The purpose of this study was to describe the postpartum concerns of primiparas. A cohort study included 79 mothers in Dar es Salaam, Tanzania. Mothers sorted topics into worry, interest, and confidence. Trends of decreasing worry and increasing interest and confidence for baby-related and mother-related topics were observed from 1 to 6 weeks. At 1 week mothers worried about baby's eyes, respiration, temperature, safety, and crying; but, at 6 weeks only crying was a problem. Need for information was constant about general health, baby behavior, and care of the baby. At 1 week mothers worried about swollen perineum, and feeling tired and nervous. They wanted information about preventing hemorrhage and infection and taking care of the perineum, breasts, and nipples. Trends of increasing worry and decreasing confidence were observed with respect to family relationships. At 6 weeks, mothers worried about the husband/partner's reaction to themselves and to the baby. Confidence in relatives' reaction to themselves and the baby decreased. Being aware of the changes in the way concerns are expressed may guide nursing/midwifery interventions for mothers as to the content and timing.

Adult↗

PubMedDate not supplied

Trends in fertility patterns of women in rural Zimbabwe.

To study changes over time in reproductive health and living conditions of women in a rural setting in Zimbabwe, 12 villages were selected at random in the Gutu district, Masvingo province. During two study periods in 1992 and 1993, 1,213 women of fertile age (15-44 years) were interviewed and examined. Median age at menarche was 15 years, with a decrease of 0.4 years from the oldest to the youngest age group. There has been no increase in the mean height of women, indicating no change in determinants of nutritional status of girls in childhood and adolescence. Younger women still marry at a median age of 19 years but prefer smaller families. Level of education is the main determinant for age at marriage and preferred family size. A low prevalence of primary (1%) as well as secondary infertility (4%) was found in spite of the currently reported high prevalence of sexually transmitted diseases in Zimbabwe.

Adolescent↗

PubMedDate not supplied

Limited value of preoperative serum analyses of matrix metalloproteinases (MMP-2, MMP-9) and tissue inhibitors of matrix metalloproteinases (TIMP-1, TIMP-2) in colorectal cancer.

PURPOSE: We studied whether preoperative serum levels of free MMP-2, the MMP-2/TIMP-2 complex, and total amounts of MMP-9, TIMP-1 and TIMP-2 correlated to the tumor stage and prognosis in colorectal cancer. METHODS: Samples from 158 patients operated on for colorectal cancer (100 colon, 58 rectum) and samples from 80 healthy blood donors were analyzed using an ELISA technique. One hundred and thirty-three patients were resected for cure, (31, 61, and 41 in Dukes' stages A, B, and C, respectively). At follow-up in January 1998, 44 patients had died from their cancer after a median time 14 months (range 2-55). Fifteen patients died without tumor relapse. Ninety-nine patients were alive after, a median time of 46 months (range 17-68). RESULTS: Wide, overlapping ranges were observed for all factors both in the patients and in the control group. The patients as compared to the control group had significantly higher levels of free MMP-2 and total amounts of MMP-9, TIMP-1 and TIMP-2, whereas the level of the MMP-2/TIMP-2 complex was significantly lower. TIMP-1 was significantly higher in Dukes' D compared to Dukes' A-C cases; the other factors did not correlate to tumor stage. Elevated TIMP-2 levels (median cut-off limit), only, correlated to worse prognosis when analysed in all patients (p < 0.05). None of the factors (median cut-off limit) correlated to survival in Dukes' A-C patients; analyses based on the upper quartile cut-off limit demonstrated that elevated MMP-2 levels correlated to shorter survival time (p < 0.05). CONCLUSION: Serum analyses of free MMP-2 the MMP-2/TIMP-2 complex and total amounts of MMP-9, TIMP-1 and TIMP-2 are of limited value for tumor staging and prognosis in colorectal cancer.

Adult↗

PubMedDate not supplied

Vaginal misoprostol for induction of labour: a more effective agent than prostaglandin F2 alpha gel and prostaglandin E2 pessary.

