OBJECTIVE: Our objective was to assess whether, for women with previous cesarean section, a prenatal education and support program promoting vaginal birth after cesarean delivery increases the ...probability of vaginal delivery.
STUDY DESIGN: Women with a single previous cesarean were recruited before 28 weeks' gestation. Women's self-assessed motivation to attempt vaginal birth after a previous cesarean delivery was measured on a 10 cm visual analog scale: stratum I, low motivation; stratum II, high motivation. Women were randomized by stratum to one of two groups. Those in the “Verbal” group participated in an individualized education program. Those in the “Document” group were provided with a pamphlet detailing the benefits of planned vaginal birth after cesarean delivery.
RESULTS: Rates of vaginal birth after cesarean section were similar in the verbal and document groups: verbal, 339 of 641 (53%); document, 310 of 634 (49%); relative risk 1.1, 95% confidence interval 1.0 to 1.2. There was no evidence of heterogeneity across motivational strata. Regardless of treatment group, women with low motivation for vaginal birth after cesarean section were more than three times as likely to undergo elective repeat cesarean than were women with high motivation (47% vs 13%).
CONCLUSIONS: There was no evidence that an individualized prenatal education and support program, when offered to all women with previous cesarean delivery, results in a clinically significant increase in the rate of vaginal birth after cesarean section.(Am J Obstet Gynecol 1997;176:419-25.)
Economic Analysis of Pavement Preservation Techniques Zuniga-Garcia, Natalia; Martinez-Alonso, Wilfrido; de Fortier Smit, Andre ...
Transportation research record,
12/2018, Letnik:
2672, Številka:
12
Journal Article
Recenzirano
This paper summarizes the research study conducted to develop and implement a methodological framework, using an economic analysis technique, to evaluate the cost effectiveness of the three different ...preventive maintenance treatments applied to roadways in Texas: chip seals, microsurfacing, and thin overlays. The analysis is based on a stochastic evaluation of the effective life and cost of more than 14,000 maintenance and rehabilitation projects undertaken from 1994 to 2015. The effect of traffic loads, traffic volume, and roadway type was also evaluated. The life-cycle cost of the preventive maintenance techniques was obtained using a Monte Carlo simulation. Among the principal results, it was found that chip seals are the most cost-effective treatment and present the lowest life-cycle cost variability. The effective life of all three treatments was found to be quite similar. Additionally, it was found that the chip seals and microsurfacing tend to present comparable life-cycle costs when used on heavy traffic roadways.
To determine the effects of transforming growth factor-beta 1 (TGF-beta 1) on the synthesis of DNA, collagen, and proteoglycans (PG) by equine chondrocytes.
Articular cartilage obtained from multiple ...joints of a 4-month-old foal.
Chondrocytes were isolated by collagenase digestion, cultured in monolayer, trypsinized, and implanted at a cellular density of 10 x 10(6) chondrocytes/ml in a three-dimensional fibrin matrix. Chondrocytes in culture were supplemented with TGF-beta 1 at concentrations of 0, 1, 5, or 10 ng/ml in serum-free medium or medium containing fetal bovine serum (FBS). Total PG accumulation, 35S-labeled PG synthesis, PG monomer hydrodynamic size, type II collagen production, total DNA content, and 3Hthymidine incorporation into DNA were determined at 7 and 14 days of culture.
Chondrocytes maintained a rounded phenotype, dedifferentiating slightly to a more fibroblastic appearance only in medium containing FBS and 10 ng of TGF-beta 1/ml. Type II collagen immunoreaction on day 14 was decreased in the pericellular matrix in cultures containing FBS and 1, 5, and 10 ng of TGF-beta 1/ml, and in all serum-free culture conditions compared to FBS and 0 ng of TGF-beta 1/ml. Total proteoglycan accumulation and 35S-labeled proteoglycan synthesis in cultures on days 7 and 14 were increased by the addition of exogenous TGF-beta 1 in serum-free conditions and decreased by TGF-beta 1 in FBS-supplemented conditions. Calculation of the partition coefficients for PG indicated that there was synthesis of low molecular weight PG in serum-free conditions and larger sized proteoglycans in FBS-supplemented conditions. Proteoglycan molecular size was unchanged by the addition of TGF-beta 1. Total DNA content of chondrocytes increased with the addition of TGF-beta 1 in FBS-supplemented conditions and decreased in serum-free conditions.
