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PubMed1995

[Relationship between perceived health status and career choice in a sample of wage-earners].

Many factors were related with subjective health status (SHS), but few studies have focused on identifying some intrinsic personal factors like the choice of job and perceived working situations. The present paper examines the relationships among such factors in a large French sample. Data were collected from 21,378 subjects who were randomly selected from the lists of male and female wage earners who were followed up by 380 occupational physicians and who were born in 1938, 1943, 1948 or 1953. SHS was evaluated using the French version of the Nottingham Health Profile (NHP). Socio-demographic and job characteristics were assessed by means of closed questions during the annual medical examination. Results showed that low subjective health status was related to sex, age and perceived working situation: for each of the six areas of the NHP (pain, physical mobility, energy, sleep, social isolation, emotional reactions) there was a lower SHS for women and a decrease with age for both sexes. The poorer the perceived working situations the worse was the SHS. Using general linear models it appeared that independently of these factors and the socio-economical category dichotomized in upper classes versus lower classes, those who had claimed to have not chosen their job had a lower SHS, whatever the area of SHS. Awaiting the second survey in 1995, it is difficult to explain these results from this cross sectional analysis: is the choice of job a possible risk factor or an artefact due to some unmeasured confounding factors like motivation or job satisfaction.

Adult↗

PubMedDate not supplied

[Limitations of case-mix systems in primary care: comparison of the severity of patients in community hospitals and health care centers in the United States].

OBJECTIVE: The aim was to show the limitations of the case-mix "based on attendance", which take into account neither the seriousness of the diagnoses nor the comorbidity. DESIGN: A crossover descriptive study of a retrospective nature. SETTING: In New York, in two centres located in the Hispanic community of Upper Manhattan and a third in the Presbyterian Hospital. PARTICIPANTS: During 1991, 225 patients were studied: 150 attended in the hospital PCC and 75 in the non-hospital PCCs. A simple random sampling of the list of patients attended was performed. INTERVENTIONS: The seriousness of the conditions of the patients attended in the two different types of PCC was compared through the Duke Severity of Illness Scale (DUSOI), a patient-based case-mix which assesses the level of seriousness of each individual diagnosis and the comorbidity linked to the diagnoses grouped together. MEASUREMENTS AND MAIN RESULTS: Significant differences between the seriousness of the conditions of the patients in the two sub-samples were found when comparison by means of bivariant analysis was performed. Scoring on the Severity Scale was significantly higher for those attending hospital (65.5 and 55.1 respectively). CONCLUSIONS: Patient classification systems based on the reasons for attendance underestimate the seriousness of the condition. A case-mix in which the patient is the unit of analysis needs to be developed.

Community Health Services↗

PubMedDate not supplied

[Vaccinal coverage for measles and pertussis: a study in 7 regions of Italy].

During the year 1993 a series of surveys aimed to estimate the immunization coverage against measles and pertussis have been carried out in seven Italian regions and two large towns (Milan and Naples). Mothers of children aged between 12 and 23 months, randomly selected from the list of newborns, by using the EPI cluster sampling, have been interviewed in order to determine the reasons for absent or incomplete vaccinations. The observed coverage for pertussis ranges between 8% in the Molise region and 71% in the town of Milan; coverage for measles ranges between 9% in the town of Naples and 52% in the region Lombardy. The most commonly reported reason for not-vaccinating for pertussis has been the negative advise given by the caring physician. Immunization against measles has often not been administered because of relative contraindications and the negative advise by the physicians. The coverage for the two non-compulsory vaccinations are low compared to compulsory vaccinations and to the immunization level reported for most European countries, pointing out that further health education is needed for improving the up-take of such voluntary vaccinations.

Adult↗

PubMed1996

Cardiovascular risk and responsivity to mental stress: the influence of age, gender and risk factors.

