A prospective cohort study to assess the prevalence and risk factors of antepartum depression and its effect on maternal and fetal outcome

Antepartum depression (APD) is a public health issue has negative repercussions on the health of the mother, child, and family. Early screening for APD will help in early detection and further prevention of postpartum depression and adverse maternal and fetal outcomes. This study was designed to determine i) the prevalence rate of APD in the Indian population and its associated risk factors, ii) the impact of APD on maternal and fetal outcomes. A retrospective cohort study was conducted among antenatal women in the third trimester and screened for antepartum depression between October 2021 and March 2022 by adopting the Edinburgh Postnatal Depression Scale (EPDS). In the study population, 36.6 % had mild to moderate level of depressive symptoms (EPDS score of 8-12) and 28 % had high levels of depressive symptoms (EPDS score of ≥13). An unplanned pregnancy, a history of abortion, and a history of any pregnancy complications were the likely maternal risk factors for developing antepartum depression. The APD risk was also likely to be increased by sociodemographic and personal factors such as insufficient family support, a history of domestic violence, marital dissatisfaction, and a partner with a poor level of education (P < 0.05). Women screened with antepartum depression had 58.34 times the likelihood of developing postpartum depression and a threefold greater risk of having premature delivery. These findings may help to improve pregnancy outcomes by early identification, referral for early treatment of antepartum depression, also inform maternal mental health service development and utilization for boosting women's mental wellbeing.

Efficacy of the Standard Breast Crawl Technique on Maternal and Newborn Outcomes After Term Vaginal Birth: A Randomized Controlled Trial

INTRODUCTION

The breast crawl technique is a strategy for initiating breastfeeding during the first hour of life, an important goal with long-lasting effects on newborn health and development. However, there is a lack of research to back up the benefits of the standard breast crawl technique over routine skin-to-skin care.

METHODS

A single-center single-masked randomized controlled trial was conducted among 132 women who had given birth vaginally to a full-term newborn. The study group had received the standard breast crawl (SBC) technique and the control group had received skin-to-skin contact (SSC). The outcome measures included time to initiation of breast crawl and breastfeeding, LATCH score, newborn breastfeeding behavior, time to expulsion of placenta, episiotomy suturing pain, amount of blood loss, and uterine involution.

RESULTS

Outcomes were analyzed for 60 women in each group who remained eligible. Compared with those in the SSC group, women in the SBC group had shorter time to initiation of the breast crawl (7.40 minutes vs 10.42 minutes, P = .001), shorter time to initiation of breast feeding (23.18 minutes vs 30.58 minutes, P = .003), higher LATCH scores (7.57 vs 5.35, P = .001), and higher newborn breastfeeding behavior scores (11.38 vs 9.08, P = .001). Women in the SBC group also had decreased mean time to birth of the placenta (4.67 minutes vs 6.58 minutes, P =.001), lower episiotomy suturing pain scores (2.72 vs 4.50, P =.001), and decreased maternal blood loss (16.66% vs 53.33%, P = .001); were more likely to involute the uterus below the umbilicus after 24 hours of birth (77% vs 10%, P = .001); and had higher maternal birth satisfaction score (7.15 vs 2.0, P = .001).

DISCUSSION

The study demonstrates improvement of newborn and maternal short-term outcomes with use of the SBC technique. Findings support the use of SBC technique as a routine labor room practice to improve immediate maternal and newborn outcomes.

Barriers and Acceptance of Intrauterine Contraceptive Devices (IUCD) Among Married Women of Reproductive Age in Odisha, India

INTRODUCTION

The Copper-T (Cu T-380 A), an intrauterine contraceptive device (IUCD), is widely available and is a highly effective, safe, long-term, and reversible method of contraception. Despite this fact, there is low utilization of IUCDs in India. Hence, this study focused on determining the rate of acceptability of IUCDs, identifying barriers to acceptance of IUCDs, and finding out the cause of IUCD discontinuation.

METHODS

A hospital-based cross-sectional study was conducted among 720 married women in the Khordha district, Odisha, India, via a questionnaire and a structured interview schedule. A systematic random sampling method was applied to select the participants. A multivariate logistic regression test was used to determine the factors associated with the acceptance of IUCDs.

RESULTS

This study revealed that only 20.97% of the potential users were currently using IUCDs, 73.75% had never used n IUCD as a contraceptive, and 20.1% of women had discontinued it. Multiple socio-demographic, obstetrical, and family planning behaviours and a lack of awareness were identified to be linked to IUCD acceptability. Fear of adverse effects, family members' objections, availability of other modern contraceptive methods, husband's disagreement, and lack of awareness about the benefits of IUCDs were the most stated reasons for refusal of IUCDs. The most common reason for discontinuing an IUCD was the desire for another child.

