Randomised controlled trial of routine cervical examinations in pregnancy. European Community Collaborative Study Group on Prenatal Screening

Preterm delivery is strongly associated with neonatal mortality and morbidity. In some European countries, cervical examinations are used routinely during pregnancy to identify women at risk of preterm delivery. We sought to evaluate the efficacy and secondary effects of these routine cervical examinations. We did a randomised controlled trial in seven European countries, comparing two policies--namely, an attempt to do a cervical examination at every prenatal visit (2803 women) and avoidance of cervical examination if possible (2799). The median number of cervical examinations was 6 in the experimental group and 1 in the controls. There were 6.7% preterm (< 37 weeks) deliveries in the experimental group and 6.4% in the control group (risk ratio 1.05 [95% confidence interval 0.85-1.29]; non-significant). The low birthweight rate was 6.6% in the experimental group and 7.7% in the controls (non-significant). Premature rupture of membranes was not significantly more frequent in the experimental group (27.1% vs 26.5%). Our findings do not support the routine use of cervical examinations during pregnancy.

[Abdominal emergencies in patients with AIDS]

This is a report on five patients suffering from AIDS who underwent emergency abdominal surgery: One patient with gangrenous appendicitis, three with a small bowel perforation and a third with a colonic bleeding. The first outlived the appendectomy by seven month; the second and the third the small bowel resection by eight weeks resp. by 10 weeks. The fourth died four weeks after hemicolectomy and a relaparotomy with colonic resection for profuse bleeding. The fifth died because of infiltration of the heart by a malignant lymphoma. None of the patients developed any complications due to surgery. A review is given on emergencies caused by abdominal diseases which a surgeon must be aware of in patients with AIDS. The palliative character of surgery in these patients is stressed.

A joint labor-management hazard communication training program: a case study in worker health and safety training

The 1983 OSHA Hazard Communication Standard requires training of employees exposed to hazardous chemicals. The authors provide a detailed look at the successes and failures of a joint labor-management training program that was designed to bring a firm with more than 50 manufacturing facilities into compliance with the standard.

Primary central-nervous-system lymphoma - treatment with multiagent systemic and intrathecal chemotherapy with radiation-therapy

Nine patients with primary central nervous system lymphoma (PCNSL) were evaluated in a protocol of systemic and intrathecal chemotherapy and radiation therapy (RT). The median survival was 30 months; median time to recurrence was 14 months. Leukoencephalopathy developed in 7/9 patients, 6-12 months after combination therapy. 5/9 patients worsened cognitively 6-14 months after therapy; all developed leukoencephalopathy. The four patients who had an initial positive cytology or delayed CSF outflow did not worsen cognitively, although two developed leukoencephalopathy. The combination of chemotherapy and RT improves survival of patients with PCNSL; however, leukoencephalopathy and cognitive changes are frequent.

Effects of birth weight of alcohol and caffeine consumption during pregnancy

The aim of this study was to investigate the effect of alcohol and caffeine consumption on birth weight and the possible interaction of these substances with smoking. The sample included 628 women who were interviewed at their first visit to the maternity hospital of Roubaix, France, in 1985-1986. A significant reduction in birth weight was found to be associated with an average daily alcohol consumption of three drinks or more after gestational age, infant sex, maternal age, parity, weight, and height, and cigarette smoking had been controlled for. There was no interaction between smoking and alcohol consumption on birth weight, but a significant relation between alcohol consumption and birth weight was observed among nonsmokers as well as heavy smokers. The relation observed between caffeine and birth weight disappeared after adjustment for smoking. Our results indicate that alcohol reduces birth weight, but do not support the hypothesis of an interaction between smoking and alcohol consumption.

