Background: Persons with intellectual disability (ID) are supposedly pre-disposed to weight gain and obesity. Factors such as medication, distress and metabolic diseases are blamed for their weight excess. Persons with ID may not be allowed to make independent decisions about their calorie intake and food choice. Data on weight status and weight loss interventions in persons with intellectual disability (ID) is scarce. We sought to ascertain the prevalence of obesity in an ID population and the impact of a ‘healthy lifestyle’ clinicMethods / Intervention: We reviewed data on 149 adults (women=69) attending an ID service.Prospective data was available on 23 adults (women=22, baseline BMI=39.1±7.5kgs/m2) of which 17 had a Mental Health diagnosis. These persons attended a weekly ‘healthy lifestyle’ clinic where diet & lifestyle advice was available and re-enforced at this review with the person and staff involved in food preparation.Bi-annually, visits included food & exercise diary analysis, weight measurement, rationalisation of psychotropic/epileptic drugs by Psychiatry/Neurology and biochemical testing for diabetes & thyroid dysfunction.Results: At Baseline 9.4% (n = 14) were underweight (BMI<18), 25.5% (n = 38) were normal weight (BMI = 18-25), 25.5% (n = 38) were overweight (BMI = 25 - 30) and the remaining 39.6% (n = 59) were obese (BMI > 30).Women had a significantly higher BMI compared to men (29.7±7.8 vs. 26.1±7.3kg/m2, p=0.004).Conclusions:In this adult ID cohort:Prevalence of obesity is similar compared to the general public.Women with DS had a significantly higher BMI then women with ID only.Reviews by the MHID team and the rationalising of medication assisted with the positive outcomes for the 17 persons identified with mental health out of the 23 adults who’s prospective data available.Diet & Lifestyle interventions and medication rationalisation were successful in producing sustained weight loss.

Oxytocin infusion used in labour can sometimes be left hung on the stand for many hours. There has been no study to determine if oxytocin is equally distributed throughout the infusion bag and if the distribution stays the same with time. We postulated that there may be settling of the molecules such that oxytocin concentrates at the bottom of the infusion bag. Eight infusion bags were prepared by mixing 10 IU of oxytocin in 1 litre of normal saline. The infusion bags were hung on infusion stands for 8 hours after which 10 samples of 100 mls of the solution from each bag were taken in different containers and the concentration of oxytocin calculated using oxytocin specific Enzyme Immunoassay (EIA) in the different samples. No statistically significant correlation between the oxytocin concentration and the sample number was observed (p-value = 0.738). There was no obvious relationship between oxytocin concentration and the sample number in each bag. There was no evidence to suggest that a linear oxytocin concentration gradient develops in a bag of normal saline over an 8-hour period. In fact the distribution appears to be random and unequal.

BACKGROUND:In 2008, the management of women in Ireland with atypical glandular cells changed to immediate referral to colposcopy. The optimal management of these women is unclear. A balance between the detection of occult disease and overtreatment is required.METHODS:Our study aim was to document the experience of this policy at the National Maternity Hospital, Dublin. Information from the computerized data management system was analysed with the statistical package SPSS.RESULTS:In 2009, 156 women attended colposcopy following a single atypical glandular cell diagnosis on liquid-based cytology. The mean age was 41 years. Thirty (19.2%) women had abnormal vaginal bleeding, 31 (19.9%) were smokers and 34 (21.8%) had received previous treatment. The colposcopy was satisfactory in 125 (80.1%) and unsatisfactory in 31 (19.9%). Cervical histology was available for 146 (93.6%) women: 57 excisional procedures and 89 diagnostic biopsies. Abnormal histology was detected in 46 women (31.5%). Four women (2.7%) had invasive cancer, five (3.4%) had adenocarcinoma in situ, 21 (14.4%) had cervical intraepithelial neoplasia (CIN) grade 2 or 3 and 16 (11.0%) had CIN1. No abnormality was detected in 100 women (68.5%), including 35 (61.4%) of those who had undergone excisional procedures. The colposcopic impression in this group was unsatisfactory in 10 women (28.6%), glandular abnormalities in six (17.1%), high- and low-grade changes in 12 (34.2%) and six (17.1%) women, respectively, and normal in one (2.9%). The findings were essentially negative in the remaining 10 women: overall, 30 (19.2%) of the 156 women referred to colposcopy had at least CIN2.CONCLUSION:This study confirmed significant levels of high-grade disease in women referred to colposcopy with atypical glandular cells on cytology. Concerns about undetected endocervical disease resulted in high levels of negative excisional biopsies. Alternative strategies, including endometrial sampling, human papillomavirus testing and discussion at clinicopathological meeting, should be considered.