CONCLUSION

The rate of acceptability of IUCDs was quite low in Odisha as compared to other parts of India and, therefore, this study recommends imparting counselling on effective methods of family planning to increase the acceptance of IUCD use.

A modelling study on quantifying the impact of urbanization and regional effects on the wintertime surface temperature over a rapidly-growing tropical city

Climate change and sustainability are among the most widely used terms among policymakers and the scientific community in recent times. However, climate action or steps to sustainable growth in cities in the global south are mostly borrowed from general studies at a few large urban agglomerations in the developed world. There are very few modeling studies over south Asia to understand and quantify the impact of climate change and urbanization on even the most primary meteorological variable, such as temperature. Such quantifications are difficult to estimate due to the non-availability of relevant long-term observational datasets. In this modeling study, an attempt is made to understand the urban heat island (UHI), its transition, and the segregation of regional climate change effects and urbanization over the rapidly growing tier 2 tropical smart city Bhubaneswar in India. The model is able to simulate the UHI for both land surface temperature, called the SUHI, and 2-m air temperature, called UHI, reasonably well. Their magnitudes were ~ 5 and 2.5°C, respectively. It is estimated that nearly 60–70% of the overall air and 70–80% of the land surface temperature increase during nighttime over the city between the period 2004 and 2015 is due to urbanization, with the remaining due to the regional/non-local effects.

Effectiveness of multistimulation approach on feeding habits of low-birth-weight babies-A randomized control trial

Introduction

Low- birth- weight neonates face oral feeding difficulties due to hemodynamic instability, immaturity of central nervous systems, and incomplete development of oral functions. Use of several interventions might help in improvement of the feeding ability of neonates. The objective of the study was to evaluate the effect of the multistimulation approach in low-birth-weight babies on the oral feeding performance, oral intake volume, weight gain and transition time from tube to total oral intake.

Methods

A Randomized, parallel-group, multiple arm trial study was conducted, and a total of 44 low birth weight babies were randomized into three parallel groups with a 2:1:1 ratio. Babies who are Hemodynamically stable were included in the trial. In two Intervention groups, one received an oral stimulation program, another intervention group received tactile stimulation, and the control group received routine newborn procedures for the same duration of time. Oral feeding performance was determined by Oral Feeding Skills (OFS) on a daily basis for five days after providing ten days of intervention. Neonates were monitored until hospital discharge.

Results

Infants in the stimulation groups had significantly better oral feeding performance than infants in the control group in terms of mean proficiency, transfer rate and overall transfer of feeding volume. There was a substantial increase in mean feeding score, daily weight, oral intake volume, and early transition time in both intervention groups compared to control. There was no significant difference in feeding behaviours between the oromotor and multistimulation groups, but the multistimulation group gained more weight compared to the oromotor group.

Conclusions

Infants exposed to the stimulation programme had better feeding skills and a shorter transition period from tube feeding to oral feeding; however, the babies who received multistimulation gained greater weight than babies who received only oromotor stimulation. The study recommends multi stimulation in the form of oromotor, and tactile stimulation can be used as an effective NICU procedure for maintaining an infant's ability to take feeds orally before being discharged from the hospital.

•

This study observed that Oromotor or with combination of tactile stimulation, was quite effective in improving feeding habits of low birth weight babies when compared to routine newborn care.

•

Providing low birth weight babies with multistimulation help in improving infants’ growth and motor development due to the additive or synergistic effect on oral feeding performance and weight gain.

•

In clinical practice, multistimulation can be implemented as a routine intervention in the NICU for enhancing early transition to independent feeding among premature and low birth weight babies.

Knowledge, perceived threats and protective behaviour related to COVID 19 among pregnant women

Pregnancy is usually a period of joy, happiness, and expectation for a baby. However, COVID-19 changed the priority and created an environment of worry, perceived threats, and increased protective behaviour to safeguard mother and baby against COVID-19.

METHOD

A cross-sectional study was conducted to assess, the level of knowledge, perceived threats, protective behavior, and factors affecting protective behavior among pregnant women by using a convenient sampling technique. The questionnaire collected the demographic profile, knowledge related to the risk factors of COVID-19, perceived treats (severity and susceptibility), and protective behaviors adopted by pregnant women.

RESULT

Among the 325 pregnant women, knowledge was high (50.5%), the highest relative Importance Index for perceived susceptibility and severity was coming to hospital visits (0.64), and the belief that COVID-19 is a severe health problem (0.81) respectively. Around 69.8% had followed COVID appropriate protective behaviors. The study also revealed that, a high level of knowledge (AOR=2.45, 95%CI:1.45-4.13) and having a university education (AOR= 2.91, 95%CI:1.62-5.22) had a significantly higher probability of adapting COVID appropriate behavior among pregnant women.