BACKGROUND: Exaggerated cardiovascular and neuroendocrine responses to mental stress may enhance cardiovascular disease risk. Coronary heart disease and hypertension increase in prevalence with advancing age, whereas the excess male/female ratio declines in later middle age. Psychosocial factors may contribute to these changing risk profiles. The hypothesis that cardiovascular and neuroendocrine stress responses are associated with age and gender differences in cardiovascular disease risk was tested. METHOD: 132 healthy men and women from younger (30-40 years) and older (55-66 years) age bands were selected at random from general practice lists. They performed a series of mental stress tests during which blood pressure, heart rate, cardiovascular baroreflex sensitivity, cortisol, respiration patterns and electrodermal activity were monitored. A submaximal exercise test was performed and psychological characteristics were assessed by questionnaire. RESULTS: At rest, systolic and diastolic blood pressure was higher in men than in women, while cardiac baroreflex sensitivity was greater in younger than in older participants. Blood pressure responses to tasks were substantial, with changes from the baseline averaging 18.6/8.11, 26.0/13.5 and 40.7/19.0 mmHg for computerized problem solving, mirror drawing and speech tasks, respectively. Men and women in the older age band did not differ from each other in blood pressure, heart rate or baroreflex sensitivity responses. Systolic blood pressure responses (mean +/- SEM) were larger in older than in younger women (mean peak difference 6.87 +/- 2.67 mmHg), and in the younger male compared with the younger female groups (mean peak difference 7.20 +/- 2.97 mmHg). Diastolic blood pressure and heart rate responses to mental stress were larger in younger than in older age participants of both sexes. Baroreflex sensitivity was inhibited during behavioural tasks, with significantly greater suppression in younger than in older groups (5.28 +/- 0.52 and 2.62 +/- 0.35 ms/mmHg, respectively). Cortisol responses were greater in men than in women, but did not vary with age. Across the entire sample, systolic blood pressure responsivity was negatively related to the expression of anger. Among older men, heightened blood pressure responses were associated with elevated fasting low-density lipoprotein cholesterol levels, and with lower concentrations of high-density lipoprotein cholesterol. CONCLUSIONS: Systolic blood pressure stress responsivity increases with age in women but not in men. Other data do not support the notion that stress responsivity mediates age and gender differences in cardiovascular disease risk. However, in middle-aged men, ex-aggerated cardiovascular stress responsivity is associated with an unfavourable risk profile.

Adult↗

PubMedDate not supplied

Pilot study of low-dose azathioprine in presensitized patients awaiting heart or lung transplantation.

In an effort to reduce the level of presensitization in patients on our heart and lung transplant waiting list, ten patients with random panel reactivity above 10% on monthly screening for durations of 2 to 59 months were given low-dose azathioprine (25 to 75 mg/day) for 1 to 22 months. All patients had positive T-cell panel reactivity (10% to 70%) against specific (n = 6), multi-specific (n = 1), or undefined (n = 3) HLA loci, and four additional patients had positive B-cell panel reactivity (5% to 40%). No effect of azathioprine on panel reactivity was seen in four of ten patients (40%), whereas a significant and sustained reduction in panel reactivity occurred in six patients (60%), all within 2 months of commencing azathioprine. All nonresponders had antibodies with class I (A locus) specificity, whereas all six responders had multi-specific or undefined antibody specificities. A formal trial of low-dose azathioprine in presensitized recipients is warranted.

Adult↗

PubMed1996

[Cost of asthma therapy in relation to severity. An empirical study].

BACKGROUND: The aim of asthma therapy, i.e. the permanent elimination of the patient's symptoms, is as a rule, achievable over the long-term only with the aid of anti-inflammatory drugs. As well as medical, this approach also has considerable economic implications. The comparatively low compliance among asthmatics makes treatment in this context all the more difficult. An alternative that presents itself is the use of combination preparations, a mixture of a long-term prophylactic and a therapeutic agent. PATIENTS AND METHODS: With the aid of standardised questionnaires, data were acquired from 216 patients and assigned to subgroups in accordance with the degree of severity of the asthma. The patients were treated in the offices of a total of 23 GPs and internists selected at random from a complete list of all relevant practices in Germany. The use of resources, i.e. all diagnostic and therapeutic measures, was recorded retrospectively for a period of 1 year. In this way, all those resources of relevance to the health insurance carriers used during the observation period were identified. In addition to direct costs, so-called indirect costs were also estimated, i.e. in the present study the productivity loss to the economy due to illness-related absence from work. RESULTS: The annual cost of treating adult asthmatics was calculated to be DM 3,339 for level 1 severity, DM 5,260 for level 2 severity and DM 12,016 for level 3 severity. As the illness progresses in particular the direct cost of inpatient care and the indirect costs rise disproportionately. The yearly expenditure for women sufferers is about DM 800 more than for male sufferers. The direct cost of asthma treatment in children amounts to DM 2,950 for level 1, DM 3,225 for level 2, and DM 4,811 for level 3, severity. Here, drug-related costs in particular, rise significantly as the disease progresses. CONCLUSION: One of the results of the present study is the fact that for asthma sufferers in general, there is a positive correlation between average total costs and degree of severity. It may thus be postulated that preventive medical treatment of asthma that slows the progression of the illness, together with appropriate patient instruction, would have a positive effect on the total expenditure per patient. If, for example, the appropriate use of drugs in combination with patient instruction improved the compliance of asthmatics, lower treatment costs and a better quality of life for the patient could be expected.

