Fetal heart rate during a maternal grand mal epileptic seizure

Peer Reviewe

Teratogenic risk and contraceptive counselling in psychiatric practice: analysis of anticonvulsant therapy

<p>Background: Anticonvulsants have been used to manage psychiatric conditions for over 50 years. It is recognised that some, particularly valproate, carbamazepine and lamotrigine, are human teratogens, while others including topiramate require further investigation. We aimed to appraise the documentation of this risk by psychiatrists and review discussion around contraceptive issues.</p> <p>Methods: A retrospective review of prescribing patterns of four anticonvulsants (valproate, carbamazepine, lamotrigine and topiramate) in women of child bearing age was undertaken. Documented evidence of discussion surrounding teratogenicity and contraceptive issues was sought.</p> <p>Results: Valproate was most commonly prescribed (n=67). Evidence of teratogenic risk counselling at medication initiation was sub-optimal – 40% of individuals prescribed carbamazepine and 22% of valproate. Documentation surrounding contraceptive issues was also low- 17% of individuals prescribed carbamazepine and 13% of valproate.</p> <p>Conclusion: We found both low rates of teratogenic risk counselling and low rates of contraception advice in our cohort. Given the high rates of unplanned pregnancies combined with the relatively high risk of major congenital malformations, it is essential that a detailed appraisal of the risks and benefits associated with anticonvulsant medication occurs and is documented within patients’ psychiatric notes.</p&gt

A multicentre matched case control study of risk factors for Preeclampsia in healthy women in Pakistan

<p>Abstract</p> <p>Background</p> <p>Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality world-wide. The risk for developing preeclampsia varies depending on the underlying mechanism. Because the disorder is heterogeneous, the pathogenesis can differ in women with various risk factors. Understanding these mechanisms of disease responsible for preeclampsia as well as risk assessment is still a major challenge. The aim of this study was to determine the risk factors associated with preeclampsia, in healthy women in maternity hospitals of Karachi and Rawalpindi.</p> <p>Methods</p> <p>We conducted a hospital based matched case-control study to assess the factors associated with preeclampsia in Karachi and Rawalpindi, from January 2006 to December 2007. 131 hospital-reported cases of PE and 262 controls without history of preeclampsia were enrolled within 3 days of delivery. Cases and controls were matched on the hospital, day of delivery and parity. Potential risk factors for preeclampsia were ascertained during in-person postpartum interviews using a structured questionnaire and by medical record abstraction. Conditional logistic regression was used to estimate matched odds ratios (ORs) and 95% confidence intervals (95% CIs).</p> <p>Results</p> <p>In multivariate analysis, women having a family history of hypertension (adjusted OR 2.06, 95% CI; 1.27-3.35), gestational diabetes (adjusted OR 6.57, 95% CI; 1.94 -22.25), pre-gestational diabetes (adjusted OR 7.36, 95% CI; 1.37-33.66) and mental stress during pregnancy (adjusted OR 1.32; 95% CI; 1.19-1.46, for each 5 unit increase in Perceived stress scale score) were at increased risk of preeclampsia. However, high body mass index, maternal age, urinary tract infection, use of condoms prior to index pregnancy and sociodemographic factors were not associated with higher risk of having preeclampsia.</p> <p>Conclusions</p> <p>Development of preeclampsia was associated with gestational diabetes, pregestational diabetes, family history of hypertension and mental stress during pregnancy. These factors can be used as a screening tool for preeclampsia prediction. Identification of the above mentioned predictors would enhance the ability to diagnose and monitor women likely to develop preeclampsia before the onset of disease for timely interventions and better maternal and fetal outcomes.</p

Poor glycated haemoglobin control and adverse pregnancy outcomes in type 1 and type 2 diabetes mellitus: Systematic review of observational studies

