Complementary food introduction practices in infants with intestinal failure

BACKGROUND

Oral intake in infants with intestinal failure (IF) may be limited due to intolerance or feeding difficulties. Guidelines for the introduction of semisolid or solid complementary foods (CFs) to infants with IF do not exist. CF intake and caloric contribution from CF is difficult to assess due to malabsorption and incomplete recording. The aim of this study was to identify institutional approaches to introducing CF to infants with IF.

METHODS

The American Society for Parenteral and Enteral Nutriton (ASPEN) Pediatric Intestinal Failure Section Registered Dietitian/Nutritionist (RDN) working group designed a 10-question online cloud-based survey to assess group member practice related to the introduction of CF to infants with IF.

RESULTS

Twenty-six surveys were completed. Thirteen (50%) RDNs recommend introduction of CF between 4 and 6 months of age. Nineteen (76%) recommend adding pureed foods to gastrostomy tube feedings. Seventeen (65%) follow standard infant feeding practice guidelines with half citing the American Academy of Pediatrics. Approximately half (44%) recommend introducing vegetables first and the majority (80%) recommend delaying the introduction of fruits. The vast majority (92%) recommend specific foods to minimize stool output including green beans, bananas, infant cereals, and meats/protein.

CONCLUSION

Institutional practices related to the introduction of CF to infants with IF vary. Similarities with first food choice and foods to avoid were observed. Evidenced-based practice guidelines for the introduction of CF to infants with IF need to be established to determine best practices for reducing stool output, encouraging weaning from parenteral nutrition, and achieving enteral autonomy.

P-639 A randomised controlled trial comparing intrauterine-insemination or expectant management in couples with unexplained subfertility and a poor prognosis for natural conception: impact on coital frequency

Study question

Is coital frequency (CF) influenced by intrauterine insemination with ovarian stimulation (IUI-OS) or expectant management in couples diagnosed with unexplained subfertility and a poor prognosis?

Summary answer

Couples allocated to expectant management had a higher CF than those allocated to IUI-OS. We found no evidence for associations with live birth.

What is known already

In couples with unexplained subfertility and a poor prognosis for natural conception, IUI-OS is generally first line treatment. Not much is known about the CF of these couples and to what extend they are still trying to conceive naturally and whether allocation to treatment or no treatment has an influence on CF. It is often postulated that the effect of IUI-OS might be derived from replacing coitus, especially in couples with longstanding subfertility i.e., over 24 months. Keeping a sex diary can provide insight on this.

Study design, size, duration

We performed a multicentre randomised-controlled-trial in couples with unexplained subfertility and a poor prognosis of conceiving naturally within one year. The couples were allocated in a 1:1 ratio to six months IUI-OS or six months expectant management. CF was assessed with diaries on moment of coitus in relation to the menstrual cycle. We intended to include 1091 couples but after almost 4 years, the study was stopped due to slow inclusion and lack of funding.

Participants/materials, setting, methods

We recruited 178 women; 86 women were assigned IUI-OS and 92 women expectant management. All participating Dutch-reading women were eligible for the online diaries (CASTOREDC). We defined the fertile window as 7 days before and 2 days after the estimated ovulation date for all cycles. We used the Mann Whitney U test for differences in CF and timing and logistic regression for the estimated association with live birth, adjusting for cycle number and treatment allocation.

Main results and the role of chance

After IUI-OS 28/86 women (33%) had a live birth and 12/92 (13%) after expectant management, yielding a relative risk of 2.5 (90%CI 1.49 to 4.17). Of the 178 recruited women 79 (44%) filled out at least one monthly diary on sex and/or menstruation dates, 35 after IUI-OS and 44 after EM. Of these10/35 (29%) had a live birth after IUI-OS and 3/44 (7%) after expectant management.

In a total of 497 cycles, the 79 couples reported 2023 dates of coitus (average of 4.1 per cycle). The median CF was 3 (IQR: 0 to 7) in the IUI-OS group and 4 (1 to 6) in the expectant management group (p for difference: 0.08). The median CF that took place within the fertile window was 1 (0 to 3) in the IUI-OS group and 2 (0 to 3) in the expectant management group (p for difference: <0.01).

No interaction was found between intercourse frequency or timing and treatment on live birth rate. The adjusted odds ratio for intercourse frequency was 0.93 (95%CI: 0.78-1.09). The adjusted odds ratio for intercourse timing was 0.94 (95%CI: 0.64-1.37). The odds ratio for allocated treatment was unaffected by these adjustments for intercourse frequency or timing.

Limitations, reasons for caution

Only 44% of trial population returned the CF and menstruation diaries which could have induced selection bias. We estimated the day of ovulation based on the date of the next menstrual period in the expectant management group of this pragmatic trial.

Wider implications of the findings

Even though the duration of subfertility was longstanding, couples in both groups still had coitus and the median CF was higher in the expectant management group.

Trial registration number

NTR5599

Body Composition of Infants With Congenital Gastroschisis

ABSTRACT

Infants born with congenital gastroschisis are at risk for intrauterine growth restriction, small for gestational size at birth, and growth failure during the newborn period despite advanced care. Body composition provides a more complete picture of proportional growth than weight and length alone. Fat-free mass (FFM) represents organ growth, and in preterm infants without gastroschisis, improved FFM deposition is associated with improved neurodevelopmental outcomes. There is limited literature regarding the body composition of infants with gastroschisis. This case series describes the body composition of 10 infants with gastroschisis.

Quality Improvement Efforts Reduce Incidence of Surgical Necrotizing Enterocolitis and Related Deaths

OBJECTIVE

The aim of this study was to determine whether a regional quality improvement (QI) initiative decreased incidence and severity of surgical necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants.

STUDY DESIGN

A retrospective review of all VLBW infants who received care at one of the three hospitals involved in a NEC QI initiative from 2011 to 2016. Primary outcome was the number of surgical NEC cases per year. Secondary outcomes included associated outcomes and mortality.

RESULTS

Sixty-three infants with either a diagnosis of Stage III NEC (n = 40) or spontaneous intestinal perforation (SIP) (n = 23) were included. The incidence of medical and surgical NEC and the mortality rate of infants with surgical NEC decreased over time. Incidence and mortality of SIP did not significantly change.

CONCLUSION

A regional QI bundle to reduce the overall incidence of NEC also significantly decreased the incidence of surgical NEC and all-cause mortality of infants diagnosed with surgical NEC.

KEY POINTS

· QI reduces surgical necrotizing enterocolitis.. · Reduction in NEC rate improves mortality.. · Human milk does not change SIP incidence..

