Lancet
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Screening for carriers of CF (cystic fibrosis) is now possible but the best way of delivering such a service is unknown. In one model 4348 women attending antenatal clinics in an Edinburgh maternity hospital were invited to participate in a trial of prenatal screening. Mouthwash samples were tested for six CF alleles (85% of mutant genes) and when a woman was found to be a CF carrier her partner was also tested. ⋯ There was a significant increase in stress at the time of the test result among women identified as carriers. However, this disappeared when their male partners tested normal and did not reappear later in the pregnancy. By providing time for couples to discuss the possibility of screening and by offering the test at a point (the antenatal booking clinic) at which most pregnant women are seen, this approach has advantages, provided that counselling is readily available.
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Randomized Controlled Trial Comparative Study Clinical Trial
Randomised trial of cardiotocography alone or with ST waveform analysis for intrapartum monitoring.
It is possible to record the fetal electrocardiographic waveform (ECG) from the scalp electrode used in labour for detection of fetal heart rate. Animal and observational studies of changes in the ST waveform of the ECG during hypoxia suggest that a combination of heart rate and ST waveform analysis might improve the predictive value of intrapartum monitoring. In a randomised trial, we have studied intervention rates and neonatal outcome for high-risk labours monitored either by conventional cardiotocography (CTG) or by ST waveform analysis plus CTG. 1200 women with pregnancy of at least 34 weeks' gestation were assigned to the groups when the decision to apply a fetal scalp electrode was made. ⋯ The review of recordings showed that the reduction in intervention rate was among cases with CTG patterns classified as normal or intermediate, whereas there was no difference in intervention rates among cases with abnormal recordings. Our findings confirm that ST waveform analysis discriminates CTG changes in labour and that our protocol for interpretation is safe. Further randomised studies are warranted.
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Prevalence of schizophrenia and rates of first admission to hospital for this disorder are higher in most modern industrialised cities, and in urban compared with rural areas. The "geographical drift" hypothesis (ie, most schizophrenics tend to drift into city areas because of their illness or its prodrome) has remained largely unchallenged. We have investigated the association between place of upbringing and the incidence of schizophrenia with data from a cohort of 49,191 male Swedish conscripts linked to the Swedish National Register of Psychiatric Care. ⋯ The association persisted despite adjustment for other factors associated with city life such as cannabis use, parental divorce, and family history of psychiatric disorder. This finding cannot be explained by the widely held notion that people with schizophrenia drift into cities at the beginning of their illness. We conclude that undetermined environmental factors found in cities increase the risk of schizophrenia.