OBJECTIVES: To compare labour outcome in women who had labour induced with PGF2 alpha gel, PGE2 vaginal pessary or misoprostol administered intravaginally or orally. STUDY DESIGN: Unmasked randomised controlled trial. SETTING: Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare. SUBJECTS: Women with a singleton foetus in cephalic presentation after 37 weeks gestation admitted for induction of labour who were randomised to prostaglandin F2 alpha gel (n = 76), prostaglandin E2 pessary (n = 75) and misoprostol administered either intra-vaginally (n = 128) or orally (n = 127). MAIN OUTCOME MEASURES: Primary outcome was induction to delivery interval. Secondary outcomes included use of oxytocin during labour, mode of delivery, duration of labour, neonatal condition at delivery and maternal complications. METHODS: Four hundred and six women admitted for induction of labour with a singleton foetus in cephalic presentation after 37 weeks gestation were enrolled. To estimate the risk with induction using other agents the odds ratio and 95% confidence interval was calculated using the group that received prostaglandin F2 alpha gel as referents. RESULTS: The women were comparable for baseline characteristics. Compared to prostaglandin F2 alpha gel, the need for augmentation with oxytocin in labour was significantly reduced in women induced with prostaglandin E2 pessary (OR 0.46; 95%CI 0.23 to 0.93), vaginal misoprostol (OR 0.34; 95%CI 0.18 to 0.63) and oral misoprostol (OR 0.42; 95%CI 0.22 to 0.78). There was no difference in mode of delivery. There was a significantly reduced risk (OR 0.20; 95%CI 0.04 to 0.86) of Caesarean section (CS) for failure to progress in the vaginal misoprostol group. Labour induced with misoprostol and prostaglandin E2 pessary was significantly shorter than in prostaglandin F2 alpha gel. Vaginal misoprostol significantly shortened the induction to delivery interval. There were more admissions to the neonatal unit in the misoprostol groups. CONCLUSION: Compared to prostaglandin F2 alpha gel, misoprostol and prostaglandin E2 pessary had reduced need for oxytocin and a shorter duration of labour. Effects of misoprostol on the foetus need further investigation before it is used as a routine agent for induction of labour.

Administration, Intravaginal↗

PubMedDate not supplied

Field efficiency of syphilis screening in antenatal care: lessons from Gutu District in Zimbabwe.

OBJECTIVES: To determine coverage for antenatal syphilis screening in a rural area and evaluate the accuracy of on-site Rapid Plasma Reagin (RPR) tests performed by nurse-midwives. DESIGN: Descriptive cross sectional. SETTING: Rural Health Centres (n = 23) in the Gutu District of Zimbabwe. SUBJECTS: Women booking for antenatal care in the district were used to determine coverage of screening. Results from women who had an RPR test performed during a nine week period were used in assessing the accuracy of tests performed by nurse-midwives. INTERVENTION: On-site antenatal screening for syphilis using an RPR kit with immediate results and treatment for women who tested positive. MAIN OUTCOME MEASURES: Prevalence of syphilis (positive RPR) at booking and the level of agreement between three observers (RHC nurse-midwife, medical practitioner under field conditions and medical laboratory technologist). RESULTS: Eighty five percent of women were screened for syphilis at the first antenatal visit and 11% had a positive RPR. Almost all (97.3%) women with a positive RPR test result were treated. The accuracy of tests performed by RHC staff was poor with a sensitivity of 40% (95% CI 21.8 to 61.1) when compared to those done by the medical practitioner and 8.7% (95% CI 1.5 to 29.5) when compared to those done in a laboratory. The predictive value of a positive test was 22.7% and that of a negative test was 94.9%. CONCLUSION: The coverage of screening for syphilis in pregnant women in Gutu District was good but the results were unreliable. There is need for nurse-midwives, who perform the majority of RPR tests in the RHC, to receive adequate training to ensure competence in testing and to strengthen quality control procedures.

Antibodies, Bacterial↗

PubMedDate not supplied

Surgery for colorectal cancer in elderly patients.

In 545 consecutive patients undergoing elective or emergency surgery for colorectal cancer (370 colon and 175 rectum), mortality and morbidity were analysed in different age groups with special reference to patients over 80 years old. In that group, 33% had an emergency operation, compared with 18% below that age. Postoperative mortality after elective surgery ranged from 3 to 11% in the different age groups, but was not significantly related to age. In contrast, postoperative in-hospital mortality after emergency surgery was high (38%) among those older than 80 years, compared with 6% below 75 years and 24% between 76 and 80 years. Postoperative morbidity, i.e. infections and cardiovascular disease, increased with age, as did the length of hospital stay. Five-year survival, independent of age, was poorer after emergency surgery than after elective surgery. It is concluded that elective colorectal resection for cancer in elderly patients is a safe procedure.

Adult↗

PubMedDate not supplied

Heterogeneity in proliferation markers in colorectal cancer.