CONCLUSION

This study emphasizes the need to streamline communication and adequate education for pregnant women which can help reduce perceived threats and improve protective behavior.

Effect of Preconception Care Intervention on Maternal Nutritional Status and Birth Outcome in a Low-Resource Setting: Proposal for a Nonrandomized Controlled Trial

BACKGROUND

The provision of preconception care approaches such as maternal assessments and education on healthy lifestyle (including physical activity, nutrition, and dietary supplements such as folic acid), general and sexual health, avoidance of high-risk behavior, and immunizations has been shown to identify and reduce the risk of adverse birth outcomes through appropriate management and preventive measures.

OBJECTIVE

The goal of the study is to determine the effect of an integrated preconception care intervention on delivery outcomes, which is a novel challenge for lowering unfavorable birth outcomes in India's low-resource setting. The main objectives are to investigate the relationship of birth outcomes to both maternal and paternal preconception health and determine the effect of preconception care intervention on improvement of maternal nutritional status and reduction of the risk of adverse birth outcomes such as prematurity, low birth weight, and maternal and neonatal complications.

METHODS

A nonrandomized controlled trial design will be used for comparing 2 groups: preconception care with a standard maternal health care (MHC) program and an integrated MHC program (without preconception care). Two rural field areas of Khordha district, Odisha, will be selected for conducting the study. The study will enroll 782 married women between the ages of 18 and 35 years with their spouses, with 391 women in each group. The couples will receive preconception care based on their health circumstances, and they will be followed up at 3-month intervals before pregnancy. Following pregnancy, they will be followed up for 8 prenatal monitoring and care visits as well as 6 weeks after delivery as part of the standard MCH program. The preconception care intervention package includes couples counseling, contraceptive education and distribution, sex education, lifestyle modification, and nutritional supplementation of iron and folic acid, along with multivitamins if needed.

RESULTS

The proposal was approved by the institutional ethical committee for conducting the study in June 2020 (Ref No: T/EMF/Nursing/20/6). Participants were enrolled in phase 1 in April 2021, phase 2 of offering preconception services will begin in August 2021, and study outcomes will be measured from 2023 to 2024.

CONCLUSIONS

Through preconception care and counseling, the eligible couples will recognize, embrace, and implement the actions to improve their preconception health. Finally, it is expected that maternal and paternal health will have a significant impact on enhancing maternal nutritional status and birth outcomes.

TRIAL REGISTRATION

Clinical Trials Registry-India CTRI/2021/04/032836; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=48239&EncHid=&userName=CTRI/2021/04/032836.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/28148.

The Effect of Different Timings of Delayed Cord Clamping of Term Infants on Maternal and Newborn Outcomes in Normal Vaginal Deliveries

Background and objective Delayed cord clamping (DCC) has proven to be an ideal approach to reduce iron deficiency anemia; however, different timings of DCC relative to the birth outcome lead to conflicting results. The present study was conducted to determine the effects of different timings of DCC on the maternal and neonatal outcomes in normal vaginal deliveries at term. Methods This was an interventional study on neonates born at term without complications to mothers with uneventful pregnancies in the labor unit of a district hospital in Odisha, India. A total of 147 women were randomized to three intervention groups: DCC at one minute, DCC at two minutes, and DCC at three minutes. Hemoglobin and bilirubin levels, maternal blood loss, the timing of the third stage of labor, oxytocin use, and birth weight of the neonates were measured as the outcomes of different timings of DCC. Results At 24-48 hours of age, hemoglobin and bilirubin levels of the neonates were significantly higher with DCC at three minutes compared to DCC at one and two minutes. However, there were no significant differences among the three groups in terms of the need for phototherapy. The duration of the third stage of labor was significantly longer with DCC at three minutes. Maternal blood loss, oxytocin use, and birth weight of the neonates were not significantly associated with the timing of DCC. Conclusion Based on our findings, waiting to clamp the umbilical cord until three minutes can effectively reduce the incidence of iron deficiency anemia in newborns.

Impact of yoga intervention on menopausal symptoms-specific quality of life and changes in hormonal level among menopausal women

AIM

The menopause transition is experienced by women often involves troublesome symptoms due to changes in the level of reproductive hormones. Non-hormonal therapies are more commonly accepted by women than hormonal therapy for coping with the climacteric symptoms. The aim of the study was to evaluate the effects of yoga practice on menopausal symptoms, specific quality of life, and changes in hormonal levels among menopausal women.

METHOD

A single-blinded randomized control trial was conducted among 80 participants aged 40 of 50 years and was randomly divided into two study arms, that is, Sudarshan Kriya Yoga (SKY) and brisk walking intervention, to find the effect on the hormonal changes and menopausal quality of life (measured by MENQOL tool). The significant improvements in the outcome measures were measured by using repeated measures analysis of variance and McNemar's test.

