First and second trimester ultrasound in pregnancy: A systematic review and metasynthesis of the views and experiences of pregnant women, partners, and health workers.

BACKGROUND: The World Health Organization (WHO) recommends one ultrasound scan before 24 weeks gestation as part of routine antenatal care (WHO 2016). We explored influences on provision and uptake through views and experiences of pregnant women, partners, and health workers. METHODS: We undertook a systematic review (PROSPERO CRD42021230926). We derived summaries of findings and overarching themes using metasynthesis methods. We searched MEDLINE, CINAHL, PsycINFO, SocIndex, LILACS, and AIM (Nov 25th 2020) for qualitative studies reporting views and experiences of routine ultrasound provision to 24 weeks gestation, with no language or date restriction. After quality assessment, data were logged and analysed in Excel. We assessed confidence in the findings using Grade-CERQual. FINDINGS: From 7076 hits, we included 80 papers (1994-2020, 23 countries, 16 LICs/MICs, over 1500 participants). We identified 17 review findings, (moderate or high confidence: 14/17), and four themes: sociocultural influences and expectations; the power of visual technology; joy and devastation: consequences of ultrasound findings; the significance of relationship in the ultrasound encounter. Providing or receiving ultrasound was positive for most, reportedly increasing parental-fetal engagement. However, abnormal findings were often shocking. Some reported changing future reproductive decisions after equivocal results, even when the eventual diagnosis was positive. Attitudes and behaviours of sonographers influenced service user experience. Ultrasound providers expressed concern about making mistakes, recognising their need for education, training, and adequate time with women. Ultrasound sex determination influenced female feticide in some contexts, in others, termination was not socially acceptable. Overuse was noted to reduce clinical antenatal skills as well as the use and uptake of other forms of antenatal care. These factors influenced utility and equity of ultrasound in some settings. CONCLUSION: Though antenatal ultrasound was largely seen as positive, long-term adverse psychological and reproductive consequences were reported for some. Gender inequity may be reinforced by female feticide following ultrasound in some contexts. Provider attitudes and behaviours, time to engage fully with service users, social norms, access to follow up, and the potential for overuse all need to be considered.

A qualitative study of the work experiences of midwives performing obstetric ultrasound in Norway.

BACKGROUND: Performing obstetric ultrasound is part of midwifery practice in Norway. Knowledge of these midwives' working situation can enhance understanding of what their work involves and the challenges they encounter in their practice. The aim of this study was to gain insight into how midwife sonographers perceive their work in obstetric ultrasound. METHODS: A qualitative study with individual interviews was conducted in 2018. Midwives (n = 13) with a postgraduate ultrasound qualification who performed obstetric ultrasound in private clinics and/or the public health sector were included. All four regional health authorities in Norway were represented. The data gathered were analysed using content analysis. RESULTS: The analysis resulted in three main themes. (1) Working as a midwife sonographer involves a holistic approach. By practising their competence, in both midwifery and sonography, they could answer questions and reassure pregnant women. The participants also had a feeling of great responsibility in their work. (2) Being part of a professional environment in obstetric ultrasound was important for professional interaction, belonging and learning. (3) Developing and maintaining competence as a midwife sonographer had a positive influence on midwives' motivation and confidence, and allowed for more variety in their work. CONCLUSIONS: Holistic care of the pregnant woman, her partner and the unborn baby was an important part of the participants' work. They wanted to meet colleagues within their field, develop their expertise and have influence over their work situation. Organizational factors seemed to affect the participants' overall ability to practise their skills and thus also their job satisfaction.

Barriers and facilitators to standardization of ultrasound use and probe disinfection in the ambulatory setting.

To determine barriers and facilitators to standardization of ultrasound probe disinfection at ambulatory sites, we conducted observations and interviews of staff. Variability was noted in disinfection practices and in the use of protective equipment even for procedures with the potential for the probe to contact sterile tissues. Standardization is needed.

Ethical Implications for Potential Placebo Effects of Point of Care Ultrasound.