Factors associated with dysmenorrhea among workers in French poultry slaughterhouses and canneries

The food and agriculture industry employs 15% of the female industrial work force in France. Workers in this industry are exposed to a variety of environmental and organizational constraints: cold, uncomfortable postures, assembly-line work, irregular schedules. In 1987 to 1988, a medical examination and questionnaire were administered to 726 menstruating women who had not been pregnant during the 2 previous years, as part of a study of French workers in 17 poultry slaughterhouses and 6 canning factories. Dysmenorrhea during the previous year was more prevalent among younger women and smokers, and less prevalent among users of oral contraceptives. After adjustment for nonoccupational variables, dysmenorrhea was significantly related to several parameters expressing cold exposure and physical work load. Other parameters such as job satisfaction and hours of domestic work were not associated with dysmenorrhea.

Trends in multiple deliveries and infertility treatments in France

OBJECTIVE

To point out the association between infertility treatments and the increasing number of multiple deliveries.

DESIGN

Comparison over time of the incidence of multiple deliveries, the proportion of deliveries resulting from assisted conception (AC), and ovulation inductor sales.

DATA

Use of existing statistics: vital statistics, surveys of AC centres and ovulation inductor sales.

RESULTS

Between 1972 and 1989 the incidence of twin deliveries rose from 8.8/1000 to 11.2/1000, and the incidence of triplet deliveries from 0.9/10,000 to 4.4/10,000. This upward trend was particularly remarkable among women aged 30 to 39. Since 1978, the triplet delivery rates and the sales of Human Menopausal Gonadotrophin have been rising similarly. Between 1985 and 1989, 26 per cent of the triplet deliveries followed assisted conception and nearly 50 per cent were estimated to be due to ovulation inductor agents.

CONCLUSIONS

The results suggest a strong influence of infertility treatments and especially ovulation inductor agents in the dramatic increase of triplet deliveries.

Menstrual-cycle characteristics and work conditions of workers in poultry slaughterhouses and canneries

The food and agriculture industry employs 14.6% of the female industrial work force in France. Workers are exposed to a variety of environmental and organizational constraints (eg, irregular schedules, cold, uncomfortable postures, repetitive movements). In 1987-1988 a medical examination and questionnaire were administered to 726 workers with menstrual periods in 17 poultry slaughterhouses and six canning factories. Anomalies (irregular cycles, amenorrhea, long cycles) during the previous year were associated with work conditions. After adjustment for relevant nonoccupational variables, irregular cycles were significantly related to schedule variability and cold exposure, amenorrhea was associated with cold exposure, and long cycles with schedule variability. Other parameters such as repetitive work, standing posture, lifting weights, job satisfaction, and hours of domestic work were not associated with cycle anomalies. Cycle anomalies may be a useful indicator of occupational effects on female reproduction, analogous to the use of sperm parameters to warn of effects on male workers.

Evaluation of different policies for the management of labour

Various policies of management of prolonged labour have been proposed to prevent its two main consequences--caesarean section and fetal distress. Two randomised controlled trials were organised; the first to assess the value of amniotomy with oxytocin compared to a more conservative approach. The second trial compared the effect of continuous professional support during labour with the intermittent presence of a member of staff. These were multicentre studies in several countries of Europe. Preliminary results of early amniotomy suggested no difference in the rate of operative delivery. Continuous professional support was associated with a significant reduction in operative deliveries.

Folate status during pregnancy: relationship with alcohol consumption, other maternal risk factors and pregnancy outcome

This study was designed to identify the factors affecting folate status in pregnant women and to explore the relationship between folate status and alcohol consumption during pregnancy. For this purpose, 347 French women were recruited during 1985-1986 on their first visit to the antenatal clinic at Roubaix Hospital (northern France). Alcohol consumption was ascertained by a standardized interview. Folate status assessment was available for 246 pregnant women who were not given folate supplementation. Average folate levels during pregnancy were lower among young women and smokers. Serum folate values diminished with the educational level, and red cell folate values increased with high parity. Unexpectedly, high red cell folate values were strongly related with high alcohol consumption after adjustment for the maternal risk factors associated with alcohol consumption and folate status. This was probably because in the Roubaix region where the study was conducted women consume mostly beer, which contains folates. Pregnancy outcome was not related to folate levels; birthweight was negatively associated with alcohol consumption during the first trimester of pregnancy.