RESULTS

Significant improvements in the menopausal-specific quality of life were observed in the domain of vasomotor, psychosocial, and physical symptoms (p < 0.05). The antioxidant enzymes (superoxide dismutase and glutathione peroxidase (GPX) were significantly elevated after 1 year of regular practice of SKY compared to walking intervention (p < 0.05). In contrast, no significant improvement was observed in follicle-stimulating hormone and dehydroepiandrosterone sulfate levels. The women reported no adverse events after SKY practice or brisk walking.

CONCLUSION

The study concluded that 1 year of SKY practice could be one of the preferred non-hormonal, lifestyle-modifying regimens for improving the overall quality of life in menopausal women.

Challenges faced by student nurses and midwives in clinical learning environment - A systematic review and meta-synthesis

OBJECTIVES

This systematic review aimed to offer insight and understanding, through synthesis of findings from studies that report on perspectives of student nurses/midwives, clinical instructors, clinical nurses/midwives on the challenges faced by student nurses/midwives in the clinical learning environment (CLE).

DESIGN

All primary qualitative research studies published in the English language that reported on the views of student nurses/midwives, clinical instructors and clinical nurses/midwives on the challenges faced by student nurses/midwives in the CLE were included.

DATA SOURCES

The electronic databases of Medline EBSCO (1946-), CINAHL (1970), Embase Ovid (1974-), ScielO, WHOLIS (2002-), ASSIA (1985-), Web of Science (1956-), PsycINFO (1800s-) and Maternal and Infant Care (1970-) were searched in November 2019.

REVIEW METHODS

Retrieved papers were reviewed independently by two authors for selection by title, abstract and full text, and two authors agreed for inclusion of the papers. The COREQ criteria checklist was used for assessment of methodological quality of the included studies.

RESULTS

The review included 32 studies published over 22 years between 1997 and 2019 involving 853 nursing/midwifery students, clinical instructors, and clinical nurses/midwives from 14 countries. Three key themes emerged: 'The support structure', 'Personal factors', and 'Planning and organisation - influence of extrinsic factors'.

CONCLUSION

Attitude of clinical staff, instructors, and significant others had a major influence on students' clinical learning. Lack of a sense of belongingness and self-motivation to learn, and perceived fear of doing errors were some of the demotivating factors. Lack of resources to facilitate need-based training, staff shortages, workload and inconsistencies between theory and practice were other key challenges in the CLE. Understanding the challenges faced by students in clinical practice can help overcome the barriers leading to development of competent and confident nurses and midwives.

Enhanced exudation of malate in the rhizosphere due to AtALMT1 overexpression in blackgram (Vigna mungo L.) confers increased aluminium tolerance

Worldwide, 50% of soil is acidic, which induces aluminium (Al) toxicity in plants, as the phyto-availability of Al³⁺ increases in acidic soil. Plants responds to Al³⁺ toxicity by exuding organic acids into the rhizosphere. The organic acid responsible for Al³⁺ stress response varies from species to species, which in the case of blackgram (Vigna mungo L.) is citrate. In blackgram, an Arabidopsis malate transporter, AtALMT1, was overexpressed with the motive of inducing enhanced exudation of malate. Transgenics were generated using cotyledon node explants through Agrobacterium tumefaciens-mediated transformation. The putative transgenics were initially screened by AtALMT1-specific genomic DNA PCR, followed by quantitative PCR. Two independent transgenic events were identified and functionally characterized in the T₃ generation. The transgenic lines, Line 1 and 2, showed better root growth, relative water content and chlorophyll content under Al³⁺ stress. Both lines also accounted for less oxidative damage, due to reduced accumulation of ROS molecules. Photosynthetic efficiency, as measured in terms of F_v /F_m , NPQ and Y(II), increased when compared to the wild type (WT). Relative expression of genes (VmSTOP1, VmALS3, VmMATE) responsible for Al³⁺ stress response in blackgram showed that overexpression of a malate transporter did not have any effect on their expression. Malate exudation increased whereas citrate exudation did not show any divergence from the WT. A pot stress assay found that the transgenics showed better adaptation to acidic soil. This report demonstrates that the overexpression of a malate transporter in a non-malate exuding species improves adaptation to Al³⁺ toxicity in acidic soil without effecting its stress response mechanism.

Prevalence and risk factors of obstetric fistula: implementation of a need-based preventive action plan in a South-eastern rural community of India

BACKGROUND

The study was conducted to estimate the prevalence and risk factors of obstetric fistula in the rural area of the south eastern community of India and the training of community health workers for its prevention.