Anecdotally, practitioners of point of care ultrasound (POCUS) describe instances where patients appear to experience a placebo-like response after the examination, also described as a positive care effect. Extensive study of therapeutic ultrasound has yet to reveal differences between intervention and placebo, both of which respond to therapy. Indeed, POCUS is exemplary in incorporating many components known to modulate placebo-like effects. Patient expectations, ritualistic aspects of hands-on care, symbolic power of sophisticated medical instruments, the power of real-time POCUS images, therapeutic practitioner-patient communication, and the effect of cultural and linguistic concordance all have significant potential to modulate positive or negative care effects of POCUS. Drawing from complementary and alternative medicine's discussion of characteristic and incidental factors, this review argues that POCUS should be studied as a complex medical intervention intertwined with and inextricable from diagnostic and care processes in the hospital setting. Since POCUS is a diagnostic tool with care effect potential, its similarity to the physical exam can guide preliminary ethical guidance on disclosure of potential placebo effects or efforts to maximize that potential effect. However, more data is needed to balance the benefits and risks of effective diagnosis and overdiagnosis, respectively.

Provider Perspectives of Patient Experiences in Primary Care Imaging.

BACKGROUND: Imaging tests are a widely used tool in primary care with many known benefits. Without an understanding of which outcomes matter the most to patients, clinicians are challenged to balance the benefits and harms of imaging tests. This study aimed to explore the perceived impacts imaging tests have on patients from the perspective of the primary care providers (PCPs) and determine PCPs' understanding of patient-centered outcomes (PCOs) from imaging tests. METHODS: Recruitment of PCPs occurred at 4 family medicine clinics in Washington and Idaho. Primary care physicians, nurse practitioners, or physician assistants who order imaging tests were eligible to participate. Semistructured interviews explored providers' perceptions of patient experiences during the process of ordering, performing and following up on imaging tests. Classic content analysis generated themes and subthemes. RESULTS: Sixteen PCPs, including 11 physicians, 3 physician assistants, and 2 nurse practitioners, completed interviews. Two themes were identified: 1) perceived PCOs, and 2) factors influencing the incorporation of PCOs into clinical management. Perceived outcomes included emotions related to the answer a test provides and costs to the patient such as monetary, physical, and added risk. Patient expectations, provider-patient communication, and inadequate knowledge all contributed as barriers to incorporating PCOs into clinical management. DISCUSSION: PCPs recognize different outcomes of imaging tests that they consider important for patients. While providers are perceptive to patient outcomes there remains a challenge to how patient outcomes are used to improve care. Communication with patients and improving provider knowledge are needed to incorporate identified PCOs.

Barriers to thyroid cancer screening with ultrasound in patients with familial adenomatous polyposis.

OBJECTIVES/HYPOTHESIS: To identify barriers to care in patients with familial adenomatous polyposis (FAP) that have not undergone ultrasound for thyroid cancer (TC) screening. STUDY DESIGN: Case series and survey. METHODS: A study was conducted examining referral patterns for thyroid ultrasound (TUS) in FAP patients for TC screening. Patients with FAP seen at our institution were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes. Chart review was performed for TUS and the results were recorded. Patients and healthcare providers were surveyed to determine barriers to TUS and opportunities for improvement. RESULTS: Thirteen out of 35 patients surveyed (37%) were told by a healthcare provider that TUS was recommended for TC screening. The incidence for TC in FAP patients ranges from 15 to 12%, whereas the general population risk is 0.02% to 1%. In our series, one patient of 12 (8%) had TC. Barriers to care included poor patient education about the risk of TC in FAP and miscommunication among specialties for referral for TUS. Also, patients enrolled in a FAP registry have improved care, as they are more likely to undergo TUS than those not enrolled. CONCLUSIONS: FAP patients are at a higher risk of developing TC. Therefore, it is important for these patients to be informed and follow the recommended guideline to get a baseline TUS for screening as well as receive better patient education about the risk of TC and improved communication among specialties. Additionally, patients enrolled in a FAP registry are more likely to undergo ultrasound for TC screening, so there needs to be more centralized coordination for the multidisciplinary care of this disease. LEVEL OF EVIDENCE: NA Laryngoscope, 129:2436-2441, 2019.

Effect of MRI on preterm infants and their families: a randomised trial with nested diagnostic and economic evaluation.