Calcium binding to metallochromic dyes and calmodulin in the presence of combined, AC-DC magnetic fields

The possibility that weak, ac and dc magnetic fields in combination may affect binding equilibria of calcium-ions (Ca2+) was investigated with two metallochromic dyes as calcium-binding molecules: murexide and arsenazo III. Calcium-dye equilibria were followed by measuring solution absorbances with a fiber-optic spectrophotometer. A Ca(2+)-arsenazo solution was also used indirectly to monitor the binding of Ca2+ to calmodulin. Parallel, ac and dc magnetic fields were applied to each preparation. The ac magnetic field was held constant during each of a series of experiments at a frequency in the range between 50 and 120 Hz (sine wave) or at 50 pps (square wave) and at an rms flux density in the range between 65 and 156 microT. The dc magnetic field was then varied from 0 to 299 microT at 1.3 microT increments. The magnetic fields did not measurably affect equilibria in the binding of metallochromic dyes or calmodulin to Ca2+.

Investigation of AC-DC magnetic field effects in planar phospholipid bilayers

Observations recently reported by others indicate that a combination of a weak dc magnetic field and extremely-low-frequency ac magnetic field can produce resonant effects in biological systems. We report measurements of the effects of combined dc and ac magnetic fields on the dc current through channel-free planar phospholipid membranes. The combined dc-ac magnetic fields did affect the dc current through planar phospholipid membranes, but not in every membrane, and not consistently at the same values of magnetic flux density and frequency. None of our measurements showed resonant response akin to the cyclotron-like resonance reported in diatoms [Smith et al., 1987] and lymphocytes [Liboff et al., 1987].

Attitudes toward condom use and AIDS among patients from an urban family practice center

As part of an effort to better educate patients about using condoms, a survey was done to assess the sexual practices, attitudes toward acquired immunodeficiency syndrome (AIDS) and condom use by patients who visit an urban family practice center. A self-administered questionnaire was given to 126 patients of whom the majority were black and single. Seventeen percent indicated they had sex with more than one person in the 3 months before the survey. Within the last 5 years, 10% had sex with an intravenous drug abuser, and 6% with someone of the same sex. Fifty percent believed that condoms decrease sexual pleasure for men and 31% thought condoms made sex inconvenient. Twenty-seven percent of those surveyed believed that a man's penis may be too large for a condom and 18% believed that uncircumcised men could not use condoms. Forty-five percent believed they should be screened for human immune deficiency virus exposure. The results highlight attitudes and beliefs that may function as barriers to condom use and should be addressed when encouraging condom use with this population.

High blood pressure during pregnancy and working conditions among hospital personnel

The relationship between working conditions and high blood pressure during pregnancy was analysed in a sample of 621 women hospital employees in the Paris region over the period 1979-1981. Data were collected by interviews during the routine medical visit at the end of postnatal leave. Women who had to work standing up for extended periods of time, who had to carry heavy loads or who had to perform heavy cleaning tasks had high blood pressure during their pregnancy more often than women not exposed to these working conditions. The accumulation of two out of the three or these three working conditions by the same woman was strongly related to high blood pressure. This relation remained significant when other risk factors of hypertension, such as age, parity, corpulence and tobacco use, were taken into account in a multiple logistic regression.

Comparison of vaginal examination findings in two antenatal clinics

Findings of routine vaginal examinations during pregnancy were compared in two teaching hospitals located in the same area of Paris. We selected 2943 women who had had at least one antenatal visit between 29 and 31 weeks of gestation. Large differences in the frequency of maturation signs were observed between the two hospitals for mid-position, soft consistency and expanded lower uterine segment, although the higher frequency of each sign was not found in the same hospital. No difference was observed for dilatation of the internal os. A better reliability in assessing dilatation than other signs of maturation may explain our results and the role of dilatation in the prediction of preterm delivery.

Is preterm delivery still related to physical working conditions in pregnancy?