P–504 A randomised controlled trial comparing expectant management or intrauterine-insemination in couples with unexplained subfertility and a poor prognosis for natural conception: the impact on health-related-quality-of-life

Study question

Is health-related quality of life (HRQoL) in women with unexplained subfertility and a poor prognosis influenced by expectant management or intrauterine insemination with ovarian stimulation?

Summary answer

HRQoL did not differ, except for the relational domain which was lower after expectant management. Anxiety and depression disorders occurred frequently in both groups.

What is known already

In couples with unexplained subfertility and a poor prognosis, IUI with ovarian stimulation (IUI-OS) is a first line treatment. Not much is known about quality of live or depression and anxiety in these couples. The Fertility Quality of Life (FertiQoL) is reliable for assessment within relational and social domains, the Hospital Anxiety and Depression Scale (HADS) is a reliable tool to detect anxiety and depression disorders.

Study design, size, duration

We performed a multicentre RCT in couples with unexplained subfertility with a poor prognosis of conceiving naturally within one year. Women were allocated 1:1 to six months expectant management or to six months IUI-OS. HRQoL was assessed with standard self-administered psychometric measures with established reliability and validity: FertiQol and HADS. We intended to include 1091 couples but after almost 4 years, the study had to stop due to slow inclusion and therefore lack of funding.

Participants/materials, setting, methods

Between June 2017 and September 2020, we recruited 178 women of wich 92 were assigned expectant management and 86 IUI-OS. All women who participated and could read Dutch were eligible for the HRQoL measurements because HRQoL questionnaires in foreign languages were not yet available online. Women completed the questionnaires before randomisation, 3 and 6 months after randomisation. We used mixed model analyses to assess differences between treatment groups and the effect of time.

Main results and the role of chance

One hundred sixty-two women could read Dutch and were invited (162/178 (91%)). Analyzable data of the FertiQol questionnaire were available for 80% (130/162). Compared to women allocated to IUI-OS, women allocated to expectant management had a lower FertiQol score in the relational domain (mean difference –4.3 (95% CI –7.3 to –1.3) but not in the social domain (mean diff van –0.8 (95% CI –4.5 to 2.9).

Data of the HADS questionnaire were available of 156 women (96% (156/162)). Both groups had comparable scores in the Anxiety (mean difference –0.20; 95% CI 0.63; –0.99 to 0.6) and Depressions score (mean difference 0.002; 95% CI –0.67 to 0.67) at all three moments. At baseline, the incidence of an anxiety disorder (definition score 8 or higher) was 19% (30/156) and increased to 30% and 29% at 3 months and 6 months respectively. The incidence of a depression disorder (definition score 8 or higher) was 5% (7/156) and increased to 16% and 18% at 3 months and 6 months respectively. The incidences of anxiety or depression disorders did not differ significantly between expectant management and IUI.

Limitations, reasons for caution

Our randomized controlled trial did not reach the planned sample size. The results are only applicable to women with unexplained subfertility and a poor prognosis and not to all women with unexplained subfertility.

Wider implications of the findings: Although often assumed, IUI-OS does not improve HRQoL compared to expectant management in all domains. IUI might prevent loss of quality of the relationship, but the impact seems small. Future studies should look into the high incidence of anxiety and depression disorders in these women and how to support them.

Trial registration number

Trial register NL5455 (NTR5599)

P–753 A randomised controlled trial comparing expectant management versus intrauterine insemination in couples with unexplained subfertility and a poor prognosis for natural conception

Study question

Does 6 months expectant management reduces ongoing pregnancy rates compared to intrauterine insemination with ovarian stimulation (IUI-OS) in couples with unexplained subfertility?

Summary answer

In couples with unexplained subfertility and a poor prognosis for natural conception, 6 months of expectant management decreases ongoing pregnancy rates as compared to IUI-OS.

What is known already

In couples with unexplained subfertility and a poor prognosis, IUI-OS is a first line treatment. We have previously shown that in couples with unexplained subfertility and a good prognosis for natural conception (>30% in 12 months), 6 months expectant management does not reduce pregnancy changes. However, in couples with a poor prognosis for natural conception, effectiveness of IUI-OS is uncertain.

Study design, size, duration

We performed a non-inferiority multicentre randomised controlled trial (RCT) within the infrastructure of the Dutch Consortium for Healthcare Evaluation and Research in Obstetrics and Gynaecology. We studied couples with unexplained subfertility and a poor prognosis for natural conception. The couples were allocated in a 1:1 ratio to six months expectant management or six months IUI-OS with either clomiphene citrate or gonadotrophins.

Participants/materials, setting, methods

We intended to include 1091 couples. The trial was halted pre-maturely due to slow inclusion after randomisation of 178 couples. The primary outcome was ongoing pregnancy leading to a live birth with multiple pregnancy and miscarriage rate as important secondary outcomes. We calculated relative risks with 95% CI and a corresponding hazard-rate for ongoing-pregnancy-over-time based on intention-to-treat.

Main results and the role of chance

Between October 2016 and September 2020 92 couples were allocated to expectant management and 86 to IUI-OS. Baseline characteristics were equally distributed. Mean female age was 34 years, median duration of subfertility was 21 months. Within 6 months after randomisation, women allocated to expectant management had a lower ongoing pregnancy rate than women allocated to IUI-OS (12/92 [13.0%] vs 29/86 women [33.7%], risk ratio 0.39 (95%CI 0.21 to 0.71)). There were two ongoing twin pregnancies in the expectant management group versus none in the IUI-OS group. Of 15 clinical pregnancies in the expectant management group three miscarried (20%), of 36 clinical pregnancies in the IUI-OS group seven miscarried (19.4%) (RR 1.03 (95% CI 0.31 to 3.45)). For the outcome ongoing pregnancy, the hazard ratio for expectant management versus IUI-OS was 0.34 (95%CI 0.18 to 0.67).

Limitations, reasons for caution

Our trial did not reach the planned sample size and therefore the results are limited by the number of participants. As 8 women are still pregnant, in this abstract we report ongoing pregnancy rates. Live birth rates will be presented at the conference.

Wider implications of the findings: In couples with unexplained subfertility and a poor prognosis for natural conception, expectant management is inferior to IUI-OS. We advise the basic work-up for subfertility to contain a prognostic assessment, and when subfertility is unexplained and natural fertility prospects are poor IUI-OS should be the preferred treatment.

