摘要：Objectives The purpose of this study was to determine the frequency of perineal pain in the 6 weeks after vaginal delivery and to assess the association between perineal trauma and perineal pain. Study design This was a prospective cohort study of parturients at 1 day, 7 days, and 6 weekspost partum in an academic tertiary obstetric unit in Toronto, Canada. Four hundred fortyfour women were followed up, including women with an intact perineum (n=84), first/seconddegree tears (n=220), episiotomies (n=97), or third/fourthdegree tears (n=46). Primary outcome was the incidence of perineal pain on day of interview; secondary outcomes were pain score measurements and interference with daily activities. Results Perineal trauma was more common among primiparous women, those with operative vaginal deliveries, and those with epidural analgesia during the second stage of labor. The incidence of perineal pain among the groups during the first week was intact perineum 75%(day 1) and 38%(day 7); first/seconddegree tears 95%and 60%; episiotomies 97%and 71%; and third/fourthdegree tears 100%and 91%. By 6 weeks, the frequency of perineal pain was not statistically different between trauma groups. Conclusion Acute postpartum perineal pain is common among all women. However, perineal pain was more frequent and severe for women with increased perineal trauma.

摘要：Context: Little is known about how the pharmaceutical industry responds to evidence of harm associated with its products, such as the publication in July 2002 of the Women s Health Initiative Estrogen Plus Progestin Trial (WHI E+ P) report demonstrating that standard dose Prempro produced significant harm and lacked net benefits. Objective: To examine pharmaceutical industry response to the WHI E+ P results by analyzing promotional expenditures for hormone therapy before and after July 2002. Design and Setting: Nationally representative and prospectively collected longitudinal data (January 2001 through December 2003) on prescribing and promotion of hormone therapies were obtained from IMS Health and Consumer Media Reports. Main Outcome Measures: Trends in quarterly prescriptions for hormone therapy and expenditures on 5 modes of drug promotion: samples, office based detailing, hospital based promotion, journal advertisements, and direct to consumer advertising. Results: Prior to the WHI E+ P report, prescribing rates and promotional spending for hormone therapy were stable. In the quarter before the WHI E+ P report (April June 2002), 22.4 million prescriptions for hormone therapy were dispensed and ＄ 71 million was spent on promotion (in annual terms, ＄ 350 per year per US physician). Within 9 months of the report s publication (quarter 1 of 2003), there was a 32% decrease in hormone therapy prescriptions, and a nadir had been reached for promotional spending (37% decrease compared with pre WHI E+ P levels). Spending decreased for all promotional activities and most hormone therapies. Overall, the greatest declines were for samples (36% decrease as of quarter 1 of 2003) and direct to consumer advertising (100% decrease). The greatest declines in promotion occurred for standard dose Prempro (61% decrease as of quarter 1 of 2003), the agent implicated by the WHI E+ P report. More recently, promotional efforts have increased, particularly for lower dose Prempro, a r

摘要：The purpose of this study was to assess the risk of neonatal death in the second *** carried o ut a retrospective cohort study of 128,219live born sec ond twins in the U-nited States for the years 1995throu gh *** study subjects were divided into 3groups:second twins who were delivered by cesarean delivery afte r vaginal delivery of the first twin(group 1),both twins delivered vaginally(group2),and both twins delivered by cesarea n delivery(group3).The risk of asphyxia -related neonatal deaths was in-creased in groups 1and 2;the increased risk in group 1was stronger in term births than in pr eterm *** risk of neonatal deaths,especially for t erm infants with as-phyxia -related deaths,is increase d for the second twins who are delivered by cesarean delive ry after vaginal deliv-ery of the first twins.