BJOG: An International Journal of Obstetrics & GynaecologyVolume 106, Issue 3 p. 183-187 Active management of labour revisited Lawrence Impey, Lawrence Impey The Oxford Radcliffe Hospital, Headington, OxfordSearch for more papers by this authorPeter Boylan, Peter Boylan The National Maternity Hospital, Dublin, IrelandSearch for more papers by this author Lawrence Impey, Lawrence Impey The Oxford Radcliffe Hospital, Headington, OxfordSearch for more papers by this authorPeter Boylan, Peter Boylan The National Maternity Hospital, Dublin, IrelandSearch for more papers by this author First published: 19 August 2005 https://doi.org/10.1111/j.1471-0528.1999.tb08229.xCitations: 26Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1 Olah K, Gee H. The active mismanagement of labour. Br J Obstet Gynaecol 1996; 103: 729–731. 2 Thornton J. Active management of labour. BMJ 1996; 313: 378. 3 O'Driscoll, Foley M, MacDonald D. Active management of labor as an alternative to cesarean section for dystocia. Obstet Gynecol 1984; 63: 485–490. 4 Turner M, Brassil M, Gordon H. Active management of labour associated with a decrease in the caesarean section rate in nulliparas. Obstet Gynecol 1988; 71: 150–154. 5 Akoury H, Brodie G, Caddick R, McLaughlin V, Pugh P. Active management of labour and operative delivery in nulliparous women. Am J Obstet Gynecol 1988; 158 255–258. 6 Boylan P, Frankowski R, Roundtree R, Selwyn B, Parrish K. Effect of active management on the incidence of cesarean section for dystocia in nulliparas. Am J Perinatol 1991; 8: 373–379. 7 Lopez-Zeno J, Peaceman A, Adashek J, Socol M. A controlled trial of a program for the active management of labour. N Engl J Med 1992; 326 450–454. 8 Frigoletto F, Lieberman E, Lang J, Cohen A, Barss V, Ringer S, Datta S. A clinical trial of active management of labour. N Engl J Med 1995; 333: 745–750. 9 Cammu H, Van Eeckhout E. A randomised controlled trial of early versus delayed use of amniotomy and oxytocin infusion in nulliparous labour. Br J Obstet Gynaecol 1996; 103: 313–318. 10 Fraser W, Venditelli F, Krauss I, Breart G. Effects of early augmentation of labour with amniotomy and oxytocin in nulliparous women: a meta-analysis. Br J Obstet Gynaecol 1998; 105: 189–194. 11 Naylor CD. Meta-analysis and the meta-epidemiology of clinical research. BMJ 1997; 315: 617–619. 12 O'Driscoll, Jackson R, Gallagher J. Prevention of prolonged labour. BMJ 1969; 2: 477–480. 13 MacDonald D. The use of intrapartum fetal heart rate monitoring to reduce perinatal asphyxia in the term infant. In: D Stevenson, P Sunshine, editors. Feral and Neonatal Brain Injury. Oxford : Oxford University Press, 1997: 167–180. 14 Fraser W, Krauss I, Brisson-Carrol G, Thornton J, Breart G. Amniotomy to shorten spontaneous labor. In The Cochrane Library, Issue 3. Oxford : Update Software. 1998. 15 Fraser W, Marcoux S, Moutquin J, Christen A. Effect of early amniotomy on the risk of dystocia in nulliparous women. N Engl J Med 1993; 328: 1145–1149. 16 Olah K, Neilson J. Failure to progress in the management of labour. Br J Obstet Gynaecol 1994; 101: 1–3. 17 Friedman E. The graphic analysis of labor. Am J Obstet Gynecol 1954; 68: 1568–1575. 18 Johnson N, Lilford R, Guthrie K, Thornton J, Barker M, Kelly M. Randomised trial comparing a policy of early with selective amniotomy in uncomplicated labour at term. Br J Obstet Gynaeco1 1997; 104: 340–346. 19 Boylan P, Parisi V. Effect of active management on latent phase labor. Am J Perinatol 1990; 7: 363–365. 20 Olah K, Gee H, Brown J. The response of the cervix to oxytocic stimulation in the latent phase of labour. Br J Obstet Gynaecol 1993; 100: 635–640. 