Pregnancy and breastfeeding in mental health policy: a narrative review.

OBJECTIVES: Mental health difficulties are often exacerbated during the perinatal period. Policy and guidelines are increasingly being used to enhance the quality of healthcare. We conducted a literature review of published research relating to pregnancy and breastfeeding in mental health policy. METHODS: Relevant terms were searched in Medline, CINAHL, APA PsycINFO and EMBASE for articles published in English from 1970 until 2020. Only papers that referenced policy, guidance, legislation or standards were included. While a systematic approach was used, the nature of the results necessitated a narrative review. RESULTS: Initially, 262 papers were identified, 44 met the inclusion criteria. Reproductive health is given sparse consideration in research relating to mental health policy. Despite this, some key areas emerged. These included: the need for proactive preconception psychoeducation, proactive screening of mothers of infants and young children for perinatal mental health issues, enhanced prescribing practice for women of child-bearing age, enhanced monitoring during pregnancy, development of safe modification of coercive practices should they need to be employed in emergency circumstances and targeted measures to reduce substance misuse. Themes that arose relating to breastfeeding and bonding are also described. CONCLUSIONS: Female reproductive health is often ignored in research relating to mental health policy, guidelines and standards. These tools need to be harnessed to promote good healthcare. Reproductive health should be included in the care plan of all mental health patients. These topics need to be integrated into existing relevant policies and not isolated to a separate policy.

SU-E-J-182: Patient Specific Assessment of External Radiation Exposure to Bystanders Interacting with Patients Following 131I Therapy.

PURPOSE: Conventional calculation methods of patient release criteria for compliance with NRC regulations are based on the assumption that both patient and bystander are each a single point in space. This study was intended to assess the patient-specific external radiation exposure to a bystander interacting with the patient following radionuclide therapy with 131I. METHODS: 131I-sodium iodide treatment for hyperthyroidism and thyroid cancer and 131I-tositumomab treatment of non-Hodgkin's lymphoma were considered. 131I distribution provided by the patient SPECT image was rendered on the SPECT-fused CT images. The CT images were then imported to a Monte Carlo based simulation code, MCNPX 2.7, as a source phantom. For a target phantom, we employed the adult male hybrid phantom developed at the University of Florida and National Cancer Institute. A single orientation - patient and a bystander facing one another at 1.0 m - was considered. S factors (dose per unit cumulative activity (A)) for each organ in a bystander was obtained from the MC calculations and effective dose (EDE) per A was calculated based on tissue-weighted individual organ doses. The results were compared with the calculations using UF/NCI adult hybrid source/target phantoms and the revised adult ORNL stylized source/target phantoms. RESULTS: EDE per A of the stylized phantom was 1.5% higher than that of the hybrid phantom for uniform source localization in the thyroid. However, EDE per A of the hybrid phantom was 20% less than that of stylized phantoms for a torso source. The difference is attributed to the realistic shape of the frontal body comparing to the simple ellipsoidal trunk of the stylized phantom. CONCLUSIONS: Based on the realistic hybrid phantoms and accurate MC radiation transport calculation tools, patient specific dosimetry for a bystander is feasible. S factors will be calculated using the patient CT image with 131I bio-distributions and hybrid phantoms.

Pubovaginal sling: 4-YEAR outcome analysis and quality of life assessment.

PURPOSE: Stress urinary incontinence is a common disease with a devastating impact on patient quality of life. Needle suspension procedures, which produce disappointing long-term results for type II stress incontinence, are being replaced by pubovaginal slings which previously were reserved solely for the treatment of type III stress incontinence. We report the long-term outcomes of pubovaginal slings for the treatment of types II and III stress urinary incontinence, and assess its quality of life impact. MATERIALS AND METHODS: From January 1993 until December 1996, 247 females 10 to 84 years old (mean age 54.5) with type II (54%) or III (46%) stress urinary incontinence diagnosed by fluoroscopic urodynamics received a pubovaginal sling. Concomitant urge incontinence was present in 109 patients (44%). Quality of life was assessed with the Urogenital Distress Inventory short form. RESULTS: At a mean followup of 51 months (range 22 to 68) the continence rates were 88% overall, 91% for type II and 84% for type III. Preoperative urge incontinence resolved in 81 of 109 patients (74%), while de novo urge incontinence developed in 10 (7%). Intermittent urethral catheterization duration averaged 8.4 days, with 5 women undergoing urethrolysis for a hypersuspended urethra. Secondary procedures were required in 9 patients with type II and 5 with type III incontinence, and included transurethral collagen injections in 6 and repeat pubovaginal slings in 8. There was a 4% complication rate due to pelvic hematoma in 2 cases, incisional hernia in 2, deep venous thrombosis in 1 and pulmonary embolus in 1. Of the 247 patients 235 (95%) completed the quality of life questionnaire with 92% reporting a high degree of satisfaction with low (less than 20 of 100 points) symptom distress scores. CONCLUSIONS: Pubovaginal slings are effective and durable, and significantly improve quality of life in patients with types II and III stress urinary incontinence.