BACKGROUND: We tested the hypothesis that routine MRI would improve the care and well-being of preterm infants and their families. DESIGN: Parallel-group randomised trial (1.1 allocation; intention-to-treat) with nested diagnostic and cost evaluations (EudraCT 2009-011602-42). SETTING: Participants from 14 London hospitals, imaged at a single centre. PATIENTS: 511 infants born before 33 weeks gestation underwent both MRI and ultrasound around term. 255 were randomly allocated (siblings together) to receive only MRI results and 255 only ultrasound from a paediatrician unaware of unallocated results; one withdrew before allocation. MAIN OUTCOME MEASURES: Maternal anxiety, measured by the State-Trait Anxiety inventory (STAI) assessed in 206/214 mothers receiving MRI and 217/220 receiving ultrasound. Secondary outcomes included: prediction of neurodevelopment, health-related costs and quality of life. RESULTS: After MRI, STAI fell from 36.81 (95% CI 35.18 to 38.44) to 32.77 (95% CI 31.54 to 34.01), 31.87 (95% CI 30.63 to 33.12) and 31.82 (95% CI 30.65 to 33.00) at 14 days, 12 and 20 months, respectively. STAI fell less after ultrasound: from 37.59 (95% CI 36.00 to 39.18) to 33.97 (95% CI 32.78 to 35.17), 33.43 (95% CI 32.22 to 34.63) and 33.63 (95% CI 32.49 to 34.77), p=0.02. There were no differences in health-related quality of life. MRI predicted moderate or severe functional motor impairment at 20 months slightly better than ultrasound (area under the receiver operator characteristic curve (CI) 0.74; 0.66 to 0.83 vs 0.64; 0.56 to 0.72, p=0.01) but cost £315 (CI £295-£336) more per infant. CONCLUSIONS: MRI increased costs and provided only modest benefits. TRIAL REGISTRATION: ClinicalTrials.gov NCT01049594 https://clinicaltrials.gov/ct2/show/NCT01049594. EudraCT: EudraCT: 2009-011602-42 (https://www.clinicaltrialsregister.eu/).

Transvaginal Sonography: perception and attitude of Nigerian women.

BACKGROUND: To assess the attitude to and perception of transvaginal sonography (TVS) among Nigerian women of mixed educational status in order to ascertain factors that may prevent them from submitting to TVS when recommended. METHODS: A Cross-sectional survey was adopted for the study. In all, one missionary, one government and eight private hospitals were enlisted. The instruments for data collection were visual analogue scale (VAS), to ascertain patients' pain/discomfort experience, and a researcher-developed semi-structured questionnaire. The level of pain/discomfort on the VAS was categorized into four on a scale of 100. The categories were: 0-5 (no pain), 6-40 (mild pain), 41-74 (moderate pain), and 75-100 (severe pain). RESULTS: Majority (50.6%) of the respondents who attained secondary education had positive attitude to TVS. Also majority of the respondents (63.1%) preferred female sonographers. Majority of the respondents (54.1%) perceived TVS as not embarrassing, 78% did not consider it stressful, 96.9% reported that the sonographers were professional, 46.7% felt that a chaperon was needed, 98.4% reported there were enough privacy and 84.7% reported they needed prior information. Most of the respondents (82%) were willing to consent to TVS in future, 90.5% reported no pain, 8.6% reported mild pain/discomfort and 0.9% reported moderate pain. CONCLUSIONS: Majority of our respondents had positive attitude to TVS and were willing to consent to TVS in future, hence it was acceptable to them. It was however observed that acceptability increased with increasing academic status.

Assessment of women's attitude to and perception of transvaginal sonography in Nigeria.

PURPOSE: To assess the attitude to and perception of transvaginal sonography (TVS) among Nigerian women of mixed educational status in order to ascertain factors that may prevent them from submitting to TVS when recommended. METHODS: A Cross-sectional survey was adopted for the study. Subjects were enrolled from one missionary, one government and eight private hospitals. The instruments for data collection were visual analogue scale (VAS), to ascertain patients' pain/discomfort experience, and a researcher-developed semi-structured questionnaire. The level of pain/discomfort on the VAS was categorized into four on a scale of 100. The categories were: 0-5 (no pain), 6-40 (mild pain), 41-74 (moderate pain), and 75-100 (severe pain). RESULTS: The majority (50.6%) of the respondents who attained secondary education had positive attitude to TVS. The majority majority of the respondents (63.1%) preferred female sonographers. A majority of the respondents (54.1%) perceived TVS as not embarrassing, 78% did not consider it stressful, 96.9% reported that the sonographers were professional, 46.7% felt that a chaperon was needed, 98.4% reported there was enough privacy and 84.7% reported they needed prior information. Most of the respondents (82%) were willing to consent to TVS in future, 90.5% reported no pain, 8.6% reported mild pain/discomfort and 0.9% reported moderate pain. CONCLUSIONS: Majority of our respondents had a positive attitude to TVS and were willing to consent to TVS in future, hence it was acceptable to them. It was however observed that acceptability increased with increasing education.