STUDY OBJECTIVE

The aim was to determine the relationship between working conditions during pregnancy, women's occupation, and preterm birth.

DESIGN

This was a retrospective survey.

SETTING

The study was carried out in four public maternity units in France in 1987 and 1988.

SUBJECTS

1949 women were interviewed after the delivery during their stay in hospital. Of these, 1002 held a job during pregnancy, but this report is confined to 875 women who had a single live birth and who had worked for more than the first trimester of pregnancy.

MEASUREMENTS AND MAIN RESULTS

Information about social and occupational status was obtained through interviews, and data about gestational length were obtained from medical records. The primary results showed that preterm birth did not vary significantly according to working conditions whereas it differed according to occupational group.

CONCLUSIONS

Occupation, but not working conditions, affected the incidence of preterm birth. This result is discordant with other studies which underlined the excess of preterm births among women with strenuous working conditions. Reasons for this discrepancy may include (1) change in perception of "strenuous working conditions"; (2) improved working conditions; (3) the development of "preventive" strategies by pregnant women. Occupation is a more reliable indicator of risk than self described working conditions.

Alcohol use in pregnancy, craniofacial features, and fetal growth

STUDY OBJECTIVE

The aim was to study the relationship between the level of alcohol consumption in pregnancy and craniofacial characteristics of the neonate.

DESIGN

This was a prospective survey of a sample of pregnant women, stratified on prepregnancy level of alcohol consumption.

SETTING

The study was carried out at the public antenatal clinic of Roubaix maternity hospital.

PARTICIPANTS

During an eight month period, 684 women (89% of those eligible) were interviewed in a standardised way at their first antenatal clinic visit. Of these, all who were suspected of being alcoholic or heavy drinkers (at least 21 drinks per week) were selected for follow up, as was a subsample of light (0-6 drinks per week) and moderate (7-20 drinks per week) drinkers. Of 347 women selected in this way, 202 had their infants assessed by a standardised morphological examination. MEASUREMENTS AND AND MAIN RESULTS: Suggestive craniofacial characteristics of the infants, present either in isolation or in association with growth retardation ("fetal alcohol effects"), were compared in relation to maternal alcohol consumption (alcoholic 12%; heavy drinking 24%; moderate drinking 28%; light drinking 36%). No differences were found between light and moderate drinkers. Infants born to alcoholics had a greater number of craniofacial characteristics and the proportion with features compatible with fetal alcohol effects was higher. There was a similar trend for infants of heavy drinkers. Infants of heavy drinkers who had decreased their alcohol consumption during pregnancy had fewer craniofacial features. Infants of heavy smokers were also found to have increased numbers of craniofacial characteristics.

CONCLUSIONS

Craniofacial morphology could be a sensitive indicator of alcohol exposure in utero. Altered morphology is usually considered specific for alcohol exposure, but the relation observed with smoking needs further exploration.

Implementation of the Federal Hazard Communication Standard: does training work?

A joint labor-management training program intended to bring a large US manufacturing firm into compliance with the training requirements of the Federal Hazard Communication Standard appeared to achieve increases in employee knowledge and improved work practices. The program also evidenced positive indirect effects on management's institution of hazard control measures and organizational handling of health and safety issues. Most observed effects were maintained over a 2-year period after the training. More interactive, trainer-intensive delivery methods to smaller groups were associated with more positive effects on reported training usefulness and changes in work practices and working conditions.

The acceleratory effect of thrombin on fibrin clot assembly

Inhibition of thrombin proteolysis of fibrinogen with D-phenylalanyl-L-propyl-L-arginine chloromethyl ketone (PPACK) results in irreversible inactivation of the thrombin catalytic site, but the PPACK-inhibited thrombin, through its exosite, retains its ability to bind to fibrinogen or fibrin. Hirudin inactivates thrombin at the catalytic site and also inhibits thrombin exosite binding to fibrin or fibrinogen. PPACK or hirudin was added to a clotting mixture of fibrinogen and active thrombin (enzyme:substrate ratio, 1:400 and 1:800) prior to the onset of gelation. Subsequent fibrin assembly was evaluated by turbidity measurements at 350 nm and by determining the fibrin and fibrinogen content of the clots that ultimately formed. Polymerization rates and the fibrin/fibrinogen content of the clots that formed were greater in the PPACK-inhibited system than in the hirudin-inhibited system. Lowering the ionic strength from 0.14 to 0.09 amplified these differences. The results suggest that in addition to its well-recognized role in the proteolytic conversion of fibrinogen to fibrin, thrombin functions as a cofactor in the fibrin assembly process.

