First Midwives in the Town of Bjelovar, Croatia 1756-1856

Prve izučene (aprobirane) primalje dolaze u novoosnovani Bjelovar, jako vojno središte Vojne krajine početkom druge polovice XVIII. stoljeća zajedno s vojnim liječnicima, kirurzima i ljekarnicima, a većina njih je germanskoga podrijetla. U do sada neistraženom arhivskom materijalu za razdoblje 1756.-1856. pronađeni su podaci o 23 izučene primalje, od kojih je 14 bilo pukovnijskih i 9 gradskih primalja. Visok perinatalni pomor djece i majki i kriminalni pobačaji karakteristike su toga razdoblja. Uz model domicilnoga primaljstva: skrb za trudnice, rodilje, babinjače, novorođenčad i dojenčad, primalje u teškim porodima obavljaju krštenje iz nužde ugroženoj novorođenčadi ili su pak krsne kume zdravoj dojenčadi. Premda je u samom gradu Bjelovaru ustrojeno stručno primaljstvo, u okolici grada i dalje se porodi obavljaju bez stručne pomoći. Za razliku od većine tadašnjih gradova kontinentalne Hrvatske, pa i Dalmacije, u Bjelovaru postoji kontinuirano izučeno primaljstvo i zaštita materinstva od polovice XVIII. stoljeća.The first trained (certified) midwives came to the newly founded town of Bjelovar, a strong military centre of Vojna Krajina (Croatian province bordering Ottoman Empire), at the beginning of the 1750s, along with army physicians, surgeons, and pharmacists. Most were of German origin. The archival material investigated for the period 1756-1856 speaks of 23 certified midwives, of whom 14 were regimental and nine municipal. This period was characterised by high neonatal and maternal mortality rates and criminal abortions. Within the scope of the domiciliary midwifery model that included care for pregnant women, parturient women, neonates, and infants, midwives used to act as godmothers to newborns at risk, in periculo, or to healthy newborns. Although Bjelovar had professional midwifery service, the practice of unassisted childbirths continued in the town surroundings. Unlike other inland and coastal (Dalmatian) towns of the time, Bjelovar has had a continuous tradition of training midwives and maternal health care since the 1750s

Coliform pyosalpinx as a rare complication of appendicectomy: a case report and review of the literature on best practice

<p>Abstract</p> <p>Introduction</p> <p>Coliform pyosalpinx is a rare entity. We report a case that occurred three months after appendicectomy for gangrenous appendicitis. There follows a literature review on best practice for the treatment of pyosalpinx.</p> <p>Case presentation</p> <p>A seventeen year old girl presented with an acute abdomen three months after an appendicectomy for gangrenous appendicitis. Intraoperative findings were bilateral pyosalpinx treated by aspiration, saline and Betadine irrigation and intravenous antibiotics.</p> <p>Conclusion</p> <p>Microbiological analysis of the pus revealed <it>Escherichia coli </it>and anaerobes. Chlamydia and Candida were not isolated. This is the first known reported case of Coliform Pyosalpinx following appendicectomy. The best treatment does not necessarily involve salpingectomy especially in women of reproductive age where fertility may become compromised.</p

Physiotherapeutic interventions in multiple sclerosis across Europe : Regions and other factors that matter

Background: A wide variety of interventions exists in physical therapy (PT), but knowledge about their use across different geographical regions is limited. This study investigated the use of PT interventions in people with multiple sclerosis (MS) across Europe. It aimed to determine whether regions differ in applying interventions, and explore whether factors other than regions play a role in their use. Methods: In an online cross-sectional survey, 212 respondents from 115 European workplaces providing PT services to people with MS representing 26 countries (four European regions) participated. Cluster analysis, Pearson Chi-squared test and a Poisson regression model were used to analyze the data. Results: Thirteen of 45 listed PT interventions were used by more than 75% of centers, while nine interventions were used by less than 25%. For 12 interventions, regions differed markedly in their use. Cluster analysis of centers identified four clusters similar in their intervention use. Cluster assignment did not fully align with regions. While center region was important, center size, number and gender of physical therapists working in the center, and time since qualification also played a role. Cluster analysis exploring the use of the interventions provided the basis for a categorization of PT interventions in line with their primary focus: 1. Physical activity (fitness/endurance/resistance) training; 2. Neuroproprioceptive "facilitation/inhibition"; 3. Motor/skill acquisition (individualized therapy led); 4. Technology based interventions. Conclusions: To our knowledge this is the first study that has explored this topic in MS. The results broaden our understanding of the different PT interventions used in MS, as well as the context of their use

The organisation of physiotherapy for people with multiple sclerosis across Europe : a multicentre questionnaire survey

