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BACKGROUND AND AIM: The prevalence of dual infection was 2.8% (26/927). Majority of these patients had presented with acute flare of a chronic liver disease (42.3%) followed by acute jaundice (38.5%).We found HEV infection to be was highly prevalent among 20 to 40 years of age group. In the case of HBV only 5.37% (5/93) children were affected in the age group 0-10 years. METHODS: Serum samples from 1147 proven HEV infection suspected were collected and tested for HBsAg and HEV (IgM) antibodies using enzyme linked immunosorbent assay kits (bio Merieux, France). RESULTS: There were the 32.16% (367/1141) HEV positive cases. We found maximum HEV positivity in the age group of 21-30 years. There were 2.8% (26/927) HEV and HBV dully infected patients. The total 44.68% (273/611) suspected of acute hepatitis/jaundice were HEV positive. CONCLUSION: The HEV found to be was highly prevalent among 20 to 40 years of age group. The males were more frequent than females for HEV and HBV infection. In the children's, there were lower attack of both HEV and HBV. The maximum patients were having acute hepatitis/jaundice in both HEV and HBV infection. There were 26 dually infected patients in 12 months.

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The purpose of the study is to investigate the influence of psychosocial stress, maternal schooling, social support, psychological well-being, alcohol and smoking on intrauterine growth retardation and premature delivery. At a Copenhagen university hospital 2432 consecutive Danish-speaking women in 20th week of pregnancy completed a questionnaire including the General Health Questionnaire and Severity of Psychosocial Stressor Scale and questions about social network, education, smoking and drinking habits. In 212 cases (8.7%) the women delivered before day 259 of gestation. In a multiple logistic regression model, pre-term delivery proved to be associated with psychosocial stress and poor school education. In 152 cases (6.3%) infants had a birth weight below the defined 10th percentile. In a multiple logistic regression model, IUGR was associated with smoking. In preventive programmes, such as anti-smoking campaigns, it should be kept in mind that women who smoke are also the least educated and have the poorest support from a social network.

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In a population-based study, 3021 women in a central Copenhagen district received a questionnaire on environmental and psychological factors during mid-gestation. Of these, 70 women were selected consecutively on the basis of moderate to severe stressful life-events (DSM-III-R categories 3 to 5), in combination with an inadequate social network. They were compared with 50 non-stressed women with an intact social network. Stress and smoking significantly affected birthweight and head circumference. When birthweight was corrected, stress remained a significant determinant of small head circumference, indicating a specific effect on brain development. Stress also led to a suboptimal Prechtl neonatal neurological score. These findings suggest the existence of a fetal stress syndrome with adverse effects on fetal development, including deficient brain development.

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OBJECTIVES: This study investigated the influence of psychosocial stress, maternal schooling, social support, psychological well-being, alcohol, and smoking on intrauterine growth retardation and premature delivery. METHODS: At a Copenhagen university hospital, 2432 pregnant women completed a questionnaire on general health, psychosocial stressors, and sociodemographic characteristics. RESULTS: In 212 cases (8.7%) the women delivered prematurely. Preterm delivery as associated with psychosocial stress (adjusted odds ratio [OR]=1.14 for each 1-point increase on the psychosocial stressor 5-point scale and 1.92 for the whole scale) and poor school education (adjusted OR=2.62 for 7-9 years of schooling, 1.91 for 10 years, and 1.0 for 11-13 years). In 152 cases (6.3%), infants had a birthweight below the 10th percentile. Intrauterine growth retardation was associated with smoking, daily drinking, school education, and social network variables. In a multiple logistic regression model, intrauterine growth retardation was associated with smoking habits (adjusted OR=2.40 for 0-9 cigarettes daily, 2.68 for 10-15 daily, and 2.88 for more than 15 daily). CONCLUSIONS: Psychosocial stressors and limited duration of schooling appeared to influence preterm delivery. Smoking habits influenced intrauterine growth retardation.

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In a population-based study, 3021 women in a central Copenhagen district received a questionnaire on environmental and psychological factors during mid-gestation. Of these, 70 women were selected consecutively on the basis of moderate to severe stressful life-events (DSM-III-R categories 3 to 5), in combination with an inadequate social network. They were compared with 50 non-stressed women with an intact social network. Stress and smoking significantly affected birthweight and head circumference. When birthweight was corrected, stress remained a significant determinant of small head circumference, indicating a specific effect on brain development. Stress also led to a suboptimal Prechtl neonatal neurological score. These findings suggest the existence of a fetal stress syndrome with adverse effects on fetal development, including deficient brain development.

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The number of electrodes employed, the frequency of reapplication, the technical quality of monitoring and the complications of use of spiral electrodes and Copeland electrodes for cardiotocographic monitoring of deliveries are assessed in a prospective randomized investigation. The number of electrodes employed and the frequency of reapplications were significantly lower employing Copeland electrodes. Similarly, the electrode signal was significantly better as assessed by the percentage of the duration of monitoring in which the cardiotocogram did not register during the second stage of labour on account of poor electrode signals. No differences were found in the frequencies of complications or subjective discomfort in the mother on employing the two types of electrodes.