METHODS

A population-based cross-sectional analytical study was conducted in the south eastern rural community of India. A total of 3939 women were included in the study and Probability proportional to size sampling was used in the study. Frequency distribution and logistic regression were computed to analyse the data using STATA version 11.2.

RESULTS

Out of 3939 participants interviewed, 23.7% women reported obstetric fistula symptoms whereas after clinical diagnosis and speculum examination the obstetric morbidity pattern was: Obstetric fistula 0.3%, stress urinary incontinence 20.0%, pelvic inflammatory diseases 1.2%, uterine prolapse 1.4% and urinary tract infection 3.8%. The awareness level of the rural women regarding the obstetric fistula was assessed by a structured knowledge questionnaire and found to be very poor, hence community based fistula training was implemented among community health workers as a health system based strategy for its prevention. Obstetric fistula found to be more prevalent among women of poor educational level, low socioeconomic status, less no of antenatal visits, delay in accessing the emergency obstetric care and prolonged labour (p ≤ 0.05).

CONCLUSION

Finding of the study indicated that the prevalence and risk of developing obstetric fistula was associated with less number of antenatal visits, prolonged labour, delay in timely intervention, delay in accessing emergency obstetric care and more number of movements from home to the delivery place. Finally, our study suggests that emphasis needs to be placed on training of community health workers to facilitate early screening for identification and referral of women with obstetric fistula.

Impact of Community-Based Continuous Training on Promoting Birth Preparedness and Pregnancy Outcome in Rural Odisha, India: An Interventional Study

Background

Birth preparedness and complication readiness extends the maternal and neonatal health continuum of care and thus contributes to one of the important tools for pregnant women to experience better pregnancy outcome, strengthening family and community health, creating space for other interventions. The present study aimed to evaluate community-based birth preparedness and complication readiness training on pregnancy outcome.

Method

The study adopted a quasi-experimental time series only one experimental design which was conducted in rural south-eastern India for 1 year among the reproductive age group 15-49 years (≤ 24 weeks pregnancy), and cases were followed up till postnatal period. A standardized birth preparedness assessment index (BPAI) was used to assess preparedness level of respondents. Community-based continuous training (CBCT) was introduced, and its effect was measured on birth preparedness level, involvement of family and their pregnancy outcomes.

Result

CBCT interventional program was effective in promoting positive behaviors on birth preparedness and complication readiness as per BPAI: 13% of women were at level 1, 15% at level 2, 19% at level 3, 49% participants were at 4th level and 5% were at 5th level which represented the best level of preparedness for their present delivery. Pregnant mothers who completed their antenatal visits and were well prepared for delivery were found to be having two times favorable pregnancy outcome than those who had not (OR 2.79).

Conclusion

BPCR intervention strategy can be utilized as a timely and effective community action plan for ensuring a favorable pregnancy outcome.

Obstetric fistula: A challenge to public health

Obstetric fistula (OF) is one of the most important consequences of a prolonged obstructed labor, a big issue for low-income countries (LICs) like India. The objective is to identify and explore the knowledge regarding OF as a public health problem in LICs from peer review literature. The PubMed, Google Scholar, and Science Direct databases were searched to identify the prevalence, risk factors, and management of OF in LICs. Quantitative evidence-based paper reviewed. Twenty-seven articles met the inclusion criteria. The 15 provided population-based OF prevalence data of OF and 12 provided risk factors and social causes of OF rates associated with the birth that caused an OF. OF has one of the big public health problems. There is a lack of scientific research on the prevalence and risk factors of OF in LICs. This review helps to eradicate or alleviate the problem of OF in LICs like India.

Land use and land cover change effect on surface temperature over Eastern India

Land use and land cover (LULC) change has been shown to have significant effect on climate through various pathways that modulate land surface temperature and rainfall. However, few studies have illustrated such a link over the Indian region using observations. Through a combination of ground, satellite remote sensing and reanalysis products, we investigate the recent changes to land surface temperature in the Eastern state of Odisha between 1981 and 2010 and assess its relation to LULC. Our analysis reveals that the mean temperature of the state has increased by ~0.3 °C during the past three decades with the most accelerated warming (~0.9 °C) occurring during the recent decade (2001 to 2010). Our study shows that 25 to 50% of this observed overall warming is associated with LULC. Further we observe that the spatial pattern of LULC changes matches well with the independently estimated warming associated with LULC suggesting a physical association between them. This study also reveals that the largest changes are linked to changing vegetation cover as evidenced by changes to both LULC classes and normalized difference vegetation index (NDVI). Our study shows that the state has undergone an LULC induced warming which accounts for a quarter of the overall temperature rise since 2001. With the expected expansion of urban landscape and concomitant increase in anthropogenic activities along with changing cropping patterns, LULC linked changes to surface temperature and hence regional climate feedback over this region necessitates additional investigations.

