Biomedical subjects

A L M Lagro-Janssen

Publications and source records attributed to A L M Lagro-Janssen.

14 recordsLinked to original sources

PubMed2007

Increased blood loss in upright birthing positions originates from perineal damage.

OBJECTIVE: To assess whether the risk of severe blood loss is increased in semi-sitting and sitting position, and if so, to which extent blood loss from perineal damage is responsible for this finding. DESIGN: Secondary analysis of data from a large trial. SETTING: Primary care midwifery practices in the Netherlands. POPULATION: About 1646 low-risk women who had a spontaneous vaginal delivery. METHODS: Blood loss was measured using a weighing scale and measuring jug. Logistic regression analysis was used to examine the net effects of birthing position and perineal damage on blood loss greater than 500 ml. MAIN OUTCOME MEASURES: Mean total blood loss and incidence of blood loss greater than 500 ml and 1000 ml. RESULTS: Mean total blood loss and the incidence of blood loss greater than 500 ml and 1000 ml were increased in semi-sitting and sitting position. In logistic regression analysis, the interaction between birthing position and perineal damage was almost significantly associated with an increased risk of blood loss greater than 500 ml. Semi-sitting and sitting position were only significant risk factors among women with perineal damage (OR 1.30, 95% CI 1.00-1.69 and OR 2.25, 95% CI 1.37-3.71, respectively). Among women with intact perineum, no association was found. CONCLUSIONS: Semi-sitting and sitting birthing positions only lead to increased blood loss among women with perineal damage.

Adult↗

PubMed2006

[Menstruation disorders more frequent in women with a history of sexual abuse].

OBJECTIVE: To determine the relationship between menstruation disorders and prior sexual abuse. DESIGN: Questionnaire investigation. METHOD: A questionnaire was developed consisting of 50 questions about menstruation disorders, premenstrual syndrome and sexual abuse. The questionnaire was mailed to all female patients aged 12-54 years (n = 1805) of one family practice in Den Helder, the Netherlands. RESULTS: The response rate to the questionnaire was 69% (n = 1254). After excluding women who were postmenopausal, pregnant, without a uterus, or who did not answer the questions on sexual abuse, 947 remained. Of these women, 83 (8.7%) reported having experienced sexual abuse. These women had significantly more dysmenorrhoea, more dysfunctional menstrual bleeding and significantly more menstrual cycle irregularities. CONCLUSION: A statistically significant association was found between menstrual problems and prior sexual abuse. Sexual abuse should be considered in the differential diagnosis and treatment of women who seek medical help for inexplicable menstrual disorders.

Adolescent↗

PubMed2006

[Diagnostic value of patient history and physical examination in elderly patients with urinary incontinence; a literature review].

OBJECTIVE: To assess the validity of patient history and physical examination in elderly patients in the diagnosis ofvarious types of urinary incontinence. DESIGN: Literature review. METHOD: Articles on the diagnosis of urinary incontinence in elderly patients (patient history and/or physical examination versus urodynamic testing) were identified using PubMed, Picarta (a Dutch database) and the reference lists of the articles found. Articles were published between January 1970 and August 2005. The applicability and quality of the articles were assessed using the relevant Cochrane criteria. 'Sufficient diagnostic evidence' was defined as a positive likelihood ratio > 5 and a negative likelihood ratio < 0.02. RESULTS: 5 studies met the eligibility criteria; 4 were performed in the second-line setting and 1 in a general population. All 5 studies involved women aged 55 years or older. None of the 5 studies found a positive or negative likelihood ratio for providing sufficient diagnostic evidence for various types of urinary incontinence. In the study conducted in a general population, the positive and negative likelihood ratios for the presence of stress incontinence according to patient history and physical examination were 3.23 and 0.40, respectively. CONCLUSION: Few adequate studies have been reported on the validity of clinical evaluation in the diagnosis of urinary incontinence in older women, and no studies have been conducted in men. The validity of clinical evaluation has been demonstrated only in the diagnosis of stress incontinence in older women.

Aged↗

PubMed2005

[Sexual harassment of medical students during their period of work placement].