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To solve the problem of low predictive values in the visual assessment of the CTG, several computer programs have been designed. Only a few of those programs describe the CTG automatically and thus consistently. The aim of this study was to construct a diagnostic procedure for computer-aided automatic assessment of the CTG. A computer program quantified 17 variables of the CTG. Within a window of user-defined length, a second program calculated the number of measurements, the mean, the trend, and the coefficient of variation of each of the 17 variables, and produced a total of 56 distinct subvariables. A discriminant procedure was set up which could use any number and combination of the 56 subvariables to calculate the probability of a CTG derived from a compromised infant. The diagnostic procedure was optimized by "direct forward search" for the combination of subvariables discriminating best between normal and compromised infants. Using the last half hour of the first stage of labor, 50 CTGs entered the optimizing procedure. A combination of nine subvariables was found. In a separate paper its performance is compared with that of clinicians.

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The chief aim of our work has been to create a computer Cardiotocographic Assessment System (CAS) and thus eliminate the intra- and inter-observer variability of the visual assessment of the cardiotocogram (CTG), and to improve the assessment of the CTGs to the standard of the most experienced obstetricians. The purpose of this paper is to present the accuracy of the prediction of fetal outcome obtained by the CAS and to compare it with 4 experienced obstetricians' accuracy. Fifty CTGs from the last 30 min. of labor were assessed as normal or pathological by the computer and by the obstetricians. The condition of the newborn was evaluated from the one-minute Apgar score, the umbilical artery pH and standard base excess, and the need for resuscitation. The accuracy of the CAS was significantly better than the accuracy of the obstetrician obtaining the best result. We conclude that the development of a computer-aided cardiotocographic assessment system is worthwhile.

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The diagnostic value of a test depends on the variability of the test results and the accuracy of the test. The object of this investigation was to estimate the observer variability and the accuracy, when intrapartum CTGs were assessed by experienced obstetricians. Fifty CTGs were evaluated twice by four obstetricians. They were asked to identify the CTGs belonging to the compromised infants. They were told the criteria for a compromised infant and the incidence (one-third). Eleven (22%) of the CTGs were assessed in the same way of all the obstetricians in both evaluations. Between the obstetricians, the accuracy ranged from 50 to 66%. We conclude that the considerable observer variability found in this and other investigations must severely impair the clinical value of electronic fetal monitoring (EFM). The variability must be reduced before the "true" predictive value and the cost/benefit of EFM can be estimated.

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In a prospective clinical randomized investigation 487 women had the condition of the fetus during labour supervised by means of stethoscope (AUS), while 482 women went through labour under surveillance of electronic fetal monitoring, cardiotocography (EFM). 349 women refused to participate in the investigation (NAI) and had delivery conducted according to the normal procedures of the department (70% AUS, 30% EFM). Significantly more pathological fetal heart rate patterns (FHR) were found in the EFM group compared to the AUS group in both the first and the second stage of labour. As a result significantly more vacuum extractions were performed in the EFM group than in the AUS group, while no statistical difference was found between the groups in the incidence of acute cesarean sections carried out for asphyxia. One case of intrapartum death occurred in the AUS group. No differences were found in Apgar scores after 1 and 5 min or in neonatal morbidity at examination on the 2nd and 5th days after delivery. A tendency towards more biochemically compromised children was found in the AUS group. The specificity for both methods was found to be acceptably high (80%), while the predictive value for both methods was low (50%). More research is therefore urgently needed to evaluate supplementary investigations and parameters for the evaluation of the intrapartum fetal condition.

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During a randomized clinical trial concerning alternative methods of intrapartum fetal surveillance (electronic fetal monitoring (EFM) and auscultation (AUS)) an investigatory interview was carried out. Out of 655 expecting mothers the antepartum preference of EFM was 39.5%, of AUS 32.3% and 28.1% were undecided (UD). EFM was especially preferred by obstetrical high-risk patients. Reasons for preference of AUS were a natural childbirth, a non-technological milieu, and the lack of supposed discomfort from sensors and belts. The pregnant women found as major advantages of EFM continuous observation and the possibility of quick intervention. Postpartum 385 patients were again interviewed. The majority upheld the original preference if that method was used. If the non-preferred method had been applied many would stick to the primary preference although a tendency to prefer the experienced method was seen. The patients who antepartum preferred AUS, but had EFM, became more positive toward the method, and a significantly increased number were positively influenced by the EFM signal/trace and found the method promoting their partner's involvement in labor. Enforced immobility, however, was a major disadvantage as well as the technical milieu. If EFM is to be accepted by a majority of women giving birth it is necessary to increase the pregnant women's knowledge of the method and to take milieu factors into consideration in order to reduce the intrinsic depersonalization of EFM.

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