Obstetric audit in Namibia and the Netherlands

Roosmalen, J.J.M. van [Promotor

The origin of stiffening in cross-linked semiflexible networks

Strain stiffening of protein networks is explored by means of a finite strain analysis of a two-dimensional network model of cross-linked semiflexible filaments. The results show that stiffening is caused by non-affine network rearrangements that govern a transition from a bending dominated response at small strains to a stretching dominated response at large strains. Thermally-induced filament undulations only have a minor effect; they merely postpone the transition.Comment: 5 pages, 5 figure

Antenatal corticosteroid therapy for foetal maturation in women with eclampsia and severe pre-eclampsia in a rural hospital in Western Tanzania

Contains fulltext : 171449.pdf (publisher's version ) (Open Access)BACKGROUND: Preterm birth is a major cause of neonatal mortality, especially in low and middle income countries. Antenatal corticosteroid therapy for foetal maturation could have a significant impact and therefore is often referred to as an important strategy to reduce neonatal mortality. A recently conducted large multinational trial showed that antenatal corticosteroids can have adverse effects in low income countries, but this is likely to depend on the specific setting. In our hospital preterm birth is only recognized in patients with severe maternal disease, due to physician-initiated delivery. Spontaneous preterm births are rarely seen in the hospital and often take place in the community or while on the road to a health facility. OBJECTIVE: To investigate the effects of antenatal corticosteroid therapy in a rural hospital in Tanzania. METHODS: A secondary analysis of a retrospective medical records study of women with severe pre-eclampsia and eclampsia performed in Ndala Hospital between July 2011 and December 2012. We used data on gestational age, birth weight, Apgar score, time between admission and birth, use of corticosteroids and maternal and foetal survival. Ethical clearance was obtained from the directorate of research and publications of the University of Dodoma (ref. UDOM/DRP/346). RESULTS: Thirty-six women with forty live foetuses were analysed. Twelve women (13 neonates) were given corticosteroids and could be compared to 24 women (27 neonates) who did not get corticosteroids. The incidence of fresh stillbirths (antenatal death) was 20 %. The 13 neonates who received corticosteroids had significantly smaller birth weight, longer interval between admission and delivery and poorer outcomes (stillbirth and neonatal death). An analysis of 24 neonates with a birth weight between 1.5 and 2.5 kg showed a trend toward better outcome in neonates who did not receive antenatal corticosteroid therapy. CONCLUSION: Small retrospective studies as these have a low level of evidence, but this study helped to gain more knowledge of local conditions affecting the effectiveness of antenatal corticosteroid therapy in our setting of a small rural hospital. Reliability of estimating gestational age, epidemiology of preterm birth, exposure to infections, foetal monitoring and quality of neonatal care are likely to influence the effect of antenatal corticosteroid therapy. Further larger prospective studies should be conducted to determine the exact preconditions of antenatal corticosteroid therapy in low-income countries. Until that time, the WHO precautions seem reasonable and audits and small observational studies like ours can help in assessing whether a specific hospital is suited for antenatal corticosteroid therapy

Association between surgical technique, adhesions and morbidity in women with repeat caesarean section:a retrospective study in a rural hospital in Western Tanzania

BACKGROUND: The worldwide incidence of birth by Caesarean Section (CS) is rising. Many births after a previous CS are by repeat surgery, either by an elective CS or after a failed trial of labour. Adhesion formation is associated with increased maternal morbidity in patients with repeat CSs. In spite of large-scale studies the relation between the incidence of adhesion formation and CS surgical technique is unclear. This study aims to assess maternal and neonatal morbidity and mortality after repeat CSs in a rural hospital in a low-income country (LIC) and to analyse the effect of surgical technique on the formation of adhesions. METHODS: A cross-sectional, retrospective medical records study of all women undergoing CS in Ndala Hospital in 2011 and 2012. RESULTS: Of the 3966 births, 450 were by CS (11.3%), of which 321 were 1st CS, 80 2nd CS, 36 3rd CS, 12 4th and one 5th CS (71, 18, 8, 3 and 0.2% respectively). Adhesions were considered to be severe in 56% of second CSs and 64% of third CSs. In 2nd CSs, adhesions were not associated with closure of the peritoneum at 1st CS, but were associated with the prior use of a midline skin incision. There was no increase in maternal morbidity when severe adhesions were present. Adverse neonatal outcome was more prevalent when severe adhesions were present, but this was statistically non-significant (16% vs 6%). CONCLUSIONS: Our results give insight into the practice of repeat CS in our rural hospital. Adhesions after CSs are common and occur more frequently after midline skin incision at 1st CS compared to a transverse incision. Reviewing local data is important to evaluate quality of care and to compare local outcomes to the literature

