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Biomedical subjects

Lisa Baker

Publications and source records attributed to Lisa Baker.

10 recordsLinked to original sources
PubMed2006

Systematic review of nulliparous women's views of planned cesarean birth: the missing component in the debate about a term cephalic trial.

BACKGROUND: The suggestion that planned cesarean birth is gaining acceptance among women has led some physicians to advocate the need for a trial of primary planned cesarean section versus planned vaginal birth in healthy women with singleton cephalic pregnancies at term. This paper reviews published studies of nulliparous women's views of mode of birth collected in the antenatal period, examining why women may express a preference for cesarean birth and exploring implications for the debate about the need for a trial. METHODS: A systematic literature review was undertaken of Cochrane, CINAHL, EMBASE, MEDLINE, and PsycINFO using the MeSH heading "cesarean section" and four free text spellings of "cesarean," or "birth" or "delivery," near truncated synonyms of 17 words meaning expressed preference. Studies of nulliparous women with a medical indication for cesarean birth, studies where a woman's preference for mode of birth was reported in the postpartum period, surveys of midwives or obstetricians, and opinion and non-English language papers were all excluded. RESULTS: Nine papers were included in the review, which reported rates of women expressing a preference for cesarean birth that ranged from 0 to 100 percent at recruitment. However, the papers raised specific methodological, conceptual, and cultural issues that may have influenced women's preferences for mode of birth in the populations studied. These issues included the timing and frequency of data collection, complexity of factors determining individual women's decision making, and influence of societal norms. CONCLUSIONS: Little evidence is available that an increasing cultural acceptance of cesarean delivery will bring about support for a trial among pregnant nulliparous women. Further qualitative research investigating the influence of both obstetric and psychosocial factors on women's views of vaginal and cesarean birth is required.

Adult↗
PubMed2006

Breastfeeding and family life.

The problems faced by breastfeeding mothers are well documented. However, the influence of social networks has mainly received attention solely through the eyes of the women. Therefore, we explored the views of the family as a whole. This exploratory study utilizes semi-structured interviews, diaries and questionnaires. A purposive sample of 24 women and their families, from a hospital in the north-west of England were invited to participate. Questionnaire data were analysed descriptively. Diaries and interviews were analysed using an open coding mechanism to identify emergent themes. Twenty-three women and 27 of their family members participated. Questionnaire data showed that the majority of women (n = 17) expected to breastfeed for more than 3 months; 12 actually did this. Women anticipated that family members would provide the main source of breastfeeding support. Three main themes emerged from the interviews and diaries: "moving with the times", "marketable commodity" and "disparate communications". The authors conclude that multi-layered approach to breastfeeding promotion and support should be considered. Society needs to proactively encourage a positive breastfeeding culture, family members need direction on how to support a woman to breastfeed and women need to be able to articulate their individual requirements. Midwives could be instrumental in supporting such needs and facilitating change.

Adolescent↗
PubMed2005

Prevalence of postpartum depression in a native American population.

OBJECTIVES: Data were collected on postpartum depression from 151 women, ages 16-40 years who received postpartum health services from a rural obstetrical clinic in North Carolina between September 2002 and May 2003. Reflective of the racial and socio-economic makeup of the county, 60.9% of the sample were American Indian (Lumbee tribe) 25.8% were African American and 13.3% were Caucasian or other. METHODS: The Postpartum Depression Screening Scale (PDSS) was utilized to explore the prevalence of postpartum depression requiring clinical intervention in a largely unexplored population, minority women. RESULTS: The incidence of postpartum depression symptoms was over 23%, which is significantly higher than even the most liberal estimates in other populations. As with previous literature on risk factors, the sample demonstrates a strong association between symptoms of depression, history of depression and receiving treatment for depression. CONCLUSIONS: The PDSS proved to be a clinically useful tool in this setting. Findings support the importance of implementing routine screening protocols to guide practice and implement support services.

Adolescent↗
PubMed2005

Racial difference in circulating sex hormone-binding globulin levels in prepubertal boys.

Racial differences in disease risk (eg, osteoporosis, metabolic cardiovascular syndrome, and prostate cancer) may arise partly on a hormonal basis. While reports of racial differences in gonadal steroid hormone levels in middle-aged men have produced conflicting results, there is evidence that high sex hormone-binding globulin (SHBG) and estradiol levels are more common among young adult African American men than white men. To determine whether this difference relates to pituitary-testicular functioning or to other factors, we conducted a cross-sectional study of 47 healthy prepubertal African American and white boys aged 5 to 9 years at the time of their annual school physical examination. Height, weight, blood pressure, waist and hip circumference, and Tanner staging were determined, and a fasting blood sample was obtained. The African Americans studied were slightly older than the whites (mean +/- SD, 82.4 +/- 15.0 vs 70.5 +/- 10.3 months, P = .003). African Americans were also slightly taller and heavier and had a lower waist-to-hip ratio, but these differences could be explained by the difference in age. Mean SHBG levels were 25% higher (P = .15) in African Americans than in whites (197 +/- 104 vs 157 +/- 79 nmol/L), and when adjusted for age, values were 46 nmol/L higher among African Americans. The fifth quintile for SHBG (values > 245 nmol/L) included 1 (4.2%) of 24 whites and 8 (35%) of 23 African Americans studied (P = .003). There was no significant correlation between age, body mass index, waist circumference, or fasting insulin and SHBG. Total testosterone, the free androgen index, and dehydroepiandrosterone increased with age in both groups, but after adjusting for age, no racial differences were found. Estradiol, estrone, and inhibin B levels, as well as systolic and diastolic blood pressures, were also comparable in both groups. We conclude that high levels of SHBG are more common among African American than in white boys and hypothesize that this difference and its effect on the ratio between bound and free steroid hormones may contribute to racial differences in disease risk in adult men.