BACKGROUND: Glycaemic control in women with diabetes is critical to satisfactory pregnancy outcome. A systematic review of two randomised trials concluded that there was no clear evidence of benefit from very tight versus tight glycaemic control for pregnant women with diabetes. METHODS: A systematic review of observational studies addressing miscarriage, congenital malformations and perinatal mortality among pregnant women with type 1 and type 2 diabetes was carried out. Literature searches were performed in MEDLINE, EMBASE, CINAHL and Cochrane Library. Observational studies with data on glycated haemoglobin (HbA(1c)) levels categorised into poor and optimal control (as defined by the study investigators) were selected. Relative risks and odds ratios were calculated for HbA(1c )and pregnancy outcomes. Adjusted relative risk estimates per 1-percent decrease in HbA(1c )were calculated for studies which contained information on mean and standard deviations of HbA(1c). RESULTS: The review identified thirteen studies which compared poor versus optimal glycaemic control in relation to maternal, fetal and neonatal outcomes. Twelve of these studies reported the outcome of congenital malformations and showed an increased risk with poor glycaemic control, pooled odds ratio 3.44 (95%CI, 2.30 to 5.15). For four of the twelve studies, it was also possible to calculate a relative risk reduction of congenital malformation for each 1-percent decrease in HbA(1c), these varied from 0.39 to 0.59. The risk of miscarriage was reported in four studies and was associated with poor glycaemic control, pooled odds ratio 3.23 (95%CI, 1.64 to 6.36). Increased perinatal mortality was also associated with poor glycaemic control, pooled odds ratio 3.03 (95%CI, 1.87 to 4.92) from four studies. CONCLUSION: This analysis quantifies the increase in adverse pregnancy outcomes in women with diabetes who have poor glycaemic control. Relating percentage risk reduction in HbA(1c )to relative risk of adverse pregnancy events may be useful in motivating women to achieve optimal control prior to conception

Real Light Curves of EI Eridani

The class of RS Canum Venaticorum (RS CVn) variables are rapidly rotating, close detached Chromospherically Active Binary Stars (CABS). Their spectra show strong Ca II H and K emission lines, which indicate the presence of solar type chromospheric activity. Observed amplitudes of brightness variations in RS CVn stars are caused by large starspots. Their orbital periods are typically few days. EI Eridani (EI Eri) is an active, rapidly rotating (v sin i = 51 ± 0.5 km/s) binary star that belongs to the class of RS CVn variables. The primary component is a subgiant star with spectral type G5 IV. Its rotation and orbital motion are synchronised, i.e. P_rot = P_phot ≈ P_orb. We analyse 30 years of standard Johnson V differential photometry of EI Eri. The data were obtained with the Tennesee State University’s T3 0.4-meter Automatic Photometric Telescope (APT). We analyse the data with a new two-dimensional period finding method formulated by Jetsu (2019). This new method allows us to detect the real light curves of long-lived starspots of EI Eri. We also solve the parameters of these real light curves: periods, amplitudes and minimum epochs. Our analysis shows that the parameters of these real light curves are connected to long-lived starspots. There are also spatial correlations between these real light curve parameters. We detected two different period level starspot groups, P_1 ≈ 1.915920 ± 0.000079 days and P_2 ≈ 1.9472324 ± 0.0000040 days, rotating on the surface of EI Eri. The faster rotating starspots P_1 are non-stationary and the slower rotating starspots P_2 are stationary in the orbital reference of frame. The slower rotating starspots are at the longitudes coinciding with the line connecting the centres of the members of EI Eri. The slower rotating starspots have larger amplitudes than the faster rotating starspots. Hence, the slower rotating starspots are dominating the observed light curves. Our results show that the hypothesis, where the observed light curve is the sum of the real light curves (Jetsu, 2019), is valid for EI Eri. We can also show that the starspots of EI Eri are dark. The traditional one-dimensional period finding methods have given spurious results, like the rapid rotation period changes of starspots or abrupt longitudinal 180 degrees shifts of activity. Because of the short lap cycle period P_lap = 119.14 ± 0.30 days between the slower and the faster rotating starspots of EI Eri, the light curves have previously been misinterpreted

Evaluation of placental function in women on antiepileptic drugs

Peer Reviewe

Prenatal pain in album making process. : How to anticipate and understand stressful situations and whether we can learn something from childbirth.

In this thesis, the target is to map the situations and reasons why the pressure increases the closer the end comes in album making and how the production team could avoid stressful situations in advance. The final purpose is to make producers work more creatively and effectively. As a result, the artist’s music can be more crystallised and make it more successful. The thesis discusses the phases of the whole album making process briefly, and then the emphasis is a little more on the mixing phase. Because there was hardly any literature available of the mental side of the album making process, the main emphasis is in interviews and literature that handles the mental side of the other areas where is high pressure and expertise on the working process. As comparing a song making process to a childbirth is so common, I wanted to take a specific look into this matter and try to find out, if something interesting could be found by juxtaposing the birth of a child to the birth of an album. Music making can be stressful, and the thesis discusses also how stress appears when a matter of life and death is at hand. In addition to interviews with music professionals, I did an interview with an obstetrician and with a psychotherapist, who are experts in the treatment of the human mind in very stressful situations. I also compared a producer’s occupation to a doctor’s occupation and transilluminated what kind of similarities could be found and whether a music producer can learn a lesson from a doctor’s way of handling the patient. At the end of this thesis there is an example case. I was the producer in the production of Estado Novo album where I made observations of the mental side of the production

