The objective of this study was to determine the frequency of shoulder pain in the first 12 weeks after acute stroke, and its relationship to functional outcome. The study was prospective observational in design, carried out weekly over 12 weeks from consecutive admissions. Acute medical and geriatric wards in three district hospitals provided the setting, and the 76 included patients admitted to hospital with a first documented episode of stroke resulting in neurological deficit lasting more than seven days.The main outcomes measured were frequency and severity of pain using visual analogue scores; arm function (by Frenchay Arm Test and Motricity Index) and length of stay in hospital. Fifty-five patients (72%) experienced shoulder pain at some stage, most commonly on movement. Length of stay in those with pain was 82 days and those without pain 39 days (p < 0.001). All patients requiring continuing care, or dying after inclusion in the study, suffered shoulder pain. Patients with pain showed greater weakness and poorer arm function at study entry and at study termination, the rate of recovery of arm function being slower in those with pain than those without.The results concluded that shoulder pain is a common phenomenon in acute hemiplegia and is strongly associated with prolonged hospital stay, and poor recovery of arm function in the first 12 weeks of illness.
SUMMARY In a case control study, prescription data were examined for the three months before the last menstrual period and for the first trimester ofpregnancy in (a) 115 mothers ofchildren with limb reduction defects, (b) 676 mothers of children with oral cleft, and (c) an equal number of control mothers ofnormal babies from the same doctor's practice for each case. In the limb reduction study, the study mothers were prescribed more drugs generally although this did not reach statistical significance, nor were there significant differences between study and control mothers for individual groups of drugs. In the oral cleft study, significantly more drugs were prescribed to study mothers in the three months before the last menstrual period, and a similar trend, which did not reach statistical significance, was observed in the first trimester. Anticonvulsant drugs were prescribed significantly more frequently to study mothers during the whole period of the study. A significant association was also demonstrated between oral contraceptives taken in the three months before the last menstrual period and oral cleft, but doubt must remain concerning this relationship; the risk is not well understood and is likely to be nonspecific. A number of other significant associations were identified, although their importance in practice is uncertain in view ofthe confounding factors that may affect a study of this kind.
ObjectivePertussis vaccination during pregnancy has recently been recommended in both the USA and UK to prevent pertussis infection in infants. While there are no apparent safety concerns about the administration of Tdap vaccine during pregnancy, there is only limited safety data available. We aimed to closely monitor infants exposed to Tdap during pregnancy to look for any adverse outcomes that may be attributable to the vaccine.DesignThis was a prospective observational study, collecting information to evaluate the safety of Tdap vaccine for infants exposed during pregnancy. Infants were followed for between 6 and 12 months after birth, with 84% completing 12 months of follow-up. Information was obtained from objective sources including routine health visits and vaccination records wherever possible, as well as frequent parental reports.SettingThe Canterbury region of New Zealand.PatientsA cohort of 403 infants whose mothers had received Tdap vaccine.Main outcome measuresGestational age at birth, growth parameters, congenital anomalies, immunisation status and timeliness of immunisation, development of pertussis infection.ResultsThere were no significant differences in birth weight, gestational age at birth, congenital anomalies or infant growth as compared with baseline population data. Infants of mothers who had received the vaccine were more likely to receive their vaccinations on time during infancy. No cases of pertussis occurred in this cohort despite high rates of disease in the community. We have not found any adverse events attributable to vaccine exposure.ConclusionsThese data add to the growing pool of evidence that the administration of Tdap vaccine during pregnancy is an appropriate strategy for reducing the burden of pertussis in infants.Clinical trial registrationAustralia New Zealand Clinical Trials Registry ACTRN12613001045707.
The aim of this study was to decide whether shoulder pain in stroke is a marker of severity, or an independent predictor of poor outcome. The study was prospective observational in design from consecutive admissions. Acute medical and geriatric wards in three district hospitals provided the setting, and the subjects were 76 patients acutely admitted to hospital with a first stroke. The main outcomes measured were length of stay in hospital, Barthel Index, Frenchay Arm Test, Motricity Index and discharge placement. After controlling for other indicators of stroke severity, shoulder pain on movement was the most important predictor of poor recovery of arm power and function, and an important contributor to length of stay in hospital. Urinary incontinence was the strongest indicator of length of stay and Barthel Index scores. Patients with subluxation and malalignment of the shoulder fared much more poorly than those with normal shoulder alignment. The results concluded that shoulder pain appears to influence outcome of stroke independent of severity. We recommend that this symptom receive careful attention.
INTRODUCTION New Zealand experienced a major epidemic of pertussis from September 2011 to January 2014. In response to this epidemic, a pertussis-containing tetanus, diphtheria and acellular pertussis (Tdap) vaccine was funded for pregnant women of 28-38 weeks' gestation. AIM To investigate the factors influencing women's decisions regarding having the Tdap vaccine during pregnancy. METHODS A retrospective, self-reported postal survey of early postpartum women in Canterbury that assessed participant knowledge, beliefs, attitudes and influencing factors about the Tdap vaccine was conducted from June to October 2013. RESULTS Of the 1883 surveys distributed, 596 women completed the survey. The main factors influencing women's decisions to accept the Tdap vaccine during pregnancy were: the desire to protect their baby, a health professional's recommendation, the threat of pertussis in the community and the fact that the vaccine was administered at no cost. Conversely, for women who did not receive the Tdap vaccine, the main factors that influenced their decisions were: they did not know the vaccine was available, fear of side-effects and doubt regarding vaccine effectiveness. CONCLUSION A clear health professional recommendation for maternal Tdap immunisation was a significant factor influencing pregnant women and would most likely improve the uptake of the vaccine.
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