Preparedness of young girls for prevention of cervical cancer and strategy to introduce the HPV vaccine

Objective:

Cervical cancer incidence and mortality rates remain high in developing country due to low levels of awareness on preventive measures. The main study objective was to sensitize the young girls on the prevention of cervical cancer.

Study Design:

Quasi-experimental pretest and posttest design was used.

Methods:

A total of 240 young girls enrolled and 60 were selected randomly for the sensitization program. The preparedness for prevention of cervical cancer was assessed through structured preparedness criteria and perception toward vaccination was ascertained through rating scale.

Results:

Changes in knowledge level and intention to be vaccinated and for developing positive attitude to be screened in future were assessed using paired t-tests and found to be statistically significant. There is been an improvement in knowledge score noticed from pretest to posttest. The greatest improvements were observed in responses to questions on knowledge on symptoms (60%) and prevention (88%) that is maximum responded vaginal bleeding is the most common symptoms of cervical cancer and avoiding early sexual intercourse is the preventive measures of cancer cervix. Out of the 60 girls, 52 (86%) shown their agreement for human papillomavirus (HPV) vaccination, 35 (58.33%) took the HPV vaccine as a preventive measure.

Conclusion:

Study concludes that periodical sensitization through educational intervention may act as a cascade for girls and help them to be more aware about the preventive aspects of cervical cancer.

Evaluations of allelopathic effect of Echinochloa colona weed on rice (Oryza sativa L. 'Vandana')

Echinochloa colona (L.) Link is a very problematic weed in up land and medium land rice causing significant reduction in yield. In the present investigation, laboratory and field experiments were conducted to evaluate the nature of interaction E. colona on germination and growth of the up land rice cultivar 'Vandana'. The effects of decomposing and decomposed aqueous leachates (1-10% w/v) obtained from the dried biomass of 20, 30, 40 and 60 days old Ecolona plants were studied on rice using petridish bioassay technique with three different types of culture media like filter paper, soil, and soil + activated charcoal. The decomposing leachates of E. colona showed strong toxic effect on root and shoot growth of rice, the highest being noted with 10% leachates of 60 days old plant residue. It inhibited root and shoot growth by 100% and 43.9% respectively as compared to control. The corresponding decomposed leachates inhibited rice germination by 90% and root and shoot growth by 70 and 25% respectively. These toxic effects of leachates showed in filter paper medium were significantly reduced in soil and soil plus activated charcoal media proving their allelopathic nature. In a field experiment, E. colona and rice were grown in proportions of 1:1, 1: 2 and 1:4, the total plant density being maintained at 100 pants m(-2). The height and dry matter of rice were adversely affected with increasing in E. colona population. From another similar field trial, data on dry matter of 20, 30, 40, and 60 days old plants were taken and their plant relative yield (PRY) and relative yield total (RYT) values were calculated. The PRY and RYT values were found to be less than unit (< 1) throughout the growth period studied which suggested the presence of severe antagonistic interspecific interaction between rice and E. colona due to allelopathy.

Determining the effect of stocking rate on the spatial distribution of cattle for the subtropical savannas

With the commercial development of the global positioning system (GPS), it is now possible to monitor the distribution of free ranging cattle and derive measures to describe landscape use. Animal GPS data can be integrated with a geographic information system (GIS) detailing topography, vegetation, soil type and other landscape features. Combining GPS and GIS information is useful for understanding how animals respond to spatial variability. This study quantified land-type preferences for Brahman cross steers over three time periods, from October 2004 to March 2006 in a replicated trial, under heavy (4 ha/AE; animal equivalent of ~450 kg steer) and light (8 ha/AE) stocking in four, ~105 ha paddocks of subtropical semi-arid savanna near Charters Towers, Queensland, Australia. The grazing trail was conducted at a scale much less than would be found in commercial situations. Consequently, the spatial pattern of cattle reported here may not represent what occurs at a commercial scale and implications are discussed. Results were analysed in terms of the spatial distribution of steers fitted with GPS devices in each of the four paddocks and for each stocking rate to provide insight into cattle distribution and land-type preferences. Steers walked in excess of 6 km per day, regardless of stocking rate, and exhibited diurnal patterns of movement, with peak activity around dawn (0500–0700 hours) and dusk (1800–2000 hours). The spatial distribution of the collared steers was not uniform and appeared to be strongly influenced by the prevailing drought conditions and location of water points within each paddock. A hierarchy of drivers for distribution was identified. With the exception of drinking water location, land subtype based on soil-vegetation associations influenced animal distribution. Preference indices (ŵi) indicated that steers selected sites associated with heavy clay and texture contrast soils dominated by Eucalyptus coolabah Blakely & Jacobs (ŵi = 5.33) and Eucalyptus brownii Maiden & Cambage (ŵi = 3.27), respectively, and avoiding Eucalyptus melanophloia F.Muell. ridges (ŵi = 0.26) and Eucalyptus cambageana Maiden (ŵi = 0.12) on sodosols. The results suggest that spatial variation in cattle distribution within a paddock may be more critical than overall stocking rate in influencing the pattern of biomass utilisation. However, to quantifying the effects of different grazing land management practices on animal distribution on a commercial scale, additional studies in extensive paddocks are required.