21 Allman A, Genevier E, Johnson M, Steer P. Head-to-cervix force: an important physiological variable in labour. 2. Peak active force, peak active pressure and mode of delivery. Br J Obstet Gynaecol 1996; 103: 769–775. 22 Allman A, Genevier E. Johnson M. Steer P. Head-to-cervix force: an important physiological variable in labour. 1. The temporal relationship between head to cervix force and intrauterine pressure during labour. Br J Obstet Gynaecol 1996; 103: 763–768. 23 Saunders N, Spiby H, Gilbert L, Fraser R, Hall J, Mutton P et al. Oxytocin infusion in second stage of labour in primiparous women using epidural analgesia: a randomised double blind placebo controlled trial. BMJ 1989; 299: 1423–1426. 24 Ward A. Introducing active management to Nigeria. Presented to the Society of Gynaecology and Obstetrics of Nigeria, 1977. 25 Masoli P, Pico V, Pellerano I. Manejo activo del parto. Experienca en el hospital Gustavo Fricke. Rev Chi1 Obstet Ginecol 1986; 51: 223–230. 26 Vengadasalam D. Active management of labour: an approach to reducing the rising caesarean rate. Singapore J Obstet Gynecol 1986; 17: 33–36. 27 Hogston P, Noble W. Active management of labour: the Portsmouth experience. J Obstet Gynaecol 1993; 13: 340–342. 28 Glantz JC, McNanley T. Active management of labor: a meta-analysis of cesarean delivery rates for dystocia in nulliparas. Obstet Gynecol Surv, 1997; 52: 497–505. 29 Black N. Developing high quality clinical databases. BMJ 1997; 315: 381–382. 30 Turner M, Rasmussen M, Turner J, Boylan P, MacDonald D. Stronge J. Influence of birth weight on labour in nulliparas. Obstet Gynecol 1990; 76: 159–163. 31 Thornton J, Lilford R. Active management of labour: current knowledge and research issues. BMJ 1994; 309: 366–369. 32 Hodnett ED. Support from caregivers during childbirth. In The Cochrane Library, Issue 3. Oxford : Update Software, 1998. 33 Rogers R, Gilson G, Miller A, Izquierdo L, Curet L, Qualls C. Active management of labor: does it make a difference Am J Obstet Gynecol 1997; 177: 599–605. 34 Boylan P. Active management of labour [letter]. BMJ 1997; 314: 606. 35 Urquhart D, Grieve R, Geals M. The rising caesarean rate: a year's audit to assess the trend. Health Bull 1987; 45: 316–328. 36 Sanchez-Ramos L, Kaunitz A, Peterson H, Martinez-Schnell B, Thompson R. Reducing cesarean sections at a teaching hospital. Am J Obstet Gynecol 1990; 163: 1081–1088. 37 Robson M, Scudamore I, Walsh S. Using the medical audit cycle to reduce the cesarean section rate. Am J Obstet Gynecol 1996; 174: 199–205. 38 Cartmill R, Thornton J. Effect of presentation of partogram information on obstetric decision-making. Lancet 1992; 339: 1520–1522. 39 Goffinet E Fraser W, Marcoux S, Breart G, Moutquin J-M. Daris M. early amniotomy increases the frequency of fetal heart rate abnormalities. Br J Obstet Gynaecol 1997; 104: 548–553. 40 Thorp I, Boylan, Parisi V, Heslin E. Effects of high-dose oxytocin augmentation on umbilical cord blood gas values in primigravid women. Am J Obstet Gynecol 1988; 159: 670–675. 41 Cahill D, Boylan P, O'Herlihy C. Does oxytocin augmentation increase perinatal risk in primigravid labor Am J Obstet Gynecol 1992; 166: 847–850. 42 Lavender T, Alfirevic Z, Walkinshaw S. Partogram action line study: a randomised trial. Br J Obstet Gynaecol 1998; 105: 976–980. 43 Reid M. What are consumer views of maternity care? In: GVP Chamberlain, N Patel, editors The Future of Maternity Services. London : RCOG Press, 1994: 3–11. 44 Changing Childbirth. Department of Health. London : HMSO, 1993. Citing Literature Volume106, Issue3March 1999Pages 183-187 ReferencesRelatedInformation