OBJECTIVE: To investigate the incidence, type and consequences of sexual harassment of medical students at the Radboud University in Nijmegen, the Netherlands, during their period of work placement, as well as the students' need for care thereafter. DESIGN: Questionnaire. METHOD: During the period from 1 July to 31 December 2003, 5th and 6th year medical students were asked about their experiences with sexual harassment by means of a questionnaire. Sexual harassment was defined as unwelcome, sexually-coloured attention. RESULTS: Of the 183 questionnaires distributed, 113 (62%) were returned. 15 (20%) of the 75 female students and none of the 38 male students had experienced sexual harassment. The offenders included 9 patients and 6 doctors (54 men and 1 woman). In 7 of the 15 cases the harassment consisted of combinations of unwanted behaviour and unwanted sexually-coloured remarks. 9 of the 15 students had discussed their experiences with their peers, 7 with a supervisor and 3 with nobody. The most important reason to discuss it first in their peer group was that, despite the fact that the students were convinced that the offender's behaviour was unacceptable, they still doubted their own judgement. 5 students felt inhibited in their contacts with patients after the incident. 8 of the 15 offenders were not confronted with their behaviour. 6 of the 15 students were not satisfied with the way their case was handled. CONCLUSION: The problem of sexual harassment of medical students during their period of work placement should not be underestimated. It has a negative impact on the personal and professional conduct of future doctors. This subject should be part of the training of both medical students and their supervisors.

Adult↗

PubMed2005

[The practice guideline 'Miscarriage' (second revision) from the Dutch College of General Practitioners; a response from the perspective of general practice].

The practice guideline 'Miscarriage' has been reviewed for the second time in fifteen years. It provides the practitioner with distinct diagnostic tools for vaginal bleeding in the first sixteen weeks of pregnancy and a clear management algorithm. The management of miscarriage is based on a joint decision between the general practitioner and the woman concerned. A more reserved attitude towards the surgical termination of pregnancy is advised. The guideline sufficiently addresses the issue of informing the woman as to the expected amount of bleeding during a miscarriage and the relationship with fertility. However, the risk factors for heavy blood loss are not mentioned in the guideline. The psychological impact of early miscarriage on women is given adequate attention and is part of the counselling during the follow-up period. Finally, the medical treatment of threatened miscarriage seems to result in an earlier miscarriage with less loss of blood compared to expectant management. The guideline pays also attention to medical treatment. Future research will clarify whether medical treatment is feasible in general practice.

Abortion, Spontaneous↗

PubMed2005

[Intimate partner abuse of women: identification of victims in medical practice].

Intimate partner abuse is world-wide much more prevalent than often suspected. Three female patients consulted their family doctor with a variety of complaints. A 53-year-old woman, mother of three grown-up children, and divorced a year ago, sought help after four days, for a large infected wound of her right hand. A 32-year-old single mother of a 2-year-old girl asked the practice assistant for an iteration of a tranquillizer because of tension headache. A 36-year-old divorced mother of three sons was sent by her company doctor to ask for a referral to a psychiatrist because of chronic fatigue. All three women appeared to have been severely abused by their partners, recently or in the past, and were reluctant to disclose the abuse. Two women were regular visitors of doctor's offices with diverse unspecific complaints. The third woman was a victim of sexual abuse as a child and was severely depressed. Active asking about experiences of intimate partner abuse helped these women to disclose the real nature of their problem. Important effect is that abused women can accept help and experience support to improve their situation. Doctors should suspect intimate partner abuse more often in patients who are heavy medical consumers, depressed or victims of sexual abuse in childhood. Single and divorced mothers can hide a history of abuse. Doctors should ask clear and specific questions about relationships and listen without passing judgement so as to help women to disclose abuse.

Adult↗

PubMed2005

Integrating gender into a basic medical curriculum.

INTRODUCTION: In 1998, gaps were found to exist in the basic medical curriculum of the Radboud University Nijmegen Medical Centre regarding health-related gender differences in terms of biological, psychological and social factors. After screening the curriculum for language, content and context, adjustments aimed at incorporating gender issues were proposed. The aim of this study was to evaluate those adjustments, as well as to investigate whether gender had been successfully incorporated into the basic medical curriculum, and to identify the factors that played a role in this. METHODS: The education material of 9 curricular blocks was re-evaluated and interviews were held with block co-ordinators. RESULTS: Since the beginning of the project, gender has increasingly been brought to the attention of the students. Various factors have played a role: concrete and directly executable content-oriented proposals for adjustment; adequate translation of gender differences into actual patient care; motivated block co-ordinators; the presence of a 'trigger person' in the faculty; incorporation into the existing education programme; the involvement of block co-ordinators in decision making, and the provision of practical support. DISCUSSION: Integrating gender into the basic medical curriculum has been largely successful. Block co-ordinators' personal recognition of the importance of gender in patient care greatly facilitated implementation. The evaluation stimulated the forming of new ideas. It is recommended that these factors and those mentioned above should be taken into consideration when integrating gender into other faculties.

Curriculum↗

PubMed2004

[Genital prolapse; treatment and course in four general practices].