Postnatal treatment of rats with the beta 2-adrenergic agonist salbutamol influences the volume of the sexually dimorphic nucleus in the preoptic area

Sexual differentiation of the brain seems to be influenced by postnatal interaction of gonadal steroids with neurotransmitter systems, in particular the adrenergic system. Stimulation or inhibition of adrenergic receptors during early postnatal development had previously been shown to influence steroid-induced sexual differentiation of rat brain function. In the present study newborn male and female rats were treated daily for 5 days with salbutamol, a specific beta 2-receptor agonist, or with alprenolol, a beta-receptor antagonist and the volume of the sexually dimorphic nucleus of the preoptic area (SDN-POA) was examined in adulthood. This nucleus, one of the most striking sex differences in brain anatomy, is several-fold larger in male than in female rats. Postnatal treatment with salbutamol increased SDN-POA volume in female and in male rats. The effect was particularly striking in males, because any previous pre- and/or postnatal treatment of male rats with large amounts of gonadal steroids had been unable to increase the volume of the SDN-POA above normal. The beta-receptor antagonist alprenolol had no effect on SDN-POA differentiation. The results indicate that beta 2-adrenergic stimulation influences development and differentiation of the SDN-POA.

Prediction of preterm delivery: is it substantially improved by routine vaginal examinations?

The ability of routine vaginal examinations to improve the prediction of preterm delivery was assessed in a group of 6909 women who were registered at each prenatal visit and on whom this examination had been carried out. We compared two risk scores, one including known risk factors (maternal characteristics and symptoms reported by women), and the other including these factors and the findings of vaginal examination. These risk scores were computed by multiplying the adjusted odds ratio estimations obtained by logistic regressions. The prediction of preterm delivery was improved significantly by vaginal examination at 25 to 28 weeks' and 29 to 31 weeks' gestation. However, the improvement was not very large: when 30% of nulliparous women were classified as high risk at 29 to 31 weeks, the sensitivity was 55% when considering only the risk factors and 63% when adding the findings of vaginal examination; the percentages were 52% and 55%, respectively, for parous women. These results partially explain why the medical practice of routine vaginal examinations varies from country to country.

Psychosocial consequences of caesarean childbirth: a four-year follow-up study

This paper describes the last part of a study on the long-term psychosocial consequences of caesarean delivery. One group of 103 primiparous caesarean delivered women and one control group of 103 women delivered vaginally were followed from delivery to the children's fourth birthday. Previous assessments were made at birth, two months and one year later (Garel, M., Lelong, N. and Kaminski, M. (1987) J. Psychosom. Obstet. Gynecol., 6, 197-209 and (1988) Early Hum. Dev., 16, 271-282). Four years after delivery, 58 mothers of the caesarean group and 50 mothers of the control group returned a completed questionnaire. The questionnaire included questions about subsequent pregnancies and mother's and child's general state of health. The comparisons between respondents and non-respondents showed no significant difference with regard to social and medical factors. As far as possible, factors which might have interfered with the mothers' and children's conditions were controlled in the analysis. There was no association between the method of delivery and the mother's overall state of health. However, after a caesarean section, mothers tended to have fewer children and more difficulty in conceiving. Four years after delivery, mothers in the caesarean group reported fatigue more frequently than control mothers. Five mothers (9%) consulted a psychiatrist, none in the control group (P less than 0.09). Between one and four years, caesarean born children had more hospital admissions but their overall behaviour and development, as reported by the mothers, was not different from those of children in the control group.