Activities of Daily Living↗

PubMed1996

Who treats minorities?

We studied the characteristics of psychological service providers who treat ethnic minority clients in a representative random sample of psychologists listed in the National Register of Health Service Providers (NR) in 1986. Ethnic minority providers saw more than twice the proportion of ethnic minority clients than did non-Latino White providers (24.0% and 11.7%, respectively). Providers with cognitive-behavioral clinical/theoretical orientations saw significantly more ethnic minority clients than did those with psychodynamic or other orientations. Providers with eclectic orientations saw significantly more ethnic minority clients than did those with psychodynamic orientations, but eclectic providers did not differ from any other provider orientation group. The results suggest that more ethnic minority providers are needed and that other providers need to increase their ethnic minority clientele.

Adult↗

PubMedDate not supplied

Pleural malignant mesothelioma and environmental asbestos exposure in Casale Monferrato, Piedmont. Preliminary analysis of a case-control study.

A case-control study on pleural malignant mesothelioma (MM) was conducted in Casale Monferrato, where the largest Italian asbestos cement (AC) factory had been operating from 1907 to 1985. In a previous study we observed a five to seven-fold increase in the incidence of MM among people living in that city and never employed in the factory mentioned. The present study includes cases of MM with histological diagnosis over the period 1.1.1987-30.6.1993 among residents in the Local Health Unit (LHU) of Casale Monferrato. Population controls were randomly extracted from the list of the residents in the LHU, matched to cases on sex, date of birth, vital status and date of death. Cases and controls (or their closest relative) were interviewed with a standardised questionnaire focusing on asbestos exposure in the (life-long) residential and occupational histories and in leisure time activities as well as on occupational asbestos exposure of relatives and cohabitants, smoking and chest or occupational diseases. The interview was blind in respect to case or control status. For the analyses the addresses were coded on map grids with a 500 m. mesh size. Statistical analyses were conducted with conditional logistic regression in order to keep the matching between cases and controls. Eighty-eight cases and 244 controls were interviewed (95.6% of cases and 80.1% of controls): 26 and 11 respectively reported an activity in the AC industry. Seven cases and 7 controls were also exposed because of parental occupation. The main analyses are based on the conditional regression model including both occupational and residential exposure. The different modes of exposure are included on an ordinal scale: each subject is classified according to their highest level. Domestic exposure is included as an independent factor. Odds Ratios (OR) are estimated with reference to subjects without either occupational or residential exposure. The OR is 39.3 among subjects reporting occupational exposure, 11.9 among those never engaged in the AC industry but living within 1000 m. of the factory. A statistically significant risk is also observed for persons at some time living in the other areas of Casale Monferrato.

Aged↗

PubMed1998

Outcome of recruitment and report on participation rate in the New Mexico Elder Health Survey.

The purpose of this paper is to report on the outcome of recruitment and participation rate in the New Mexico Elder Health Survey. This survey is the first community based epidemiological survey to examine health and health related issues of elderly (65 years or older) Hispanics and non-Hispanic whites in Bernalillo County (Albuquerque), New Mexico. This survey was conducted from May 1993 to September 1995. Subjects (N=2200) were randomly selected from the list of 50,700 Medicare recipients residing in Bernalillo County and stratified by ethnicity and gender. Hispanics were identified using a computer program that selects Hispanic surname patterns and ethnicity was verified by self report. Subjects participated in a home interview, followed by an interview and examination in a senior health clinic. Use of the Medicare list resulted in 75.7% (N=1666) of subjects being contacted. Of the 1666 subjects available, 1130 (67.8%) completed a home interview and 883 (54%) completed the full examination. There were no significant differences in participation by ethnicity, but there were significant differences by gender, with women less likely to participate. The mean age of participants was 74 years, age range 65 to 100. Hispanic elderly demonstrated greater economic poverty and lower levels of formal education. Our survey results show that the elderly and Hispanic elderly can be successfully recruited to participate in a research study. This paper is the first to summarize the details of the survey design, present the results of recruitment and participation, and describe the survey participants.

