Charles University, Prague. METHODS: Statistical data analysis of questionnaire survey of low-risk parturients (n=657) was carried out. Respondents were divided into experimental groups (EG) according to experienced interventions and complications (hemorrhage, failure to progress, fetal distress, forceps/VEX delivery, caesarean birth, failure to progress followed by caesarean birth, labour acceleration infusion, other infusion, epidural anesthesia, other form of pharmacological analgesia, episiotomy, amniotomy). EG were compared with a control group (CG) of women with no complications and interventions (n=107) in evaluation of psychosocial factors of perinatal care (healthcare provider attitude; control; communication; woman-friendliness of hospital rules) and physical comfort and services, presence of other persons at birth, prevailing emotional reaction and overall satisfaction with maternity care. The interpretation of results draws from qualitative analysis of open-ended question answers. RESULTS: EG and CG differed significantly in control (all EGs scored lower) and healthcare provider attitude evaluation (significantly more negative perception at EGs: hemorrhage, failure to progress, fetal distress, forceps/VEX delivery, labour acceleration infusion, episiotomy). Significant differences were noted also for woman-friendliness of hospital rules (lower scores for EGs: hemorrhage, failure to progress, failure to progress followed by caesarean birth) and for presence of other persons at birth. Possible interpretations of the above results are discussed. CONCLUSION: Psychosocial factors of perinatal care constitute important childbirth process determinants, while playing a key role for parturients ability to cope with anxiety and stress connected with childbirth complications and interventions. Beneficial psychosocial climate of a hospital contributes to higher patient satisfaction as well as to lower maternal and neonatal morbidity.

The association between low 25-hydroxyvitamin D and increased aortic stiffness.

There is accumulating evidence that vitamin D exerts important pathophysiological effects on cardiovascular system. Low vitamin D was associated with increased cardiovascular risk in several reports. We studied the association between vitamin D and arterial stiffness in a random sample of 560 subjects selected from general population. Arterial stiffness was measured as aortic pulse-wave velocity (PWV) using Sphygmocor device. Serum 25-hydroxyvitamin D (25(OH)D) was measured using commercial kits. We found a clear negative trend in aortic PWV among 25(OH)D quartiles. Subjects in the bottom 25(OH)D quartile (<20 ng ml(-1)) showed the highest aortic PWV (9.04 m s(-1)), compared with 2nd-4th quartile (8.07 m s(-1), 7.93 m s(-1) and 7.70 m s(-1), respectively; P for trend <0.0001). The association between 25(OH)D and aortic PWV remained significant after adjustment for age, gender and other potential confounders; subjects in the first 25(OH)D quartile had adjusted odds ratio 2.04 (1.26-3.30) for having aortic PWV ≥9 m s(-1) (top quartile) in multiple regression. In conclusion, we found a clear significant and independent negative association between 25(OH)D and aortic PWV. Subjects with lowest vitamin D status showed the highest arterial stiffness.

Relation of central and brachial blood pressure to left ventricular hypertrophy. The Czech Post-MONICA Study.

Central blood pressure (BP) has been shown to be a better predictor of target organ damage and cardiovascular events than brachial BP. Whether central BP is a better predictor of left ventricular hypertrophy (LVH) determined by electrocardiography (ECG) is not known. Radial applanation tonometry and ECG were performed in 728 subjects from the Czech Post-MONICA Study (a randomly selected 1% population sample). LVH was determined using the Sokolow-Lyon index and Cornell product; central pressure was derived from radial pulse. Of 657 subjects included in the analysis, 17 (9.4%) below 45 years and 43 (9%) over 45 years had LVH. In multiple linear regression analysis, the Sokolow-Lyon index in younger individuals was only associated with male sex and low BMI, with no association with BP found. In older individuals, LVH was associated with higher central and brachial BP. In separate binary logistic regression analyses adjusted for covariates, the odds ratio for central systolic pressure was higher than those for brachial systolic and pulse pressure in LVH prediction. Noninvasively determined central pressure in subjects over 45 years is more strongly related to ECG LVH than brachial pressure. This further supports a closer association of central pressure with target organ damage. Voltage criteria of LVH are not independently associated with central or brachial BP in younger individuals.

A novel oscillometric device for peripheral arterial disease screening in everyday practice. The Czech-post MONICA study.

AIM: Ankle brachial index (ABI) is a diagnostic tool for peripheral arterial disease (PAD) and a cardiovascular risk stratification tool. Despite this evidence and guidelines recommending its use in everyday practice, ABI is not widely used. Automatic ABI measurement may lower the barrier to incorporate ABI measurement into everyday practice. The aim of this study was to validate a novel automatic oscillometric ABI device (BOSO ABI) against a gold standard-Doppler device in an epidemiological setting. METHODS: In 839 patients from the Czech post-MONICA study (a randomly selected representative population sample aged over 25 years), mean age 54.3±13.8 years (47% of men), ABI measurement was performed using the BOSO ABI device and a handheld Doppler device in a random fashion. The two techniques were carried out by different investigators each blinded to the findings of the other. Analyses were conducted as proposed by Bland and Altman. RESULTS: The mean ABI difference between the two methods was 0.1±0.11, with 95% limits of agreement ranging from -0.11 to 0.30. The difference between Doppler and oscillometric ABI increased significantly with increasing mean ABI (r=0.29; P<0.001). When considering Doppler the gold standard, automated oscillometric measurement had a 76.9% sensitivity, 97.9% specificity, and 37% positive and 99.6% negative predictive values in diagnosing ABI <0.9. CONCLUSION: The BOSO ABI device cannot be used interchangeably for standard Doppler ABI measurement in diagnosing PAD. However, its high negative predictive value allows using it as a screening tool for PAD.