Trial registration number

NTR5599

Delay in achieving enteral autonomy and growth outcomes in very low birth weight infants with surgical necrotizing enterocolitis

OBJECTIVE

To understand the nutritional intake and growth outcomes of very low birth weight infants with surgical necrotizing enterocolitis (NEC).

STUDY DESIGN

In a retrospective cohort study, linear mixed models were used to compare growth outcomes from birth to 24 months corrected age for very low birth weight (VLBW) infants with surgical NEC to those with spontaneous intestinal perforation (SIP). Kaplan-Meier curves were developed to demonstrate the duration of parenteral nutrition (PN) use.

RESULT

Height differed by surgical NEC and SIP over time (interaction p = 0.03). Surviving infants with surgical NEC had lower head circumference z-scores at 24 months. Of infants surviving surgical NEC, 71% received PN for >60 days after diagnosis.

CONCLUSION

The majority of infants with surgical NEC have a delay in achieving enteral autonomy. There was a difference in linear catch-up growth over time between infants with SIP and surgical NEC at 24 months.

Factors that Influence Longitudinal Growth from Birth to 18 Months of Age in Infants with Gastroschisis

OBJECTIVE

This study aimed to investigate factors that influence growth in infants with gastroschisis.

STUDY DESIGN

Growth parameters at birth, discharge, 6, 12, and 18 months of age were collected from 42 infants with gastroschisis.

RESULTS

The mean z-scores for weight, length, and head circumference were below normal at birth and decreased between birth and discharge. Lower gestational age correlated with a worsening change in weight z-score from birth to discharge (rho 0.38, p = 0.01), but not with the change in weight z-score from discharge to 18 months (rho 0.04, p = 0.81). There was no correlation between the day of life when the enteral feeds were started and the change in weight z-score from birth to discharge (rho 0.12, p = 0.44) or discharge to 18 months (rho -0.15, p = 0.41).

CONCLUSION

Our study demonstrates that infants with gastroschisis experience a significant decline in weight z-score between birth and discharge, and start to catch up on all growth parameters after discharge. Prematurity in gastroschisis infants is associated with a greater risk for weight loss during this time. This information emphasizes the importance of minimizing weight loss prior to discharge in premature infants with gastroschisis and highlights the need for optimal management strategies for these infants.

Feeding Tolerance, Intestinal Motility, and Superior Mesenteric Artery Blood Flow in Infants with Gastroschisis

OBJECTIVE

The aim of this study was to determine the relationship of superior mesenteric artery (SMA) blood flow and intestinal motility with feeding tolerance in infants with gastroschisis.

STUDY DESIGN

This was a prospective observational cohort study of 23 infants with gastroschisis. Magnetic resonance images were obtained at abdominal wall closure, initiation of feeds, and full feeds. Motility and SMA flow data were correlated with feeding tolerance.

RESULT

All infants had abnormal motility, and most continued with abnormal motility despite achieving full feeds. Increased SMA flow at the time of abdominal wall closure was found to be significantly related to the earlier achievement of full feeds (ρ = -0.45, p = 0.05) and trended towards earlier initiation of feeds (ρ = -0.36, p = 0.13), shorter parenteral nutrition days (ρ = -0.42, p = 0.07), and earlier discharge (ρ = -0.41, p = 0.08).

CONCLUSION

Increased SMA blood flow at the time of abdominal wall closure is positively correlated with feeding tolerance, suggesting the importance of initial intestinal perfusion in the pathophysiology for feeding intolerance and intestinal dysmotility in gastroschisis.

A Low-Power Injection-Locked VCO for an Implantable MICS Band Transmitter with Wireless Frequency Reference and Tune-while-Lock Channel Calibration

This paper presents the design of an 800 MHz VCO for both free-running and injection locked operation in a novel low power transmitter with wireless frequency reference, operating in the MICS band (402-405 MHz). The transmitter employs simultaneous tuning and locking, to set the desired channel with a minimal injected power. The VCO is designed and fabricated in a 0.13 $\mu \mathrm{m}$ SiGe BiCMOS process and has a core area of 0.5 $\mathrm{m}\mathrm{m}^{2}$. The measurement of the free-running VCO shows -107 dBc/Hz phase noise at 300 kHz frequency offset. If locked to an external frequency reference the VCO shows 118 dBc/Hz phase noise at 300 KHz offset, while consuming 3 mA from a 1.2 V supply (3.6 mW). When the VCO is tuned during the locking, 20 dBm of reference power is required to enable operation in the whole MICS band. The measured phase noise of the free-running VCO ensures reliable calibration of the proposed transmitter and the locked VCO satisfies all requirements of an implantable device using MICS band data transmission. Therefore, this VCO presents a key building block of an injection locked, frequency agile, implantable transmitter for the MICS band.

Evaluation of Early Onset Sepsis, Complete Blood Count, and Antibiotic Use in Gastroschisis

OBJECTIVE

Gastroschisis is a congenital defect in which the abdominal viscera herniate through the abdominal wall. In this population, antibiotics are often initiated immediately following delivery; however, this may be unnecessary as infections typically develop as a consequence of chronic issues in gastroschisis. The objective of this study was to evaluate the incidence of culture positive early onset sepsis, the reliability of the immature to mature neutrophil count (I:T) ratio as an infectious biomarker, and antibiotic use in infants with gastroschisis.

STUDY DESIGN

This retrospective chart review analyzed clinical data from 103 infants with gastroschisis and 103 weight-matched controls that were evaluated for early onset infection.

RESULTS

Compared with the control group, there was a significantly increased percentage of infants with an I:T ratio > 0.2 in the gastroschisis group (43% vs. 12%, p < 0.001) and an increased percentage of infants exposed to greater than 5 days of antibiotics regardless of their I:T ratio (75% vs. 6%, p < 0.001). There were no episodes of culture positive early onset sepsis in either group.

CONCLUSION

Our results indicate that I:T ratio is not a reliable marker of infection in gastroschisis, and suggest that empiric septic evaluation and antibiotic use, immediately following delivery in gastroschisis infants, may be unnecessary.

Evaluation of menstrual bleeding patterns: a new proposal for a universal guideline based on the analysis of more than 4500 bleeding diaries

OBJECTIVE

To develop a universal guideline allowing the comparison of interventions like oral contraceptives and hormone replacement therapy with an impact on menstrual bleeding pattern.

METHODS

Literature analysis and cluster analysis of 4612 bleeding diaries.

RESULTS

We summarized key definitions needed for the evaluation of menstrual bleeding patterns from the literature. We developed a methodology to systematically evaluate menstrual bleeding patterns that distinguishes between cyclical and continuous hormonal regimens.