BACKGROUND: The intratumoral heterogeneity in different markers of proliferation, and the immunohistochemical overexpression of the p53 protein-a possible regulator of proliferation-have been investigated to only a minor extent in colorectal cancer. The evaluation of tumour biopsy samples, especially preoperatively, when multiple sampling is not always feasible, must be based upon markers being more or less homogeneously expressed. MATERIALS AND METHODS: Three different DNA-labelling techniques were investigated in multiple biopsy samples (2-10, median 4) from 19 tumours obtained from 18 patients. Anti-bromodeoxyuridine and Ki-67 monoclonal antibodies were used to detect nuclei of proliferating cells in adjacent tumour sections. Adjacent tumour material was analysed by flow cytometry of propidium iodide labelled nuclei. In addition, overexpression of the p53 protein was detected using the monoclonal anti-p53 antibody DO-7 RESULTS: There was considerable intratumoral heterogeneity in the labelling indices. No correlation was found between overexpression of the p53 protein and markers for proliferation, as indicated by observations made using three different methods. In contrast, the staining for p53 protein was either homogeneously positive or negative. CONCLUSIONS: The results indicate that analyses of proliferation in preoperatively obtained tumour biopsies are of limited value for prognostic prediction, or other purposes, in view of the extensive intratumoral heterogeneity shown with three different markers.

Adult↗

PubMedDate not supplied

Limited clinical significance of the serum tumour marker Ca 72-4 in colorectal cancer.

BACKGROUND: We explored the potential value of CA 72-4 in the staging and prognostic prediction of colorectal cancer, as compared to six previously investigated serum tumour markers - CEA, CA 19-9, CA 50, CA 242, TPA, and TPS. MATERIALS AND METHODS: CA 72-4 was analysed using an immunoradiometric assay in serum samples obtained, prior to surgery, from 196 consecutive patients resected between Jan. 1987 and Nov. 1992. RESULTS: CA 72-4 levels increased with progressive tumour stages; a high level correlated with poor prognosis. However, the information obtained from CA 72-4 did not improve the ease of staging, as compared with other tumour markers. Various combinations of CA 72-4 with the other tumour markers did not add any substantial information to the staging process either. The value of the CA 72-4 in prognostic prediction, as shown in the univariate analysis, was limited in the multivariate tumour marker analyses. CONCLUSIONS: CA 72-4 does not improve the staging and prognostic prediction of colorectal cancer, when compared with other serum tumour markers used.

Adult↗

PubMedDate not supplied

Immunohistological p53 staining is of limited value in the staging and prognostic prediction of colorectal cancer.

PURPOSE: To compare immunohistochemical staining using different anti-p53 antibodies, and to evaluate the possible clinical implications of the overexpression of p53 in a series of patients resected for colorectal cancer with a long follow-up. METHODS: Tumor biopsy samples were collected from 294 surgical colorectal cancer specimens, obtained from two series of patients with a median follow-up of 4.5 years. The samples stained with four commercially available anti-p53 antibodies, (mouse monoclonal antibodies 421, 1801, and DO-7; and rabbit polyclonal antibody CM1), were evaluated and compared with cryosections from a subset of 20 biopsies from tumors in various stages and grades, obtained from patients with different outcomes. RESULTS: DO-7 gave a homogeneous nuclear staining, which, when further investigated, turned out to be identical in the formalin-fixed paraffin-embedded and in the frozen specimens. Therefore, DO-7 was found to be suitable for the further analysis of archival or frozen sections from the sample. p53 overexpression was shown in 162 (55%) cases, with a significantly higher proportion having DNA aneuploidy (p<0.01) in left-sided colonic and rectal tumors (p<0.01). p53 staining was not associated with tumor stage, tumor grade, or survival. CONCLUSIONS: A significantly higher proportion of p53 overexpressing tumors are DNA aneuploid, indicating that mutations in the TP53 gene constitute a sign of genetic instability, which might be of importance in malignant transformation. However, we could not find any indication that TP53 mutations, as reflected in the overexpression of p53, constitute a prerequisite for tumor progression in colorectal cancer.

Adult↗

PubMedDate not supplied

A community-based investigation of avoidable factors for maternal mortality in Zimbabwe.

A community-based investigation of maternal deaths was undertaken in a rural province (Masvingo) and an urban area (Harare) of Zimbabwe in order to assess their preventability. Avoidable factors were identified in 90 percent of the 105 rural deaths and 85 percent of 61 urban deaths. Delay in seeking treatment contributed to 32 percent and 28 percent of rural and urban deaths, respectively. Lack of transportation delayed or prevented access to healthy facilities in the rural area, a major problem in 28 percent of the cases studied. Suboptimal clinic and hospital management was identified in 67 percent and 70 percent of rural and urban deaths, respectively. Lack of appropriately trained personnel contributed to suboptimal care. In both settings, the severity of patients' conditions was frequently unrecognized, leading to delays in treatment and referral, and inadequate treatment. Appropriate community and health-service interventions to reduce maternal mortality are discussed.

Abortion, Induced↗