Severity of labour pain: influence of physical as well as psychologic variables.

The role of physical factors in the severity of labour pain has been neglected. The amount of cervical dilation, the frequency of the contractions, the woman''s height and usual weight before the pregnancy and other physical factors were therefore examined in relation to the intensity of labour pain in 141 primiparous and 99 multiparous women. In general, pain increased gradually during labour in both groups of women, though the severity of the pain was lower in the women who had received prepared childbirth training than in those who had not. Although the average pain scores in this study were high, there were striking individual differences, some women having extremely severe pain and others having almost none. The pain scores in both groups of women were significantly correlated with the ratios of the women''s usual weight to height. In the multiparous women the scores were also correlated with the woman''s usual weight and the baby''s weight but not with the woman''s weight gain during pregnancy. Thus, the results show that physical as well as psychologic factors contribute to the severity of labour pain.     

CMA abortion survey.

Responses to the question as to whether abortions should be performed at the woman''s request during the first trimester of pregnancy were evenly divided. There was support for abortion on socioeconomic grounds, during the first trimester, from 61.5% of the respondents. Termination of pregnancy beyond the first trimester was supported by a majority of the respondents only in cases in which the woman''s life is in danger (73.9%) or in which there is evidence of a severe physical abnormality in the fetus (70.6%) or in cases in which the woman''s physical health is in danger (55.5%). Those who said they would not support abortion under any circumstances constitute, at most, 5.1% of the respondents. Support for the maintenance or the elimination of therapeutic abortion committees was addressed in two questions and in both cases the respondents were evenly divided. The responses to these two questions were compared and found to be logically consistent. Only physicians should perform abortions, and they should be performed in hospitals with the woman either as an inpatient or, during the first trimester, as an outpatient. The performance of first-trimester abortions in provincially approved abortion clinics was supported by 47.3% of the respondents. Of the 885 respondents who wished to see some amendment to the Criminal Code, 409 stated that the term "health" as used in the Criminal Code relative to the legal grounds for therapeutic abortion should be defined.     

What do patients with medically unexplained physical symptoms (MUPS) think? A qualitative study

Context Medically unexplained physical symptoms (MUPS) are frequently encountered in family medicine, and lead to disability, discomfort, medicalisation, iatrogenesis and economic costs. They cause professionals to feel insecure and frustrated and patients to feel dissatisfied and misunderstood. Doctors seek answers for rather than with the patient.Objectives This study aimed to explore patients'' explanations of the medically unexplained physical symptoms that they were experiencing by eliciting their own explanations for their complaints, their associated fears, their expectations of the consultation, changes in their ideas of causality, and the therapeutic approach that they considered would be useful.Methodology A qualitative analysis was under-taken of interviews with 15 patients with MUPS in a family medicine unit, 6 months after diagnosis.Results Experience is crucial in construction of the meaning of symptoms and illness behaviour. Many patients identify psychosocial causes under-lying their suffering. These patients received more medication and fewer requests for diagnostic examinations than they had expected. Normalisation is a common behaviour in the clinical approach. Normalisation without explanation can be effective if an effective therapeutic relationship exists that may dispense with the need for words. Listening is the procedure most valued by patients. Diagnostic tests may denote interest in patients'' problems. The clinician''s flexibility should allow adaptation to the patient''s phases of acceptance of the significance of their physical, emotional and social problems.Conclusion Patients with MUPS have explanations and fears associated with their complaints. The patient comes to the consultation not because of the symptom, but because of what he or she thinks about the symptom. The therapeutic relationship, therapeutic listening, and flexibility should be the basis for approaching patients with MUPS. Patients do not always expect medication, although it is what they most often receive. Diagnostic tests, although used sparingly, can be a way to maintain and build a relationship. Drugs and tests can be a ritual statement of clinical interest in the patient and their symptoms.     

Bioethics for clinicians: 12. Ethical dilemmas that arise in the care of pregnant women: rethinking "maternal-fetal conflicts".