OBJECTIVE: To obtain insight into the treatment and course of genital prolapse in four general practices. DESIGN: Historical cohort study. METHOD: The files of patients in whom a prolapse was first diagnosed in the period 1976-2000 and who belonged to the four general practices associated with the General Practice Department of the UMC St Radboud in Nijmegen, the Netherlands, were studied. Data were collected concerning the management, course and symptoms arising from the use of pessaries and complications after operations. RESULTS: 324 patients were included with a median follow-up of 9 years; 15 of them had been treated by a gynaecologist. The initial treatment prescribed by the general practitioner (n = 309) was a wait-and-see policy in 29% of the cases, a pessary (40%), exercises of the muscles of the pelvic floor (15%) or medication (5%). A total of 192 of the 324 patients (59%) received a pessary in the course of time; 47% of them had no problems during the use of a pessary, 17% had increased vaginal discharge and 17% had a pressure ulcer. In 15% of the cases the pessary was ultimately lost because of insufficient support from the pelvic floor muscles. The pessary remained in situ for an average of 5.4 years (SD: 5.4). In 107 (56%) cases it was removed after a period of time; the most important reasons for this were complaints arising from the use of the pessary (54%) and ineffectiveness (24%). In case of a conservative approach (n = 299), the prolapse became worse in 15% of the cases. A total of 128 patients (40%) were referred to a gynaecologist. Of the 92 patients who were operated, 10% experienced a complication and 24% a recurrence. CONCLUSION: The pessary was a frequent and justified treatment in women with a genital prolapse. It is important that the complications of the pessary be reduced further.

Cohort Studies↗

PubMed2004

Supine position compared to other positions during the second stage of labor: a meta-analytic review.

The routine use of the supine position during the second stage of labor can be considered to be an intervention in the natural course of labor. This study aimed to establish whether the continuation of this intervention is justified. Nine randomized controlled trials and one cohort study were included. A meta-analysis indicated a higher rate of instrumental deliveries and episiotomies in the supine position. A lower estimated blood loss and lower rate of postpartum hemorrhage were found in the supine position, however it is not clear whether this is a real or only an observed difference. Heterogenous, non-pooled data showed that women experienced more severe pain in the supine position and had a preference for other birthing positions. Many methodological problems were identified in the studies and the appropriateness of a randomized controlled trial to study this subject is called into question. A cohort study is recommended as a more appropriate methodology, supplemented by a qualitative method to study women's experiences. Objective laboratory measurements are advised to examine the difference in blood loss. In conclusion, the results do not justify the continuation of the routine use of the supine position during the second stage of labor.

Adult↗

PubMed2004

Birthing positions. A qualitative study into the views of women about various birthing positions.

The aim of this study was to gain insight into the influences on women's use of birthing positions, and into the labor experiences of women in relation to the birthing positions they used. Quantitative studies have shown some medical advantages of non-supine birthing positions. They also suggested some psychological benefits but these are difficult to interpret. In this study in-depth interviews were conducted to gain a deeper understanding of the relationship between birthing positions and the labor experience. We found that the advice given by midwives was the most important factor influencing the choice of birthing positions. If medically possible, women benefited from having the autonomy to find the positions that were most useful to them. Their choices varied greatly, as did their experience of pain in relation to the type of position. Women, regardless of ethnicity, were most familiar with the supine position but valued practical information on other options. In conclusion, because the supine position is dominant in westernized societies, midwives have an important role to play in widening the range of women's choices. Midwives should empower women to find the positions that are most suitable for them, by giving practical advice during pregnancy and labor.

Adult↗

PubMed2004

Complications of the intrauterine device in nulliparous and parous women.

OBJECTIVES: The intrauterine device (IUD) is still related to pelvic inflammatory disease (PID), pregnancy, expulsion, perforation and menstrual problems, particularly in nulliparous women. We aimed to study the complications and symptoms of the intrauterine device in general practice, particularly in nulliparous women. METHODS: We used a retrospective cohort study in four general practices participating in the Nijmegen Continuous Morbidity Registration. Selected women had one or more IUDs inserted between 1981 and 2000. Data on complications, symptoms and removal of the IUD were obtained from the medical records. RESULTS: 461 women were included, 129 nulliparous and 332 parous women. Users of copper IUDs had a rate of PID of 3.5 per 1000 women-years, rates of (ectopic) pregnancy of 0.6 to 1.1% per year and rates of expulsion of 0 to 1.2% per year. Rates of expulsion for the levonorgestrel-releasing IUDs were 0 to 0.2% per year. Nulliparous women did not show more complications than parous women. Menstrual problems were frequent among users of copper and levonorgestrel-releasing IUDs. One third of the IUDs were removed within the first year after insertion. There was no significant excess of IUD removal among nulliparous women compared with parous women. Main reasons for removal were 'menstrual problems' and 'contraception no longer necessary'. CONCLUSION: Both copper and levonorgestrel-releasing IUDs are safe and highly effective contraceptives, which can adequately be inserted and monitored by general practitioners in nulliparous and parous women.