Risk factors for residual thrombotic occlusion after proximal deep vein thrombosis of the legs.

AIM: Residual thrombotic occlusion (RTO) after deep vein thrombosis (DVT) is considered as a risk factor of recurrent venous thromboembolism (VTE). We searched for risk factors associated with RTO after proximal DVT at the lower extremities. METHODS: Using compression ultrasound, we evaluated the presence of RTO at 6 months after DVT (RTO defined as a residual thrombus occupying, at maximum compressibility, >/=20% of the vein lumen before compression). RESULTS: We examined 126 Czech patients: mean age 57.5 years; 50.0% women, 68.3% femoral location of DVT (otherwise popliteal), RTO found in 45.2%. While accounting for covariates, in the whole population, RTO was significantly associated with following factors: (OR; 95% confidence limit; p value): male sex (2.01; 1.27-3.19; P=0.003), femoral location (2.76; 1.59-4.78; P=0.0003). In women, but not in men, an association was demonstrated for: concurrent pulmonary embolism (PE) (18.51; 1.85-185.7; P=0.0131), diabetes mellitus (4.62; 1.38-15.51; P=0.0133) and statin use (0.11; 0.02-0.62; P=0.0125). In contrast, in men RTO was associated with an unprovoked DVT (2.6; 1.26-5.34; P=0.0094). CONCLUSION: In the whole study population, male sex and femoral location of DVT were positively associated with RTO. In women, concurrent PE and diabetes mellitus were risk factors for RTO, while the use of statins was a protective factor. There was a positive association between RTO and unprovoked DVT in men. These findings deserve further evaluation in a larger study.

Laboratory evaluation of antiphospholipid antibodies in patients with venous thromboembolism.

The objective of our study was to evaluate the significance of extended antiphospholipid profile in patients with venous thromboembolism without any systemic autoimmune disease. In 140 patients (age 18-69 years; 47.1% men) with venous thromboembolism and 136 control participants we tested anticardiolipin antibodies, anti-beta 2 glycoprotein I (anti-beta2-GPI) and also non-criteria antiphospholipid antibodies: antiphosphatidic acid, antiphosphatidylethanolamine, antiphosphatidylglycerol, antiphosphatidylinositol, antiphosphatidylserine. Commercial and in-house enzyme-linked immunosorbent assays were used. The antibodies with significantly higher prevalence in patients (compared to controls) were: immunoglobulin (Ig) M-anticardiolipin antibodies (12.9%; P = 0.035), IgG-anti-beta2-GPI (16.4%; P = 0.0032), IgM-antiphosphatidylethanolamine (14.3%; P = 0.014). In most cases, these three antibodies did not overlap. In conclusion, of non-criteria antiphospholipid antibodies, only antiphosphatidylethanolamine were significantly more prevalent in patients with venous thromboembolism, with only minor overlapping with the criteria antiphospholipid antibodies. Our results suggest the possible utility of searching for antiphosphatidylethanolamine in the clinical suspicion of antiphospholipid syndrome and the absence of criteria antiphospholipid antibodies.

Arterial properties in relation to genetic variation in alpha-adducin and the renin-angiotensin system in a White population.

Earlier studies have demonstrated the interaction between ADD1 and ACE in relation to arterial properties. We investigated whether arterial characteristics might also be related to interactions of ADD1 with other renin-angiotensin system genes. Using a family-based sampling frame, we randomly recruited 1064 Flemish subjects (mean age, 43.6 years; 50.4% women). By means of a wall-tracking ultrasound system, we measured the properties of the carotid, femoral and brachial arteries. In multivariate-adjusted analyses, we assessed the multiple gene effects of ADD1 (Gly460Trp), AGT (C-532T and G-6A) and AT1R (A1166C). In ADD1 Trp allele carriers, but not in ADD1 GlyGly homozygotes (P-value for interaction < or =0.014), femoral cross-sectional compliance was significantly higher (0.74 vs 0.65 mm(2) kPa(-1); P=0.020) in carriers of the AT1R C allele than in AT1R AA homozygotes, with a similar trend for femoral distensibility (11.3 vs 10.2 x 10(-3) kPa(-1); P=0.055). These associations were independent of potential confounding factors, including age. Family-based analyses confirmed these results. Brachial diameter (4.35 vs 4.18 mm) and plasma renin activity (PRA) (0.23 vs 0.14 ng ml(-1) h(-1)) were increased (P< or =0.005) in AGT CG haplotype homozygotes compared with non-carriers, whereas the opposite was true for brachial distensibility (12.4 vs 14.4 x 10(-3) kPa(-1); P=0.011). There was no interaction between AGT and any other gene in relation to the measured phenotypes. ADD1 and AT1R interactively determine the elastic properties of the femoral artery. There is a single-gene effect of the AGT promoter haplotypes on brachial properties and PRA.