Strenuous working conditions and musculo-skeletal disorders among female hospital workers

The relations between working conditions and various aspects of health among female hospital workers were studied in 26 departments of large hospitals in the Paris area in 1986; 90% of the workers of these departments filled in a questionnaire about their working conditions, sociodemographic characteristics and health in the previous 12 months and attended a medical examination. The study sample included 1505 women. The main cause of sick leave was musculoskeletal disorders and affected 16% of the women. Back pain was described by 47% of the women, and treatment for musculo-skeletal disorders by 28%. Three working conditions were considered to characterize the posture at work: standing more than six hours a day, bending over more than ten times per hour, and maintaining an uncomfortable posture. A cumulative posture index was constructed by adding for each worker the number of the working conditions to which she had been exposed. A cumulative lifting index was constructed in a similar way from the four following characteristics: lifting weights of more than 15 kg, lifting patients more than ten times a day, making beds normally or often, and pushing beds or trolleys more than ten minutes a day. A mixed index was then constructed associating the two previous ones. The relations between these indexes and musculoskeletal disorders (MSD) were studied after adjustment for potential confounders such as age, obesity, number of children, travel duration, sport practice, occupational level, number of years in the occupation, previous attack of back pain, and mental health (assessed by the score to the general health questionnaire). The logistic regressions of MSD indicators on the mixed index and other risk factors showed that MSD was about twice as frequent among women with a maximal load in posture and/or in lifting than among women with no more than one medium index (tiring posture or lifting). These facts support the necessity for improvement of the work load in hospitals.

Stress at work and mental health status among female hospital workers

Relations between working conditions and mental health status of female hospital workers were studied in a sample of 1505 women: 43% were nurses, 32% auxiliaries, and 7% ancillary staff; 13% were other qualified health care staff, mainly head nurses; 5% had occupations other than direct health care; 63% worked on the morning, 20% on the afternoon, and 17% on the night shift. Data were collected at the annual routine medical visit by the occupational health practitioner, using self administered questionnaires and clinical assessments. Five health indicators were considered: a high score to the general health questionnaire (GHQ); fatigue; sleep impairment; use of antidepressants, sleeping pills, or sedatives; and diagnosis of psychiatric morbidity at clinical assessment. Four indices of stress at work were defined: job stress, mental load, insufficiency in internal training and discussion, and strain caused by schedule. The analysis was conducted by multiple logistic regression, controlling for type of occupation, shift, number of years of work in hospital, daily travel time to work, age, marital status, number of children, and wish to move house. Sleep impairment was mostly linked to shift and strain due to schedule. For all other indicators of mental health impairment and especially high GHQ scores, the adjusted odds ratios increased significantly with the levels of job stress, mental load, and strain due to schedule. This evidence of association between work involving an excessive cumulation of stress factors and mental wellbeing should be considered in interventions aimed at improving the working conditions of hospital workers.

[Congenital choledochus cyst in adulthood]

New methods of visualisation of the cysts like ultrasonography, computertomography and endoscopy make a praeoperative diagnosis possible. Because of the malignant potential of the cyst resection is now the treatment of choice instead of cystenterostomy which was formerly used.

Angiogenesis induction by CD-4 positive lymphocytes

Adult splenocytes from BALB/c mice, labeled with a monoclonal antibody directed against the L3T4 (CD-4) differentiation antigen, were sorted to obtain pure suspensions of this T-cell subset. When inoculated intradermally into irradiated, semi-allogeneic adult animals these cells were found to be the effector cells responsible for the lymphocyte-induced angiogenesis. The experiments demonstrate that the CD-4 lymphocyte subset is primarily or entirely responsible for this immune-mediated elicitation of the host neovascular reaction.