Comparison of effects of digital vaginal examination with transperineal ultrasound during labor on pain and anxiety levels: a randomized controlled trial.

OBJECTIVE: To evaluate whether routine vaginal examination during labor is associated with increased levels of anxiety and pain compared with transperineal ultrasound assessment. METHODS: This was a single-blinded, parallel, randomized controlled trial conducted in a tertiary care facility. Parous pregnant women without a known psychiatric condition who were seen at the care facility between November 2015 and March 2016 were included in the trial. Participants had an uneventful pregnancy and were assigned randomly to routine digital vaginal examination or transperineal ultrasound assessment during labor. Psychological distress levels, measured by the Symptom Checklist-90-Revised, and anxiety levels, measured by State-Trait Anxiety Inventory (STAI), were recorded before admission, and pain, measured using a visual analog scale, and anxiety were recorded during the latent phase of labor, the beginning of active labor and the postpartum period. A sample size of 45 women per group (n = 90) was planned to compare methods of assessment. RESULTS: Ninety women were randomized (1:1 allocation) to one or other of the interventions. Preadmission psychological distress and anxiety levels were similar between the two groups (P = 0.93 and 0.65, respectively). Most of the studied characteristics were similar in each group including duration of labor, number of examinations, analgesic administration during labor, episiotomy rate and interval between deliveries. Visual analog scale scores revealed that pain perception was reduced during latent (mean difference, -1.5 (95% CI, -2.51 to -0.57); P < 0.01) and active (mean difference, -1.2 (95% CI, -2.45 to -0.09); P = 0.03) stages of labor and during the postpartum period (mean difference, -0.5 (95% CI, -1.02 to -0.06); P = 0.02) in participants who had a transperineal ultrasound assessment compared with participants who had a digital vaginal examination. STAI scores revealed that anxiety levels were similar between the two groups during the latent and active phases of labor and during the postpartum period (P = 0.07, P = 0.38 and P = 0.13, respectively). CONCLUSIONS: The perception of pain was significantly reduced with the use of a transperineal ultrasound assessment compared with routine digital vaginal examination. However, only during the latent stage of labor was the magnitude of the observed effect sufficiently great to be considered clinically significant. Our results indicate that transperineal ultrasound assessment could be preferred to digital examination for the evaluation of progression of labor during this phase. Digital examination has no clinically relevant effects on state anxiety levels, as measured by the STAI. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Cognitive load imposed by knobology may adversely affect learners' perception of utility in using ultrasonography to learn physical examination skills, but not anatomy.

Ultrasonography is increasingly used for teaching anatomy and physical examination skills but its effect on cognitive load is unknown. This study aimed to determine ultrasound's perceived utility for learning, and to investigate the effect of cognitive load on its perceived utility. Consenting first-year medical students (n = 137) completed ultrasound training that includes a didactic component and four ultrasound-guided anatomy and physical examination teaching sessions. Learners then completed a survey on comfort with physical examination techniques (three items; alpha = 0.77), perceived utility of ultrasound in learning (two items; alpha = 0.89), and cognitive load on ultrasound use [measured with a validated nine-point scale (10 items; alpha = 0.88)]. Learners found ultrasound useful for learning for both anatomy and physical examination (mean 4.2 ± 0.9 and 4.4 ± 0.8, respectively; where 1 = very useless and 5 = very useful). Principal components analysis on the cognitive load survey revealed two factors, "image interpretation" and "basic knobology," which accounted for 60.3% of total variance. Weighted factor scores were not associated with perceived utility in learning anatomy (beta = 0.01, P = 0.62 for "image interpretation" and beta = -0.04, P = 0.33 for "basic knobology"). However, factor score on "knobology" was inversely associated with perceived utility for learning physical examination (beta = -0.06; P = 0.03). While a basic introduction to ultrasound may suffice for teaching anatomy, more training may be required for teaching physical examination. Prior to teaching physical examination skills with ultrasonography, we recommend ensuring that learners have sufficient knobology skills.

Medicine and the holistic understanding of the human being: ultrasound examination as dialog.