In a solid three-dimensional fibrin matrix, the effects of TGF-beta 1 on chondrocyte biological activity depend on the culture duration and on the presence of FBS in the medium. Stimulatory effects of TGF-beta 1 were most pronounced in serum-free culture conditions with high concentration of TGF-beta 1 (5 and 10 ng/ml) on day 7 and with low concentration of TGF-beta 1 (1 ng/ml) on day 14.
TGF-beta 1 may not be a suitable growth factor for enhancement of equine articular grafting in sites exposed to serum.
To assess the effects of supraphysiologic concentrations of insulin-like growth factor-1 (IGF-1) on morphologic and phenotypic responses of chondrocytes.
Articular cartilage obtained from 2 young ...horses.
Chondrocytes were suspended in fibrin cultures and supplemented with 25, 12.5, or 0 mg of IGF-1/ml of fibrin. Chondrocyte morphology and phenotypic expression were assessed histologically, using H&E and Alcian blue stains, immunoreaction to collagen type I and II, and in situ hybridization. Proteoglycan content, synthesis, and monomer size were analyzed. The DNA content was determined by bisbenzimide-fluorometric assay, and elution of IGF-1 into medium was determined by IGF-1 radioimmunoassay.
Both 12.5 and 25 kg of IGF-1/ml enhanced phenotypic expression of chondrocytes without inducing detrimental cellular or metabolic effects. Highest concentration of IGF-1 (25 microg/ml) significantly increased total DNA content, glycosaminoglycan (GAG) content, GAG synthesis, and size of proteoglycan monomers produced, compared with cultures supplemented with 12.5 microg of IGF-1/ml or untreated cultures. Histologic examination confirmed these biochemical effects. Matrix metachromasia, type-II collagen in situ hybridization and immunoreaction were increased in cultures treated with 25 microg of IGF-1/ml, compared with cultures supplemented with 12.5 microg of IGF-1/ml or untreated cultures.
Chondrocytes exposed to high concentrations of IGF-1 maintained differentiated chondrocyte morphology and had enhanced synthesis of matrix molecules without inducing apparent detrimental effects on chondrocyte metabolism. These results suggest that application of such composites for in vivo use during cartilage grafting procedures should provide an anabolic effect on the grafted cells.
Chronic pain affects millions of Americans. Treating chronic pain can be difficult because it is a complex condition influenced by genetic makeup and physiological and psychological factors. The ...experience of major life events has also been found to affect the psychosocial functioning, health, and health behaviors of patients. Whereas the impact of major life events on the use of traditional medical practices has been explored, only one study to date has examined the relationship between major life events and use of complementary and alternative medicine (CAM).
This study examined the impact of major life events on the use of CAM among patients with chronic pain syndromes.
Participants were consecutive patients seeking treatment at a pain clinic.
The study occurred at a tertiary center for pain management in Southern California.
Participants were adult patients experiencing chronic pain for at least 6 mo, seeking treatment at a pain center.
Participants completed a measure assessing their use of CAM modalities as well as their receptiveness to using previously unused CAM modalities, and they provided demographic information, including the occurrence of major life events, such as a job loss.
A total of 199 adults with chronic pain participated in the study. The majority (91.6%) of chronic pain patients in the study reported using at least one form of CAM, with an average of at least five different forms of CAM. Individuals reported receptiveness to CAM modalities that they had not previously used (P < .05). Rates of CAM use were greater among those that had experienced a major life event in the prior 6 mo (P < .05). The most common major life events for this group included a compromised medical status, death of a loved one, financial hardship, a major geographical move, and altered family relationships.