When a pregnant woman makes a decision or acts in a manner that may be detrimental to the health and well-being of her fetus, her physician may be faced with an ethical dilemma. Is the physician''s primary duty to respect the woman''s autonomy, or to promote behaviour that may be in the best interest of the fetus? The controversial concept of "fetal rights" or the "fetus as a patient" contributes to the notion that the pregnant woman and her fetus are potential adversaries. However, Canadian law has upheld women''s right to life, liberty and security of the person and has not recognized fetal rights. If a woman is competent and refuses medical advice, her decision must be respected even if the physician believes that her fetus will suffer as a result. Coercion of the woman is not permissible no matter what appears to be in the best interest of the fetus.     

Congenital Anomalies of the Limbs: Part II. Psychological and Educational Aspects

As a preparatory step towards the development of a complete habilitation program for children with congenital limb anomalies associated with maternal ingestion of thalidomide, the medical records of all patients with congenital limb anomalies referred to the Rehabilitation Institute of Montreal in the past decade were studied, and an examination and a thorough reassessment were made of 41 patients (21 males and 20 females). The medical and prosthetic aspects were dealt with in Part I of this paper. Part II describes, in a joint report, the results of psychiatric, psychological and educational assessments.There was no evidence of major emotional disorder in any of the patients, although conflicts were intensified by the presence of the physical anomaly. No relation was found between intelligence, emotional adjustment and disability. The patient''s attitude towards his disability and prosthesis is definitely influenced by the degree of parental acceptance of the handicap and by the character of the emotional undertones in the total environment. In order to favour the occurrence of the healthiest modes of development in these children, the authors believe that the medical profession should be made fully aware of the physical and emotional problems which may arise after the birth of a deformed child. It is considered very important that the mother should receive psychotherapeutic support as soon as possible after the child is born.     

Exploring the Relation of Harsh Parental Discipline with Child Emotional and Behavioral Problems by Using Multiple Informants. The Generation R Study

Parental harsh disciplining, like corporal punishment, has consistently been associated with adverse mental health outcomes in children. It remains a challenge to accurately assess the consequences of harsh discipline, as researchers and clinicians generally rely on parent report of young children''s problem behaviors. If parents rate their parenting styles and their child''s behavior this may bias results. The use of child self-report on problem behaviors is not common but may provide extra information about the relation of harsh parental discipline and problem behavior. We examined the independent contribution of young children''s self-report above parental report of emotional and behavioral problems in a study of maternal and paternal harsh discipline in a birth cohort. Maternal and paternal harsh discipline predicted both parent reported behavioral and parent reported emotional problems, but only child reported behavioral problems. Associations were not explained by pre-existing behavioral problems at age 3. Importantly, the association with child reported outcomes was independent from parent reported problem behavior. These results suggest that young children''s self-reports of behavioral problems provide unique information on the effects of harsh parental discipline. Inclusion of child self-reports can therefore help estimate the effects of harsh parental discipline more accurately.     

Educational homogamy lowers the odds of reproductive failure

Assortative mating based on education is a common phenomenon. We investigated whether it affected parameters of reproductive performance such as childlessness, offspring number and age at first marriage. On the basis of the US census from 1980 (n = 670,631 married US couples), we find that the proportion of childless individuals is usually minimal in women married to a husband of the same educational level. This holds particularly true in the highest and the lowest educated women. Educational homogamy is also associated with a lower average age at first marriage. No obvious effect of educational homogamy on a woman''s average offspring number is found, where mean offspring number generally increases both with decreasing woman''s and decreasing husband''s educational attainment. We conclude that educational homogamy reduces the likelihood of reproductive failure.     

Pregnancy, microchimerism, and the maternal grandmother

Background

A woman of reproductive age often harbors a small number of foreign cells, referred to as microchimerism: a preexisting population of cells acquired during fetal life from her own mother, and newly acquired populations from her pregnancies. An intriguing question is whether the population of cells from her own mother can influence either maternal health during pregnancy and/or the next generation (grandchildren).