Background: Understanding the organisational set-up of physiotherapy services across different countries is increasingly important as clinicians around the world use evidence to improve their practice. This also has to be taken into consideration when multi-centre international clinical trials are conducted. This survey aimed to systematically describe organisational aspects of physiotherapy services for people with multiple sclerosis (MS) across Europe. Methods: Representatives from 72 rehabilitation facilities within 23 European countries completed an online web-based questionnaire survey between 2013 and 2014. Countries were categorised according to four European regions (defined by United Nations Statistics). Similarities and differences between regions were examined. Results: Most participating centres specialized in rehabilitation (82 %) and neurology (60 %), with only 38 % specialising in MS. Of these, the Western based Specialist MS centres were predominately based on outpatient services (median MS inpatient ratio 0.14), whilst the Eastern based European services were mostly inpatient in nature (median MS inpatient ratio 0.5). In almost all participating countries, medical doctors - specialists in neurology (60 %) and in rehabilitation (64 %) - were responsible for referral to/prescription of physiotherapy. The most frequent reason for referral to/prescription of physiotherapy was the worsening of symptoms (78 % of centres). Physiotherapists were the most common members of the rehabilitation team; comprising 49 % of the team in Eastern countries compared to approximately 30 % in the rest of Europe. Teamwork was commonly adopted; 86 % of centres based in Western countries utilised the interdisciplinary model, whilst the multidisciplinary model was utilised in Eastern based countries (p = 0.046). Conclusion: This survey is the first to provide data about organisational aspects of physiotherapy for people with MS across Europe. Overall, care in key organisational aspects of service provision is broadly similar across regions, although some variations, for example the models of teamwork utilised, are apparent. Organisational framework specifics should be considered anytime a multi-centre study is conducted and results from such studies are applied

Breech presentation at term and associated obstetric risks factors-a nationwide population based cohort study

Purpose The aim of this study was to estimate whether breech presentation at term was associated with known individual obstetric risk factors for adverse fetal outcome. Methods This was a retrospective, nationwide Finnish population-based cohort study. Obstetric risks in all breech and vertex singleton deliveries at term were compared between the years 2005 and 2014. A multivariable logistic regression model was used to determine significant risk factors. Results The breech presentation rate at term for singleton pregnancies was 2.4%. The stillbirth rate in term breech presentation was significantly higher compared to cephalic presentation (0.2 vs 0.1%). The odds ratios (95% CIs) for fetal growth restriction, oligohydramnios, gestational diabetes, a history of cesarean section and congenital fetal abnormalities were 1.19 CI (1.07-1.32), 1.42 CI (1.27-1.57), 1.06 CI (1.00-1.13), 2.13 (1.98-2.29) and 2.01 CI (1.92-2.11). Conclusions The study showed that breech presentation at term on its own was significantly associated with antenatal stillbirth and a number of individual obstetric risk factors for adverse perinatal outcomes. The risk factors included oligohydramnios, fetal growth restriction, gestational diabetes, history of caesarean section and congenital anomalies.Peer reviewe

Prevalencija infekcije Neisseriom gonorrhoeae ili Chlamydiom trachomatis kod akutnoga mukopurulentnog cervicitisa

The aim of this study was to determine the incidence of N. gonorrhoae (NG) and/or C. trachomatis (CT) in acute mucopurulent cervicitis (MPC). The study included 617 non-pregnant women with MPC, who had not been receiving any antimicrobial treatment. The average age of patients was 22.2 years. There were no statistically significant differences according to place of residence, education, and marital status. Samples for laboratory analysis were collected using a routine procedure; NG was identified using the cytochrome oxidase test and Gram staining. CT was isolated on McCoy cell culture and stained with Lugol solution. NG was isolated in three women (0.8 %) and CT in 58 women (9.4 %). Fifty-six of the CT-positive patients were nullipara and only two were unipara. All NG-positive patients were also nullipara. The mean number of sexual partners was 2.2 in all study subjects, 2.4 in CT-positive subjects, and 2.9 in NG-positive subjects. Vaginal discharge purity according to Schröder was significantly deteriorated in CT-positive patients (p=0.011). When asked about the use of contraceptives, as many as 32.7 % patients answered that they did not use any protection, 39 % women used the rhythm method and coitus interruptus, 20 % were taking oral contraceptives, 6.1 % used mechanical devices, and 1.9 % used chemical protection. Previous acute and chronic pelvic infl ammatory diseases correlated with MPC (p<0.01). Our statistical analysis suggests that chlamydial infection significantly reduces the purity of vaginal discharge, which is more pronounced in nulliparae. Pap smear was not specific enough to demonstrate chlamydial infection. In view of the MPC findings, the prevalence of CT and NG infection is low.Cilj istraživanja jest utvrditi koincidenciju N. gonorrhoae (NG) i/ili C. trachomatis (CT) u akutnim mukopurulentnim cervicitisima (MPC). Istraživanje je provedeno na populaciji 617 žena izvan trudnoće koje prethodno nisu uzimale antimikrobnu terapiju. NG i CT su izolirane iz obrisaka vrata maternice primjenom standardnih metoda. NG je transportirana na selektivnoj hranjivoj podlozi i identificirana citokrom-oksidaznim testom bojenjem po Gramu. CT je izolirana McCoyevom staničnom kulturom nakon bojenja Lugolovom otopinom. NG je izolirana u tri ispitanice (0,8 %), a CT u 58 ispitanica (9,4 %). Srednja dob bolesnica iznosila je 22,2 godine. Školovanje i bračno stanje nisu statistički značajno utjecali na rezultate istraživanja. Među bolesnicama s izoliranom CT prevladavaju nulipare, a u slučaju NG sve su pozitivne bolesnice također bile nulipare. Srednja vrijednost broja partnera za čitavu populaciju iznosi 2,2. Bolesnice s potvrđenom CT imale su prosječno 2,4, a one s potvrđenom NG 2,9 partnera. Vrijednost određivanja stupnja čistoće rodničkog iscjetka po Schroderu značajno je povišena u CT-pozitivnih bolesnica (p=0.011). Utvrđeno je da 32.7 % ispitanica uopće nije koristilo kontracepciju, dok je većina (39 %) rabila ritmičke metode i prekinuti snošaj. Preostale ispitanice uzimale su oralne kontraceptive (20 %), mehaničku zaštitu (6,1 %) ili lokalne kemijske kontraceptive (1,9 %). Također je dokazano da prethodna akutna i kronična zdjelična upalna bolest korelira s MPC-om (p<0.01). Zaključeno je da klamidijska infekcija statistički značajno korelira sa stupnjem čistoće rodničkog iscjetka, posebice u nulipara. Papanicolaouov razmaz nije specifičan u određivanju klamidijske infekcije. Rezultati istraživanja pokazuju da je učestalost klamidijske i gonokokne infekcije ipak relativno niska u odnosu na nalaz MPC-a