The study found that individuals with chronic pain frequently use CAM therapies, especially those who had recently experienced a major life event. Major life events may motivate patients with chronic pain to seek out different forms of CAM as a way to manage their pain.
Abstract
Disparities in quality of life in Latino youth in cancer treatment and their families have been well documented. Parents of children undergoing cancer treatment experience increased stress ...that impacts physical and emotional health and subsequently, quality of care received by children. Access to supportive interventions may also be limited for Latino caregivers, due to myriad factors such as lack of insurance, income, language barriers, and documentation status. Accordingly, we aimed to address this gap in the literature by engaging in an equitable collaboration with community partners to develop an intervention to improve quality of life in Latino caregivers of children with cancer. Specifically, we utilized a community-based participatory research (CBPR) model to create a community advisory board with which to partner in this endeavor. Spanish-speaking parents of youth who were in or had previously undergone cancer treatment were recruited. We held regular meetings over the course of one year to identify themes of recurring experiences and barriers to optimal quality of life during children’s cancer treatment. Meetings were continuously evaluated to ensure adherence to the following CBPR principles: 1. collaborative & equitable, 2. mutually beneficial, 3. co-learning process and were transcribed and coded for thematic elements. Significant themes unique to this population included: increased parental stress given cancer care generally fell to one parent, minimal access to self-care strategies, lack of culturally competent healthcare, lack of access to appropriate health-related information, and language barriers affecting quality of communication and information transfer. These themes were used to identify components of a caregiver intervention that includes modules addressing interactions with healthcare providers, self-care with a focus on stress management, and health literacy. Next steps in this program of research are to vet the intervention components with a larger community advisory board to ensure cultural relevance and appropriateness and develop and implement the intervention. This program of research has the potential to minimize disparities in psychosocial outcomes in underserved Latino families of children with cancer.
Citation Format: Michelle A Fortier, Ramon Garcia, Lessley Torres, Sonia Zavala, Beverly Mendoza, Elisa Ornelas, Haydee Cortes, Zeev N Kain, Belinda Campos. A community-based participatory research approach to address healthcare disparities in quality of life of Latino parents of children with cancer abstract. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B038.
The regulation of prostagladin (PG) production and cAMP generation was studied in vitro in cultured smooth muscle cells isolated specifically from the circular or longitudinal layers of the bovine ...myometrium. We found that prostacyclin (PGI2) was the principal PG produced by the myometrium, especially in the longitudinal layer, followed clostly by PGE2 and marginally by PGF2a. The PG production (fg/ml, mean +/- SD) in the circular and longitudinal layers was, respectively, PGE2 (424.4 +/- 162.0) PGI2 (189.5 +/- 19.0) PGF2a (9.5 +/- 3.0) versus PGI2 (751 +/- 36) PGE2 (515.7 +/- 94.0) PGF2a (16.3 +/- 3.0); production was stimulated up to 15-fold 24 h after addition of phorbol 12-myristate (PMA; 100 nM). Hormonal control of PC production was assessed by use of a steroidal antiestrogen, EM-139. PG production was inhibited in a concentration-dependent manner by EM-139 in both circular and longitudinal layers, with maximal inhibition at 1 micromolar. In parallel studies, chronic treatment with EM-139 resulted in significant increases in isoproterenol-induced cAMP production in both muscle layers, but more especially in the circular layer. This antiestrogenic effect was reversed by addition of 17-beta-estradiol. These results indicate that the two smooth muscle layers of the bovine myometrium have distinct patterns of PG production and that the adenylate cyclase/cAMP response of the circular layer is more sensitive to estrogen modulation. Our findings with a cell culture model of separated myometrial layers provide strategic information for a better understanding of the regulation of uterine contractility during pregnancy