Ultrasound can capture the living nature of a person. This capturing of life depends greatly on experience as well as sense of touch, intuition, sense of speech, and not least a sense for the distinctiveness of every person. Performing ultrasound is not simply the application of a technique but rather a merging of man and technology in the framework of an interpersonal encounter. Therefore, as much should be invested in the interpersonal nature of the encounter as in the development of the technical principles of the ultrasound probe. To effectively perform ultrasound, it is necessary to avoid viewing ultrasound from a purely technical view and to always remember the importance of the relationship to the patient, particularly during the technical examination.

Relationship between ultrasound viewing and proceeding to abortion.

OBJECTIVE: Ultrasound scanning is a routine part of preprocedure abortion care, and many health care providers offer patients the opportunity to view their ultrasound images. It has been speculated that ultrasound viewing will dissuade women from having an abortion. We examine whether viewing the image is associated with choosing to continue the pregnancy. METHODS: Data from medical records for 15,575 visits by women seeking abortion care at a large, urban abortion provider in 2011 were analyzed for factors associated with choosing to continue the pregnancy. All patients received a preprocedure ultrasound scan and were offered the opportunity to view the image. RESULTS: Patients opted to view the ultrasound image 42.5% of the time. Nearly all pregnancies (98.8%) were terminated: 98.4% of pregnancies among women who viewed their ultrasound images and 99.0% of pregnancies among the patients who did not. Among women with high decision certainty, viewing was not associated with deciding to continue the pregnancy. Viewing was significantly associated with deciding to continue the pregnancy only among the 7.4% of women who reported medium or low decision certainty about having an abortion (adjusted odds ratio 3.21, 95% confidence interval 1.18-8.73). CONCLUSION: Voluntarily viewing the ultrasound image may contribute to a small proportion of women with medium or low decision certainty deciding to continue the pregnancy; such viewing does not alter decisions of the large majority of women who are certain that abortion is the right decision. LEVEL OF EVIDENCE: II.

O papel do exame ultrassonográfico na representação do bebê imaginário em primigestas / The role of ultrasound examination in the representation of the imaginary baby in first time mothers / El papel del examen ultrasonográfico en la representación del bebé en primerizas / Le rôle de l'examen ultrasonographique dans la représentation du bébé imaginaire en primigestes

Este estudo objetivou analisar a influência do exame ultrassonográfico na representação psí-quica do bebê imaginado em mulheres que engravidaram pela primeira vez. O mundo repre-sentacional desempenha um importante papel na determinação da natureza do relacionamento dos pais com o bebê. Para este autor convém pensar em dois mundos paralelos: o mundo externo real e o mundo das representações, imaginário e subjetivo, onde existem o bebê real no ventre ou nos braços da mãe e o bebê imaginado em sua mente. O confronto do bebê imaginário com o bebê real, via de regra, acontece após o nascimento, porém atualmente com o advento da ultrassonografia obstétrica, alguns aspectos concretos do bebê podem ser reconhecidos durante a gestação. Os dados apresentados neste estudo de cunho qualitativo consistem no relato de três primigestas que não haviam se submetido à ultrassonografia antes do contato para a participação nesta pesquisa. Foram realizadas duas entrevistas com as participantes: uma anterior e outra posterior ao exame. Com base em teóricos psicanalíticos, foram analisados os relatos das grávidas relacionados ao bebê imaginado e a influencia da ultrassonografia sobre o exercício imaginativo das mulheres acerca do futuro filho, uma vez que o exame pode revelar alguns aspectos concretos do bebê durante a gestação. Entre outros achados observou-se que a ultrassonografia introduz uma nova temporalidade à gravidez, permitindo reformulações em suas representações e uma aproximação com o bebê real.(AU)

The aim of this is study is to analyze the influence of ultrasound test in the mental representation of the imagined baby in women who became pregnant for the first time. The representational world plays an important role in determining the nature of the parents' relationship with the baby. For the author is important to think of two parallel worlds: the external real world and the representational subjective world of ideas and imagery, where there is the real baby in the womb or in the mother's arms and the baby pictured in her mind. The comparison of the imaginary baby with the real baby, usually happens after birth, but now with the advent of obstetric ultrasound, some specific aspects of the baby may be recognized during pregnancy. The data presented in this study, of a qualitative nature, consisted of three first-time mothers' reports that had not undergone ultrasound tests before contact for participation in research. There were two interviews: one before and another after the ultrasound test. Based on psychoanalytic theory, we analyzed the reports of the pregnant women related to the imaginary baby and the influence of ultrasound on their imaginative exercise about the future child, since the examination can reveal some specific aspects of the baby during pregnancy. Among other findings results showed that ultrasound introduces a new temporality to pregnancy, allowing reformulations in their representations and a rapprochement with the real baby.(AU)