CONCLUSION

This universal guideline can be applied to all prospective clinical studies that affect menstrual bleeding patterns. It allows regulatory agencies and prescribing physicians to make meaningful comparisons of different products.

Inheritance of occlusal topography: a twin study

AIM

This was to determine the relative contribution of genetic factors on the morphology of occlusal surfaces of mandibular primary first molars by employing the twin study model.

METHODS

The occlusal morphology of mandibular primary first molar teeth from dental casts of 9 monozygotic (MZ) twin pairs and 12 dizygotic (DZ) twin pairs 4 to 7 years old, were digitized by contact-type three-dimensional (3D) scanner. To compare the similarity of occlusal morphology between twin sets, each twin pair of occlusal surfaces was superimposed to establish the best fit by using computerized least squared techniques. Heritability was computed using a variance component model, adjusted for age and gender.

RESULTS

DZ pairs demonstrated a greater degree of occlusal morphology variance. The total amount of difference in surface overlap was 0.0508 mm (0.0018 (inches) for the MZ (n=18) sample and 0.095 mm (0.0034 inches) for the DZ (n=24) sample and were not statistically significant (p=0.2203). The transformed mean differences were not statistically significantly different (p=0.2203). Heritability estimates of occlusal surface areas for right and left mandibular primary first molars were 97.5% and 98.2% (p<0.0001), respectively.

CONCLUSIONS

Occlusal morphology of DZ twin pairs was more variable than that of MZ twin pairs. Heritability estimates revealed that genetic factors strongly influence occlusal morphology of mandibular primary first molars.

Heritability of oral microbial species in caries-active and caries-free twins

Oral microbes that colonize in the mouths of humans contribute to disease susceptibility, but it is unclear if host genetic factors mediate colonization. We therefore tested the hypothesis that the levels at which oral microbes colonize in the mouth are heritable. Dental plaque biofilms were sampled from intact tooth surfaces of 118 caries-free twins. An additional 86 caries-active twins were sampled for plaque from carious lesions and intact tooth surfaces. Using a reverse capture checkerboard assay the relative abundance of 82 bacterial species was determined. An integrative computational predictive model determined microbial abundance patterns of microbial species in caries-free twins as compared to caries-active twins. Heritability estimates were calculated for the relative microbial abundance levels of the microbial species in both groups. The levels of 10 species were significantly different in healthy individuals than in caries-active individuals, including, A. defectiva, S. parasanguinis, S. mitis/oralis, S. sanguinis, S. cristatus, S. salivarius, Streptococcus sp. clone CH016, G. morbillorum and G. haemolysans. Moderate to high heritability estimates were found for these species (h(2) = 56%-80%, p < .0001). Similarity of the overall oral microbial flora was also evident in caries-free twins from multivariate distance matrix regression analysis. It appears that genetic and/or familial factors significantly contribute to the colonization of oral beneficial species in twins.

Validity of self-report measures of pain and disability for persons who have undergone arthroplasty for osteoarthritis of the carpometacarpal joint of the hand

OBJECTIVE

To establish the validity of three self-report scales used to measure function following arthroplasty for osteoarthritis (OA) of the carpometacarpal joint.

METHOD

Persons with OA of the carpometacarpal joint (n=122) were assessed on one occasion 9-117 months following tendon interposition arthroplasty. They completed three self-report measures of hand/upper limb disability: the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Patient-Rated Wrist Hand Evaluation (PRWHE), and the Disabilities of Arm, Shoulder and Hand (DASH). They also completed the Short Form 36 (SF-36) and performed tests of strength, range of motion (ROM), and dexterity. Factor analysis and correlations were used to determine the association among the scales and subscales considered to measure similar constructs (e.g., pain and physical disability). Correlations between the scales and measures of impairment were also conducted to examine construct validity of the disability measures. t-Tests evaluated the hypotheses that subjects with isolated hand OA would have lower scores than those with additional joint involvement.

RESULTS

All three scales or their subscales loaded on one factor. Convergent validity of the disability measures was demonstrated by high correlations between similar subscales (r>0.75), and divergent validity by a lack of correlation between the measures and self-report hand appearance. As expected, correlations between disability and strength, dexterity, or a global measure of ROM were higher than with ROM of individual joints. The AUSCAN and the DASH were better able to discriminate those with localized hand OA from those with involvement of other joints.

CONCLUSIONS

The AUSCAN, PRWHE, and DASH are valid assessments of pain and/or disability of hand OA, and provide information distinct from impairment measures.

Plasma concentrations of endogenous hormones during one regular treatment cycle with a low-dose oral contraceptive and during two cycles with deliberate omission of two tablets

In this open, prospective, phase-I study we closely monitored levels of endogenous progesterone, 17beta-estradiol, luteinizing hormone (LH) and follicle stimulating hormone in six healthy women. We determined plasma concentrations every 1-3 days during one untreated baseline cycle and during the first treatment cycle with regular pill intake of an oral contraceptive containing 30 microg ethinylestradiol plus 75 microg gestodene. During the following two treatment cycles, two tablets were deliberately omitted (in cycle 2 on days 6/7 and in cycle 3 on days 11/12). All but possibly one volunteer ovulated in the untreated pre-cycle, as concluded from LH peaks followed by marked increases of progesterone. During the regular first treatment cycle and even after deliberate omission of two tables in treatment cycles 2 and 3, the progesterone and estradiol levels remained low, so that we concluded that no ovulation took place. However, two volunteers showed some sort of LH peak in the first regular treatment cycle and all women showed LH increases of > 40 microg/ml in at least one omission cycle. In ten out of 12 cycles, omissions of pill intake were followed by an episode of intermenstrual bleeding. In conclusion, we have shown that, after omission of two consecutive oral contraceptive tables, the endogenous hormone parameters did not provide evidence for ovulation. Although this provides confirmation of the robustness of this oral contraceptive towards non-compliance, the widely published practical recommendations should be followed.