Adolescent↗

PubMed2004

Treating urinary incontinence in the elderly--conservative therapies that work: a systematic review.

OBJECTIVE: To evaluate the effectiveness of conservative treatment in the community-based elderly (aged > or = 55 years) with stress, urge, and mixed urinary incontinence. DESIGN: Systematic review of before-after studies or randomized controlled trials on the effect of exercise and drug therapy in urinary incontinence. MAIN OUTCOMES MEASURED: Reduction of urinary accidents, patient's perception, cystometric measurement, perineometry, and side effects. SEARCH STRATEGY: MEDLINE (1966-2001), EMBASE (1986-2001), Science Citation Index (1988-2001), The Cochrane Library, and PiCarta were searched. RESULTS Four before-after studies and 4 randomized controlled trials were identified. Drug therapy alone: no study of sufficient quality. Drug therapy compared with behavioral therapy, 3 studies: bladder-sphincter biofeedback reduced urinary accidents in cases of urge or mixed incontinence by 80.7%, significantly better than oxybutynin (68.5%) or placebo (39.4%). Adding drug to behavioral treatment or behavioral to drug treatment also resulted in significant reduction in urodynamic urge incontinence (57.5%-88.5% vs 72.7-84.3%). Pelvic floor exercises alone reduced urinary accidents by 48% (compared with 53% for phenylpropanolamine) in patients with mixed or stress incontinence. Behavioral therapy, 5 studies: bladder-sphincter biofeedback in case of urge or mixed incontinence, bladder training in case of urge incontinence and pelvic floor exercises in case of stress incontinence reduced the urinary accidents with 68% to 94%. CONCLUSION: There are only a few studies of sufficient methodological quality on the effect of conservative treatment of urinary incontinence in the elderly. Behavioral therapy reduced urinary accidents; the effect of drug therapy is unclear. We recommend behavioral therapy as first choice.

Aged↗

PubMed2004

[What do dental students think about their future career practice? Differences between men and women].

Aim of this study was to get more insight into the career choice, plans and expectations, and practice pattern preferences of male and female dental students in The Netherlands. A structured questionnaire was sent out to all 5th year dental students in The Netherlands in the academic year 2001/2002 (n = 258). The overall response was 65%. Both male and female students prefered working in a group practice environment rather than a solo practice, in which significant more males prefered ownership. Only 23% of the males and 7% of the females expected to work full time in the future. An important factor was leisure time, but for the female students 'taking care for children' was still decisive. The new job description 'oral physician' for the future dentist as advocated by Dutch health authorities was found less attractive than the present profession 'dentist'. Only a quarter of the females and half of the males is interested to serve as manager of a team of dental health professionals. It is concluded that male and female dental students differ in their plans and expectations with respect to their future career choices and practice pattern preferences. As the majority of the present dental students is female this will have a major impact on the dental profession.

Adult↗

PubMed2003

Prevalence of urinary, fecal and double incontinence in the elderly living at home.

The aim of this study was to evaluate the prevalence of urinary, fecal and double incontinence in the elderly, through a population-based cross-sectional survey. The study included all patients aged 60 and over of nine general practices in the Nijmegen Monitoring Project. Patients living in a home for the elderly were excluded, as well as patients with dementia, patients who were too ill to participate and patients with a catheter. There were 5278 selected patients who received a postal questionnaire. Of these, 88% returned it. Nineteen percent of the respondents had involuntary loss of urine twice a month or more, 6% loss of feces and 3% both. The prevalence of urinary, fecal and double incontinence increased with age in both men and women, and especially in men in the oldest age group. Urinary incontinence was more prevalent in women than in men. The prevalence of fecal incontinence showed no sex differences, but the type of fecal incontinence did differ between men and women. In men loss of mucus was twice as common as in women. Double incontinence was also equally prevalent in men and women, except in the age group 65-74 years. In conclusion, urinary, fecal and double incontinence are common conditions in the community-dwelling population. The prevalence rates increase with age. Urinary incontinence is more prevalent in women. There were no sex differences in the prevalence of fecal incontinence but the type of fecal incontinence was different in men and women.

Aged↗