Este estudio tiene como objetivo analizar la influencia del examen ultrasonográfico en la repre-sentación psíquica del bebé imaginado para casos de madres primerizas. El mundo represen-tacional desempeña un importante papel en la determinación de la naturaleza de la relación de los padres con el bebé. Para este autor, conviene pensar en dos mundos paralelos: el mundo externo real y el mundo de las representaciones, imaginario y subjetivo, en los que existen el bebé real en el vientre o los brazos de la madre, y el bebé imaginado en su mente. La confron-tación del bebé imaginario con el real ocurre generalmente después de su nacimiento, pero actualmente con el avance de la ultrasonografía obstrética, algunos aspectos concretos del bebé se pueden reconocer durante la gestación. La información presentada en este estudio de carácter cualitativo consiste en el relato de tres primerizas que no habían sido sometidas a ultrasonografía antes del contacto para la participación en la pesquisa. Fueron realizadas dos entrevistas con las participantes: una anterior y otra posterior al examen. Basándose en la teoría psicoanalítica, fueron analizados los relatos de las mujeres embarazadas referentes al bebé imaginado y la influencia de la ultrasonografía sobre el ejercicio imaginativo acerca de su futuro hijo, una vez que el examen pudiera revelar algunos aspectos concretos del bebé durante la gestación. Entre otros, se observó que la ultrasonografía introduce una nueva temporalidad a la gravidez, permitiendo reformulaciones en sus representaciones y una aproximación con el bebé real.(AU)

Cette étude a pour but analyser l'influence de l'échographie dans la représentation psychique du bébé imaginé par les femmes qui tombent enceintes pour la première fois. La représentation du monde joue un rôle important dans la détermination de la nature de la relation des parents avec le bébé. Pour cet auteur il existe deux mondes parallèles : le monde extérieur et le monde réel des instances, imaginaire est subjective, où il y a le vrai bébé dans l'utérus ou dans les bras de la mère et le bébé imaginé dans son esprit. La confrontation des bébés imaginaires avec le bébé réel, se fait toute fois après la naissance, mais aujourd'hui, avec l'avènement de l'échographie obstétricale, certains aspects spécifiques de l'enfant peuvent être reconnu au cours de la grossesse. Les données présentées dans cette étude sont de nature qualitative se composent des rapports des trois primigestes qui n'ont pas participé à l'examen ultrasonographique avant le contacte pour la participation à la recherche. Deux entretient on été réalisé avec les participants: une antérieure et l'autre après l'examen. Basé sur des approches théoriques et psychanalytiques, les rapports des femmes enceintes sur leur bébés imaginaires ont été analyse, ainsi que l'influence de l'échographie médicale en ce que concerne à l'exercice d'imagination des femmes sur le futur de l'enfant, étant donné que l'examen peut révéler certains aspects spécifiques du bébé pendant la grossesse. Parmi les autres conclusions, il a été remarqué que l'examen ultrasonographique introduit une nouvelle temporalité à la grossesse, permettant des reformulations aux représentations ainsi qu' un rapprochement avec le bébé réel.(AU)

O papel do exame ultrassonográfico na representação do bebê imaginário em primigestas / The role of ultrasound examination in the representation of the imaginary baby in first time mothers / El papel del examen ultrasonográfico en la representación del bebé en primerizas / Le rôle de l'examen ultrasonographique dans la représentation du bébé imaginaire en primigestes

Este estudo objetivou analisar a influência do exame ultrassonográfico na representação psí-quica do bebê imaginado em mulheres que engravidaram pela primeira vez. O mundo repre-sentacional desempenha um importante papel na determinação da natureza do relacionamento dos pais com o bebê. Para este autor convém pensar em dois mundos paralelos: o mundo externo real e o mundo das representações, imaginário e subjetivo, onde existem o bebê real no ventre ou nos braços da mãe e o bebê imaginado em sua mente. O confronto do bebê imaginário com o bebê real, via de regra, acontece após o nascimento, porém atualmente com o advento da ultrassonografia obstétrica, alguns aspectos concretos do bebê podem ser reconhecidos durante a gestação. Os dados apresentados neste estudo de cunho qualitativo consistem no relato de três primigestas que não haviam se submetido à ultrassonografia antes do contato para a participação nesta pesquisa....