A meta-analysis on the correlation between ovarian activity and the incidence of intermenstrual bleeding during low-dose oral contraceptive use

We aimed to evaluate potential correlation between ovarian activity during use of combined oral contraceptives and the incidence of intermenstrual bleeding. Data from seven prospective clinical studies with five different combined low-dose oral contraceptives were retrospectively analyzed to determine ovarian activity measured by the Hoogland Score (follicle diameter and endogenous hormone levels) and cycle control. A total of 227 young fertile women were evaluated over three treatment cycles each. Women with intermenstrual bleeding had statistically significantly higher estradiol levels than those without intermenstrual bleeding. Also, women with intermenstrual bleeding had significantly larger follicle-like structures than those without intermenstrual bleeding. For example, in the second treatment cycle the difference of the mean follicle diameters between women without intermenstrual bleeding (12.5 mm) and women with spotting (16.9 mm) or breakthrough bleeding (16.1 mm) was statistically significant (p = 0.0179). Less than 17% of women with Hoogland Score 1, 2 or 3 (low ovarian activity) reported intermenstrual bleeding. On the other hand, 35.2% of women with Hoogland Score 4 (active follicle-like structures) reported intermenstrual bleeding. The association between bleeding and Hoogland Score was statistically significant (p < 0.0011). The findings of this retrospective analysis provide evidence that high ovarian suppression is positively correlated with improved cycle control in terms of less frequent intermenstrual bleeding - slight and heavy.

[Projective identification and denial of pregnancy--considerations of the reasons and background of unrecognized pregnancy also undiagnosed by a physician]

BACKGROUND

In denial of pregnancy, the pregnant woman does not consciously perceive the pregnancy and, in extreme cases, awareness occurs only during delivery. The attending physicians also often fail to recognize the pregnancy, even though the somatic complaints leading to consultation with a physician are typically pregnancy associated. This "iatrogenic participation" was described in the earliest historical publications. Different theories are presented in this paper to elaborate this phenomenon. Elementary deficiencies in perception or incompetence do not explain most cases.

PATIENTS AND METHODS

Twenty five women with denial of pregnancy, interviews PSYCHODYNAMIC EXPLANATIONS: Based on the deep-rooted subjective attitude of not being pregnant, the pregnant woman is able to include family, friends, and associates into the denial of pregnancy mindset. In a similar way, she is able to influence her doctor. The woman's autosuggestive wishful notions of not being pregnant receive suggestive confirmation by the physician's misdiagnosis and lead to a continuing denial of pregnancy.

PROJECTIVE IDENTIFICATION

In 1946, M. Klein introduced this term to describe a certain defense mechanism relating to fantasies and accompanying object relationships. The self initially successfully disposes of unwanted aspects, splits them off, and transfers them to another person, to finally reclaim them in a modified form. Certain elements of this psychoanalytical concept can characterize the interaction between physician and pregnant woman, which, in the case of denied pregnancies, does not lead to a diagnosis of pregnancy. Through projection, the pregnant woman is capable of manipulating the physician so that he perceives her, according to her wishes, as not being pregnant and misdiagnoses her correspondingly as "service in return". Opportunities for more mature handling of the denied content in terms of psychological development through accurate diagnosis of the pregnancy are indicated.

Body weight change during use of a monophasic oral contraceptive containing 20 microg ethinylestradiol and 75 microg gestodene with a comparison of the women who completed versus those who prematurely discontinued intake

OBJECTIVES

Evaluation of the impact of an oral contraceptive on body weight with a comparison ofwomen who completed versus women who prematurely discontinued intake.

METHODS

Data on body weight were retrospectively analyzed from four large prospective clinical trials with an oral contraceptive containing 20 microg ethinylestradiol and 75 microg gestodene (EE/GSD). A total of 1971 young fertile women were included in the evaluation, and 1467 completed 12 cycles.

RESULTS

We found no clinically relevant change of body weight during treatment with an oral contraceptive containing 20 microg ethinylestradiol and 75 microg gestodene in the vast majority of users after 12 treatment cycles. The mean change of body weight was less than 0.3 kg in this time period for all users. Nearly 70% of women experienced a minor change in their body weight of +/- 2 kg. An additional 13% lost more than 2 kg body weight in the course of 12 treatment cycles. A total of 11% increased their weight by 2-4 kg. A total of 1255 (85.5%) of women had a body mass index (BMI) of < or = 25 at baseline compared to 1253 (85.4%) after 12 cycles of treatment. There was no significant difference in the change ofbody weight between the women completing 12 cycles of treatment and those who prematurely discontinued EE/GSD.

CONCLUSIONS

This retrospective analysis confirms that there was only a negligible change of body weight during intake of an oral contraceptive containing 20 microg ethinylestradiol and 75 microg gestodene. There was no difference in weight change between the women completing the study or discontinuing intake.

The Edmonton Functional Assessment Tool: further development and validation for use in palliative care

The objective of this study was to examine the validity of the revised version of the Edmonton Functional Assessment Tool (EFAT-2), which was designed to measure physical impairment and functional performance of patients in palliative care. The EFAT-2 was administered to 275 patients on admission to an acute palliative care unit. Principal-components factor analysis was performed on the 10 items of the scale, and Cronbach's alpha was calculated to measure internal consistency. A one-way analysis of variance (ANOVA) was carried out to compare the admission EFAT-2 scores of three groups of patients: (a) deceased on the unit, (b) transferred to a continuing care palliative unit, (c) discharged home. Two main factors were revealed: physical and non-physical (cognitive/affective). Pain was identified as an independent item and did not correlate with any other item. Cronbach's alpha was 0.86. The ANOVA was significant (F [2,267] 29.063, p < 0.001). The results suggest that the EFAT-2 measures one construct. They also suggest that the EFAT-2 is able to discriminate between palliative care patients based on discharge location.

Validity of the baltimore therapeutic equipment work simulator in the measurement of lifting endurance in healthy men

OBJECTIVE

To examine the criterion validity of the Baltimore Therapeutic Equipment (BTE) work simulator by comparing endurance time, oxygen uptake (VO2), and heart rate measured during real and simulated lifting tasks and to derive a regression equation for predicting actual lifting endurance from measurements on the work simulator.

METHOD

Twenty healthy male volunteers repetitively lifted and lowered a load of 40 lb using the BTE work simulator and actual weights at a laboratory workstation. Postures, location, and frequency of lifts were kept constant. Endurance (defined as the time taken for the rating of perceived exertion to increase 2 units on the Borg scale) was measured under both conditions. VO2 and heart rate were also recorded, using standard physiological procedures.

RESULTS

The mean values for endurance time, steady-state VO2, and heart rate were significantly different between the real and simulated tasks (p < .05). Correlation of endurance time between the two tasks was significant (r = .71, p < .05). Step wise regression analysis resulted in the following equation for predicting real endurance from simulated time measurements: predicted real time = .34 simulated time + 3.29; r = .71; SE = 1.00 min.

