Comparison of pain, cortisol levels, and psychological distress in women undergoing surgical termination of pregnancy under local anaesthesia versus intravenous sedation

<p>Abstract</p> <p>Background</p> <p>The weight of evidence suggests that women who freely choose to terminate a pregnancy are unlikely to experience significant mental health risks, however some studies have documented psychological distress in the form of posttraumatic stress disorder and depression in the aftermath of termination. Choice of anaesthetic has been suggested as a determinant of outcome. This study compared the effects of local anaesthesia and intravenous sedation, administered for elective surgical termination, on outcomes of pain, cortisol, and psychological distress.</p> <p>Methods</p> <p>155 women were recruited from a private abortion clinic and state hospital (mean age: 25.4 ± 6.1 years) and assessed on various symptom domains, using both clinician-administered interviews and self-report measures just prior to termination, immediately post-procedure, and at 1 month and 3 months post-procedure. Morning salivary cortisol assays were collected prior to anaesthesia and termination.</p> <p>Results</p> <p>The group who received local anaesthetic demonstrated higher baseline cortisol levels (mean = 4.7 vs 0.2), more dissociative symptoms immediately post-termination (mean = 14.7 vs 7.3), and higher levels of pain before (mean = 4.9 vs 3.0) and during the procedure (mean = 8.0 vs 4.4). However, in the longer-term (1 and 3 months), there were no significant differences in pain, psychological outcomes (PTSD, depression, self-esteem, state anxiety), or disability between the groups. More than 65% of the variance in PTSD symptoms at 3 months could be explained by baseline PTSD symptom severity and disability, and post-termination dissociative symptoms. Of interest was the finding that pre-procedural cortisol levels were positively correlated with PTSD symptoms at both 1 and 3 months.</p> <p>Conclusion</p> <p>High rates of PTSD characterise women who have undergone surgical abortions (almost one fifth of the sample meet criteria for PTSD), with women who receive local anaesthetic experiencing more severe acute reactions. The choice of anesthetic, however, does not appear to impact on longer-term psychiatric outcomes or functional status.</p

Man and the Last Great Wilderness: Human Impact on the Deep Sea

The deep sea, the largest ecosystem on Earth and one of the least studied, harbours high biodiversity and provides a wealth of resources. Although humans have used the oceans for millennia, technological developments now allow exploitation of fisheries resources, hydrocarbons and minerals below 2000 m depth. The remoteness of the deep seafloor has promoted the disposal of residues and litter. Ocean acidification and climate change now bring a new dimension of global effects. Thus the challenges facing the deep sea are large and accelerating, providing a new imperative for the science community, industry and national and international organizations to work together to develop successful exploitation management and conservation of the deep-sea ecosystem. This paper provides scientific expert judgement and a semi-quantitative analysis of past, present and future impacts of human-related activities on global deep-sea habitats within three categories: disposal, exploitation and climate change. The analysis is the result of a Census of Marine Life – SYNDEEP workshop (September 2008). A detailed review of known impacts and their effects is provided. The analysis shows how, in recent decades, the most significant anthropogenic activities that affect the deep sea have evolved from mainly disposal (past) to exploitation (present). We predict that from now and into the future, increases in atmospheric CO2 and facets and consequences of climate change will have the most impact on deep-sea habitats and their fauna. Synergies between different anthropogenic pressures and associated effects are discussed, indicating that most synergies are related to increased atmospheric CO2 and climate change effects. We identify deep-sea ecosystems we believe are at higher risk from human impacts in the near future: benthic communities on sedimentary upper slopes, cold-water corals, canyon benthic communities and seamount pelagic and benthic communities. We finalise this review with a short discussion on protection and management methods

Antimicrobial protein and Peptide concentrations and activity in human breast milk consumed by preterm infants at risk of late-onset neonatal sepsis