Black People↗
PubMed2005

Factors that influence women's decisions about whether to participate in research: an exploratory study.

BACKGROUND: Women are increasingly being asked to consider participating in medical research. We sought to investigate views of women who participated in and declined to participate in a study that was part of a program of maternity care research. METHODS: An exploratory study using focus group interviews and semistructured interviews was conducted. A purposive sample of 17 postnatal women who had participated in research, from a hospital in the North West of England, were interviewed. An open coding mechanism to identify emergent themes was used for the analysis of data. RESULTS: Of women who had not declined to participate in any research, the following themes were identified: altruism versus self-protection, enhanced versus inferior care, professional guidance versus self-direction, and welcome versus unacceptable methodology. Of women who had participated in some research but declined to participate in other research, the following themes were identified: feeling disempowered by the process, inability to believe equipoise existed, and practical inconvenience. CONCLUSIONS: These findings suggest that although health care researchers adopt an individualistic approach to care, they may fail to adopt a similar approach within research. What is important and acceptable to women needs to be ascertained to develop appropriate research strategies. This plan will ensure that research is carried out to the highest ethical standard, which may increase recruitment rates.

Clinical Trials as Topic↗
PubMed2005

Breastfeeding expectations versus reality: a cluster randomised controlled trial.

OBJECTIVE: To evaluate the affect of an antenatal educational breastfeeding intervention on women's breastfeeding duration. DESIGN: Cluster randomised controlled trial. Unit of randomisation: electoral ward. The primary outcome was the proportion that fulfilled their antenatal breastfeeding expectation. Secondary outcomes were the number of women breastfeeding on discharge and at four months. Data were collected using a series of questionnaires and diaries. SETTING: Teaching hospital in North West of England. PARTICIPANTS: Women who expressed a desire to breast-feed at the start of their pregnancy. METHODS: Women were allocated to either routine antenatal education or an additional single educational group session supervised by a lactation specialist and attended by midwives from their locality. MAIN OUTCOME MEASURE: The proportion of women who fulfilled their expectation of breastfeeding. RESULT: One thousand three hundred and twelve women were randomised, with 1249 (95%) women available for analysis. There was no difference between the groups in the proportion of women who attained their expected duration of breastfeeding (OR 1.2; 95% CI 0.89-1.6; chi(2)= 1.4, df= 1, P= 0.2; mean cluster size 156, design effect 1.6). There were no differences between the groups in the uptake of breastfeeding on discharge (OR = 1.2; 95% CI 0.8-1.7; chi(2)= 1.1, df= 1, P= 0.3; mean cluster size 163, design effect = 2.0) or exclusively at four months (OR = 1.1; 95% CI 0.6-1.8; chi(2)= 0.07, df= 1, P= 0.8; mean cluster size 156, design effect 1.6). CONCLUSION: The provision of a single educational group session supervised by a lactation specialist, and attended by midwives and women, failed to promote the uptake of breastfeeding. Public health interventions, which encourage positive attitudes to breastfeeding within the family and wider community, should be developed and evaluated.

Adult↗
PubMed2004

Repeated immunization with plasmid DNA formulated in poly(lactide-co-glycolide) microparticles is well tolerated and stimulates durable T cell responses to the tumor-associated antigen cytochrome P450 1B1.

Injection of microparticle-encapsulated DNA elicits immune responses to plasmid-encoded antigens in mice and humans. Cytochrome P450 CYP1B1 (CYP1B1) is a member of the CYP1 P450 enzyme family that is overexpressed in a variety of solid tumors. The work described herein was performed to study the kinetics of stimulating T cell responsiveness with an encapsulated DNA encoding CYP1B1 and provides support for the clinical development of this formulation. Immunization of HLA-A2/Kb transgenic mice with human CYP1B1 encoding plasmid DNA formulated in poly(lactide-co-glycolide) (PLG) microparticles elicits CD8+ T cells that respond to human CYP1B1-positive target cells. The duration of the immune response, the effect on the immune response of multiple injections, and the safety of repeated injections were studied. These results show that the PLG-encapsulated DNA therapeutic elicits durable immune responses to CYP1B1, the responses are dependent on repeat immunization, and that the formulation is well tolerated.

Animals↗
PubMed2004

Evolving spinal analgesia practice in palliative care.

Intraspinal analgesia can be helpful in some patients with intractable pain. Over 15 years palliative care professionals evolved their spinals policy through a repeated series of evaluations, discussions and literature reviews. One hundred intraspinal lines were then reviewed. Notable changes in policy were the switch from epidurals to intrathecals, and the insertion of lines during working hours rather than as emergencies. Our efficacy, and frequency of adverse effects, is equal or better to published studies. Key issues in reducing adverse effects were the improved care of the spinal line exit site, a change from bolus administration to continuous infusions, and modifying line insertion techniques. Current policy is to use continuous infusions of diamorphine and bupivacaine in a 1:5 ratio through externalized intrathecal lines. The lines are effective in approximately two thirds of patients and can be kept in place for up to 18 months. The policy continues to be updated and common documentation is now in place.

Adult↗