Tumor cells are protected from NK-cell-mediated lysis by adhesion to endothelial cells

We have examined the effect of various cell monolayers on the ability of mouse spleen cells to lyse tumor cell targets (natural cytotoxicity reaction). Natural killer (NK) cell activity was reduced by as much as 75% depending on the cell substrate, with the greatest protection afforded by endothelial cells. Cell adhesion to the underlying cell monolayer was directly correlated with the degree of protection from lysis. Since it has previously been shown that tumor cells manifest selective adhesion to endothelial cells from those organs to which they are likely to metastasize, the experiments suggest a means by which natural surveillance mechanisms might be circumvented during the metastatic process.

Follow-up study of psychological consequences of caesarean childbirth

This study was the follow-up part of a survey of psychosocial consequences of caesarean delivery (J. Psychosom. Obstet. Gynecol., 6 (1987) 197-209). Two groups of primiparous mothers were compared, one group of 103 mothers delivered by caesarean section and one control group of 103 mothers delivered by vaginal delivery. Semi-structured questionnaires were mailed at 2 months and 1 year after birth to explore the mothers' physiological and psychological condition and mother-infant adaptation. At 2 months, 92 mothers in the caesarean section group and 84 mothers in the control group returned a completed questionnaire. At one year there were, respectively, 79 and 71 in each group. The data indicated that the most obvious long-term psychological ill-effects of caesarean delivery appeared to be on mothers. They more often reported psychosomatic symptoms during first year than controls. At 2 months the concerns of caesarean mothers seemed more self-oriented than in the control group. They also felt less confident about their abilities to care for their babies. At 1 year these differences disappeared. Signs of disturbance in mother-infant interaction were not linked to the mode of delivery either at 2 months or at 1 year. The influence of the mode of anaesthesia for surgical delivery was also examined. The positive consequences of epidural analgesia which were observed are discussed taking into account the role of confounding variables.

Management of pregnancy and childbirth in England and Wales and in France

This paper reviews national data on obstetric and neonatal practices in England and Wales, and in France between 1970 and 1980. The data have been derived from national statistics and surveys on national samples of births in 1970, 1975 and 1980 in England and Wales, and 1972, 1976 and 1981 in France. The analysis shows that there was no major difference in pregnancy outcome, but wide variations in medical practices, and their trend over time. The main differences were: in England and Wales a higher number of antenatal visits, a higher percentage of inpatient admissions during pregnancy, a higher rate of induction, more episiotomies, a higher rate of resuscitation at birth, and admission to neonatal special care units; in France, a higher rate of caesarean sections before and during labour, some evidence of a more active management of labour, and a longer hospital post-natal stay. These differences in practice reflect differences in objectives and assessment of the effectiveness of care between the two countries: they point out the need for better monitoring and evaluation of obstetric and neonatal practices.

Contribution of specialists to antenatal care in France: impact on level of care during pregnancy and delivery

This study was based on a survey of a national sample of births in France in 1981 which included 5508 women. Four pathways of antenatal care were defined according to the stage of pregnancy at first intervention of a specialist, as opposed to a general practitioner, in the care of the pregnancy. Taking into account the sociodemographic and medical characteristics of the women in a logistic regression, a large number of antenatal visits, an ultrasound examination, and hospitalisation during pregnancy were more frequent when the degree of specialisation of the pathway increased. But the influence of pathways was less significant for deliveries. Caesarean section rates, for example, did not vary according to pathway. However, induction of labour and intrapartum electronic fetal monitoring were less frequent among women cared for solely by a general practitioner than among those who had consulted a specialist at least once during pregnancy. The increase in medical care and the role of the specialist in antenatal care are discussed.