From the brain to the field: The applications of social neuroscience to economics, health, and law

Social neuroscience aims to understand the biological systems that underlie people’s thoughts, feelings and actions in light of the social context in which they operate. Over the past few decades, social neuroscience has captured the interest of scholars, practitioners, and experts in other disciplines, as well as the general public who more and more draw upon the insights and methods of social neuroscience to explain, predict and change behavior. With the popularity of the field growing, it has become increasingly important to consider the validity of social neuroscience findings as well as what questions it can and cannot address. In the present review article, we examine the contribution of social neuroscience to economics, health, and law, three domains with clear societal relevance. We address the concerns that the extrapolation of neuroscientific results to applied social issues raises within each of these domains, and we suggest guidelines and good practices to circumvent these concerns

Derailing the streetcar named desire. Cognitive distractions reduce individual differences in cravings and unhealthy snacking in response to palatable food

People who are sensitive to food temptations are prone to weight gain and obesity in food-rich environments. Understanding the factors that drive their desire to eat is key to limiting their reactions to available food. This study tested whether individual differences in sensitivity to hedonic food cues are cognitively based and, accordingly, can be regulated by blocking cognitive resources. To this end, one lab study (study 1; N=91) and one field study (study 2; N=63) measured sensitivity to hedonic food cues using the Power of Food Scale (PFS; Lowe et al., 2009) and assessed participants’ appetitive responses to high-calorie food options. To test the role of cognitive elaboration of food cues, participants completed a menu-selection task to induce food cravings and then were free to elaborate those cravings (control group) or were blocked from doing so by cognitive distraction (solving puzzles, playing Tetris; experimental group). Compared to non-sensitive participants, sensitive participants displayed a greater attentional bias to high-calorie food (Study 1), reported stronger cravings (Study 2), and more often chose an unhealthy snack (Studies 1 & 2), but only when they had not been distracted. When distracted, all participants were similarly unresponsive to high-calorie food. This finding suggests that temptation can be effectively controlled by blocking people’s cognitive resources, even for people highly sensitive to hedonic food cues

Variables associated with performance of an active limb movement following within-session instruction in people with and people without low back pain

Modification of a movement pattern can be beneficial in decreasing low back pain (LBP) symptoms. There is variability, however, in how well people are able to modify performance of a movement. What has not been identified is the factors that may affect a person’s ability to modify performance of a movement. We examined factors related to performance of active hip lateral rotation (HLR) following standardized instructions in people with and people without LBP. Data were collected during performance of HLR under 3 conditions: passive, active, and active instructed. In people with LBP, motion demonstrated during the passive condition (r=0.873, P<0.001), motion demonstrated during the active condition (r=0.654, P=0.008), and gender (r=0.570, P=0.027) were related to motion demonstrated during the active-instructed condition. Motion demonstrated during the passive condition explained 76% (P<0.001) of the variance in motion demonstrated during the active-instructed condition. A similar relationship did not exist in people without LBP. The findings of the study suggest that it may be important to assess motion demonstrated during passive HLR to determine how difficult it will be for someone with LBP to modify the performance of HLR. Prognosis should be worst for those who display similar movement patterns during passive HLR and active-instructed HLR