Judgement of the quality of bowel preparation at screening flexible sigmoidoscopy is associated with variability in adenoma detection rates

BACKGROUND AND STUDY AIMS

Adenoma detection rates (ADRs) at screening flexible sigmoidoscopy are known to vary between endoscopists. Variability in the technique used and in the quality of bowel preparation may explain this. The aim of this study was to establish whether there is a relationship between the grading of bowel preparation and the ADR.

MATERIALS AND METHODS

The relationship between the ADR and assessment of bowel preparation was examined using the full United Kingdom Flexible Sigmoidoscopy Screening Trial data set (n = 38 601). The consistency of the bowel preparation classification was then investigated by six experienced endoscopists (video scorers), who examined 260 flexible sigmoidoscopy cases - 20 from each of the 13 trial endoscopists.

RESULTS

Overall, the ADR was significantly higher in flexible sigmoidoscopy examinations with excellent or good bowel preparation ( P = 0.02). However, endoscopists with a higher ADR coded a smaller proportion of their examinations as having excellent/good preparation ( P = 0.002). Video scorers agreed with the trial endoscopists' definition of bowel preparation in 48.9 % of the readings, but they scored the quality of preparation as poorer than the trial endoscopists in 36.4 % and 40.6 %, respectively, in the intermediate-performance group (10 % < ADR < 14 %) and lower-performance group (ADR </= 10 %) in comparison with only 12.9 % in the high-performance group (ADR > or =14 %). There was a significant linear trend between the proportion scored as having poor bowel preparation and the ADR ( P < 0.001), varying from 2.7 % in the higher-performance ADR group to 13.4 % in the lower-performance group.

CONCLUSIONS

Endoscopists with a higher ADR are more likely to be critical of the quality of bowel preparation. Training in judgement processes such as non-acceptance of suboptimal bowel preparation is required in order to ensure universally high standards in screening procedures.

Development of a video assessment scoring method to determine the accuracy of endoscopist performance at screening flexible sigmoidoscopy

BACKGROUND AND AIMS

Variation in the adenoma detection rate (ADR) at flexible sigmoidoscopy screening has been shown to be due to variation in endoscopist performance. There are no objective methods for scoring an endoscopist's performance reliably, and the aim of this study was to develop a valid and reliable objective scoring method using video footage of screening flexible sigmoidoscopies.

METHODS

In a series of five experiments, experienced endoscopists (the scorers) independently scored a sample (n = 43) of the 40 000 flexible sigmoidoscopy extubations recorded as part of the United Kingdom Flexible Sigmoidoscopy Screening Trial (UK FSST). The scoring system, the parameters scored, and their definitions evolved over the course of the five experiments. The initial visual analogue score (range 0-100) used in the first two experiments evolved into a five-point score that ranged from 1 (E, poor) to 5 (A, excellent) in the last three experiments. The final parameters scored were: time spent viewing the mucosa, re-examination of poorly viewed areas, suctioning of fluid pools, distension of the lumen, lower rectal examination, and overall quality of the examination. The first four experiments scored one individual case per endoscopist; in experiment 5, an overall score was awarded for five cases performed by each endoscopist being assessed.

RESULTS

Scoring five cases examined by an individual endoscopist using the A-E grading system was the most reliable method (interclass correlation coefficient 0.89). Cluster analysis demonstrated that the endoscopists in the high-scoring ADR group (ADR 14.7-15.9 %) could be differentiated from those in the intermediate- and low-scoring ADR groups (ADR 8.6-12.6 %).

CONCLUSIONS

An objective scoring system for assessing the accuracy of performance at screening flexible sigmoidoscopy, based on video footage, is described. Endoscopists who might benefit from further training can be identified using this method.

Oral vitamin B12 can change our practice

Oral vitamin B12 can provide an effective alternative to intramuscular injections, so giving patients a choice and reducing costs in primary care. This study investigated the effectiveness, safety, and acceptability of oral vitamin B12 as replacement therapy in patients with vitamin B12 deficiency in a city general practice population. Forty patients previously maintained on vitamin B12 injections were given 1000 micro g of oral cyanocobalamin daily for up to 18 months. All the patients maintained satisfactory serum B12 levels and showed normal haematology and neurology. Compliance and acceptability was excellent. The time for a change in practice has indeed arrived.