Age Factors↗

PubMed1999

Why don't men seek help? Family physicians' perspectives on help-seeking behavior in men.

BACKGROUND: Men tend to underuse primary care health services despite their susceptibility to particular types of illness. The purpose of this study was to report the family physician's perspective on why men do not access the health care system for medical problems. METHODS: We used focus group interviews to identify major themes. The participants were family physicians in active practice randomly selected from a list of 500 full- and part-time teachers. Four focus groups were formed from 18 participants (12 men, 6 women), in practice an average of 17 years. Eleven of the physicians were in community practice. RESULTS: Three key themes were identified: (1) Support: Men appear to get most of their support for health concerns from their female partners, little from their male friends. Their pattern of seeking support tends to be indirect rather than straightforward. (2) Help Seeking: Perceived vulnerability, fear, and denial are important influences on whether men seek help. They look for help for specific problems rather than for more general health concerns. (3) Barriers: Personal barriers involved factors related to a man's traditional social role characteristics: a sense of immunity and immortality; difficulty relinquishing control; a belief that seeking help is unacceptable; and believing men are not interested in prevention. Systematic barriers had to do with time and access; having to state the reason for a visit; and the lack of a male care provider. CONCLUSIONS: Many of these findings are supported by psychological theories. Future research should apply these theories in more transferable populations and settings. However, an in-depth understanding of the patterns of men's use of primary care services is needed before we can determine if a regular source of primary care would have a positive impact on their health.

Adult↗

PubMed2003

Ketamine as adjuvant to opioids for cancer pain. A qualitative systematic review.

Ketamine is increasingly being used as an adjuvant to opioids in the treatment of refractory cancer pain. This systematic review examines the available evidence. Randomized, controlled trials, with or without crossover, were included. Studies were identified from MEDLINE, EMBASE, CANCERLIT, the Cochrane Library, handsearched reference lists from review articles and chapters from standard textbooks on pain and palliative care and reference lists from papers retrieved. Four randomized, controlled studies were identified. Two were excluded due to poor quality. Both included studies concluded that ketamine improves morphine treatment in cancer pain. Quantitative meta-analysis was not possible. The available evidence is not sufficient to conclude that ketamine improves the effectiveness of opioid treatment in cancer pain. High quality, randomized, controlled trials with larger numbers of patients and standardized, clinically relevant routes of administration of ketamine are needed.

Analgesics↗

PubMed2006

Indoor radon and lung cancer risk in connecticut and utah.

Radon is a well-established cause of lung cancer in miners. Residents of homes with high levels of radon are potentially also at risk. Although most individual studies of indoor radon have failed to demonstrate significant risks, results have generally been consistent with estimates from studies of miners. We studied 1474 incident lung cancer cases aged 40-79 yr in Connecticut, Utah, and southern Idaho. Population controls (n = 1811) were identified by random telephone screening and from lists of Medicare recipients, and were selected to be similar to cases on age, gender, and smoking 10 yr before diagnosis/interview using randomized recruitment. Complete residential histories and information on known lung cancer risk factors were obtained by in-person and telephone interviews. Radon was measured on multiple levels of past and current homes using 12-mo alpha-track etch detectors. Missing data were imputed using mean radon concentrations for informative subgroups of controls. Average radon exposures were lower than anticipated, with median values of 23 Bq/m3 in Connecticut and 45 Bq/m3 in Utah/southern Idaho. Overall, there was little association between time-weighted average radon exposures 5 to 25 yr prior to diagnosis/interview and lung cancer risk. The excess relative risk (ERR) associated with a 100-Bq/m3 increase in radon level was 0.002 (95% CI -0.21, 0.21) in the overall population, 0.134 (95% CI -0.23, 0.50) in Connecticut, and -0.112 (95% CI -0.34, 0.11) in Utah/Idaho. ERRs were higher for some subgroups less prone to misclassification, but there was no group with a statistically significant linear increase in risk. While results were consistent with the estimates from studies of miners, this study provides no evidence of an increased risk for lung cancer at the exposure levels observed.

Adult↗

PubMed2006

Association between skin diseases and severe bacterial infections in children: case-control study.