CONCLUSION

The BTE work simulator tends to overestimate real lifting endurance performance in healthy men. The lower physiological stress during the simulated task suggests a significant difference between the real and simulated loads. Occupational therapists should exercise caution when using the results of the BTE work simulator during functional capacity evaluations.

Inter-rater reliability of formally trained and self-trained raters using the Edmonton Functional Assessment Tool

The primary objective of this study was to determine the inter-rater reliability of the revised version of the Edmonton Functional Assessment Tool (EFAT-2). A second objective was to determine whether both formally trained and self-trained therapists had an acceptable level of inter-rater reliability. The EFAT-2 was administered to consenting palliative care patients by one of two independent physical therapist rater pairs; one pair self-trained (R1, R2) and the other formally trained (R3, R4). The intraclass correlation [ICC (1,1)] for R1, R2 was 0.97 [95% confidence interval (CI) 0.94-0.99] and for R3, R4 was 0.95 (95% CI 0.90-0.98). The standard error of measurement was 1.09 and 1.44, respectively. The Kappa statistic for the rater pairs on individual EFAT items ranged from 0.17 to 0.96. The results suggest that both formally trained and self-trained therapists obtain an acceptable level of inter-rater reliability when using the EFAT-2.

Dose-dependent induction of transforming growth factor beta (TGF-beta) in the lung tissue of fibrosis-prone mice after thoracic irradiation

PURPOSE

The lung is the major dose-limiting organ for radiotherapy of cancer in the thoracic region. The pathogenesis of radiation-induced lung injury at the molecular level is still unclear. Immediate cellular damage after irradiation is supposed to result in cytokine-mediated multicellular interactions with induction and progression of fibrotic tissue reactions. The purpose of this investigation was to evaluate the acute and long-term effects of radiation on the gene expression of transforming growth factor beta (TGF-beta) in a model of lung injury using fibrosis-sensitive C57BL/6 mice.

METHODS AND MATERIALS

The thoraces of C57BL/6 mice were irradiated with 6 and 12 Gy, respectively. Treated and sham-irradiated control mice were sacrificed at times corresponding to the latent period (1, 3, 6, 12, 24, 48, 72 hours and 1 week postirradiation), the pneumonic phase (2, 4, 8, and 16 weeks postirradiation), and the beginning of the fibrotic phase (24 weeks postirradiation). The lung tissue from three different mice per dosage and time point was analyzed by a combination of polymerase chain reaction (PCR), immunohistochemistry, and light microscopy. The mRNA expression of TGF-beta was quantified by competitive reverse transcriptase/polymerase chain reaction (RT-PCR); the cellular origin of the TGF-beta protein was identified by immunohistochemical staining (alkaline phosphatase-anti-alkaline phosphatase [APAAP]). The cytokine expression on mRNA and protein level was correlated with the histopathological alterations.

RESULTS

Following thoracic irradiation with a single dose of 12 Gy, radiation-induced TGF-beta release in lung tissue was appreciable already within the first hours (1, 3, and 6 hours postirradiation) and reached a significant increase after 12 hours; subsequently (48 hours, 72 hours, and 1 week postirradiation) the TGF-beta expression declined to basal levels. At the beginning of the pneumonic phase, irradiation-mediated stimulation of TGF-beta release reached maximal values at 2 and 4 weeks. The elevated levels of TGF-beta mRNA during the latent phase have been found to correlate with immunohistochemical staining of alveolar macrophages. The most striking increase in TGF-beta immunoreactivity was seen during the acute phase of pneumonitis. Throughout this observation period, type II pneumocytes and fibroblasts (apart from inflammatory cells) served as important sources of TGF-beta expression. Increased TGF-beta expression was detected prominently in regions of histopathologic radiation injury. After exposure to a single radiation dose of 6 Gy, the lung tissue revealed only a minor radiation-mediated TGF-beta mRNA response. The modest upregulation ranged from 6 hours to 48 hours after irradiation. Corresponding to the only minor histopathologic changes after thoracic irradiation with 6 Gy, measurement of TGF-beta mRNA levels during the later time points revealed no significant alterations in comparison to untreated control mice.

CONCLUSIONS

This study demonstrates an acute and long-lasting increase in the expression of TGF-beta in lung tissue following thoracic irradiation with 12 Gy. The predominant localization of TGF-beta in areas of inflammatory cell infiltrates and fibrosis suggests involvement of this cytokine in the pathogenesis of radiation-induced pulmonal fibrosis. Further studies should be performed to explore the role of other cytokines in the development of radiation injury. An improved understanding of the underlying mechanisms of pulmonary fibrosis may eventually lead to modulatory intervention at the molecular level to modify the fibrotic process.

Frequency and significance of preterm delivery in twin pregnancies

OBJECTIVE

We investigated the frequency of preterm delivery and its influence on the neonatal outcome in twin pregnancies at a perinatal center. Are there differences in the course of twin pregnancies with preterm or term delivery?

METHOD

A retrospective investigation was carried out at the Department of Obstetrics on 502 twin pregnancies and deliveries between 1978 and 1993. Pregnancy history and clinical parameters were compared among preterm (<37+0 weeks) and term deliveries.

RESULT

Median duration of all twin pregnancies was 36+3 weeks of gestation. In the preterm group, preterm labor was more frequent, both, the first and the second neonate had lower birth weight and were more often admitted to the neonatal intensive care unit (NICU) where they stayed longer than full-term neonates needing intensive care. Perinatal deaths occurred only in the preterm group.

CONCLUSIONS

The incidence of preterm delivery is significantly elevated in twin pregnancies and consequently the incidence of low- and very-low-birth-weight-infants and perinatal mortality. Preterm delivery is the main reason why twin pregnancies are at a higher risk for an adverse neonatal outcome and thereby cause considerable costs.

Validity and reliability of the 6 minute walk in persons with fibromyalgia

OBJECTIVE

To assess the reliability and construct validity of the 6 minute walk (6MW) in persons with fibromyalgia (FM) and to determine an equation for predicting peak oxygen consumption (pVO2) from the distance covered in 6 minutes.

METHODS

Ninety-six women who met the American College of Rheumatology (ACR) criteria for FM were tested on the 6MW and the Fibromyalgia Impact Questionnaire (FIQ). A subset (n = 23) were tested on a separate day for pVO2 during a symptom-limited, incremental treadmill test. Twelve subjects repeated the 6MW five times over 10 days. Heart rate and rating of perceived exertion (RPE) were recorded for each walk. Intraclass correlations were used to determine the reliability of the 6MW. Validity was examined by correlating the 6MW with pVO2 and the FIQ. Body mass index (BMI) and 6MW were independent variables in a stepwise regression to predict pVO2.