Healthy worker effect and pregnancy: role of adverse obstetric history and social characteristics

Data from a survey conducted in 1981 on a national sample of 5508 births in France were used to analyse the role of a history of previous adverse pregnancy outcome (spontaneous abortion, perinatal death or adverse fetal condition) in the selection mechanisms of women with regard to occupational activity, and the impact on the relation between work and preterm delivery. The study, carried out separately in each parity group, showed that occupational activity was associated with a more favourable outcome for women of parity one: the preterm delivery rate was significantly higher among women who had never worked than among those who continued working during pregnancy. However, the hypothesis of a "healthy worker effect" linked to a history of adverse obstetric outcome was not confirmed in this study. A selection effect of women from a history of spontaneous abortions was observed, but these were not linked to preterm delivery. Among multiparous women, a history of perinatal death or adverse fetal condition did not seem to modify women's behaviour towards their work. Selection mechanisms of women towards occupational activity according to sociodemographic factors were also analysed and showed that the higher percentage of younger women among those who had never worked explained the higher rate of preterm delivery in that group.

Pregnancy outcome and social conditions of women under 20: evolution in France from 1972 to 1981

Two studies based on national samples of births in France in 1972 and 1981 have enabled a comparison of the changes in perinatal risk and social situation of women under 20 years of age with those of women 20 and over. Preterm delivery among women under 20 remained stable during the 10-year period, while it declined significantly among older women. Also, the social situation of teenagers deteriorated in terms of occupational activity, educational level, presence of the child's father in the home, and his occupation. The changes in these social characteristics do not adequately explain the increased relative risk of preterm delivery among women under 20.

Fibrinogen-sepharose interaction with prothrombin, prethrombin 1, prethrombin 2 and thrombin

Binding of prothrombin, prethrombin 1, prethrombin 2 and thrombin to fibrinogen-Sepharose was studied. Thrombin and prethrombin 2 bound to fibrinogen-Sepharose, while prethrombin 1 and prothrombin did not. Bound thrombin and prethrombin 2 were recovered from the column by eluting with 0.1 M NaCl/0.05 M Tris-HCl buffer (pH 7.4). The affinity of thrombin and prethrombin 2 to fibrinogen-Sepharose depended on ionic strength and reached a maximum at 50 mm concentration. Prethrombin 2 interacts with fibrinogen as well as thrombin; and prothrombin fragment 1.2 is not important in the formation of this complex. Thus, prethrombin 2, which is a precursor of thrombin without measurable enzymatic activity and which lacks the single cleavage at Arg-322-Ile-323 present in thrombin, has the same or very similar structural conformation as thrombin and has the same macromolecular substrate recognition site. These results confirm the earlier results that active center is not necessary in fibrinogen-thrombin interaction.

[Therapy of anal incontinence with a Schmidt free-muscle transplant]

Between 1980 to 1985 in ten patients with complete anal incontinence the autologous muscle graft introduced by Schmidt has been used. The operative results obtained were good for satisfactory in nine patients whereas in one patient the operation failed.

Structure of 5,5-dimethyl-2-phenylimino-Δ3-1,3,4-thiadiazoline from oxidative cyclization of a thiosemicarbazone

The X-ray crystal structure of 5,5-dimethyl-2-phenylimino-Δ3-1,3,4-thiadiazoline, C10H11N3S, has been determined. The compound is monoclinic, P21/c (No. 14), with a = 13.200(5), b = 6.340(4), and c = 13.823(4) Å, β = 113.50(4)°, and Z = 4. The structure was determined by direct methods and refined to R = 0.061, Rw = 0.067 for 1277 unique reflections. The molecule has the Z configuration. The thiadiazoline ring is planar. C—N and N=N bond lengths are within the normal range. The C—S bond lengths are similar to those we have observed previously in thiazolidines. Angles differ markedly from an expected average 108°. The small C—S—C angle (90.6(2)°) is accompanied by larger C—N=N angles (114.9(3), 117.8(3)°). The phenyl ring is not coplanar with the thiadiazoline ring (dihedral angle 38.6(4)°) because of repulsive interaction of the phenyl o-hydrogen atom with the sulphur atom.

A model for the evaluation of chiropractic methods

A model is proposed for the evaluation of the procedures and practices taught within a chiropractic curriculum. Questions concerning definitions, methods of observation, science consistency, and pertinent research are asked of a given procedure in the form of a decision-making flow chart. Based on this analysis, a status is assigned that establishes a procedure's current understanding. Applications of the model are discussed.