BACKGROUND: Sepsis or bacteraemia, however rare, is a significant cause of high mortality and serious complications in children. In previous studies skin disease or skin infections were reported as risk factor. We hypothesize that children with sepsis or bacteraemia more often presented with skin diseases to the general practitioner (GP) than other children. If our hypothesis is true the GP could reduce the risk of sepsis or bacteraemia by managing skin diseases appropriately. METHODS: We performed a case-control study using data of children aged 0-17 years of the second Dutch national survey of general practice (2001) and the National Medical Registration of all hospital admissions in the Netherlands. Cases were defined as children who were hospitalized for sepsis or bacteraemia. We selected two control groups by matching each case with six controls. The first control group was randomly selected from the GP patient lists irrespective of hospital admission and GP consultation. The second control group was randomly sampled from those children who were hospitalized for other reasons than sepsis or bacteraemia. We calculated odds ratios and 95% confidence intervals (CI). A two-sided p-value less than 0.05 was considered significant in all tests. RESULTS: We found odds ratios for skin related GP consultations of 3.4 (95% CI: [1.1-10.8], p = 0.03) in cases versus GP controls and 1.4 (95% CI: [0.5-3.9], p = 0.44) in cases versus hospital controls. Children younger than three months had an odds ratio (cases/GP controls) of 9.2 (95% CI: [0.81-106.1], p = 0.07) and 4.0 (95% CI: [0.67-23.9], p = 0.12) among cases versus hospital controls. Although cases consulted the GP more often with skin diseases than their controls, the probability of a GP consultation for skin disease was only 5% among cases. CONCLUSION: There is evidence that children who were admitted due to sepsis or bacteraemia consulted the GP more often for skin diseases than other children, but the differences are not clinically relevant indicating that there is little opportunity for GPs to reduce the risk of sepsis and/or bacteraemia considerably by managing skin diseases appropriately.

Adolescent↗

PubMed2001

Prevalence of anemia in children 6-59 months old in the state of Pernambuco, Brazil.

OBJECTIVE: To determine the prevalence of anemia in children 6-59 months old in Pernambuco, a state in northeastern Brazil, so as to help guide health and nutrition policies there. METHODS: In 1997 a representative sample of 777 young children had their hemoglobin concentration measured. The sampling process was in three stages. First, 18 municipalities were randomly selected to represent the state and its three geographic areas (metropolitan region of Recife, urban interior, and rural interior). Next, using census lists, 45 census sectors were randomly chosen. Finally, 777 children aged 6-59 months old were selected. Blood was collected by venipuncture, and hemoglobin was measured with a portable hemoglobinometer. In the analysis, prevalence was weighted to reflect the census age distribution. RESULTS: The prevalence of anemia among children 6-59 months old was 40.9% for the state as a whole. Prevalence in the metropolitan region of Recife was 39.6%, and it was 35.9% in the urban interior. The rural interior had the highest prevalence, 51.4%. Prevalence was twice as high in children aged 6-23 months as among those 24-59 months old, 61.8% vs. 31.0% (chi 2 = 77.9, P < 0.001). The mean hemoglobin concentrations in the younger and older age groups were 10.4 g/dL (standard deviation (SD) = 1.5) and 11.4 g/dL (SD = 1.4), respectively. There was no statistically significant difference between the sexes in terms of prevalence. CONCLUSIONS: This is the first statewide assessment of anemia prevalence among young children in Brazil. Given the very high prevalence of anemia among the children studied in Pernambuco, especially those in the age group of 6-23 months, public health interventions are needed.

Anemia, Iron-Deficiency↗

PubMed2007

Evaluation of exposure with response-prevention for obsessive compulsive disorder in childhood and adolescence.

The present study was undertaken to estimate the effect of exposure plus response-prevention (E/RP), delivered alone intensively over 5-weeks and without concomitant pharmacotherapy, for children and adolescents with OCD. Twenty children and adolescents with OCD, not receiving medication for this condition, were randomized to E/RP or a wait-list condition. Statistically and clinically significant symptomatic improvement was found in the E/RP group compared with controls, with improvement maintained at follow-up an average of 14 weeks later. Effect size in the main intention-to-treat analysis was 1.23 and in the secondary per protocol analysis was 1.64. This study lends further support to the view that E/RP is an effective treatment for childhood OCD.

Adolescent↗

PubMed1995

Child malnutrition in poor smallholder households in rural Kenya: an in-depth situation analysis.