Methodology/Principal Findings

Microchimerism from a woman''s (i.e. proband''s) own mother (mother-of-the-proband, MP) was studied in peripheral blood samples from women followed longitudinally during pregnancy who were confirmed to have uncomplicated obstetric outcomes. Women with preeclampsia were studied at the time of diagnosis and comparison made to women with healthy pregnancies matched for parity and gestational age. Participants and family members were HLA-genotyped for DRB1, DQA1, and DQB1 loci. An HLA polymorphism unique to the woman''s mother was identified, and a panel of HLA-specific quantitative PCR assays was employed to identify and quantify microchimerism. Microchimerism from the MP was identified during normal, uncomplicated pregnancy, with a peak concentration in the third trimester. The likelihood of detection increased with advancing gestational age. For each advancing trimester, there was a 12.7-fold increase in the probability of detecting microchimerism relative to the prior trimester, 95% confidence intervals 3.2, 50.3, p<0.001. None of the women with preeclampsia, compared with 30% of matched healthy women, had microchimerism (p = 0.03).

Conclusions/Significance

These results show that microchimerism from a woman''s own mother is detectable in normal pregnancy and diminished in preeclampsia, supporting the previously unexplored hypothesis that MP microchimerism may be a marker reflecting healthy maternal adaptation to pregnancy.     

The irritable bowel syndrome.

The irritable bowel syndrome (IBS) is an extremely common disorder. It is believed to occur usually after emotional stress and perhaps because of behavioural and dietary factors. There is definite evidence of disturbed gastrointestinal function associated with IBS; however, a diagnostic marker remains elusive. The current trend is to diagnose IBS on the basis of the patient''s history and the findings at physical examination and after minimal investigation. The physician-patient relationship remains the most important factor in the management of IBS. Long-term benefit may be achieved with the use of dietary fibre supplements or stool-bulking agents. The evaluation of currently available drugs is difficult because of the placebo effect. Drug therapy should be aimed at specific symptoms and used mainly during the initial phase of treatment.     

Building a home from foam—túngara frog foam nest architecture and three-phase construction process

Frogs that build foam nests floating on water face the problems of over-dispersion of the secretions used and eggs being dangerously exposed at the foam : air interface. Nest construction behaviour of túngara frogs, Engystomops pustulosus, has features that may circumvent these problems. Pairs build nests in periodic bursts of foam production and egg deposition, three discrete phases being discernible. The first is characterized by a bubble raft without egg deposition and an approximately linear increase in duration of mixing events with time. This phase may reduce initial over-dispersion of foam precursor materials until a critical concentration is achieved. The main building phase is marked by mixing events and start-to-start intervals being nearly constant in duration. During the final phase, mixing events do not change in duration but intervals between them increase in an exponential-like fashion. Pairs joining a colonial nesting abbreviate their initial phase, presumably by exploiting a pioneer pair''s bubble raft, thereby reducing energy and material expenditure, and time exposed to predators. Finally, eggs are deposited only in the centre of nests with a continuously produced, approximately 1 cm deep egg-free cortex that protectively encloses hatched larvae in stranded nests.     

Blunt abdominal trauma in pregnancy.

Two cases are presented in which the effects of blunt trauma to a pregnant woman''s abdomen were apparently minor but resulted in fetal death. Blunt trauma may result in serious injury to the fetus or the placenta. Three-point restraint systems should be worn by pregnant women travelling in automobiles to minimize the risks to mother and fetus. Awareness of the potential for injury in these circumstances is essential to reduce the risks to the fetus.     

Adaptation of children to a chronically ill or mentally handicapped sibling.

The presence of a chronically ill or mentally handicapped child in a family can be a stress for the child''s siblings, who often are ill informed about the nature and prognosis of the illness, may be uncertain what is expected of them in the caregiving role, may feel their own identities threatened, and may experience ostracism by their friends and misunderstanding at school. Although individual reactions vary widely, feelings of anger, guilt, resentment and shame are commonly reported. Excessive responsibility and concern about one''s identity may add to these feelings and culminate in psychologic problems in the sibling. The physician caring for the family must be alert for symptoms of emotional disturbance or social maladjustment among the siblings of chronically ill or mentally handicapped children and should be prepared to counsel the family or refer them to a counsellor experienced in this area. In general, the first step is to be sure that the sibling is fully informed about the condition and to encourage frank discussion between the parents and the handicapped child''s siblings.     