RESULTS

A significant increase in distance occurred from Walk 1 to Walk 2 (p = 0.000) with the distance maintained on the remaining walks (p = 0.148) The correlations of the 6MW with the FIQ and pVO2 were -0.325 and 0.657, respectively. The regression equation to predict pVO2 from 6MW distance and BMI was: pVO2 (ml/kg/min) = 21.48 + (-0.4316 x BMI) + [0.0304 x distance(m)] (R = 0.76, R2 = 0.66).

CONCLUSION

When using the 6MW it is necessary to conduct a practice walk, with the second walk taken as the baseline measure. It was determined from the correlations that the 6MW cannot replace the FIQ as a measure of function. The 6MW may be used as an indicator of aerobic fitness, although obtaining VO2 by means of a graded exercise test is preferable.

Isometric strength measurements in children with arthritis: reliability and relation to function

OBJECTIVE

To examine the reliability of testing strength in children with juvenile arthritis (JA), and to determine the relationship between strength and function.

METHODS

Children with JA were tested for grip and pinch strength (n = 32). Isometric force produced by hip abductors and knee extensors was tested with a hand-held dynamometer (n = 29). Two therapists both performed each of the tests twice so that intrarater and interrater reliability could be examined. Function was measured by means of the Childhood Health Assessment Questionnaire (CHAQ) and performance on a 50-meter run. Reliability was examined with intraclass correlations (ICC). The relationships of strength and function were determined with Pearson and Spearman correlations.

RESULTS

All measures demonstrated good intrarater (ICC = 0.92-0.97) and interrater (ICC = 0.80-0.95) reliability. Grip strength and pinch were correlated with the CHAQ (r = -0.45 and -0.33, respectively), while hip abduction and knee extension torque were correlated with rankings on the 50-meter run (rho = -0.34 and -0.38, respectively).

CONCLUSION

Isometric strength can be reliably measured in children with arthritis in a clinical setting.

Physiological and perceptual responses during household activities performed by healthy women

OBJECTIVE

The purpose of this study was to describe the physiological and perceptual responses during two physically demanding household tasks: cleaning the bathroom and vacuuming the living room. It also examined the relationship between predicted aerobic fitness and the physiological responses during the two tasks.

METHOD

Seventeen healthy women between 30 and 50 years of age volunteered as participants. They were interviewed to gather demographic information required for prediction of aerobic fitness and observed while performing each task for 17 min to 20 min in their own home.

RESULTS

The heart rate, an index of circulatory strain, varied considerably among the participants and was moderately high during both tasks. Vacuuming the living room had a higher level of circulatory strain and perceived exertion than cleaning the bathroom. An inverse relationship existed between the predicted aerobic fitness and heart rate responses during the two tasks.

CONCLUSION

Routine household tasks result in a significant circulatory strain in healthy women. Persons with high levels of aerobic fitness experience a lower degree of circulatory strain.

The relationship between strength and function in females with juvenile rheumatoid arthritis

OBJECTIVE

To describe the relationship between isokinetic concentric and eccentric quadriceps strength and function in females with juvenile rheumatoid arthritis (JRA).

METHODS

Twenty girls with JRA aged 6 to 16 years participated in the study. Function and strength were measured on one occasion. Isokinetic concentric and eccentric quadriceps torque was measured on the Kin-Com dynamometer. Function was measured with the Childhood Health Assessment Questionnaire (CHAQ) and the Canada Fitness Award 50 m run. Pain and joint count were taken as measures of disease activity. Pain was assessed on a visual analog scale through parent- and self-report. Correlations between function, standardized torque values, pain, and joint count were determined. Stepwise multiple regression analyses with function as the predicted variable were performed.

RESULTS

Correlations between standardized torque and CHAQ scores were moderate (r = -0.48, p = 0.03 for concentric torque and r = -0.43, p = 0.06 for eccentric). Correlations between torque and run scores were also moderate (r = -0.48, p = 0.03 for concentric, r = -0.31, p = 0.19 for eccentric). Pain and total joint count were the best predictors of CHAQ score (r2 = 0.80), while concentric torque was the best predictor of running ability (r2 = 0.23).

CONCLUSION

Quadriceps torque was moderately correlated to function in girls with JRA. Function as determined on the CHAQ was best predicted from measures of disease activity, while function as determined on the 50 m run was best predicted from concentric quadriceps torque. Further research is required to determine a cause-effect relationship between strength and function in girls with JRA.

Pregnancy and delivery in a patient with mutilating dystrophic epidermolysis bullosa (Hallopeau-Siemens type)

BACKGROUND

Epidermolysis bullosa dystrophica of the mutilating Hallopeau-Siemens type is a rare inherited skin disease. Those afflicted have blisters and pronounced scarring of skin and mucous membranes after minor trauma. Pregnancies are very rare in affected women.

CASE

A 24-year-old woman, gravida 1, with a severe form of the Hallopeau-Siemens type was monitored closely during pregnancy. The patient spontaneously delivered a healthy female neonate at term. Episiotomy wound healing was uncomplicated. Seven months later, she returned in her second pregnancy, which was complicated by mild anemia and polyhydramnios from possible gestational-onset diabetes mellitus. Again, vaginal delivery of a healthy neonate was performed at term. We did not observe pregnancy-induced exacerbations of the skin disease.

CONCLUSION

Women with epidermolysis bullosa dystrophica of the Hallopeau-Siemens type may decide to have children after careful evaluation of the degree of impairment and a thorough explanation of the risks associated with pregnancy and delivery. Close monitoring of the pregnant patient is important. Vaginal delivery should be the first choice. Breast-feeding is difficult, but not contraindicated.

Isometric strength measurements of knee extensors in women with osteoarthritis of the knee

OBJECTIVE

To compare torque-angle characteristics of the knee extensors of women with and without osteoarthritis (OA) of the knee, and to determine the reliability of these measures.

METHODS

The isometric torque of the knee extensors of both legs was tested on 3 occasions in 17 women with OA of the knee and 17 healthy women. Tests were performed on an isokinetic dynamometer at 3 knee angles (30 degrees, 60 degrees, 90 degrees). The peak torque values were subjected to 4 way analysis of variance (group vs leg vs angle vs time), and intraclass correlation coefficients were calculated.