The aim of this study was to assess women's level of satisfaction with management during labour and to ascertain their preference for mode of delivery. The basis for the findings was the cross-sectional anonymous questionnaire survey of 520 women at a Dublin obstetric hospital. Visual analogue scales were used to assess degree of satisfaction. The response rate was 63% (520 of 830). 98.5% of women had hoped for a vaginal delivery and 1.5% for a Cesarean section. All primiparas had wanted a vaginal delivery. The majority of women were satisfied with their care in labour (65% had a score of > or = 7). Factors significantly associated with high levels of satisfaction were good analgesia during labour (particularly epidural), vaginal delivery, adequate preparation for labour and if personal wishes were listened to by staff. Almost all women have a preference for vaginal delivery. Satisfaction with care in labour is significantly influenced by vaginal delivery, empathetic communication by staff and good analgesia in labour.

Objective To compare two management policies: rupture of the fetal membranes when women are in normal labour or leave them intact as long as feasible.

Little is known about hepatic T lymphocyte subpopulations in the human liver.The aim of this study was to document the various subpopulations present in the liver and compare them to peripheral T lymphocytes in the same patients.Normal hepatic tissue was obained at time of transplant from five patients, and a single cell suspension of lymphocytes were prepared by standard methods.Ceils were stained with monoclonal antibodies specific for CD8ct and CD8B chains, CD4, CD8, CD3, o~BTCR, and ySTCR, and analyzed by two and three colour flow cytometry.Of the hepatic CD3+ cells, 71% were CD8+ and 25% were CD4+, with a CD4/CD8 ratio of 1:3 in contrast to the peripheral CD4/CD8 ratio of 2:1.18% of the hepatic CD3+ cells expressed ySTCR.Significantly, CD8~ct accounted for 27% [mean] of the total hepatic CD8+ population.Conclusion: There is now evidence that the adult human gut can support extrathymic T cell differentation.A significant population of hepatic CD8txct cells would suggest that the liver is also a site of extrathymic differentiation, which may have important implications for the understanding of autoimmunity and graft tolerance.(0.2) LOCALISED INCREASE

Pre-operative stress is well documented and multifactorial in aetiology.Anxious patients often show further signs of stress immediately prior to indaction of anaesthesia and during pre-oxygenation.In our hospital standard black rubber masks are used for preoxygenation.Several authors have reported the use of scented oils painted onto the rubber face masks facilitating inhalationalinduction in children 1.The objective of this study was to assess whether adult patients had a preference for the type of face mask used for preoxygenation prior to the induction of anaesthesia.100 patients ASA class 1, 2 or 3 aged between 17 and 19 years were chosen at random from the theatre list for elective surgery to be included in the study.The patients were visited on the ward.It was explai ned that they would be brought directly in to the operatin g room prior to surgery.An intravenous cannula would be sited and baseline monitoring established.They would then be given oxygen to breathe for 2 rains prior to the induction of anaesthesia through either an anatomical black rubber face mask or 'King System's Fresh Scent' (mint scented) face mask.A brief description of each mask was given, alternating the order between patients.The patients were allowed to handle and breathe through the masks and then express any preference for one or other mask.

SummaryIntra-uterine pressure was measured in 40 primigravi-dae in spontaneous labour at term. Labour was conducted according to a standard protocol. Intra-uterine pressure values were calculated in Montevideo units and correlated with the progress of labour in terms of cervical dilatation. The mean intra-uterine pressure tended to be higher in the group receiving oxytocin than in the group progressing without oxytocin at equal cervical dilatation but no statistical difference was demonstrated. There is no evidence in this study that intra-uterine pressures generated by oxytocin in the active management of labour are excessive.

In October 1990 a DES (Diethylstilbestrol) clinic was established at the National Maternity Hospital, Dublin. We describe the results of the first six months of the clinic. During this time, 172 inquiries were received; 95 women were seen at the clinic, 16 were deemed to be DES--exposed and eight were classified as possibly DES exposed. Classical cervicovaginal signs of DES exposure were noted in 15 women, a further eight women showed cervical epithelial abnormalities at colposcopy, the history of in utero DES exposure was confirmed in eight cases. No cases of cervical intraepithelial neoplasia or vaginal clear-cell adenocarcinoma were detected. Pregnancy related problems possibly attributable to DES exposure were documented in six women.

In October 1990 a DES (Diethylstilbestrol) clinic was established at the National Maternity Hospital, Dublin. We describe the results of the first six months of the clinic. During this time, 172 inquiries were received; 95 women were seen at the clinic, 16 were deemed to be DES - exposed and eight were classified as possibly DES exposed. Classical cervicovaginal signs of DES exposure were noted in 15 women, a further eight women showed cervical epithelial abnormalities at colposcopy, the history of in utero DES exposure was confirmed in eight cases. No cases of cervical intraepithelial neonplasia or vaginal clear-cell adenocarcinoma were detected. Pregnancy related problems possibly attributable to DES exposure were documented in six women.