EFAS/EAN survey on the influence of the COVID-19 pandemic on European clinical autonomic education and research

Purpose: To understand the influence of the coronavirus disease 2019 (COVID-19) pandemic on clinical autonomic education and research in Europe. Methods: We invited 84 European autonomic centers to complete an online survey, recorded the pre-pandemic-to-pandemic percentage of junior participants in the annual congresses of the European Federation of Autonomic Societies (EFAS) and European Academy of Neurology (EAN) and the pre-pandemic-to-pandemic number of PubMed publications on neurological disorders. Results: Forty-six centers answered the survey (55%). Twenty-nine centers were involved in clinical autonomic education and experienced pandemic-related didactic interruptions for 9&nbsp;(5; 9)&nbsp;months. Ninety percent (n = 26/29) of autonomic educational centers reported a negative impact of the COVID-19 pandemic on education quality, and 93% (n = 27/29) established e-learning models. Both the 2020 joint EAN–EFAS virtual congress and the 2021 (virtual) and 2022 (hybrid) EFAS and EAN congresses marked higher percentages of junior participants than in 2019. Forty-one respondents (89%) were autonomic researchers, and 29 of them reported pandemic-related trial interruptions for 5&nbsp;(2; 9)&nbsp;months. Since the pandemic begin, almost half of the respondents had less time for scientific writing. Likewise, the number of PubMed publications on autonomic topics showed the smallest increase compared with other neurological fields in 2020–2021 and the highest drop in 2022. Autonomic research centers that amended their trial protocols for telemedicine (38%, n = 16/41) maintained higher clinical caseloads during the first pandemic year. Conclusions: The COVID-19 pandemic had a substantial negative impact on European clinical autonomic education and research. At the same time, it promoted digitalization, favoring more equitable access to autonomic education and improved trial design

Prospective study of individual characteristics and posttraumatic stress disorder (PTSD) symptoms following childbirth: Birth satisfaction as a moderator

Objective: The goal of this study was to (a) examine the association between childbirth-related posttraumatic stress disorder (CB-PTSD) symptoms and possible risk factors of previous trauma, individual characteristics (neuroticism, anxiety sensitivity, and resilience), type of birth, and birth satisfaction and (b) explore whether birth satisfaction moderates any association between individual characteristics and CB-PTSD symptoms. Method: This was a longitudinal questionnaire study during pregnancy and postpartum. Pregnant women (N = 396) were recruited from antenatal clinics and completed questionnaires during mid–late pregnancy (Time 1) and 6–12 weeks after childbirth (Time 2). Time 1 questionnaires measured anxiety sensitivity (Anxiety Sensitivity Index), neuroticism (International Personality Item Pool–50, Neuroticism subscale), resilience (Brief Resilience Scale), and trauma history. Time 2 questionnaires measured birth satisfaction and CB-PTSD (Birth-Related and General Symptoms subscales). Results: Regression analysis showed that previous sexual trauma, higher levels of neuroticism, and lower levels of birth satisfaction predicted higher levels of CB-PTSD symptoms. Anxiety sensitivity and resilience were not significant predictors of CB-PTSD. Additionally, birth satisfaction moderated the relationship between higher neuroticism and higher levels of CB-PTSD (total and general symptoms) and between lower resilience and higher CB-PTSD general symptoms. Effects were stronger when low birth satisfaction was reported. Conclusions: Individual characteristics and birth satisfaction interact in the development of posttraumatic stress disorder following childbirth, with previous traumatic experiences playing an additional role. These findings can inform screening and care pathways for women at greater risk