Urodynamic assessment of urethral sphincter function in post-prostatectomy incontinence.

PURPOSE: Direct measurement of maximum urethral pressure by urethral profilometry has been used widely to assess urethral sphincter function. We attempted to determine if there was any relationship between maximum urethral pressure, which is measured at the level of the membranous urethra, or extrinsic urethral sphincter function, and the amount of abdominal pressure needed to cause leakage (abdominal leak point pressure) in men with post-prostatectomy incontinence. We also examined the relationship between external sphincter function and continence or incontinence. MATERIALS AND METHODS: We retrospectively evaluated fluoro-urodynamics performed in 37 men with post-prostatectomy incontinence. Urodynamic study consisted of measurement of maximum urethral and abdominal leak point pressures, and assessment of extrinsic sphincter function by pressure measurements and radiographically. RESULTS: Data were analyzed on 27 patients for whom abdominal leak point and maximum urethral pressures were available. Mean maximum urethral pressure was 52.5 cm. water (range 20 to 165) and mean abdominal leak point pressure was 77.8 cm. water (range 27 to 132). Regression analysis was performed between maximum urethral and abdominal leak point pressures. A Pearson correlation coefficient of 0.13834 was calculated (p = 0.4914) indicating virtually no correlation between the 2 measurements in our sample. Extrinsic urethral sphincter was normal in all patients. Only 1 of 37 patients had no evidence of intrinsic sphincter deficiency, that is there was no urine leakage with increases in abdominal pressure and the patient was incontinent solely based on bladder dysfunction (detrusor instability). CONCLUSIONS: Our study indicates that incontinence after prostatectomy due to an increase in abdominal pressure (stress incontinence) does not depend on extrinsic sphincter function and is not related to maximal urethral pressure. We conclude that post-prostatectomy incontinence due to sphincter dysfunction results from intrinsic sphincter deficiency. In our experience bladder dysfunction is rarely the sole cause of post-prostatectomy incontinence.

Performance of Americans and israelis with cerebrovascular accident on the Loewenstein Occupational Therapy Cognitive Assessment (LOTCA).

OBJECTIVE: The Loewenstein Occupational Therapy Cognitive Assessment (LOTCA) measures the cognitive performance of persons with cerebrovascular accident (CVA). Although this assessment was developed and standardized in Israel, it is frequently used in the United States. The purpose of this study was to identify whether differences in performance on the LOTCA existed between Americans and Israelis who have had strokes. Additionally, this study was designed to compare the performance of persons with right CVA with the performance of persons with left CVA because the normative data for the LOTCA does not include separate information for these two groups. METHOD: The LOTCA was administered to 25 Americans with CVA (19 right CVA and 6 left CVA) and 56 Israelis with CVA (26 right CVA and 30 left CVA). RESULTS: On the majority of LOTCA subtests, there were no significant differences between American and Israeli subjects. Only one subtest, Orientation to Time, revealed significant differences between Americans and Israeli subjects both for subjects with right CVA and subjects with left CVA. Examination of subjects with right CVA versus subjects with left CVA also indicated few differences. Only one subtest, Pegboard Construction, revealed significant differences between subjects with right CVA and subjects with left CVA for both American and Israeli subjects. CONCLUSION: The LOTCA is an appropriate tool for occupational therapists to use in assessing Americans who have had strokes. In addition, for the most part, the subtests of the LOTCA assess cognitive-perceptual abilities that are not specific to the right or left cerebral hemisphere.

Clinical assessment of urethral sphincter function.

Measurements of urethral pressures, such as maximum urethral pressure, are widely believed to have relevance in the management of urinary incontinence despite evidence to the contrary. In this study maximum urethral pressure and the abdominal pressure required to cause stress incontinence were measured in 125 women with stress incontinence. In women the abdominal pressure required to cause stress incontinence was unrelated to maximum urethral pressure. These findings indicate that maximum urethral pressure has little relationship to urethral resistance to abdominal pressure. In the 9 children with myelodysplasia we compared the detrusor pressure with the abdominal pressure required to induce urethral leakage. These values also were quite different, indicating that as far as the urethra is concerned abdominal pressure and detrusor pressure are not equivalent forces.

Patient costs for urodynamic testing.

Urodynamic investigations are not completely standardized. However, the number of exhibits of urodynamic equipment at urologic meetings by commercial firms suggests that these studies have considerable applicability and relevance to everyday practice. Investment by a urologist in equipment for urodynamic testing should be cautious in the light of the costs for these investigations reported from centers in Canada, the United States, and Western Europe. The figures suggest that sophisticated urodynamic testing is not a screening test -- it is too expensive, but large urodynamic laboratories appear to charge only for a portion of the actual cost of such testing. Since urodynamic testing is much more expensive than actual patient charges, it is probably not yet cost effective in its present state of development.

Combined radiographic and manometric assessment of urethral sphincter function.

A technique combining manometric, radiographic and electromyographic data to investigate primary urethral sphincter weakness is presented. These data indicate that closure of the intraabdominal urethra by smooth muscular activity is of critical importance in passive continence.