Objective: We investigated the levels and antimicrobial activity of antimicrobial proteins and peptides (AMPs) in breast milk consumed by preterm infants, and whether deficiencies of these factors were associated with late-onset neonatal sepsis (LOS), a bacterial infection that frequently occurs in preterm infants in the neonatal period. Study design: Breast milk from mothers of preterm infants (≤32 weeks gestation) was collected on days 7 (n = 88) and 21 (n = 77) postpartum. Concentrations of lactoferrin, LL-37, beta-defensins 1 and 2, and alpha-defensin 5 were measured by enzyme-linked immunosorbent assay. The antimicrobial activity of breast milk samples against Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, and Streptococcus agalactiae was compared to the activity of infant formula, alone or supplemented with physiological levels of AMPs. Samples of breast milk fed to infants with and without subsequent LOS were compared for levels of AMPs and inhibition of bacterial growth. Results: Levels of most AMPs and antibacterial activity in preterm breast milk were higher at day 7 than at day 21. Lactoferrin was the only AMP that limited pathogen growth >50% when added to formula at a concentration equivalent to that present in breast milk. Levels of AMPs were similar in the breast milk fed to infants with and without LOS, however, infants who developed LOS consumed significantly less breast milk and lower doses of milk AMPs than those who were free from LOS. Conclusions: The concentrations of lactoferrin and defensins in preterm breast milk have antimicrobial activity against common neonatal pathogens

Effects of the renin-angiotensin system on the reflex response of the adrenal medulla to hypotension in the dog.

We have studied the influence of the renin-angiotensin system on the control of catecholamine release from innervated and denervated adrenal glands of anaesthetized dogs. Captopril reduced the resting release of catecholamines and inhibited release evoked either by lowering carotid sinus pressure or by stimulating the peripheral end of the cut splanchnic nerve. Both responses were restored by exogenous angiotensin II, and the reflex response could also be restored by corticotrophin. Cycloheximide, in the presence of captopril, further reduced the resting release of catecholamines and prevented the restoration of the reflex response by angiotension II. Plasma renin activity did not rise during baroreceptor tests lasting 10 min, but catecholamine release was evoked from the first minute. We conclude that the response of the adrenal medulla to sympathetic activity requires a minimum circulating concentration of angiotensin II. It is severely impaired by inhibition of the renin-angiotensin system but function can be restored either by exogenous angiotensin II or by corticotrophin

Contribution of Nutrient Diversity and Food Perceptions to Food and Nutrition Security Among Smallholder Farming Households in Western Kenya: A Case Study

Background:Sub-Saharan Africa is the only region in the world where hunger is prevalent in over one-third of the population, with smallholder farming households, producers of over 80% of Africa’s food, facing both calorie and micronutrient deficiencies. With agricultural systems serving as the main source of all nutrients, little is known about the extent to which agricultural diversity in different seasons can meet macro- and micronutrient needs in rural Africa.Objective:Linkages between nutrient diversity and food species were investigated.Methods:A case study was conducted in Western Kenya to assess the seasonal nutrient diversity, seasonal nutrient accessibility levels, and food perceptions in 30 smallholder farms, 7 markets, and among 97 focus group discussion participants, respectively. All present food plant and animal species were inventoried and assigned to 1 of the 7 major Food and Agriculture Organization–defined food groups. Based on 2 macronutrients and 5 micronutrients, dendrogram-based nutrient functional diversity metrics were calculated.Results:On-farm and market food species offered all 7 macro- and micronutrients under investigation, regardless of seasonal variation in species numbers. Although there were varying seasonal nutrient accessibility levels in markets, farms were especially effective in readily availing 4 of the 7 nutrients. However, the main food shortage months coincided only with maize shortage, but a diversity of local foods, deemed to be of low cultural and culinary preferences, were available.Conclusions:Nutrition education on the importance of a diversity of local foods in meeting dietary needs, thus stimulating the demand side, can contribute to achieving year-round household food security

Adapting to climate change in the mixed crop and livestock farming systems in sub-Saharan Africa

Mixed crop–livestock systems are the backbone of African agriculture, providing food security and livelihood options for hundreds of millions of people. Much is known about the impacts of climate change on the crop enterprises in the mixed systems, and some, although less, on the livestock enterprises. The interactions between crops and livestock can be managed to contribute to environmentally sustainable intensification, diversification and risk management. There is relatively little information on how these interactions may be affected by changes in climate and climate variability. This is a serious gap, because these interactions may offer some buffering capacity to help smallholders adapt to climate change