Sex,money, and paternity: The evolutionary psychology of domestic violence

Three hundred sixty-five women, with children between six and 12 years of age, were interviewed and tested on various issues theoretically related to domestic violence. The sample was stratified into three subsamples of volunteer women recruited from: (1) a temporary shelter for battered women, (2) the local community and screened specifically for the reported presence of domestic violence, (3) the same community sources and screened only for the reported presence of children of the specified age group. Factor analytic structural equation models were constructed for the predictors of violence by the woman's main sexual partner toward the woman and towards the woman's child. Common factors were constructed for the four major dimensions of domestic violence— verbal, physical, escalated, and sexual—and for the three major predictors of domestic violence—sex, money, and paternity. The sex factor indexed the general quality of the sexual relationship dynamics, the money factor indexed the couple's socioeconomic relations, and the paternity factor indexed the genetic stakes held in the family by the woman's main sexual partner. These three factors jointly accounted for 60% of the variance in violence toward the woman. Violence towards the woman—the only significant direct effect—accounted for 26% of the variance in violence toward the child. These findings suggest that the principal perpetrators of domestic violence may be competitively disadvantaged males, pursuing coercive sexual and parental strategies without regard to the deleterious indirect effects upon their own genetic offspring.     

Dogs' Social Referencing towards Owners and Strangers

Social referencing is a process whereby an individual uses the emotional information provided by an informant about a novel object/stimulus to guide his/her own future behaviour towards it. In this study adult dogs were tested in a social referencing paradigm involving a potentially scary object with either their owner or a stranger acting as the informant and delivering either a positive or negative emotional message. The aim was to evaluate the influence of the informant''s identity on the dogs'' referential looking behaviour and behavioural regulation when the message was delivered using only vocal and facial emotional expressions. Results show that most dogs looked referentially at the informant, regardless of his/her identity. Furthermore, when the owner acted as the informant dogs that received a positive emotional message changed their behaviour, looking at him/her more often and spending more time approaching the object and close to it; conversely, dogs that were given a negative message took longer to approach the object and to interact with it. Fewer differences in the dog''s behaviour emerged when the informant was the stranger, suggesting that the dog-informant relationship may influence the dog''s behavioural regulation. Results are discussed in relation to studies on human-dog communication, attachment, mood modification and joint attention.     

Encouraging Spontaneous Synchronisation with D-Jogger,an Adaptive Music Player That Aligns Movement and Music

In this study we explore how music can entrain human walkers to synchronise to the musical beat without being instructed to do so. For this, we use an interactive music player, called D-Jogger, that senses the user''s walking tempo and phase. D-Jogger aligns the music by manipulating the timing difference between beats and footfalls. Experiments are reported that led to the development and optimisation of four alignment strategies. The first strategy matched the music''s tempo continuously to the runner''s pace. The second strategy matched the music''s tempo at the beginning of a song to the runner''s pace, keeping the tempo constant for the remainder of the song. The third alignment starts a song in perfect phase synchrony and continues to adjust the tempo to match the runner''s pace. The fourth and last strategy additionally adjusts the phase of the music so each beat matches a footfall. The first two strategies resulted in a minor increase of steps in phase synchrony with the main beat when compared to a random playlist, the last two strategies resulted in a strong increase in synchronised steps. These results may be explained in terms of phase-error correction mechanisms and motor prediction schemes. Finding the phase-lock is difficult due to fluctuations in the interaction, whereas strategies that automatically align the phase between movement and music solve the problem of finding the phase-locking. Moreover, the data show that once the phase-lock is found, alignment can be easily maintained, suggesting that less entrainment effort is needed to keep the phase-lock, than to find the phase-lock. The different alignment strategies of D-Jogger can be applied in different domains such as sports, physical rehabilitation and assistive technologies for movement performance.     