OBJECTIVE: To investigate the effect of seasonal changes on household food availability on the nutritional status of preschool children from rural households. DESIGN: Households with preschool children were randomly selected from a sampling frame developed from a census list. Data were collected each month or at intervals for 14 months using pre-coded questionnaires. SETTING: The study was carried out in Njoro division, Nakuru district, Kenya. SUBJECTS: Subjects comprised 41 preschool children (22 girls and 19 boys) aged between 18 and 36 months. Households with preschool children were listed from a census conducted earlier. A random sample of 45 subjects was selected, out of which 41 completed the study. INTERVENTION: Food consumption data were collected monthly using the 24-h recall method, and by the 3-day weighed record method during the peak of each season. Subjects were measured once each month, while length was measured at three intervals over the study period. RESULTS: Significant differences in intake of calcium, vitamin A, thiamin and riboflavin were observed between the lean and the post-harvest months, but not with energy, protein, fat, iron, niacin and vitamin C. There were no significant seasonal differences in mean weight changes, which were at the rate of 182 g/month. Mean length increased at a faster rate during the lean season compared to the postharvest months. 51% of the children were stunted during the lean season compared to 28% in the post-harvest months. CONCLUSION: The results indicate a seasonal influence on energy and nutrient intake among preschoolers from low income rural households in Kenya.

Child Nutrition Disorders↗

PubMed2002

Functional recovery after cardiac rehabilitation.

OBJECTIVE: To study the effect of a cardiac rehabilitation programme based on the guidelines of the Dutch Heart Association (DHA). DESIGN: Randomized controlled trial with a waiting list control group. SETTING: Outpatient clinic of Rehabilitation Centre Amsterdam. SUBJECTS: Forty patients with a first myocardial infarction. INTERVENTIONS: Immediately after randomization the experimental group started the rehabilitation programme; the waiting list control group started after six weeks. No other type of treatment was given during the waiting period. MAIN OUTCOME MEASURES: Physical recovery, tested by means of an exercise test on a bicycle ergometer, and feelings of well-being (MPVH-W), handicap (MPVH-H) and distress (MPVH-D), tested using a Dutch questionnaire: the Medische Psychologische Vragenlijst voor Hartpatiënten, MPVH (medical psychological questionnaire for cardiac patients). RESULTS: The adjusted treatment effects of the cardiac rehabilitation programme were 4.72% on the exercise test, 3.43 points on MPVH-W, -1.93 points on MPVH-H, and 0.12 points on MPVH-D. These effects were not statistically significant. CONCLUSION: Changes after a cardiac rehabilitation programme are relatively small, but are found in both the physical and the psychosocial domain.

Female↗

PubMed2000

Vaginal misoprostol for cervical ripening and labour induction in late pregnancy.

BACKGROUND: Although not yet registered for such use, misoprostol has been widely used for obstetric and gynaecological indications, such as induction of abortion and of labour. OBJECTIVES: The objective of this review was to assess the effects of vaginal misoprostol for third trimester cervical ripening or induction of labour. SEARCH STRATEGY: The Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register and reference lists of articles were searched. SELECTION CRITERIA: Randomised trials comparing vaginal misoprostol with other methods of cervical ripening or labour induction, placebo or no treatment in women due for third trimester induction of labour. DATA COLLECTION AND ANALYSIS: Trial quality assessment and data extraction were done by both reviewers. MAIN RESULTS: Twenty-six studies were included. Compared to placebo, misoprostol was associated with increased cervical ripening (relative risk of unfavourable or unchanged cervix after 12 to 24 hours with misoprostol 0.20, 95% confidence interval 0.07 to 0.61). It was also associated with a reduced need for oxytocin (relative risk 0.47, 95% confidence interval 0.23 to 0.96). Misoprostol was more effective than prostaglandin E2 for labour induction (relative risk of failure to achieve vaginal delivery in 24 hours 0.70, 95% confidence interval 0.62 to 0.79). Oxytocin augmentation was used less often with misoprostol than with prostaglandin E2 (relative risk 0.64, 95% confidence interval 0.58 to 0.71). Uterine hyperstimulation and meconium stained liquor were more common with misoprostol than with prostaglandin E2. Lower doses of misoprostol compared to higher doses did not show significant differences except for more need for oxytocin augmentation and less uterine hyperstimulation without fetal heart rate changes. REVIEWER'S CONCLUSIONS: Vaginal misoprostol appears to be more effective in inducing labour than conventional methods of cervical ripening and labour induction. The apparent increase in uterine hyperstimulation is of concern. The studies were not large enough to exclude the possibility of rare but serious adverse effects.

Cervical Ripening↗