Kosketus terveyden edistäjänä : Luento Kanta-Hämeen Hengitys ry:n seniorijäsenille

Kosketus rauhoittaa, lievittää kipua ja jännitystä, sekä vahvistaa yhteenkuuluvuuden ja hyväksymisen tunnetta. Tuntoaistin tuomia terveyshyötyjä on mahdollista hyödyntää päivittäin erilaisilla yksinkertaisilla menetelmillä. Senioreilla fyysisen, sosiaalisen ja psyykkisen aktiivisuuden on havaittu edistävän toimintakyvyn säilymistä ja kohenemista. Leskeytyminen ja avioero vähentävät koskettamisen määrää, minkä vuoksi sosiaalisen kanssakäymisen merkitys korostuu. Opinnäytetyön tavoitteena oli koota tietoa koskettamisen terveyttä edistävistä syistä ja tavoista, sekä luoda saatuun tietoon perustuen luento ja havainnollistava kosketusharjoitus työn tilaajan Kanta-Hämeen Hengitys ry:n käyttöön. Luennon aiheiden ja havainnollistavan kosketusharjoituksen suunnittelun apuna käytettiin Kanta-Hämeen Hengitys ry:n seniorijäsenillä teetetyn kosketuskyselyn tuloksia. Lähteinä käytettiin tieteellisiä artikkeleita, hoitotyön kirjallisuutta, sekä lehtiartikkeleita ja -haastatteluja. Luennon ja kosketusharjoituksen tukena käytettiin Power-Point-diaesitystä. Opinnäytetyön toiminnallinen osuus toteutettiin pitämällä kaksi luentoa Kanta-Hämeen Hengitys ry:n seniorien virkistyspäivänä 22.5.2018 sekä Etelä-Hämeen Silmun virkistyspäivän yhteydessä 14.6.2018 yhdistyksen vapaa-ajanviettopaikassa Hattulassa. Luentojen jälkeen osallistujilta kerättiin kirjallinen ja suullinen palaute.Touching soothes, relieves pain and tension and strengthens feelings of togetherness and acceptance. Touch can be utilized in a number of simple ways to achieve many health benefits. With elderly people, physical, social and psychological activity was found to contribute to the maintenance and improvement of functional capacity, which is why the importance of a social connection is emphasized. The death of a spouse and divorce have both been shown to reduce the amount of touch experienced by elderly people. The aim of this practice-based thesis was to find and compile information about the reasons of how touch promotes health and what kind of methods there are to promote health by using touch in which to create a lecture as well as an illustrative touch exercise for the use of the Kanta-Häme Respiratory Health Association, which works as a commissioner. The results of the touch survey conducted among senior members of the Kanta-Häme Respiratory Health Association were used to help design the lecture topics and the design of the illustrative touch exercise. Scientific articles, nursing literature, journal articles and interviews were used as sources. A PowerPoint presentation was used to support the lecture and touch exercise. The thesis was presented by having two lectures on the recreational day of the Kanta-Häme Respiratory Health Association's senior members on May 22, 2018 and on the Hämeen Silmu recreation day on June 14, 2018 at the association's leisure club in Hattula. After the lectures, written and oral feedback was collected from the participants

How to prepare recorded material for online mixing and online mastering? : practical guide for amateurs and professionals

New technology has lowered the prices of recording equipment so that it is available to almost everybody. Today, many artists carry out their record projects with their own recording equipment and use online services in the mixing and mastering phases. Objective vision, experience and high technology are required for these production phases. There are plenty of artists who do the recording themselves, but very little material is available for them on how to prepare the recorded material for online mixing and mastering. The goal of this thesis was to provide useful information on how to develop working methods, which make online mixing and online mastering processes more efficient. There are no rules or standards in the industry for what kinds of technical measures or decisions should be made when preparing the recorded material for online mixing or online mastering. The purpose of this thesis was to provide a practical guide for those, who are planning to carry out their mixing or mastering phase online, and to develop Hiili Music's online services, who is the subscriber to this thesis. In addition, a purpose was to provide useful ideas for sound engineers, who are interested in developing their services. The sources used are Hiili Music’s archives, literature and online sources. The thesis has a constructive approach. The material was collected by researching materials from dozens of music albums and mapping out the problem areas that emerged from them. The final results showed that a big budget is not as important a factor as is often thought, but instead careful preparation is required. The recorded material should be delivered with sufficient technical quality, and many decisions must be made in advance. Interaction plays a much more important role than the industry thinks. A good production is born of interaction and collaboration