Preferred Women’s Waist-to-Hip Ratio Variation over the Last 2,500 Years

The ratio between the body circumference at the waist and the hips (or WHR) is a secondary sexual trait that is unique to humans and is well known to influence men’s mate preferences. Because a woman''s WHR also provides information about her age, health and fertility, men''s preference concerning this physical feature may possibly be a cognitive adaptation selected in the human lineage. However, it is unclear whether the preferred WHR in western countries reflects a universal ideal, as geographic variation in non-western areas has been found, and discordances about its temporal consistency remain in the literature. We analyzed the WHR of women considered as ideally beautiful who were depicted in western artworks from 500 BCE to the present. These vestiges of the past feminine ideal were then compared to more recent symbols of beauty: Playboy models and winners of several Miss pageants from 1920 to 2014. We found that the ideal WHR has changed over time in western societies: it was constant during almost a millennium in antiquity (from 500 BCE to 400 CE) and has decreased from the 15^th century to the present. Then, based on Playboy models and Miss pageants winners, this decrease appears to slow down or even reverse during the second half of the 20^th century. The universality of an ideal WHR is thus challenged, and historical changes in western societies could have caused these variations in men’s preferences. The potential adaptive explanations for these results are discussed.     

Intelligence and mate choice: intelligent men are always appealing

What role does a man's intelligence play in women's mate preferences? Selecting a more intelligent mate often provides women with better access to resources and parental investment for offspring. But this preference may also provide indirect genetic benefits in the form of having offspring who are in better physical condition, regardless of parental provisioning. Intelligence then may serve as both a cue of a mate's provisioning abilities and his overall heritable phenotypic quality. In the current study, we examined the role of a man's intelligence in women's long- and short-term mate preferences. We used a rigorous psychometric measure (men's WAIS scores) to assess intelligence (the first study to our knowledge), in addition to women's subjective ratings to predict mate appeal. We also examined the related trait of creativity, using women's ratings as a first step, to assess whether creativity could predict mate appeal, above and beyond intelligence. Finally, we examined whether preferences for intelligent and creative short-term mates shifted according to a woman's conception risk. Multilevel modeling was used to identify predictors of mate appeal. Study participants (204 women) assessed the long- and short-term mate appeal of videos of 15 men with known measures of intelligence performing verbal and physical tasks. Findings indicate that both intelligence and creativity independently predicted mate appeal across mating contexts, but no conception-risk effects were detected. We discuss implications of these findings for the role of intelligence and creativity in women's mate choices.     

The Organically Handicapped Child—How Can the Family Physician Help?

The better his understanding of some of the ways in which an organic deficit might affect normal development of the handicapped child, the more able the family physician will be to offer guidance to the family aimed at preventing the development of secondary problems. He can thus be instrumental in helping a child achieve his maximal potential.First, it is important to take into account how the parents'' emotional and intellectual responses to having a defective child may interfere markedly in normal parent-child relationship. Second, ways in which each deficit will limit a child''s exposure to stimuli must not be over-looked. Third, one must consider how a deficit may indirectly distort the normal learning patterns when parents do not make age appropriate demands. Fourth, it is important to understand how specific interference in the area of language skills may cause further developmental retardation. Fifth, one must be aware of special problems that an organically handicapped child must face in the society outside of the family. Last of all, in an older child, one must consider the need for a full scale evaluation to sort out primary and secondary factors in the picture.     

Ethical conflicts in long-term care of the aged: nutritional problems and the patient-care worker relationship.

The patient-care worker relationship was analysed by observation and unstructured group discussion in four long-stay somatogeriatric wards at Saint Lars Hospital. Investigation centred on patients entering the terminal phase who could no longer be spoon-fed. The relationship was complicated and reciprocal, and failure by the care worker to interpret her role and the dying patient''s behaviour correctly led to emotional conflict and double-binding, with resultant anxiety for both herself and the patient. Infusions and tube-feeding prescribed in such cases were given not for the patient''s benefit but to relieve anxiety in care workers and relatives. Permitting the patient a natural, painless death from water deficiency may be preferable to prolonging pain and discomfort by intervening with infusion and tube-feeding.