RESULTS

The reliability coefficients for repeated measures of isometric torque varied from 0.83 to 0.94 in the OA group and from 0.90 to 0.95 in the comparison group. The ANOVA and post hoc analyses revealed that the OA group had significantly (p < 0.05) lower knee extensor torque than the comparison group, and that the more symptomatic OA knee had lower torque than the contralateral limb. The torque was different across the 3 angles, but the torque-angle relationship was the same for both groups.

CONCLUSION

Isometric torque of the knee extensors can be measured reliably in women with OA of the knee. The torque is lower in women with OA than in women with no knee problems, and the changes are similar across different knee angles.

The reliability and validity of pain threshold measurements in osteoarthritis of the knee

The purpose of this study was to examine the reliability and validity of measuring pain threshold (PT) of persons with osteoarthritis (OA) of the knee. The PTs of women with and without OA of the knee were measured on 3 occasions at 6 sites at the knee with a pressure dolorimeter. Subjects with OA also recorded their pain on a visual analogue scale (VAS) and on the McGill Pain Questionnaire (MPQ). The reliability coefficients for repeated measures of PT varied from 0.61 to 0.91 in the OA group and from 0.71 to 0.90 in the control group. PT was lower in the OA group at all sites. Only the control group demonstrated significant differences between sites. The correlations between PT and measures of pain intensity were poor. It is concluded that the measurement of PT at the knee distinguishes OA from healthy controls, and that it has moderate reliability. However, it cannot substitute for a measure of pain intensity.

Acupuncture for the treatment of pain of osteoarthritic knees

OBJECTIVE

The purpose of this study was to determine whether acupuncture was more effective than sham acupuncture in the reduction of pain in persons with osteoarthritis (OA) of the knee.

METHODS

Forty subjects (20 men, 20 women) with radiographic evidence of OA of the knee were stratified by gender and randomly assigned to either the experimental (real acupuncture) or control (sham acupuncture) groups. Subjects were treated three times per week for 3 weeks and evaluated at three test sessions. Outcome measures were: 1) the Pain Rating Index of the McGill Pain Questionnaire, 2) the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, and 3) pain threshold at four sites at the knee.

RESULTS

The analyses of variance showed that both real and sham acupuncture significantly reduced pain, stiffness, and physical disability in the OA knee, but that there were no significant differences between groups.

CONCLUSIONS

Acupuncture is not more effective than sham acupuncture in the treatment of OA pain.

Torque of trunk flexion and trunk flexion with axial rotation in healthy men and women

The purpose of this study was to determine normal values for torque of trunk flexion and trunk flexion with axial rotation. Eighty-two healthy subjects (39 men, 43 women) were tested for isometric torque of trunk flexion at four angles, and eccentric and concentric torque at 30 degrees/sec. All tests were performed in three positions of axial rotation: neutral rotation, trunk rotated 30 degrees to the right, and trunk rotated 30 degrees to the left. The results of two separate three-way analyses of variance (gender vs. position vs. angle/contraction) indicated that the torque of men was greater than that of women, eccentric torque was greater than concentric, and the torque in neutral rotation was greater than in right or left rotation. Isometric torque decreased with increased trunk flexion. Regression and correlation analyses demonstrated that gender was generally the best predictor of torque, and that all the torque measures were significantly correlated.

Nutrition considerations in the neonatal extracorporeal life support patient

Extracorporeal life support (ECLS) is a type of heart-lung bypass commonly used to support neonates with life-threatening respiratory or cardiac failure. These patients are among the most critically ill patients in the neonatal intensive care unit and are at significant nutritional risk. Unfortunately, there is a paucity of literature regarding guidelines for nutrition support of the neonatal ECLS patient. The purpose of this article is to provide an overview of the indications, techniques, and complications of ECLS and to address the approach to nutrition support of these patients. Emphasis will be placed on issues unique to the neonatal ECLS patient.

Muscle function in chronic compartment syndrome of the leg

Chronic compartment syndrome (CCS) is a recognized cause of recurrent leg pain in the exercising patient. Decreased muscle function has been implied in this condition. This study compared the ankle dorsiflexion torque of 10 CCS patients with that of 18 control subjects during 20 repeated, maximal, isokinetic contractions at 60 degrees/sec. Peak torque, relative peak torque, and endurance data were collected. Results showed significantly lower peak torque and relative peak torque in the CCS group (p < or = 0.05), supporting the implication of muscle weakness in CCS. Paradoxically, endurance was significantly higher in the CCS group (p < or = 0.01), and there was a significant (p < or = 0.01), negative correlation (r = -0.50) between peak torque and endurance. The relationship between the findings and CCS is discussed. Strengthening may be useful in very mild cases or in postfasciotomy patients.

[Cesarean section of the second twin. Is this unusual mode of delivery justifiable?]

Within a ten-year period 1983-1992 eleven Caesarean sections were performed on the second twin after the first twin had been born vaginally. The reasons leading to this rather unusual mode of delivery are described here. Predominantly, multiple risk factors were present. One first twin and one second twin died in the early post natal period. In a comparative study of the literature, it is shown, that this, disputed mode of delivery has increased during the last twenty years and that, under special circumstances, it is a justifiable method of management of gemini deliveries.

Proprioceptive sensibility in women with normal and osteoarthritic knee joints

The objective of this study was to quantify the effect of degenerative joint change on the proprioceptive acuity of women with osteoarthritis (OA) of the knee. Middle-aged women with OA of the knee, age-matched healthy women, and younger healthy women were studied. Tests examined the ability of subjects to correctly reproduce knee angles in weightbearing and non-weightbearing situations. The knee angles were photographed and measured in degrees. The absolute error (AE) of each matching test was calculated and the mean AE of two tests was used as the criterion variable in a three-way analysis of variance (ANOVA). The relationship between the reproduction error and the osteoarthritic subjects' self-paced walking speed was also examined. Under both test conditions the AE of the osteoarthritic subjects was greater than that of the healthy subjects (p < .05). There was, however, no significant relationship between the AE measurements of the patients and their walking speed. These data indicate that while women with OA may have poorer proprioception than healthy controls, this impairment may not affect their walking ability.

[Recent results regarding indications for the "morning after pill"]

Results of interrogating 150 women who visited our department because of postcoital contraception are demonstrated. 80% did actually use one method of contraception. The rate of "condom accidents" was 70 per cent. Only 21 per cent did not use any method of contraception. Taking the facts of sexual habits into consideration we can conclude that women who wish to take the "morning after pill" have a more active sexual life. The intention to prevent an unwanted pregnancy through this postcoital method of contraception indicates a more responsible attitude towards sexuality. The popularity of this method may be increased.