The aim of this is study is to analyze the influence of ultrasound test in the mental representation of the imagined baby in women who became pregnant for the first time. The representational world plays an important role in determining the nature of the parents' relationship with the baby. For the author is important to think of two parallel worlds: the external real world and the representational subjective world of ideas and imagery, where there is the real baby in the womb or in the mother's arms and the baby pictured in her mind. The comparison of the imaginary baby with the real baby, usually happens after birth, but now with the advent of obstetric ultrasound, some specific aspects of the baby may be recognized during pregnancy...

Este estudio tiene como objetivo analizar la influencia del examen ultrasonográfico en la repre-sentación psíquica del bebé imaginado para casos de madres primerizas. El mundo represen-tacional desempeña un importante papel en la determinación de la naturaleza de la relación de los padres con el bebé. Para este autor, conviene pensar en dos mundos paralelos: el mundo externo real y el mundo de las representaciones, imaginario y subjetivo, en los que existen el bebé real en el vientre o los brazos de la madre, y el bebé imaginado en su mente. La confron-tación del bebé imaginario con el real ocurre generalmente después de su nacimiento, pero actualmente con el avance de la ultrasonografía obstrética, algunos aspectos concretos del bebé se pueden reconocer durante la gestación...

Cette étude a pour but analyser l'influence de l'échographie dans la représentation psychique du bébé imaginé par les femmes qui tombent enceintes pour la première fois. La représentation du monde joue un rôle important dans la détermination de la nature de la relation des parents avec le bébé. Pour cet auteur il existe deux mondes parallèles : le monde extérieur et le monde réel des instances, imaginaire est subjective, où il y a le vrai bébé dans l'utérus ou dans les bras de la mère et le bébé imaginé dans son esprit. La confrontation des bébés imaginaires avec le bébé réel, se fait toute fois après la naissance, mais aujourd'hui, avec l'avènement de l'échographie obstétricale, certains aspects spécifiques de l'enfant peuvent être reconnu au cours de la grossesse. Les données présentées dans cette étude sont de nature qualitative se composent des rapports des trois primigestes qui n'ont pas participé à l'examen ultrasonographique avant le contacte pour la participation à la recherche...

Should anorectal ultrasonography be included as a diagnostic tool for chronic anal pain?

OBJECTIVE: To assess the efficiency of endorectal ultrasound (ERUS) in the study of chronic idiopathic anal pain (CIAP). MATERIAL AND METHOD: This is a prospective and descriptive study in which 40 patients, 18 men and 22 women with an average of 47 years, were included. They had chronic anal pain of at least 3 months duration. A complete colonoscopy was performed in all patients, which found no abnormalities to explain clinical symptoms. Patients with anal fissure and internal hemorrhoids of any degree, perianal suppurative processes, and pelvic surgery were excluded from the study. An ALOKA ProSound SSD-4000 ultrasound console attached to a multifrequency radial transductor ASU-67 (7.5 and 10 MHz) was used. RESULTS: One patient could not tolerate the examination. In 8 patients (20% of cases) alterations were detected during ultrasonography: in 4 patients (10% of the cases; 1 man and 3 women) internal anal sphincter (IAS) hypertrophy, and in 5 patients (4 women and 1 man) a torn sphincter complex. A tear in the upper IAS canal and hypertrophy of the middle anal canal were observed in one patient (1 woman). CONCLUSIONS: ERUS is a simple, economic and useful test to study anorectal pathologies. Although in most studied cases no damage to the anal canal or rectal wall was detected, in a considerable number of patients we observed a thickening of the IAS, a probable cause of anal pain. Therefore, we understand that ERUS should be included in the study of CIAP.

Religiousness and prostate cancer screening in African American men.

This study was designed to examine the relationship between religiousness (organized, nonorganized, and intrinsic) and religious problem solving (collaborative, deferring, and self-directing) in prostate cancer screening (PCS) attitudes and behavior. Men (N = 481) of African descent between the ages of 40 and 70 participated. Hierarchical regression analyses revealed that religiousness and self-directed problem solving were associated with PCS attitudes. Intrinsic religiousness was associated with PCS attitudes after controlling for health and organized religiousness. Religiousness was not associated with PCS behavior. Intrinsic religiousness may be an important dimension of religiousness to be considered in tailoring cancer interventions for individuals from faith-based communities.