Proximal femoral fracture in Northern Ireland between 1985-1997--trends and future projections

The aims of this study were to identify changing trends with time of the incidence of proximal femoral fracture and to enable future number of hip fractures to be projected. Hospital theatre records in Northern Ireland were surveyed in 1985, 1991, 1994 and 1997 to establish the number of surgical procedures for proximal femoral fracture. The age and sex specific rates for males and females aged 50+ years were calculated. Analysis of age and sex specific incidence rates was undertaken using linear regression and Poisson regression. A 1.6% increase per annum (95% CI 1.0-2.2) was noted in males and females from 1985 to 1997. Projected increases in rates of proximal femoral fracture were calculated using population projection for 2001, 2006, 2011 and 2016. Modelling (a) assuming the age standardised rates in 1997 remain static and continue predicted a 55% fracture increase in males and a 29% increase in females by 2016, (b) assuming the secular increases continued predicted a 93% fracture increase in males and a 67% increase in females and (c) assuming further linear growth on a log-scale predicted a fracture increase in males of 135% and 99% in females. The number of proximal femoral fractures in Northern Ireland is increasing faster than that anticipated due to demographic changes alone, supporting a secular increase which was evident throughout the period of time studied, in contrast to that reported from other regions in the United Kingdom.

Monocyte esterase deficiency in gastrointestinal cancer

AIM

To substantiate the high incidence of monocyte esterase deficiency (MED) in gastrointestinal carcinoma already reported in a small group of patients; to compare the clinical findings in esterase deficient and esterase positive patients.

METHODS

Peripheral blood smears (n = 22) or cytocentrifuge preparations (n = 52) of mononuclear cells from the peripheral blood of patients with gastrointestinal carcinoma were stained by the non-specific esterase stain (pH 5.8) using a batch technique. Samples containing > or = 85% esterase negative monocytes were identified at light microscopic examination.

RESULTS

Seven of 74 patients were identified as having MED. This correlated exactly with the proportion (five of 46) found before, using an automated method, and was significantly higher than the 0.8% incidence in normal blood donors shown in that study. Comparison of the clinical details of the 12 MED patients with those of 105 esterase positive patients showed a significantly longer disease free survival in the MED cohort and increased occurrence of benign neoplasms--largely colorectal polyps--in this group also. Three patients had a borderline degree of deficiency and were excluded from comparisons, although they showed the same clinical tendencies as the MED group.

CONCLUSIONS

There is a strong degree of association between monocyte esterase deficiency and gastrointestinal carcinoma. Further evidence must be sought to prove that the deficiency precedes the disease and therefore may predispose to it, or at least may identify subjects with such a predisposition. This could lead to early diagnosis and effective treatment of gastrointestinal carcinoma in a sizeable proportion of patients.

Differential staining of the cell cycle of plant cells using safranin and indigo-picrocarmine

A trichrome staining technique using safranin-indigo-picrocarmine (SIPC) can be used to distinguish the various stages of the cell cycle in onion root tip. When the tissue was fixed first in formalin followed by picric acid and stained in SIPC, a clear differentiation of interphase nuclei into four color classes, viz., green, orange, red and brown can be recorded. Replacing crystal violet for safranin produces a similar pattern of differentiation of interphase nuclei into green, light blue, blue and deep blue. Autoradiographic study using 3H-thymidine as a DNA precursor demonstrates the reliability of the SIPC staining technique. All the orange and red nuclei are found to be labelled and therefore are in S phase of the cell cycle. Almost all the green nuclei are unlabelled and may be assigned to G1. The larger brown nuclei which are mostly unlabelled can be considered in G2 phase.

The destination and dependency of patients discharged from care of the elderly units in the West Midlands

Between November 1988 and January 1989 a prospective survey was undertaken on patients aged 65 years and over who were discharged from the care of geriatricians in seven District General Hospitals. The survey aimed to provide a regional perspective on patient dependency by relating dependency at discharge to the discharge destination. The findings show that the majority of patients were relatively independent and most returned home. A significant number of the very dependent patients were discharged to the community with private residential and nursing homes making an important contribution to the placement of highly dependent patients.

Microvascular tissue transfer. Perioperative nursing considerations

Microvascular tissue transfer is a growing subspecialty in reconstructive surgery. Its use is increasing, and it has been used to solve difficult wound problems. The use of microvascular surgery has placed new demands on the perioperative nurse to remain current on perioperative implications of this type of surgery. Operating room nurses must continue to expand their knowledge of this area through ongoing education from journal review, specialty seminars, and increased operative experiences.